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We are an independent lab. Humana and Cigna now have policies in place that they will not reimburse any higher than a G0480 tox for Humana and a G0481 tox for Cigna. What Cigna does is downcode when they reimburse and Humana pays the higher tests than recoups a couple months later and we have to bill a new claim with the G0480 What we would like to do is just bill at those levels but still test and report what the provider ordered. This would greatly simplify working denials and payment posting for us.
My concern is that we get into a compliance issue; since the payers have specific policies in place , would that cover us for downcoding? Thank sin advance!
My concern is that we get into a compliance issue; since the payers have specific policies in place , would that cover us for downcoding? Thank sin advance!