Reason Code 5D505: Certification Not Valid

Reason for Denial
The certification or recertification is not submitted, not signed, not dated, or does not cover the dates of service in question.

To Prevent This Denial

• A certification or recertification statement must be signed by an attending physician or a physician on the staff of the skilled nursing facility (SNF) who has knowledge of the case or a nurse practitioner who does not have a direct or indirect employment relationship with the facility, but who is working in collaboration with the physician, or a clinical nurse specialist who does not have a direct or indirect employment relationship with the facility, but who is working in collaboration with the physician. Initial certifications must be obtained at the time of admission, or as soon thereafter as is reasonable and practicable
• The routine physician’s admission order is not a certification of the necessity for post-hospital extended care services for purposes of the Medicare program
• When responding to a request for copies of medical records, submit the initial certification and/or subsequent recertifications related to the look back periods and the dates of service under review

More Information

• CMS Manual System, Pub. 100-08, Medicare Program Integrity Manual, Chapter 6 — Intermediary MR Guidelines for Specific Services, Section 6.3 (PDF)
• CMS Manual System, Pub. 100-02, Medicare Benefit Policy Manual, Chapter 8, Section 40 (PDF)
• Code of Federal Regulations (CFR): 42 CFR § 424.11(c)  and  424.20 Requirements for post hospital SNF care