Mgma Small Talk

In this episode of the Ask MGMA Podcast, hosts Daniel Williams and Christy Good dig into one of the most urgent issues medical practices are facing: payer downcoding and the increasing influence of artificial intelligence in reimbursement decisions. Discover why evaluation and management (E/M) claims are being reduced without medical record review, how automated systems are affecting your revenue, and what actions you can take to identify, track, and appeal unjustified downcodes. Whether you're feeling the impact already or want to stay ahead of the curve, this conversation offers practical tips and valuable resources to support your team.Key Highlights0:53 – Welcome & Topic Overview Daniel and Christy introduce the episode and the rising issue of AI-driven downcoding.1:53 – What is Payer Downcoding? Christy explains how downcoding works, what’s changed with AI, and why it goes against CMS guidelines.3:19 – How AI Flags Claims An inside look at how AI uses historical data to decide what gets downcoded — a