“Medical records not received” jumped to third among top denial reasons in the last three months of 2025, according to Targeted Probe and Educate (TPE) results released by Medicare Administrative Contractor CGS on March 4, 2026.
The denial reason didn’t make the top five in the third quarter of 2025.
Below are the top five items from the fourth quarter with the percent of total TPE denials.
1. Face-to-face documentation missing, incomplete, or untimely: 25.1% (down from 25.8% in Q3 2025)
2. Skilled nursing not medically necessary: 21.0% (down from 21.6%)
3. Medical records not received: 14.2% (not listed in Q3)
4. Initial certification invalid: 10.5% (down from 20.6%)
5. Plan of care/certification not signed: 5.6% (down from 9.8%)