ICEP Member is sounding the alarm on AI downcoding

Illinois emergency physicians are sounding the alarm on AI downcoding, and it’s time legislators take notice.

Insurance companies are increasingly using automated tools to downcode EM claims after the fact, reducing payments for services that were already provided and deemed necessary. Dr. Tom Sugarman, ICEP member and Senior Director of Government Affairs at Vituity, put it plainly: insurers are saying “we don’t think you provided the service you said you provided, so we’re going to pay you less.”

Illinois’s proposed Transparency in Downcoding Act would require any downcoding decision to be made by a licensed physician in the same specialty, with a clear appeals process and full transparency. It passed committee unanimously. Now it needs to cross the finish line.

Read the full story: https://www.thelundreport.org/content/health-care-providers-decry-use-ai-downcode-bills