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Why Cardiac Rehab Claims Get Denied Most diagnosis-related denials trace back to a short list of avoidable issues: The diagnosis code is not on the MAC's covered list , so the procedure-to-diagnosis edit denies the claim automatically A timing rule is missed , such as an MI outside the 12-month window or an acute code used when a status or old-MI code applies Documentation does not support medical necessity , for example a heart failure referral without the LVEF and NYHA class recorded MAC or payer variation , where a code accepted by one contractor or plan is not accepted by another Best Practices to Keep the Referrals Clean To keep referrals clean and compliant, confirm that the patient has a qualifying condition under the relevant National Coverage Determination (NCD)
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