January to March 2023 Hospice Medical Review Top Denial Reason Codes

Published 08/08/2023

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

5CNER

The Notice of Election Is Invalid Because it Doesn't Meet Statutory/Regulatory Requirements

468

39.0

2

5CF36

Not Hospice Appropriate

355

29.6

3

56900

Auto Denial — Requested Records not Submitted

147

12.3

4

5CFTF

Face-to-Face Encounter Requirements Not Met

34

2.8

5

5CFH9

Physician Narrative Statement Not Present or Not Valid

31

2.6

6

5CFH6

Initial Certification Not Timely

23

1.9

7

5CF91

Hospice GIP Reduction — Services Not Reasonable/Necessary

21

1.8

8

5CNOE

No Valid Election Statement Submitted

17

1.4

9

5CFH3

No Certification Present

16

1.3

10

5CFNP

No Plan of Care Submitted

14

1.2


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