The Top 5 Medical Claim Denial Codes for Home Health

There is no doubt that medical billing reviews are frustrating. They plague every healthcare agency, especially those who have yet to develop a thorough processing system. In fact, nearly 10% of all medical claims submitted by home health agencies are denied.
That is a lot of money and a loss you cannot afford to have. Being in charge of reimbursement is a huge responsibility, but do not worry, there are ways for denials to be reduced.

The Most Common Claim Denial Reasons for Home Health

Before we get to the solutions, we want to give you some insight on which claims are most commonly denied by insurance companies for home health agencies.

1. 5HC01

Percentage of denied claims: 25%
This code comes up when the face-to-face contact that is required between doctor and patient is not verified. In turn, this F2F physician certification is regarded as missing or incomplete.

2.  56900

Percentage of denied claims: 12%
You will see this code when the necessary documentation for the Additional Development Request (ADR) was not sent in a timely fashion or at all.

3. 5HY01

Percentage of denied claims: 10%
The reason for this denial is due to the treatment or services notated being deemed as unnecessary or unreasonable. It basically states that the therapist or nurse did not need to provide these services and the services provided was not at the level of complexity the clinician typically provides.

4. 5HC09

Percentage of denied claims: 10%
The reason for this particular one is that the recertification order requested with this Additional Development Request (ADR) is denied because the initial one is missing or incomplete.

5. 5HC08

Percentage of denied claims: 8%
This denial code comes back due to the recertification order for the estimated length of services being labeled as invalid, incomplete, or missing.

How To Avoid Denials

These are only a handful of insurance denial codes home healthcare providers are facing on a regular basis. Home healthcare agencies often believe they need to hire more people to manage their bills if they are getting too many denied claims, but hiring more people will not necessarily mean you are getting to the root of the actual issue.
Because there are so many possible reasons a claim can be denied, it’s in your best interest to engage true experts in the field. Some agencies take a shot at acquiring a new claims management software platform, but your best bet is to outsource your revenue cycle management to a team like Precision Medical Billing.
Doing so will not only reduce backlogs and help you to identify the true causes of your denials, it will also keep your business’ profit where it is supposed to be. For more information on medical billing, contact us here.