Issues with the initial certification and therapy visits were among the top five denial reasons under Target, Probe and Educate (TPE) review for the first three months of 2026, according to CGS.
The usual suspects remained at the top of the list, meaning issues around acceptable face-to-face documentation and justification for skilled nursing visits. But at No. 3 and No. 4: “Initial certification invalid” and “Therapy visits not medically necessary.”
The top five TPE denial reasons are listed below (along with the results for the previous three months):
- Skilled nursing not medically necessary: 26.5% (21.0%)
- Face-to-face documentation missing, incomplete, or untimely: 24.1% (25.1%)
- Initial certification invalid: 13.4% (10.5%)
- Therapy visits not medically necessary: 9.6% (not ranked)
- No Plan of Care/certification: 6.2% (not ranked)