PalmettoGBA has released its list of top reasons for medical review denials from October to December 2023.
Of the 2,169 denials, 1,223 (or 56%) were due to the requested records not being submitted.
The rest of the top five were:
2. Face-to-face encounter requirements not met — 480 (22%)
3. No Plan of Care or certification — 234 (11%)
4. Unable to determine medical necessity or HIPPS code billed as appropriate OASIS not submitted — 53 (2%)
5. Information provided doesn’t support the medical necessity for therapy services (5F301) — 31 (1%)