Modifier denials in healthcare are rising across every specialty in 2025. Most of the patterns trace back to a small group of high-risk billing modifiers — including Modifier 25, Modifier 59, Modifier 24, and the X-modifiers — that payers now flag more aggressively. These denial trends reveal workflow gaps long before aging A/R exposes the problem. If your practice is seeing more claim denial patterns tied to modifiers, the data is signaling a revenue cycle issue worth paying
This article examines how Cigna Healthcare’s R49 policy and NBC News' recent investigation reveal a growing challenge for healthcare providers and how our Downcoding Defense Tools help practices stay compliant and protect their revenue.
Aetna’s CCRP quietly began downcoding high-level E/M claims in March 2025, joining Cigna’s R49 policy effective Oct 1. Providers face hidden revenue loss, delayed payments, and rising admin burden. Learn how Downcoding Defense™ tools protect your practice.
Sep 296 min read
In fact, one healthcare provider we worked with achieved 132% of monthly collection goals.
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✓ Hidden revenue leaks in your payer contracts
✓ Downcoding exposure you might not see
✓ Early warning signs of contract breakdown
