More than one out of every four denials under CGS Medicare’s Targeted Probe and Educate program were due to missing, incomplete or untimely face-to-face documentation, according to the Medicare Administrative Contractor’s Oct. 30 update.
 
In the previous quarter, face-to-face documentation ranked fourth in TPE denials. 
 
The top five denial reasons and the percent of total TPE denials are below:
  1. Face-to-face documentation is missing, incomplete, or untimely: 26.3%
  2. Initial certification invalid: 19.7%
  3. Skilled nursing not medically necessary: 15.2%
  4. Plan of care or certification not signed: 8.7%
  5. Therapy visits not medically necessary: 8.7%