Physicians fight back against automatic downcoding and prior auth
Physician groups are pushing back against payer practices that use automatic downcoding, prior authorization friction, and AI-driven review to reduce payment or delay care. The MGMA draft bill and Patients First Act reflect a broader effort to curb administrative burden and protect physician reimbursement.
Why it matters: If automatic downcoding and AI-run prior authorization review go unchecked, practices face lower payment per claim and slower approvals, while the radiology trials show AI reimbursement is already being tested with a physician over-read still in place.
Read the reporting at Medicaleconomics → · Discussion on r/medicine