Navigating Payer Downcoding to Protect Revenue

Payer downcoding is no longer a quiet billing inconvenience — it’s rapidly becoming a direct threat to practice viability. In recent months, major insurers have introduced programs that automatically downgrade higher-level Evaluation and Management (E/M) codes, often without first reviewing clinical documentation. Provider groups are sounding the alarm. The American Academy of Sleep Medicine (AASM) […]