MSSNY is contacting physicians statewide to assess the impact of insurance companies’ automatic downcoding, a growing concern that undermines fair reimbursement and burdens physician practices. As of October 1, Cigna and Aetna are automatically downcoding claims.

Automatic downcoding occurs when insurers unilaterally reduce the level of a billed Evaluation and Management (E/M) service or procedure code without reviewing the physician’s supporting documentation. Instead, claims are automatically flagged and adjusted by internal algorithms based on coding guidelines or statistical norms. The outcome is reduced reimbursement, even when the billed service level was appropriate and supported by the medical record.

This practice has serious implications. For physicians, it means lost revenue, time-consuming appeals, and increased administrative workload. For patients, it threatens the sustainability of physician practices, particularly in underserved areas where margins are already thin. Automatic downcoding also raises broader concerns about fairness and transparency in claims adjudication, as it bypasses medical judgment and disregards the physician’s expertise.

By sharing your experiences, you will help MSSNY document the scope of this issue and determine whether further advocacy, regulatory engagement, or legal action is warranted. Submit your experiences here.

September is women physicians’ month. Celebrate and honor the achievements and contributions of women physicians by signing up for the Fall 2025 Women Physicians Leadership Academy, entitled “Dollars and Sense”.

• November 2^nd 9:45-1:15 – Advocacy & Changemaking – Worth the Effort
• November 23^rd 9:45-1:15 – Effective Communications – Communicating your Worth
• December 7^th 9:45-1:15 – Leadership – Dollars and Sense of Leadership

Check out WPLA.US for more information on the Women Physicians Leadership Academy!

The Medical Society of the State of New York is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

The Medical Society of the State of New York designates each live activity for a maximum of 3.0 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Legislative Updates on Key Issues to keep you Informed from the State Affairs Team

STATE AFFAIRS WORKGROUP

Arnold Baskies, MD, FACS (NJ); Ali Kasraeian, MD, FACS (FL); Kevin Koo, MD, FACS (MN); David Santos, MD, FACS (TX); and Kelly Swords, MD, FACS (CA). The Workgroup plays a critical role in identifying state advocacy priorities, setting new policy objectives, and evaluating state advocacy grant applications among other duties.

ACS STATE AFFAIRS PRIORITY ISSUES

• Trauma System Funding and Development
• Cancer Screening, Testing, and Treatment
• Insurance and Administrative Burden
• Professional Liability
• Criminalization of Physician Care
• Access to Surgical Care
• Health Equity

NEW YORK

A 9103 – Prior Authorization

Introduced by Assemblymember Phara Forrest (D), A 9103 requires health insurers to provide an updated list of health care services requiring preauthorization to participating physicians; list must be developed with relevant medical specialty organizations and regional physicians; list must be updated annually with a 90-day notice to physicians. The bill was introduced in the Assembly and referred to the Insurance Committee.

For more information regarding ACS State Affairs Policy Priorities in your state, please contact Catherine Hendricks, State Affairs Manager, at chendricks@facs.org  or Cory Bloom, State Affairs Associate, at cbloom@facs.org .

To view a complete list of bills ACS State Affairs is tracking, visit our online State Legislative Tracker: https://www.quorum.us/spreadsheet/external/QGjJBFIfORzJNAtlNvfp/

As of October 1, 2025, Medicare telehealth flexibilities granted during the COVID-19 Public Health Emergency have expired, rolling coverage back to pre-pandemic rules. MSSNY and the NY Chapter ACS urges New York physicians to review these changes, safeguard their practices, and engage in ongoing advocacy to preserve patient access.

The Medical Society of the State of New York is proud to launch the Your Care is At Our Core Campaign in partnership with the American Medical Association (AMA) to strengthen the bond between patients and their physicians, the foundation of health care.

Over the past few years, physicians have faced growing challenges ignited by battles over the COVID-19 pandemic, science and evidence-based care, and the prevalence of mis- and disinformation. These factors have distracted from what matters most – the connection between America’s physicians and their patients.

