Home Health & Hospice Week

While home health agencies’ reimbursement framework may have changed drastically on Jan.1 with the Patient-Driven Groupings Model, many of the billing mechanics have stayed the same — and so will top claim denial reasons.

Two of HHAs’ top claims denial reasons from the fourth quarter of 2019 address physician certification problems, according to list of top denial reasons from HHH Medicare Adminis­trative Contractor CGS. Denial codes 5HC01 (The physician certification was invalid since the required face-to-face encounter was missing/incomplete/ untimely) and 5HC09 (The initial certification was missing/incomplete/invalid, therefore the recerti­fication episode is denied) landed in the top five denial reasons, the MAC says in a new article on its website.

Another top-five denial code, 5HO02, indicates “the order(s) are incomplete as they must indicate discipline, frequency duration, and treatment.”

And the last two codes in the top five address medical necessity: 5HY01 (The medical documentation submitted did not show that the therapy services were reasonable and necessary and at a level of complexity which requires the skills of a therapist) and 5HN18 (Skilled nursing services were not medically necessary).