Downcoded

Every payer policy change, priced.

Downcoded is built on the paper trail payers already publish: Federal Register rules, CMS transmittals, contractor coverage policies across all twelve MAC jurisdictions, and the monthly bulletins from the national commercial plans. Machines read all of it so a person only has to read what changed. Here is how a brief gets made:

  1. Automated pipelines pull the primary record: proposed and final rules from the Federal Register, CMS transmittals and MLN articles, LCD changes in the Medicare Coverage Database, and the UnitedHealthcare, Aetna, and Cigna policy bulletins.
  2. Every document is diffed against its prior version, so a changed sentence in a coverage policy surfaces even when the payer never announces it.
  3. Each change is mapped to the codes it touches and run against the current fee-schedule and RVU files to model the dollar impact by specialty and code family.
  4. We write up the changes that move real money: what changed, who it hits, what it costs a practice of a given shape, and the date it takes effect.

Rules are half the coverage. The other half is payer conduct: denial patterns, Medicare Advantage plan behavior, RAC and OIG audit targets, and the enforcement record that tells you which changes payers actually intend to collect on.

Who reads it

Revenue-cycle directors and VPs, practice administrators, CFOs of physician groups and health systems, and the owners of billing companies. We assume you know what an LCD is, what a conversion factor does, and why a modifier matters. We will not explain your own jargon back to you.

What we are not

Enterprise policy platforms charge five figures a year to search the same public record, and the trade press reports that a rule dropped. Downcoded sits between them: the change detection of the expensive tools, plus the dollar math neither side does, at a price a single department can expense without a procurement cycle.

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