UCR 271: The Downcoding Dilemma – How to Fight Back and Get Paid What You Deserve
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UCR 271: The Downcoding Dilemma – How to Fight Back and Get Paid What You Deserve
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January 9, 2026
In this episode, Scott, Mark, and Ray Painter tackle the growing issue of automated downcoding by commercial payers—where level 4 and 5 E/M visits are silently paid at lower levels without a formal denial. They explain how this tactic evades typical RCM detection, outline steps to flag and appeal these incorrect payments, and emphasize why accurate documentation is more important than ever. From setting up payer-specific protocols to understanding how AI-driven reviews can misinterpret records, this episode offers practical strategies to protect your top line and push back against unjust reimbursement practices.
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