Medicare Administrative Contractor CGS has partially or fully denied 508 of 595 claims it has reviewed early on during CMS home health “probe and educate” review.
#1 denial reason
 Certification issues — 57%
  • Face to face missing/incomplete/invalid (91%)
  • Untimely plan of care (POC)/certification (2%)
  • POC/certification not signed (2%)
  • Missing certification/POC (2%)
  • Recertification estimate missing (1%)
  • Initial cert missing/invalid (1%)
#2 denial reason
 No response to ADR — 30%
#3 denial reason
 Medical necessity of therapy services — 7%
 Source: CGS