The ACR has serious concerns about the inappropriate reduction of payment for rheumatology services, as well as the burden on practices to review and appeal the downcoded claims. The ISC has engaged Aetna leaders to discuss these concerns as well as the general lack of transparency around the program’s criteria and operation.
The AMA has also created resources to assist practices in the fight against inappropriate downcoding. AMA guidance on payer evaluation and management (E/M) downcoding programs provides information and tools to help practices recognize and fight downcoding and receive appropriate payment for downcoded claims, even after the fact.
In addition to the issues outlined above, the ISC has been active on numerous other insurance concerns reported since the start of the year, including formulary adjustments, drug coverage issues and payer coding and reimbursement errors. All of these issues continue to disrupt patient care and increase the administrative burden practices face. The ISC is committed to supporting ACR members by advocating for timely and appropriate resolution.
For more information about the issues above or to request the ACR’s help on other payer issues impacting your practice, reach out to [email protected].
