Opinion: It’s called downcoding. And it’s a trend that has started to reemerge with the advent of AI, writes UCSF’s Maria Raven. sfchronicle.com/opinion/open…

Opinion: It’s called downcoding. And it’s a trend that has started to reemerge with the advent of AI, writes UCSF’s Maria Raven. sfchronicle.com/opinion/open…

Another phenomenon — seen in Chicago — is “downcoding.” Say a perp demands, and receives, a rider’s phone. The threat of violence was at least implicit. But the police may code it as a nonviolent property crime, as if the perp just plucked it off a seat. Voila — better stats.

Ever wonder why credentialing takes forever or where your revenue goes during downcoding? 🧐 We’re hosting a FREE deep-dive session to uncover the real dynamics of provider-payer relationships. Don't miss out! 🔗FREE Registration here: hubs.la/Q04l5W660 #PMI #ProviderPayer

Don't forget all the top brass that had to resign because they were downcoding crime; if it was even reported...

Big win for physicians: The Illinois legislature has unanimously passed the ISMS-backed Transparency in Downcoding Act. It cleared the House by a vote of 111-0 Wednesday evening and now heads to the governor’s desk for consideration. buff.ly/OqRutG0

IL House unanimously passes downcoding transparency bill wandtv.com/news/statehouse/i… via @wandtvnews #twill @DaveKoehler_IL @sharonchungIL @WilliamHauter @JeffKeicher

IL House unanimously passes downcoding transparency bill wandtv.com/news/statehouse/i…

SB 3114 Transparency in Health Insurnace Downcoding passes the IL House unanimously 111-00 after also passing IL Senate unanimously! Now heads to the Governor for final approval. Thank you to our sponsors @sharonchungIL @DaveKoehler_IL @WilliamHauter @IllinoisDoctors

TY to our sponsors and committee members for advancing the downcoding bill! This is an important step toward protecting patients and ensuring fair reimbursement for physician care. We urge timely passage on the House floor. #twill @sharonchungIL @WilliamHauter @JeffKeicher

Recently, the Connecticut state senate passed SB 342, a bipartisan bill that: -Bans health insurance companies from “downcoding,” or providing purposefully inadequate treatment to save costs -Strengthens the appeal process for patients fighting claim denials -Forces health insurance corporations to include specific payout terms in their provider contracts This bill easily passed by a 35-1 margin. The only vote against was from Rob Sampson. Every other senator took this opportunity to make the lives of their constituents better- but Senator Sampson used the bill to show his solidarity with the insurance executives

Illinois Senate unanimously passes ISMS-backed downcoding reform bill! buff.ly/8MjGuka

IL Senate passes SB3114 reforms in health insurance downcoding unanimously. Now heads to the House for approval. Thank you sponsors @SenatorKoehler @sharonchungIL buff.ly/zt86OUV

Regulatory burden isn’t just an administrative issue — it’s a workforce crisis. In the 2026 MGMA Regulatory Burden Report, more than three‑quarters of medical practices (77%) say regulatory and administrative requirements are a significant contributor to physician burnout. What’s driving that burnout? ➡️ Prior authorization and appeals that pull clinicians into uncompensated work ➡️ Medicare Advantage denials and downcoding that undermine payment predictability ➡️ Reporting and documentation requirements that crowd out time for patient care For many practices, this isn’t about inconvenience — it’s about sustainability. Burnout is pushing physicians to reduce hours, leave practice, or retire early, worsening access challenges for patients nationwide. MGMA Government Affairs continues to advocate for administrative simplification, stronger oversight of Medicare Advantage plans, and regulatory reforms that let physicians focus on care — not paperwork. View the full report: bit.ly/3PvKxdQ

ni coba liat rs vertikal tipe b, Bill rs 6 harian di 8jutaan, bpjs cm bayar segitu, itu juga kalo ga pending atau minta downcoding dia ngiranya askes indemnity kali ah, kena charge semua terus cm bayar admin

@docdano Colorado lines up with the broader trend. Indiana banned AI as the sole basis for downcoding without record review. Utah requires public disclosure for prior auth AI. Texas requires written notice. The pattern: AI in benefits decisions now needs a provenance layer that survives discovery. The model output is not the artifact, the rationale tied to the plan provision is.

Health insurance companies will make up any reason to increase cost of coverage and decreasing care covered including downcoding diagnoses. These people deserve to live.

Governor ceremonially signs Rep. McGuire's legislation to help Hoosiers with medical debt STATEHOUSE (May 1, 2026) – The governor recently ceremonially signed a new bipartisan law authored by State Rep. Julie McGuire (R-Indianapolis) to provide more transparency and predictability to healthcare bills. Nearly 1 in 5 Hoosiers has medical debt, totaling over $2 billion and ranking Indiana highest in the Midwest and 11th nationally in number of residents with healthcare bills in collections. McGuire said many hospitals have financial assistance programs but don't consistently disclose them to patients before medical bills go to collections. Additionally, healthcare providers can face unexpected reductions in reimbursement due to insurance claim adjustments or changes in payment policies. House Enrolled Act 1271 requires hospitals to inform patients about financial assistance programs before sending their bill to collections, and to proactively make this information available at intake, discharge and with the initial bill. The law also addresses downcoding, which is when insurance companies change a claim to a lower-cost service than what the provider submitted, leading to lower reimbursement. Insurers can no longer solely use automated systems or artificial intelligence to downcode a claim without human review. The time allowed for them to recoup overpayments is also shortened from two years to 180 days, and they must provide at least 60 days' notice before implementing any prospective rate reductions. McGuire said this new law continues her work to address medical costs. During the 2025 legislative session, she authored House Enrolled Act 1604 to incentivize Hoosiers to seek more affordable care options without being penalized and encourage insurers to make their prices competitive to attract more patients. @93wibc

Downcoding is not fraud. It’s a lie generally propagated by Ron and his community college friends.

"code for PA, downcoding, care denials, etc." And VBP. "Our goal, through Optum and UnitedHealthcare, is to help lead the transition to a value-based health system" They're not pushing this because they're nice - it's all about profit. AAFP should stand with FPs, not United.