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  • Writer's pictureRYAN FERGUSON

Downcoding by Payors Detrimental to Family Practices

Updated: Oct 20, 2023

Physicians are seeing complex Evaluation and Management (E/M) visits being downcoded by payors, according to Medscape. What’s more, is that family practices and other smaller ambulatory care centers experience the most harm.

In one instance, a physician with a solo owned office, who treats complex patients with multiple chronic conditions, is witnessing his office visit charges downcoded before the claim processes. For example, office visits requiring moderate complexity and risk (30-39 minutes) are being downcoded to an office visit needing only low complexity and risk (20-29 minutes). This automatic downcoding reduces his payment from $86 to $68 for that single office visit.

While these downcoded claims can be disputed with an appeal and supporting documentation, that too is an added administrative cost and burden to these smaller practices. One, which many practices are unable to handle, therefore revenue deserved remains in the payors’ depository.

With revisions of the Evaluation and Management (E/M) Services Guidelines by the American Medical Association (AMA) January 1st, 2021, the opportunity for physicians to focus more on patient care and less on administrative burden became a reality. With MCC’s RemitOneTM platform, encounter data is accurately captured at the point-of-care, thus translating it into a correctly coded and compliant claim.

Do you want to avoid payor downcoding while reducing administrative burden? Contact our team at info@mccremitone.com to find out how you can utilize RemitOneTM to improve clinical documentation, coding, and compliance, all while providing quality patient care.

To see more about MCC and RemitOne, visit our documentary segment that aired on CNBC here: https://www.mccremitone.net/r1video/MCC_03.mp4.

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