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.
Reimbursement · last 3 daysPhysician groups are pushing back on payer automation. MGMA has a draft bill to ban automatic downcoding, and the Patients First Act is aimed at curbing administrative burden and protecting reimbursement.
Physician groups like MGMA say automatic downcoding, prior authorization friction and AI-run review cut payment and delay care, and want legislation to stop them.
Radiology offers a counterexample: it is already being read by AI and reimbursed by CMS in several trial locations, with a radiologist still over-reading.
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