Among the 2,461 home health claims Medicare administrative contractor Palmetto GBA denied from April through June 2015, the top denial reason remained 5CHG3 — medical review HIPPS code change due to partial denial of therapy.
 
In fact, Palmetto’s top 10 denial reasons remained in the same order as they had the prior quarter (HHL 6/1/15).
 
5FF2F — face-to-face encounter requirements not met — was the fourth-most common denial reason. It resulted in 10.6% of claims denials.
 
Denial
Denial description
% of claims denied
5CHG3
Medical review HIPPS code change due to partial denial of therapy
23.2%
56900
Auto deny — requested records not submitted
19.4%
5F041
Information provided does not support the medical necessity for this service
11.0%
5FF2F
Face-to-face encounter requirements not met
10.6%
5A041
Information provided does not support the medical necessity for this service 
8.8%
5A301
Information provided does not support the medical necessity for therapy services
3.4%
5T080
Absence of short- and/or long-term goals within the initial (PT/OT/ST as appropriate) therapy evaluation documentation
3.3%
5FNOA
Unable to determine medical necessity of HIPPS code billed as appropriate — OASIS not submitted
2.9%
5F012
Physician’s plan of care and/or certification present — signed but not dated
2.6%
5F301
Information provided does not support the medical necessity for therapy services
2.0%
Source: Palmetto GBA