Has anyone appealed a Medicare focused review? I have a provider where Medicare did a review and has down coded many of his visits based on Medical necessity. I understand on many of them the justification, but there are several which I am agreeing with the providers coding.
I noticed on this review Medicare is not using a coder but a RN. Is this the norm for them? Does the nurse understand the MDM component?
Any thoughts are greatly appreciated. I just do not want to appeal and he be a target of future audits. I know all auditors have their own opinion.
Thanks !
Medicare Review Audit
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