Top denial/partial denial reasons and high-level results are listed below from each round of JH therapy services TPE reviews that have been conducted thus far by us. If you have questions about your individual results, please contact the nurse reviewer assigned to your review for additional information. Additional rounds of review will be utilized when the TPE topic demonstrates a continued need for review with newly identified providers.
The most common reasons for denial or partial denials are the following:
1. Medical necessity - The documentation submitted does not support medical necessity as listed in coverage requirements.
2. Insufficient documentation – Insufficient documentation was provided to support the services as billed to Medicare. Novitas Medical Review makes multiple attempts to correct these error types before completion of the review. Below are the following denial reasons for insufficient documentation that we were not able to resolve:
Insufficient documentation of signed initial certification/recertification.
Insufficient documentation of signed therapy progress notes/daily treatment notes. completed by a licensed therapist at least every 10 treatment days to support services billed.
Insufficient documentation of therapy evaluation/plan of care to support services billed.
Insufficient documentation to support number of therapy minutes/units billed.