Hospice Top Medical Review Denial Reason Codes
September 2022 – August 2023
The following information provides hospice medical review’s most recent YTD denial data. Please review this information and the educational resources to assist with preventing these types of denials. Refer to the Hospice Denial Reason Codes Web page for a complete list of denial codes.
Rank | Denial Code | Denial Description | # of Claims Denied | % of Claims Denied |
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1 | 5PM01 | According to Medicare hospice requirements, the information provided does not support a terminal prognosis of six months or less. | 1,173 | 44% |
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Rank | Denial Code | Denial Description | # of Claims Denied | % of Claims Denied |
2 | 5PX06 | The notice of election is invalid because it doesn't meet statutory/regulatory requirements. | 1,073 | 40% |
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Rank | Denial Code | Denial Description | # of Claims Denied | % of Claims Denied |
3 | 5PC08 | Face-to-Face Encounter requirements not met. | 120 | 5% |
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Rank | Denial Code | Denial Description | # of Claims Denied | % of Claims Denied |
4 | 56900 | Medical records not received/not received timely. | 72 | 3% |
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Rank | Denial Code | Denial Description | # of Claims Denied | % of Claims Denied |
5 | 5PX07 | The notice of election not present. | 47 | 2% |
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Updated: 09.29.23