Palmetto GBA has released its top reasons for medical review denials from July to September.
The Medicare Administrative Contractor working in 16 states noted that 42% of all claim denials were due to requested records not being submitted.
In 28% of cases, the face-to-face encounter did not meet CMS requirements.
The rest of the top five were no plan of care or certification (13%), medical necessity not supported (3%) and unable to determine medical necessity due to OASIS not being submitted (2.5%).