Top Reasons for Claims Denials

The Claims and Compliance Departments have begun working closely together to identify common reasons for denials.


These items are included in the Compliance and allow us to be proactive rather than reactive to avoid denials.


At this time, the common reasons for denial are:

  1. Documentation to support ongoing rehab services, especially when modifier KX is in use (KX is applied when a Med B OT claim or combined PT/ST claim exceeds $2300. You can track Med B utilization in Nethealth in the “Part B Threshold Management” Report)
  2. When payer changes from Med A to Med B, the completion of a Recert/Updated POC
  3. GG collaboration between Rehab and Nursing (Med A/Mgd A)
  4. Timely MD signatures of Evals/Recerts/DC in NetHealth. We strongly recommend Physicians use the Clinisign feature in Nethealth
  5. Timely completion of Notes! Therapists must complete their notes timely!
  6. Signed MD orders for rehab in the FACILITY’s EMR software (this will be added to the compliance quarterly risk assessment as a mandatory field)

When the Compliance Department completes their audit, they will share their findings and may provide additional training if necessary.

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