A Pennsylvania health system filed suit this week against Aetna, challenging a policy around "downcoding" that has drawn ire ...

The clash between payers and providers over AI-driven coding is intensifying, with insurers arguing that documentation tools are inflating reimbursement without corresponding care.

Conclusions: Our findings suggest that Medicare inpatient encounters are associated with higher coding intensity than ...

After pushback from prominent provider organizations, Aetna is easing a controversial "downcoding" policy for inpatient Medicare Advantage claims. The insurer said in an updated notice late last week ...

Hospitals are seeing more denials of medically necessary inpatient care based on alleged delays in services. In these cases, a health plan ...