BLOGS

When UNC Health and Cigna failed to reach a contract agreement, 60,000+ North Carolina patients were left scrambling. But the deeper lesson isn’t just about one health system — it’s about how downcoding, administrative overload, and payer tactics are threatening revenue and continuity of care nationwide. This post breaks down the real risks, early warning signs, and how providers can proactively protect their revenue and patients before their own contracts are at risk.

With only days left before October 1, physicians must understand what’s really at stake. A mid-sized practice that bills for 20 high-level visits per week could lose $4,000 to $5,000 per month if claims are downcoded. Over 12 months, this amounts to nearly $50K in lost reimbursements. On October 1, 2025, Cigna Healthcare will enforce its new Evaluation and Management (E/M) Coding Accuracy (R49) Policy. This change is significant for many physicians; it represents a seismic s

In 2026, modifiers such as KX, CQ, and CO will be under tighter scrutiny than ever before. This means that physical therapy clinics without airtight processes are not just risking denials; they’re also risking audits and penalties.

Let’s face it, physical therapy billing write-offs are nobody’s favorite line task. Every week, PT clinics quietly sweep denied or unpaid claims under the rug, assuming they’re too small or too late to chase. It feels easier in the moment, but behind each “adjustment” lies potential revenue slipping through your fingers.