Palmetto GBA has posted the hospice medical review top denial reason codes and how to avoid them for April – June 2015. We encourage hospice provider to review this information before filing claims to help prevent denials and ensure claims are processed timely.
Common denial reasons include:
No Plan of Care Submitted
The claim has been fully or partially denied as documentation submitted for review did not include a plan of care (POC) for all or some of the dates billed.
Not Hospice Appropriate
The claim has been fully or partially denied because the documentation submitted for review did not support prognosis of six months or less.
Physician Narrative Statement Not Present or Not Valid
The claim has been denied as the physician narrative statement is not present or not valid.