Even with the government shutdown, Congress continues to work on key bills, including the Improving Seniors’ Timely Access to Care Act (H.R. 3514). This legislation is just shy of a House majority, and AAOS members’ voices can help tip the scales.
Members can send a letter to Representatives who have not yet co-sponsored the legislation asking for their support in reducing delays and administrative burden for patients and surgeons.
Take Action: https://aaos.quorum.us/campaign/143794/
AAOS staff recently attended a presentation on the liability implications of artificial intelligence (AI) in healthcare settings by Perry Nielsen Jr., a Stanford biodesign policy fellow. His talk addressed technical challenges of using generative AI and the risk of incorrect or misleading AI-generated outputs. Nielsen emphasized that physician liability can be mitigated by ensuring proper use of AI, applying clinical judgment, and appropriately documenting it.
From a legislative perspective, he shared that Congress is eager to regulate the use of AI, though he acknowledged that stakeholders are cautious of both over- and under-regulation.
Nielsen anticipates that government agencies will continue to focus on early-stage pilot programs using AI, such as the Wasteful and Inappropriate Service Reduction (WISeR) model from the Centers for Medicare & Medicaid Services.
New York State Governor Hochul's AI initiatives focus on expanding the state's AI research capabilities through the Empire AI Consortium, implementing responsible AI regulations and safety features, and supporting workforce training and small businesses.
Key projects include enhancing the Empire AI supercomputing center, establishing AI Departments at SUNY campuses, creating new safety standards for AI companions, and offering technical assistance and workforce development programs to help New Yorkers adapt to and benefit from AI.
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. As of October 1, Cigna and Aetna are automatically downcoding claims.
States attempting to tackle downcoding have sought out different avenues for the process. New York Senate Bill S4833 categorizes downcoding as an adverse decision — enabling policy prescriptions for adverse decisions, such as in prior authorization, to be applicable for downcoding.
In California, Cigna has agreed to temporarily pause a novel and controversial downcoding policy that would have automatically downcoded any higher-level evaluation and management services.
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.
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
Throughout AAOS’ Combined National Orthopaedic Leadership Conference/Fall Meeting, members recorded firsthand accounts of how prior authorization delays and denials affect patient care. Individual stories are a powerful tool that resonate with lawmakers and physicians alike. Members can add their voices by submitting a short video or written account via the AAOS Advocacy Action Center.
Watch and example
Share your story
Starting today, all health care providers in the workers' compensation system, regardless of office size or patient population — must submit the CMS-1500 universal billing form electronically, through a Board-approved electronic submission partner in order to be paid for services. This mandate applies to each individual provider in a practice who treats workers’ compensation patients. If you have not already done so, simply contact a Board-approved electronic submission partner to arrange for electronic submission of your CMS-1500 forms. Take action now to ensure uninterrupted payment for your services in treating injured workers. Going forward, the workers’ compensation payer can deny payment of services if the CMS-1500 form was not submitted through a Board-approved electronic submission partner and the Board will not enforce payment.
Learn more: https://www.wcb.ny.gov/CMS-1500/
With the CMS-1500 electronic submission mandate fast approaching, the Workers’ Compensation Board (Board) is continuing its CMS-1500 webinar series tomorrow for providers. Effective August 1, 2025, the Board is requiring health care providers, regardless of office size or patient population, to submit the CMS-1500 universal medical billing form electronically through a Board-approved electronic submission partner.
After August 1, 2025, the Board will not act on, or enforce payment of, paper CMS-1500 forms and workers’ compensation payers can deny them, which means the submitting provider will not be paid. To ensure uninterrupted payment for services, the Board urges all providers to transition to electronic submission now. For more information, join one of our upcoming webinars.
Each one-hour webinar session will cover:
The sessions are free and there will be time at the end for questions. Register here.
June
July
Visit the CMS-1500 section of the Board’s website for more information.
If you are not currently working with an electronic submission partner, this fact sheet will guide you through the process step-by-step.
The What Providers Need to Know section of the Board’s website walks health care providers through the workers’ compensation system with the following topics:
If you have not already, be sure to sign up to receive Board news straight to your inbox, including updates on the progress of this initiative, upcoming webinars, and more.
Email CMS1500@wcb.ny.gov.
If you are having trouble registering or attending these webinars, check out these Webinar FAQs.
As we chart the course for NYSSOS’s 2026–2029 Strategic Plan, we want to hear directly from you. Please join us for a Virtual Member Town Hall where you can share your ideas, priorities, and concerns, and help shape the future of orthopaedic advocacy, education, and community in New York State.
June 18, 2025 7:30pm - 8:30pm EST Registration link
This informal session will be hosted by NYSSOS leadership and is open to all members. It’s your chance to be part of the conversation as we build a bold and responsive plan for the years ahead.
We encourage all members to also complete our short strategic planning survey here
Thank you for being an active voice in the NYSSOS community.
We are excited to announce that the New York State Society of Orthopaedic Surgeons (NYSSOS) is now accepting submissions for its Poster Competition, which will take place at our Annual Symposium on Saturday, September 6, 2025 at the Turning Stone Resort in Verona, NY.
This competition provides a unique opportunity for medical students interested in orthopaedics to showcase their research, clinical case reports, or advocacy efforts. We welcome submissions in the following categories:
To submit an abstract and review detailed submission guidelines, please click here
Please note that all abstracts must follow the structure outlined in the competition regulations.
Legislative developments impacting the New York medical and dental professional liability insurance marketplace
On May 8, more than a month after the April 1 fiscal deadline, the New York State (NYS) Legislature completed work on the state budget.
The Governor and the Legislature agreed to a budget for the 2025-26 state fiscal year that totals $254 billion, which reflects a $2 billion spending increase from Governor Hochul’s proposed executive budget.
The final budget contains six items of interest to the NYS medical community - learn more
In a move to enhance healthcare access for injured workers, New York State has enacted legislation permitting resident and fellow physicians in Accreditation Council for Graduate Medical Education (ACGME)-accredited programs to provide treatment under supervision within the state's workers' compensation system.
This change, effective immediately, allows approximately 20,000 resident and fellow physicians across nearly 70 teaching hospitals in New York to participate in the care of injured workers. The initiative aims to alleviate provider shortages and improve timely access to quality medical care for those affected by workplace injuries.
Key Provisions:
Supervised Practice: Residents and fellows can treat injured workers under the supervision of a physician authorized by the New York State Workers' Compensation Board.
Billing Procedures: Services rendered by residents and fellows are billed by the supervising physician using the appropriate modifiers, ensuring compliance with the Official New York Workers' Compensation Medical Fee Schedule.
Clinical Documentation: Treatment notes must clearly identify the resident or fellow providing care, the supervising physician, and include specific information regarding the work-related nature of the condition, the patient's work status, and the degree of temporary disability.
For more information and resources, visit the New York State Workers' Compensation Board's official page for residents and fellows: https://apps.wcb.ny.gov/content/main/hcpp/residents-fellows.jsp
and the Subject Number 046-1756
https://www.wcb.ny.gov/content/main/SubjectNos/sn046_1756.jsp
Advocating for the orthopaedic surgeon, patients and musculoskeletal health in New York.
info@nyssos.org 1-518-439-0000 Address: PO Box 38004, Albany, NY 12203
