8 ways payers quietly cut your reimbursement and how to catch them

You did the work of a level five visit, documented it and moved on. Weeks later the payment posts as a level four, and the difference, $40 or $50, never gets a second look. Repeat that across a full schedule and the gap between what you earned and what you actually collected widens every month. Payers are increasingly the reason. In a Jan. 6, 2026, MGMA Stat poll, 48% of medical group leaders called denials and appeals their single biggest revenue cycle leak, far ahead of front-end problems at 23%.

Much of the shortfall is deliberate, Nate Moore, CPA, MBA, FACMPE, told physicians and practice leaders at the 2026 MGMA Summit. Payers run automated software that quietly drops a 99214 to a 99213 or a 99205 to a 99204, said Moore, president of Moore Solutions Inc., then attach a remark code claiming the lower code more accurately describes the visit. He has little patience for that explanation: Payers "wouldn't recognize your patient if they saw them on the street." For a physician paid on production or judged on collections, every silent downcode lands on your own bottom line.

The encouraging part, Moore said, is that each of these tactics leaves a trace in the data, and catching them rarely takes new software, just the right reports and someone watching them. Whether you keep your own books or rely on a billing team, here are eight places physicians are quietly losing money, and how to catch each one.