5J502: Information Submitted Does Not Support Dates Billed

This claim has been fully denied as the documentation submitted for review was not for the billing period requested in the Additional Documentation Request (ADR). As a result, there were no orders for services or documentation of medical necessity for services billed.

Documentation and tips that may be helpful to avoid future denials for this reason may include, but are not limited to, the following:

• Ensure that the correct documentation is submitted for medical review by developing a procedure for staff to follow when preparing information in response to an ADR
• Develop a form or checklist to be used when responding to an additional development request to ensure appropriate information is submitted for the dates billed

Resources

• CMS Internet-Only Manuals (IOMs), Medicare Program Integrity Manual, Publication 100-08, Chapter 6, Section 6.5 (PDF)
• CMS Internet-Only Manuals (IOMs), Medicare Program Integrity Manual, Publication 100-08, Chapter 3, Section 3.4 (PDF)