July to September 2023 Hospice Medical Review Top Denial Reason Codes

Published 11/30/2023

We encourage all providers to review this information when filing claims to prevent denials and to ensure their claims are processed timely. The following information affects providers billing 81X bill types.

Rank

Denial Code

Denial Description

# Claims

% Claims Denied

1 5CF36 Not Hospice Appropriate 263 38.8

2

5CNER

The notice of election is invalid because it doesn't meet statutory/regulatory requirements

149

22.0

3

56900

Auto Denial - Requested Records not Submitted

117

17.3

4 5CFNP No Plan of Care Submitted 19 2.8

4

5CFTF

Face to Face Encounter Requirements Not Met

19

2.8

6

5CFIP

Invalid Plan of Care Submitted

13

1.9

7

5CFH6

Initial Certification Not Timely

12

1.8

8

5FF36

Not Hospice Appropriate

10

1.5

8

 

No Certification for Dates Billed

10

1.5

8

5CFH9

Physician Narrative Statement Not Present or Not Valid

10

1.5


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