Hospice Medical Review Top Denial Reason Codes: January to March 2025

Published 05/16/2025

We encourage all providers to review this information when filing claims to prevent denials and to ensure their claims are processed timely. The following information affects providers billing 81X bill types.

81X Bill Type Denials: Total Denials 1,765

Rank Denial
Code		 Denial Description # Claims % Claims Denied
1 5CF36 Not Hospice Appropriate 634 35.9
2 56900 Auto Denial — Requested Records not Submitted 446 25.3
3 5CNER The Notice of Election Is Invalid Because it Doesn't Meet Statutory/Regulatory Requirements 221 12.5
4 5CFTF

Face-to-Face Encounter Requirements Not Met

 101 5.7
5 5CFNP No Plan of Care Submitted

71

4.0
6 5CFH3 No Certification for Dates Billed 57 3.2
7 5CNOE No Valid Election Statement Submitted 45 2.5
8 5CFH9 Physician Narrative Statement Not Present or Not Valid 41 2.3
9 5CFH6 Initial Certification Not Timely 29 1.6
10 5CFH7 Subsequent Certification Not Timely 20 1.1

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