A growing pattern of automated E/M reductions is appearing across multiple states, and most practices won’t see the losses until the month-end numbers don’t add up. Your E/M payments may already be shifting.
On October 1, Cigna Healthcare implemented its new R49 policy, introducing more stringent medical complexity criteria for Evaluation and Management (E/M) code reimbursement. For most practices, it may seem like business as usual.
Claims are still going out the door. Documentation is still being entered, and nothing unusual has appeared on your remittance reports.
But here's the catch: downcoding has already started.
Oct 35 min read
In fact, one healthcare provider we worked with achieved 132% of monthly collection goals.
