Don’t worry they’ll soon be down coding that 99214 to a 99213
Aetna and Cigna Announce Automatic Downcoding Policies
Background:
• Aetna and Cigna have announced automatic downcoding policies for complex Evaluation & Management (E/M) services -- specifically, level 4 and level 5 office visits.
• Aetna and Cigna are using algorithms or claims data alone to automatically downgrade the codes physicians assign to cases -- without reviewing individual patients' medical records.
• The result is that claims for complex visits will be paid at a lower level. Physicians who disagree with this automatic downcoding will have to appeal.
○ That process will require submitting a significant amount of paperwork and patient case documentation -- something many practices will not have the capacity or wherewithal to do.
• This "deny first, pay later" system presumes physicians are guilty of "upcoding" until proven innocent.
Issues we are facing:
• These new policies from Aetna and Cigna do not put patients first. They're not about catching bad actors. They're about boosting insurer profits at the expense of patient access and timely care.
• These policies threaten the viability of independent physician practice. Automatic downcoding will accelerate the collapse of independent practices that communities rely on for accessible, affordable care.
• Insurers are acting in bad faith. Aetna and Cigna are rewriting the rules of medical coding unilaterally, disregarding physician expertise and nationally recognized standards.
Read the full story here:
Important News: Aetna and Cigna Announce Automatic Downcoding Policies - American Society of Interventional Pain Physicians