“Physicians are called to medicine to heal, to serve, and to advocate for their patients,” said AMA President Bobby Mukkamala, MD. “Yet increasingly, the bureaucratic red tape of health care is taking physicians away from their patients. Ensuring physicians have the time to give both personal and physical attention to those that they treat is essential for building a stronger health care system – one that supports our current and future physicians, empowers our patients, and bolsters the health of our communities.”

“In New York, physicians are united by a common purpose: to serve as our patients’ strongest allies in health and healing,” said MSSNY President David Jakubowicz, MD, FACS. “Yet too often, the time and trust at the heart of that relationship are eroded by bureaucratic barriers. Through the Your Care is At Our Core campaign, we are reaffirming that the physician–patient bond must remain the foundation of medicine. As a society, we are proud to stand with our members in advocating for policies that put patients first, and I invite every physician to renew their commitment and encourage colleagues to join us in this effort. Together, we can strengthen the future of health care in New York and beyond.”

The data speak for themselves – 89% of patients agree that the doctor-patient relationship is central to health care, and 79% of patients agree that red tape bureaucracy makes it harder for physicians to provide the best care to patients.

Physicians are fighting alongside their patients for less bureaucracy and more time. The NY Chapter ACS will support MSSNY and the AMA to amplify  efforts through the Your Care is At Our Core campaign.

Despite Governor Hochul vetoing similar bills three times due to their impact on wrongful death damages and liability insurance costs, nearly identical legislation (S4423/A6063) has again passed the Senate and Assembly. MSSNY has joined with the NY Chapter ACS and 15 specialty societies to urge the Governor  to again veto this legislation.

At the same time, it is imperative for physicians to individually urge the Governor to veto the Latest Wrongful Death Bill and Preserve Patient Access to Healthcare, pointing out that any legislation to update New York’s wrongful death law must be balanced to also bring down our extraordinary medical liability costs.

Please remind the Governor that this legislation is fundamentally at odds with the policy efforts of many who seek to protect and expand patient access to care. Moreover, it is even more untenable given the huge cuts to New York’s healthcare system as a result of the reconciliation bill out of Washington that will greatly increase New York’s uninsured population and create a several billion-dollar Budget gap.

In a recent opinion piece published in the Albany Times Union, MSSNY President David Jakubowicz writes, “New York already maintains the dubious distinction of being regularly ranked as one of the worst states in the country to be a physician.  That is largely due to the extraordinary liability costs of practicing here: New York not only leads all other states but also exceeds California and Florida payouts combined. There are also very significant office overhead costs associated with practicing in New York.

“That’s why it is imperative that the Legislature and governor reject proposals that would exacerbate these already significant impediments to providing care in New York, particularly in underserved regions. For example, Gov. Kathy Hochul has appropriately vetoed legislation in each of the past three years that would have drastically increased awards in wrongful-death actions, and which would have increased liability premiums by 40%. She must again veto the nearly identical version of this bill that passed this year.”

Visit MSSNY's Oppose Huge Expansion in Medical Liability Toolkit to access ready-to-use images and posts — share them today to help amplify our message.

Legislative Updates on Key Issues to keep you Informed from the State Affairs Team

STATE AFFAIRS WORKGROUP

Arnold Baskies, MD, FACS (NJ); Ali Kasraeian, MD, FACS (FL); Kevin Koo, MD, FACS (MN); David Santos, MD, FACS (TX); and Kelly Swords, MD, FACS (CA). The Workgroup plays a critical role in identifying state advocacy priorities, setting new policy objectives, and evaluating state advocacy grant applications among other duties.

ACS STATE AFFAIRS PRIORITY ISSUES

• Trauma System Funding and Development
• Cancer Screening, Testing, and Treatment
• Insurance and Administrative Burden
• Professional Liability
• Criminalization of Physician Care
• Access to Surgical Care
• Health Equity

NEW YORK

A 9012 – Corporate Practice of Medicine

Introduced by Assemblymember Anna Kelles (D), A 9012 prohibits non-physician entities from controlling professional medical corporations; licensed physicians must hold majority ownership and governance; protects medical professionals from retaliation for reporting legal or regulatory violations. The bill was introduced in the Assembly and referred to the Corporations, Authorities, and Commissions Committee.

