Bill Reintroduced to Prohibit Down Coding

Bill Reintroduced to Prohibit Down Coding - Healthcare Law Update - February 2024 - Brach Eichler
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2/28/2024

Assembly Bill A1036, reintroduced in the New Jersey General Assembly on January 9, 2024, would prohibit health insurance payers from using down coding to prevent a healthcare provider from submitting a health benefit claim for the actual services performed. Down coding occurs when a health insurance payer disputes a specific service or argues that a certain diagnosis did not require the specific service code submitted by the health care provider. When down coding occurs, it can significantly reduce revenue for health care providers.

For more information, contact:
John D. Fanburg, Chair | 973.403.3107 | jfanburg@bracheichler.com
Edward Hilzenrath | 973.403.3114 | ehilzenrath@bracheichler.com
Erika R. Marshall | 973.364.5236 | emarshall@bracheichler.com

*This is intended to provide general information, not legal advice. Please contact the authors if you need specific advice.

Related Practices:   Healthcare Law

Related Industry:   Healthcare