Wednesday, March 11, 2020 - 03:00 pm
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Medical Provider Billing
WSI has created a new Remittance Advice Reason Code, 243, to address non-authentic medical documentation. This reason code will be used to reduce or deny payment when supporting documentation is non-compliant with WSI's Falsified Medical Records Policy. The full description of Reason Code 243 is as follows:
WSI reduced or denied this charge per the Falsified Medical Records Policy. The medical records received does not support the submitted evaluation and management code due to cloning or over documentation. Reimbursement reflects the level of service according to the authentic medical record. To request reconsideration, complete the Medical Bill Appeal form (M6) and submit to WSI within 30 days from the date of the remittance advice. This charge is not billable to the patient or other insurance.
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