Reason Code: 55H1S

Error Description:

Hospice: The documentation submitted does not support a valid face-to-face encounter occurred.

Avoiding/Correcting This Error

Include all face-to-face encounter attestations for the third benefit period and after with your medical record submission to the ADR. Ensure that the CMS requirements for the face-to-face encounter have been met in the CMS IOM Publication 100-02, Medicare Benefit Policy Manual, Chapter 9, Section 20.1. Failure to meet these requirements results in a failure by the hospice to meet the recertification obligation. The beneficiary would cease to be eligible for the benefit. Remember to verify the benefit period that the beneficiary is in with every admission, as the beneficiary may have received hospice services in the past.