5CHGE - DRG Upcode/Downcode

Published 12/12/2016

Reason for Denial
The services billed were paid at a higher/lower payment level based on medical review of the records submitted.

How to Avoid a Denial
Under the Prospective Payment System (PPS), Medicare reimbursement rates are based on the patient’s health condition and care needs.

  • Submit orders to cover the procedures billed
  • Submit all documentation related to the services rendered