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 ...

Emergency medicine (EM) has always been subject to payer scrutiny, but today’s reimbursement pressure is different: it is ...

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 ...

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 ...

U.S. physicians routinely are seeing their higher-cost claims downcoded by insurers, a strategy a family physician in Cincinnati called a revenue grab, according to Medscape. Will Sawyer, MD, said ...

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 ...

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 ...