For more information regarding ACS State Affairs Policy Priorities in your state, please contact Catherine Hendricks, State Affairs Manager, at chendricks@facs.org  or Cory Bloom, State Affairs Associate, at cbloom@facs.org .

To view a complete list of bills ACS State Affairs is tracking, visit our online State Legislative Tracker: https://www.quorum.us/spreadsheet/external/QGjJBFIfORzJNAtlNvfp/

Visit our online State Legislative Tracker.

NEW YORK

A 443 – Step-therapy ENACTED

Introduced by Assemblymember John McDonald (D), A 443 limits the requirement for patients to try and fail on more than two drugs for the same condition before coverage is provided for the prescribed drug; prevents newly enrolled patients from repeating step-therapy protocols completed under a previous plan within the past year. Governor Kathy Hochul (D) signed the bill into law February 14.

A 2250 – Cancer ENACTED

Introduced by Assemblymember Emerita Torres (D), A 2250 mandates no-cost breast cancer screening and diagnostic testing for incarcerated individuals. Governor Kathy Hochul (D) signed the bill into law February 14.

A 5375 – Insurance

Introduced by Assemblymember David Weprin (D), A 5375 prohibits arbitrary time frames on reimbursement for anesthesia services. The bill was introduced in the Assembly and referred to the Insurance Committee.

A 5480A – Criminalization

Introduced by Assemblymember Harry Bronson (D), A 5480A protects health care practitioners from being charged with professional misconduct solely for engaging in legally protected health care activities. The bill was introduced in the Assembly and referred to the Judiciary Committee.

A 5724 – Cancer

Introduced by Assemblymember Michaelle Solages (D), A 5724 expands the health education curriculum to include breast cancer screenings, including age-appropriate instruction in performing self-examinations. The bill was introduced in the Assembly and referred to the Education Committee.

S 4850 – Cancer

Introduced by Senator Christopher Ryan (D), S 4850 requires health insurers to provide coverage for breast cancer screenings to individuals with second-degree relatives who have a history of breast cancer. The bill was introduced in the Senate and referred to the Insurance Committee.

S 4914 – Criminalization

Introduced by Senator Brad Hoylman-Sigal (D), S 4914 protects individuals who provide or receive legally protected health services from criminal, civil liability, or professional sanctions imposed by jurisdictions outside the state. The bill was introduced in the Senate and referred to the Children and Families Committee.

S 5241 – Utilization Review

Introduced by Senator Nathalia Fernandez (D), S 5241 prohibits utilization review agencies conducting a retrospective review or audit of a claim from reversing or altering a determination of medical necessity. The bill was introduced in the Senate and referred to the Insurance Committee.

ACS STATE AFFAIRS WORKGROUP

Arnold Baskies, MD, FACS (NJ); Ali Kasraeian, MD, FACS (FL); Kevin Koo, MD, FACS (MN); David Santos, MD, FACS (TX); and Kelly Swords, MD, FACS (CA).

The Workgroup will play a critical role in identifying state advocacy priorities, setting new policy objectives, and evaluating state advocacy grant applications among other duties. 

ACS STATE AFFAIRS PRIORITY ISSUES

• Trauma System Funding and Development
• Cancer Screening, Testing, and Treatment
• Insurance and Administrative Burden
• Professional Liability
• Criminalization of Physician Care
• Access to Surgical Care
• Health Equity

Visit the online State Legislative Tracker.

NEW YORK

A 2715 – Medicaid

Introduced by Assemblymember Karines Reyes (D), A 2715 expands Medicaid coverage to include bariatric surgery. The bill was introduced in the Assembly and referred to the Health Committee.

 

A 3265 – Artificial Intelligence

Introduced by Assemblymember Clyde Vanel (D), A 3265 mandates notifications when artificial intelligence is used in health care decisions; mandates protections against algorithmic discrimination and the right to data privacy. The bill was introduced in the Assembly and referred to the Science and Technology Committee.

 

A 3554 – Licensure

Introduced by Assemblymember Michaelle Solages (D), A 3544 requires health care providers on probation to disclose their status to patients; violations can result in a $2,000 penalty and license suspension. The bill was introduced in the Assembly and referred to the Higher Education Committee.

