On October 1, Cigna will implement a new downcoding policy that scrutinizes how physicians bill for services, particularly focusing on those who report a higher frequency of level four or five visits. This policy will flag physicians whose billing patterns deviate from their peers, leading to potential adjustments in reimbursement for claims that do not adequately justify the higher service levels. The codes affected include 99204–99205 for new patients and 99214–99215 for established patients, among others.
This move by Cigna reflects a broader trend within the insurance industry to impose stricter controls on healthcare costs, which may inadvertently place additional burdens on physicians. As healthcare providers navigate these new requirements, the implications for patient care and the overall healthcare landscape could be significant, potentially leading to reduced access to necessary services and increased administrative overhead for practices.
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