What Is Downcoding?
Assigning a lower-level code or reduced level of service than what was documented and actually provided. This results in underpayment to the provider and represents a loss of legitimate revenue.
Downcoding across 2 exams
Downcoding appears on the following exams. Each defines it in the context candidates are tested on:
- CBCS (NHA)
- Assigning a lower-level code or reduced level of service than what was documented and actually provided. This results in underpayment to the provider and represents a loss of legitimate revenue.
- CPC
- When an insurance plan reduces the billed codes to lower-paying codes due to insufficient documentation, coding errors, or claim inconsistencies. This results in lower reimbursement than expected and is a revenue cycle impact.