More than one out of every three denials in the first quarter of 2025 were due to the requested records not being submitted, according to Palmetto GBA.
 
Experts stress that agencies should have a point person responsible for receiving and responding timely to additional documentation requests. Beyond the immediate denial, no response can also open you up to increased scrutiny from auditors.
 
The Medicare Administrative Contractor posted the top 10 reasons for medical review denials on May 16. The list is based on 1,821 denials.
 
1     
Auto Denial — Requested Records Not Submitted
706
2
No Plan of Care or Certification
573
3
Face-to-Face Encounter Requirements Not Met
254
4
Information Provided Does Not Support the M/N for Therapy Service (5F301, 5A301)
110
5
Visits/Supplies/DME Billed Not Documented or Not Documented As Used (5T070, 5F070)
70