State lawmakers have passed a bill banning the use of AI to mass downcode medical claims and prohibiting insurance companies ...

In the beginning of the year, Dr. Terry Wagner’s office manager came to him and said “something weird is going on.” For weeks, the office manager told him, Wagner had been quietly underpaid by the ...

SPRINGFIELD, Ill. (WAND) — A bill in Springfield could prohibit health insurance companies from using artificial intelligence to code a health service lower than what is actually provided to patients.

U.S. physicians routinely are seeing their higher-cost claims downcoded by insurers, a strategy a family physician in Cincinnati called a revenue grab, according to Medscape. Will Sawyer, MD, said ...

This proposal states all downcoding determinations must be made or reviewed by a real person and insurance companies would be required to notify doctors if a service is downcoded.

Illinois bill shields doctors from insurance downcoding ...

“Guilty until proven innocent.” That’s how one practice owner described downcoding policies being implemented by large insurers on local independent physicians. After reviewing billing statements, ...

Several federal agencies issued a set of final rules based on the No Surprises Act aimed at making it easier for providers to contest payer decisions. During the IDR process, an arbiter is directed to ...

Emergency medicine (EM) has always been subject to payer scrutiny, but today’s reimbursement pressure is different: it is ...