Wiki Humana downcoding issue

[abark77]

Good morning! Since August, claims sent to Humana medicare have been downcoded by them without requesting/reviewing records. Is this happening to others? What recourse do we have?

 

[nraizman@gmail.com]

Can you give some examples?

This should be appealed (as long as the original coding is appropriate), and improper denials referred to the state insurance board.
Depending on your institution's contract with humana, they may be able to get away with this. You'd have to look specifically at the contract language and perhaps renegotiate it.