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Physicians press lawmakers to ban automatic downcoding and shorten clawback windows
Summary
Doctors and other providers told the committee automated downcoding and long insurer clawback windows are forcing practices to spend hundreds of hours on appeals, threaten small‑practice viability and reduce access to care; witnesses urged a ban on algorithmic downcoding and a 12‑month limit on recoupments.
A broad coalition of physicians, specialty societies and clinicians urged the Insurance and Real Estate Committee to curtail automated insurer practices that they say reduce payments without clinical review. At the hearing Dr. Peter Hahn, a solo cardiologist, described persistent automatic reductions to evaluation and management payments and said, "They have downcoded my initial visits 50% of the time," adding that appeals are time‑consuming and often overturned on review.
Multiple providers — from emergency…
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