UCR 292: Downcoding, Record Requests, and Takebacks — Fighting Back Against Payer Tactics

June 12, 2026In this episode, Scott, Mark, Dr. Ray Painter, and special guest Marianne DeSciose discuss the growing wave of payer scrutiny impacting urology practices, including automatic E/M downcoding, stealth denials, medical record requests, takebacks, and RAC-style reviews. Drawing on real-world experiences from hundreds of recently identified downcoded claims, the team shares practical strategies for detecting reimbursement issues before appeal deadlines expire, prioritizing revenue cycle resources, and building processes to monitor payer behavior more effectively. The discussion emphasizes the importance of strong clinical documentation, payer audits, contract monitoring, and team-wide coordination. The key takeaway: clean claims are no longer enough—practices must actively monitor, audit, appeal, and defend their reimbursement to avoid losing revenue. PRS Coding and Reimbursement HubAccess the HubBotox LCD AlertDownload the AlertFree In-Office Prostate Biopsy Calculator (Suppoted by UC-Care)Download NowPRS Coding CoursesFor UrologistFor APPsFor Coders, Billers, and Admins Join the Urology Pharma and Tech Pioneer GroupEmpowering urology practices to adopt new technology faster by providing clear reimbursement strategies—ensuring the practice gets paid and patients benefit sooner.         https://www.prsnetwork.com/joinuptpClick Here to Start Your Free Trial of AUACodingToday.com   The Thriving Urology Practice Facebook group.The Thriving Urology Practice Facebook Group link to join:https://www.facebook.com/groups/ThrivingPractice/