BC Advantage - 2022 Issue 12

Payers Wrongly Cutting Payments to Physicians for E/M Services

Payers have been wrongly cutting payments to physicians for evaluation and management (E/M) services - often automatically through the use of claim-editing algorithms. A new AMA resource helps physicians fight back against health insurer downcoding.Downcoding happens when a payer changes a claim to a lower-cost service than what was submitted by the physician, leading the practice to get paid for a lower level of care than what was provided. "Claim-editing" software algorithms downcode without any review of clinical records or requests for additional information.The new AMA resource, "Payer Evaluation and Management Downcoding Programs: What You Need to...

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