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Doctors, clinicians urge ban on automatic insurer downcoding and limits on claim clawbacks
Summary
Physicians, psychologists and other clinicians told the committee that insurers have been automatically reducing claim payments using algorithms without clinical review, imposing heavy appeal burdens and threatening small practices; witnesses backed bills that would prohibit automatic algorithmic downcoding and shorten recoupment windows.
Physicians, psychologists and other clinicians testified at length about insurer practices they said amount to automatic downcoding and late claim clawbacks. Dozens of provider witnesses urged the committee to adopt statutory safeguards — including a ban on automated downcoding without clinical peer review and a 12‑month limit on retroactive recoupments — to protect practice viability and patient access.
Dr. Peter Hahn, a solo cardiologist, described a pattern of insurers reducing evaluation‑and‑management codes…
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