Home Health RCD Top 5 Non-Affirmation and Claim Denial Reasons
We encourage all providers to review this information ensure claims and pre-claim review (PCR) requests are processed timely. The following chart shows the cumulative non-affirmation and claim denial reasons for all RCD states.
|
Rank |
Code |
Category |
Description |
|
1 |
HH01D |
Face-to-Face |
The physician certification was invalid since the required face-to-face encounter was not related to the primary reason for home health services. Refer to CMS IOM Publication 100-02, Chapter 7, Section 30.5.1.2 (PDF, 543 KB). |
|
2 |
HH01A |
Face-to-Face |
The physician certification was invalid since the required face-to-face encounter document (actual clinical note for the face-to face encounter visit for admissions on/or after 1/1/15, or the narrative for admissions on/or after 4/1/11 and before 01/01/15) was missing. Refer to CMS IOM Publication 100-02, Chapter 7, Section 30.5.1.1 and 30.5.1.2 (PDF, 543 KB). |
|
3 |
HH01B |
Face-to-Face |
The physician certification was invalid since the required face-to-face encounter was untimely and/or the certifying physician did not document the date of the encounter. Refer to CMS IOM Publication 100-02, Chapter 7, Section 30.5.1 (PDF, 543 KB). |
|
4 |
HH02B |
Plan of Care/Certification/Recertification |
The content of the plan of care submitted was insufficient. Refer to CMS IOM Publication 100-02, Chapter 7, Section 30.2.1 (PDF, 543 KB). |
|
5 |
HH05B |
Subsequent Episodes |
There was no valid initial physician's certification of patient eligibility, therefore services on the subsequent episode may not be allowed. Refer to CMS IOM Publication 100-08, Chapter 6, Section 6.2.1 (PDF, 251 KB). |