Payer Downcoding Rebuttal Letter

Draft a code-specific, evidence-grounded rebuttal letter when a payer has *silently downcoded* a claim — most commonly an E/M level, an inpatient DRG, an observation-to-inpatient reclassification, or a procedure bundled without a modifier — rather than issuing a formal denial. Output reconstructs the documentation-to-code path the original biller followed, maps the downcoded level against CPT and CMS rules (2021 E/M office/outpatient overhaul, 2023 split/shared and prolonged-services rules, time-based vs. MDM pathways), and argues the specific element(s) that support the originally billed level. The skill is scoped for the 2026 environment where payer-side AI adjudicators are algorithmically reducing code levels — the "bot wars" pattern documented in the April 2026 PHTI report and HFMA commentary — and where ambient-scribe-authored notes face a new kind of scrutiny on both ends of the claim.