Medicare Contractor Releases 'Top 10' Denial Codes

Published on:
7 February 2013 at 11:11 a.m. ET

Written by: Mike Bevel –

http://www.insidearm.com/news/00004830-medicare-contractor-releases-top-10-denia/

That Medicare claims are denied by Medicare Administrative Contractors (MACs) may not be news, but what about the “Top 10 Denial Codes?”

Palmetto GBA, the nation’s largest MAC, regularly publishes the top denial codes. Earlier this week, Palmetto released December’s figures. The top codes were:

Ranking	Code	Description
1	N29	Documentation requested for this date of service was not received or was incomplete
2	N237	Information submitted deem illegible.
3	N237	Documentation received contains incorrect/incomplete/invalid patient identification or date of service
4	50	Payer deems the information submitted does not support medical necessity of services billed
5	MA81	Information submitted contains an invalid/illegible provider signature
6	150	Payer deems the information submitted does not support the level of service billed; downcoded
7	50	Per applicable LCD, payer deems the information submitted does not support medical necessity of services billed
8	N237	Original medical record has been altered.
8	N455	Documentation lacks the necessary provider order
10		Claim billed in error per Provider

Denial code “50″ is one of those that gives provider’s fits (rating fourth and seventh on the list), so Palmetto publishes the top reason a claim received that particular code (“This claim was fully or partially denied because there were incomplete or no documentation received for a specific DOS”).

Palmetto’s Top 10 list also breaks denials by provider type and offers recommendations on how to avoid getting claims denied. It also has made available it’s Top 10 lists for the past two years available as a zip file for download here: J1PartBMedicalReviewTopDenialReasonCodes2011-2012.zip (ZIP, 489 KB)