5CHGE: DRG Upcode/Downcode

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 This 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