Agencies have been struggling to document the need for skilled nursing services, according to the latest round of medical review denials published by Medicare administrative contractor CGS.
Below are the top five denial reasons for claims in January and February 2026:
- Skilled nursing services were not medically necessary: 45
- Initial certification was missing/incomplete/invalid; therefore, recertification episode is denied: 22
- Physician certification was invalid since the required face-to-face encounter was missing/ incomplete/untimely: 20
- Requested medical records were not received within the 45-day time limit: No total provided
- Medical documentation submitted did not show therapy services were reasonable and necessary and at a level of complexity which requires the skills of a therapist: 15