'Guilty until proven innocent': Inside the fight between doctors and insurance companies over 'downcoding'
Aetna spokesperson David Whitrap said the insurer “has an obligation to monitor for appropriate coding on behalf of our clients and members,” and to “safeguard against fraud, waste, and abuse in the government programs we serve.” “Evaluating the appropriateness of level 4 and 5 codes helps us ensure providers are billing for their services consistent with national guidelines,” Whitrap said. He also said that “only 3% of providers” are affected by the payment policy, but did not clarify how Aetna...
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