09/08/2025
🚨🚨Eff. October 1, 2025 Cigna will be automatically down coding your codes. Claims will be paid but in order for you to receive reimbursement for the proper coding billed you will have to submit Medical Records for the all the visits that have been paid incorrectly and appeal the payment.
📌To do this you must ensure the documentation for the office visit is in order. There are two ways to code the office visit, either MDM or time.
☝️Cigna is the only one who has officially released a statement; however you may have already seen that other insurance companies like UHC, Humana, Aetna that already had started downcoding your claims and started payer a lesser amount.
Insurance Carriers are doing this so that providers can justify the higher code billed.
🏢While huge practices might not feel such a hit, it is the smaller private practices will feel it by having to hiring additional personnel and/or have staff take additional time to pull records, have billers and coders review medical records prior to submitting them, a possibility of hiring in-house auditors, in addition to time it might take the provider to amend any records that may need it which then will flag providers and practices to insurance. We always say. Time is money, and this is taking away from practices. It is a huge burden smaller practices face, and some are already feeling it. TMA along with CMS is asking insurance carriers to reconsider. Practices are already taking the time to submitting medical records for other services to justify HEDIS, quality measures and Risk Assessment.
📍We urge our providers to make sure you document properly. Please keep an eye out on separate email that will provide some guidance to this.
☎️If you'd like more information and guidance on how to properly document or need of a consultation please reach out to us at 817-523-6466 Mon - Fri 8am-5pm
💰Your revenue care team - All Medical Billing & Consultants, LLC