 

S 309 – STOP THE BLEED®

Introduced by Senator Steven Rhoads (R), S 309 requires schools to implement a bleeding control program which includes placing bleeding control kits in schools and integrating bleeding control kits into emergency planning; schools must conduct annual inspections of kits and replace components after use; provides Good Samaritan protections. The bill was introduced in the Senate and referred to the Education Committee.

 

S 310 – Cancer

Introduced by Senator Steven Rhoads (R), S 310 mandates coverage for breast cancer detection procedures including mammography and breast tomosynthesis; removes the age requirement for annual mammograms; mandates coverage for sonograms and breast ultrasounds when recommended by nationally recognized clinical practice guidelines. The bill was introduced in the Senate and referred to the Insurance Committee.

 

S 317 – Diversity Equity and Inclusion

Introduced by Senator Julia Salazar (D), S 317 requires bias awareness and elimination training for medical students and residents. The bill was introduced in the Senate and referred to the Health Committee.

 

S 354 – Telehealth

Introduced by Senator Gustavo Rivera (D), S 354 requires reimbursement parity between in-person and telehealth services. The bill was introduced in the Senate and referred to the Health Committee.

 

S 2676 – Step Therapy

Introduced by Senator Jamaal Bailey (D), S 2676 prohibits step therapy protocols for the use of drugs not approved by the FDA for the specific condition being treated; limits the duration of using a step therapy drug to no more than thirty days unless supported by treatment guidelines; prohibits step therapy if a drug was covered in the past year. The bill was introduced in the Senate and referred to the Rules Committee.

 

S 3104 – Insurance

Introduced by Senator Jeremy Cooney (D), S 3104 requires health insurers to provide coverage for bariatric surgery. The bill was introduced in the Senate and referred to the Judiciary Committee.

 

S 3186 – Professional Liability

Introduced by Senator Roxanne Persaud (D), S 3186 requires health care providers on probation to disclose their status and related details to patients; providers must obtain a signed receipt from patients acknowledging the disclosure; violations can result in a $2,000 fine and license suspension. The bill was introduced in the Senate and referred to the Higher Education Committee.

 

S 3242 – Professional Liability

Introduced by Senator Jeremy Cooney (D), S 3242 allows discovery of testimony for parties involved in legal actions related to medical review meetings. The bill was introduced in the Senate and referred to the Higher Education Committee.

 

S 3359 – Telehealth

Introduced by Senator Gustavo Rivera (D), S 3359 requires reimbursement parity between telehealth and in person services. The bill was introduced in the Senate and referred to the Health Committee.

 

S 3425 – Single Payer

Introduced by Senator Gustavo Rivera (D), S 3425 establishes a universal single-payer health care system. The bill was introduced in the Senate and referred to the Health Committee.

 

S 3559 – Cancer

Introduced by Senator Cordell Cleare (D), S 3559 requires mammography providers to notify patients of dense breast tissue to qualify as a medical necessity for health insurers to cover a breast ultrasound. The bill was introduced in the Senate and referred to the Health Committee.

ACS STATE AFFAIRS WORKGROUP

Arnold Baskies, MD, FACS (NJ); Ali Kasraeian, MD, FACS (FL); Kevin Koo, MD, FACS (MN); David Santos, MD, FACS (TX); and Kelly Swords, MD, FACS (CA).

The Workgroup will play a critical role in identifying state advocacy priorities, setting new policy objectives, and evaluating state advocacy grant applications among other duties. 

ACS STATE AFFAIRS PRIORITY ISSUES

• Trauma System Funding and Development
• Cancer Screening, Testing, and Treatment
• Insurance and Administrative Burden
• Professional Liability
• Criminalization of Physician Care
• Access to Surgical Care
• Health Equity

As a member of the New York Chapter ACS, you have the opportunity to participate in the policymaking process of the state medical society.

Working alongside the Chapter's Board of Directors, any member can submit a resolution concept to be considered at the Medical Society of the State of New York (MSSNY) House of Delegate (HOD) meeting. 

Policies set at the HOD meetings help define the agenda for MSSNY, giving guidance on projects to pursue, products to develop and issues to influence.

Submit your draft resolution to the Chapter by: January 31, 2025

> Resolution guidelines, samples and templates <