October 31, 2025 In this Halloween-themed episode, Scott, Mark, Ray, and special guest Dr. John Lin explore the “curse” of poor documentation and its real-world consequences, including payer audits, downcoding, and revenue loss. They discuss how vague or incomplete documentation—even when care is appropriate—can lead to denials and clawbacks, especially in today’s AI-assisted claims review environment. The team also covers practical strategies to improve documentation, the risks of ov...
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October 31, 2025 In this Halloween-themed episode, Scott, Mark, Ray, and special guest Dr. John Lin explore the “curse” of poor documentation and its real-world consequences, including payer audits, downcoding, and revenue loss. They discuss how vague or incomplete documentation—even when care is appropriate—can lead to denials and clawbacks, especially in today’s AI-assisted claims review environment. The team also covers practical strategies to improve documentation, the risks of ov...
UCR 254: Downcoding on the Rise – What to Watch For, and is United Healthcare getting out of Medicare Advantage plans?
Urology Coding and Reimbursement Podcast
26 minutes
3 months ago
UCR 254: Downcoding on the Rise – What to Watch For, and is United Healthcare getting out of Medicare Advantage plans?
August 8, 2025 In this episode, Scott, Mark, and Ray discuss the troubling expansion of automatic E/M downcoding by payers—and what your practice can do about it. Mark explains which payers are leading this trend, how to identify if your claims are being affected, and practical steps to reverse these denials and protect revenue. Then, the team unpacks the recent news about UnitedHealthcare dropping certain Medicare Advantage plans, what it really means, and how to prepare your front d...
Urology Coding and Reimbursement Podcast
October 31, 2025 In this Halloween-themed episode, Scott, Mark, Ray, and special guest Dr. John Lin explore the “curse” of poor documentation and its real-world consequences, including payer audits, downcoding, and revenue loss. They discuss how vague or incomplete documentation—even when care is appropriate—can lead to denials and clawbacks, especially in today’s AI-assisted claims review environment. The team also covers practical strategies to improve documentation, the risks of ov...
