BCBS of IL & Texas are automatically downcoding E/M billing codes

They announced this policy and it's now gone in effect. We're seeing it. All 99214 billing codes are being automatically downcoded to 99213 and paid as such. It doesn't matter what diagnostic codes you attach, how long you saw the patient, etc. It's happening automatically. They're saying that you can appeal, but it's a long, unclear, arduous process. BCBS IL is the largest private insurance in IL. This is massive. It's around a $40 loss on every patient encounter that could have been a 99214. Not sure what can be done about it, but something needs to.

Author: SaveADay89