In the beginning of the year, Dr. Terry Wagner’s office manager came to him and said “something weird is going on.” For weeks, the office manager told him, Wagner had been quietly underpaid by the ...

This proposal states all downcoding determinations must be made or reviewed by a real person and insurance companies would be ...

Several federal agencies issued a set of final rules based on the No Surprises Act aimed at making it easier for providers to contest payer decisions. During the IDR process, an arbiter is directed to ...

A Pennsylvania health system filed suit this week against Aetna, challenging a policy around "downcoding" that has drawn ire from providers. Philadelphia-based Jefferson Health said in a complaint ...

Pennsylvania-based health system Jefferson Health has sued insurer Aetna, claiming a new “downcoding” policy from the CVS-owned insurer regarding inpatient admissions for Medicare Advantage ...

Some insurers are automatically lowering the service levels that doctors submit based on the diagnosis codes. Take steps to make sure your complex cases are paid for fairly. This month's column ...

Doctors say insurers are automatically downgrading their claims and paying less. Insurers say it’s their duty to prevent overbilling. In the beginning of the year, Dr. Terry Wagner’s office manager ...

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