Payer Scrutiny Is Increasing—Here’s How Billing Must Adapt

Payers in 2026 are applying heightened scrutiny to claims as part of broader cost-containment initiatives. This includes closer review of utilization patterns, modifier usage, and coding consistency over time. Claims that appear statistically unusual are increasingly delayed or denied for review.

Billing teams must now understand not just how to code correctly, but how payers interpret data trends. A claim that is technically accurate can still be challenged if it doesn’t align with payer expectations or historical benchmarks.

D’Souza and Associates stays ahead of these trends by monitoring payer behavior and adjusting billing strategies accordingly. Our team ensures submissions reflect current payer standards, reducing unnecessary scrutiny and improving approval rates.

As payer oversight grows, adaptability becomes essential. Billing strategies that evolve with payer behavior outperform those that rely on static rules.