Medicare Reimbursement Declined -

Claims may be denied or "downcoded" if the billing code reflects a more severe illness or expensive treatment than the medical record supports.

If a claim is denied, you have a legal right to appeal the decision. For Original Medicare (Part A and B), there are five distinct levels of appeal: Medicare Program Integrity Manual, Chapter 6 - CMS Medicare Reimbursement Declined

Most denials can be traced to preventable administrative or clinical documentation issues: Claims may be denied or "downcoded" if the