We have been receiving Remittance Advice from a payer where several of the claims have a Remark/Explanation Code stating the E&M Paid at a Lower Level. Upon review, some of the E&M's submitted as a new patient level were downcoded to an established E&M level as well. Can a payer downcode or pay an E&M level at a lower level without requesting medical records before hand?
Any help in this area would be appreciated.
Cheryl
Any help in this area would be appreciated.
Cheryl