Palmetto, a Medicare Administrative Contractor (MAC), has released the top denial reasons in their region for Part A providers. Palmetto covers Alabama, Georgia, and Tennessee, but trends in one region can provide valuable information on potential trends with other MACs.
Reviewing these top denial codes enables providers to review current practices to reduce the risk of future denials. The top denial reasons for Palmetto are identified as:
- Denial Code 5D504/5H504: Not Medically and Reasonable Necessary
- Denial Code 5DOWN: Medical Review Downcode
- Denial Code 56900: Auto Denial-Requested Records Not Submitted
- Denial Code 5D002/5X002: Agree With Provider (Bene Liable)
- Denial Code 5D510: There was no evidence of at least three consecutive days of inpatient hospital stay