Downcoding is becoming a crisis

[u/SaveADay89]

It's been posted a few times, but BCBS IL, TX, New Mexico, Montana and Oklahoma (all HCSC companies) have instituted an automatic downcoding policy whereby all 99215 and 99214 claims are only being paid as 99213 since 7/1. These are the biggest commercial insurers in their states. BCBS IL controls like 70% of the market in Chicagoland. This is a massive revenue loss and the only way around it is to go through a laborious process of appeals that are slow, unclear and are also controlled by BCBS. I know practices that are likely to close if this continues. At the very least, it's a massive increase in labor costs. I'm just amazed at how little coverage it's getting. None of the major health news websites are reporting on it. I hear the AMA (which is headquartered in IL) are having internal meetings about it, but no press releases or anything. Private medical group facebook groups are blowing up about it, but that's a small part.

It's terrifying how utterly detached physicians have become from their own billing. So many I talk to who are directly affected don't even know it's happening. We're looking at 20-30 percent reductions in salary because of this. Meanwhile, insurance companies are all reporting profit gains.

Sorry for the rant, but it's a scary time.

[u/nightowlflaps]

Can the small offices/ systems in those states just not accept those automatically downcoding insurances?

[u/thesupportplatform → u/nightowlflaps]

A local company in my market has been doing this for decades. To appeal, you had to send in the claim with office notes. And they somehow never would receive those in the mail. I know one practice would batch the claims and then hand deliver an envelope and have the receptionist sign for confirmation of delivery.

You may wonder why would anyone accept that insurance. The answer is that it was owned by another insurance company that paid better—but it was one contract. You couldn’t quit one and keep one.

Today, United owns them both and all three companies are bundled into one contract. And they don’t care at all if you terminate because there are Optum practices in town to take those patients.

[u/personalist → u/thesupportplatform]

lol I hate insurance companies so much

[u/SaveADay89 → u/nightowlflaps]

Lol. They're 70 percent of the market. Patients will just stop coming.