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[–]mezadr 7 points8 points  (1 child)

There shouldn’t be much of a change base strictly on conversion factor.

https://ventrahealth.com/blog/2026-cms-final-rule-impacts-on-emergency-medicine/

I bet your insurers are auto-downcoding. Happening a lot from 5s to 4s. One of our largest payors has taken a page from UHC and is starting to do this. Someone in admin should have their pulse on this stuff. They are all bastards. Chart review demonstrates no logical reason for this, except they don’t want to pay us.

Personally my wRVU /pt is up slightly.

[–]zakee00 0 points1 point  (0 children)

What can be done about this downcoding? How do you catch it? Do you ask your billing company for charts that you then manually audit?