Doctors say insurers are automatically downgrading their claims and paying less. Insurers say it’s their duty to prevent overbilling.
The practice of automatic downcoding seems to have taken off in the last few years, as health care costs soar and insurance companies use third party vendors and AI programs to reduce costs.
NBC News spoke to doctors’ offices across numerous specialties from around the country, all of whom rely heavily on office visits — rather than surgeries and procedures — for their revenue, and all of whom are experiencing downcoding from insurers.
The problem, doctors say, is that lower and lower reimbursements mean reliable community doctors, like Wagner, could have to make choices that are inherently bad for patients, like cramming more patient visits into a single day to make up for lost revenue, dropping patients on certain insurance plans, or selling their practices altogether.
Admin work dealing with health insurance companies is likely part of the problem, but i am with you on not excusing providers’ corrupt practices.
US healthcare system has been turned into a bureaucratic exercise of fighting over money first and foremost, actual health care is secondary.
You can feel it when if you ever have a misfortune to deal with these healthcare providers.