Of the 26 hospice claims denied by Medicare Administrative Contractor (MAC) Palmetto GBA between April and June 2018, the majority were due to failing to supply medical records in response to Additional Documentation Requests (ADRs), Palmetto data show.
The second most-common denial code was 5CNER (The notice of election is invalid because it doesn’t meet statutory/regulatory requirements). This code accounted for just one denial during this time period, while 56900 (Auto denial — requested records not submitted) led to the remaining 25 denials.
56900 was also the most common reason for denial in home health between April and June 2018.
Related link: For tips from Palmetto on how to avoid these common denial codes, visit https://bit.ly/2P1JrTb.