Home Health RCD Top 5 Non-Affirmation and Claim Denial Reasons

Published 06/03/2021

We encourage all providers to review this information ensure claims and pre-claim review (PCR) requests are processed timely. The following chart shows the cumulative non-affirmation and claim denial reasons for all RCD states.

Rank

Code

Category

Description

1

HH01D

Face-to-Face

The physician certification was invalid since the required face-to-face encounter was not related to the primary reason for home health services. Refer to CMS IOM Publication 100-02, Chapter 7, Section 30.5.1.2 (PDF, 543 KB).

2

HH01A

Face-to-Face

The physician certification was invalid since the required face-to-face encounter document (actual clinical note for the face-to face encounter visit for admissions on/or after 1/1/15, or the narrative for admissions on/or after 4/1/11 and before 01/01/15) was missing. Refer to CMS IOM Publication 100-02, Chapter 7, Section 30.5.1.1 and 30.5.1.2 (PDF, 543 KB).

3

HH01B

Face-to-Face

The physician certification was invalid since the required face-to-face encounter was untimely and/or the certifying physician did not document the date of the encounter. Refer to CMS IOM Publication 100-02, Chapter 7, Section 30.5.1 (PDF, 543 KB).

4

HH02B

Plan of Care/Certification/Recertification

The content of the plan of care submitted was insufficient. Refer to CMS IOM Publication 100-02, Chapter 7, Section 30.2.1 (PDF, 543 KB).

5

HH05B

Subsequent Episodes

There was no valid initial physician's certification of patient eligibility, therefore services on the subsequent episode may not be allowed. Refer to CMS IOM Publication 100-08, Chapter 6, Section 6.2.1 (PDF, 251 KB).


Was this article helpful?

Palmetto GBA Web Chat

Sounds: OnSave Transcript
Please answer the questions below. Additional fields may appear based on previous answers. Fields with a red asterisk (*) are required.
Your InformationClear
1()-x
Inquiry InformationClear
Select your stateClear
Select your stateClear
Provider InformationClear
Patient InformationClear
Patient Name must exactly match the information submitted on the claim, including suffix if applicable.
//
Appeal InformationClear
//
//
Claim InformationClear
//
//
Denial InformationClear
//
//
Rejection InformationClear
DDE InformationClear
Restore InformationClear
//
Prior Authorization InformationClear
//
//
Application InformationClear
Product InformationClear
OtherClear
Additional InformationClear

Are you sure you want to end your chat?

Keep ChattingClose ChatSave Transcript & Close

Webchat

Our dedicated webchat representatives are online to assist you with your general inquiries, provider enrollment, EDI, eServices and more in real-time.