Practical write-ups and the MD-Universe Podcast — on licensing, reimbursement, and the business of medicine. Free, no account needed.
Since 1 October 2025 an algorithm at Cigna pays level 4 and 5 E/M claims one level lower using claim data alone — the chart is never opened. Aetna runs a parallel program in nearly every commercial state. Each downcode costs $40 to $59 at Medicare rates, the reversal path is written into the policy itself, and Maryland has already ordered every affected claim repaid.
JAMA's five-center study of 1,809 clinicians measured what ambient scribes actually return — 16 minutes of documentation time per clinical day, half an extra visit a week, and no change at all in after-hours EHR time. Burnout fell hard anyway. Price the license against those numbers, not the demo.
Algorithms write the denials now. Since January plans must decide in seven days and give a reason — but nothing requires them to deny less, and CMS declined to regulate the software at all. Meanwhile over 80% of Medicare Advantage appeals are overturned and only about 20% of physicians file one.
Google ran 300 live video consultations pitting its AMIE system against 30 board-certified primary care physicians, and rated it on par or better on history, diagnosis and management. It still cannot prescribe, sign, bill or be sued — which is exactly why this is an ownership story rather than a replacement story.