What the AMA's House of Delegates Decided in Orlando, From AI Licensure to Downcoded Claims
By our count the AMA adopted 15 policies at its Nov. 6-9 meeting, including a bar on licensing AI as a physician and EHR alerts for downcoded claims.
Idea in Brief
The News
The AMA House of Delegates closed its Interim Meeting on Nov. 9 with policy that AI cannot be licensed or titled as a physician and that vendors should carry liability for defective AI tools.
The Count
By our tally of the AMA's own coverage, 15 policies were adopted: five need Congress or a federal agency, three need states and three target medical education.
The Move
Use the downcoding policy now: compare billed and paid E/M levels by payer from your 835 remittance files, and comment on HHS's peptide policy by Nov. 13.
The American Medical Association's House of Delegates ended its Interim Meeting near Orlando on Nov. 9 with new policy saying artificial intelligence cannot be licensed or titled as a physician, and asking electronic health record vendors to flag every evaluation and management claim a payer pays at a lower level than billed.
Those were two of 15 policy actions the AMA described in its own meeting coverage on Nov. 9 and Nov. 10, by our count. The meeting was held at the Walt Disney World Swan and Dolphin Resort, where delegates heard testimony on nearly 200 reports and resolutions, according to the AMA's meeting highlights page. AMA policy is a lobbying position, not law. It tells the association where to spend its advocacy money, and several of these positions run straight into federal actions now open for comment.
What did the delegates adopt?
We read each AMA article and press release about the meeting and sorted every adopted policy by who would have to act for it to take effect. Five of the 15 need Congress or a federal agency, three need state legislatures or licensing boards, three are aimed at medical education bodies, one at payers and EHR vendors, and three at health systems, health plans and physicians themselves.
| Policy | What it asks for | Who must act |
|---|---|---|
| AI and licensure | No physician license, title or certification for AI; model bills separating device clearance from licensure | State legislatures, boards |
| AI liability | Vendors liable when a properly used product harms a patient; organizations that mandate a tool share liability | Congress, states |
| Payer downcoding | Guidance on appeals and reporting; EHR alerts built from remittance data; challenge algorithmic downcoding, including in Medicare Advantage | Payers, EHR vendors |
| "Emergency department" label | Reserve the term for EMTALA-covered sites with 24/7 qualified physician coverage; signage where no physician is on site | States |
| Pain clinics | Oppose independent, unsupervised pain clinics and institutes | States |
| Unapproved peptides | Urge regulators to rescind policies easing restrictions; enforcement and physician education | HHS, FDA |
| Food additives | Premarket safety testing; every GRAS determination sent to FDA for active review | Congress, FDA |
| Sunscreen ingredients | Allow real-world evidence in FDA review of new active ingredients | FDA |
| E-bikes and scooters | A congressional task force to recommend minimum federal standards | Congress |
| USMLE fees | Fee parity for examinees testing outside the United States | Exam sponsors |
| Away rotations | Public disclosure of mandatory fees and expenses before students apply | Medical schools |
| AI in student assessment | Clarity for students on how AI is used in their assessments | Medical schools |
| Provider directories | Physicians listed separately from nonphysicians, "clear and unambiguous" | Health systems, plans |
| Deprescribing | Treat it as a routine part of medication optimization | Physicians, care teams |
| Moral injury | Develop recommendations to address it | AMA, health systems |
Can AI be licensed as a physician?
Not under AMA policy. The House said AI tools should work inside physician-led teams at the treating physician's direction and “cannot be granted physician licensure, professional titles or certification to practice medicine,” according to the AMA's Nov. 10 article on the policy. The AMA will push model legislation that keeps device authorization separate from professional licensure and bars marketing a non-human product under titles reserved for physicians.
The liability half may matter more to practices. The AMA's press release says it will back federal and state laws that protect physicians when an AI product harms a patient despite proper use and sound clinical judgment, and that put liability on vendors, manufacturers or distributors when the product is defective. It wants AI companies to carry adequate liability insurance, disclose product limits and performance data, and stop writing contracts that shift responsibility for product failures to physicians. Where a hospital, insurer or other organization mandates a specific AI tool, the policy says that organization and the vendor should bear responsibility for harm.
“Patients deserve to know who is responsible for their care,” AMA President Willie Underwood III said in the release. It arrives a month after the AMA released a liability framework for clinical AI, and as chatbots are being tested on clinical decisions, including the Choosing Wisely study we reported in October, where models over-ordered tests far more often than they withheld needed care.
None of these policies binds a payer, a vendor or a state. Their value to a practice is as a script for the next contract negotiation and the next appeal.
Clinical Pearls
- The House said AI tools should work inside physician-led teams and cannot be granted physician licensure, titles or certification.
- AMA policy now supports laws putting liability on AI vendors when a properly used product harms a patient, and on organizations that mandate a specific tool.
- Delegates asked EHR vendors to flag E/M claims paid at a lower level than billed, using the electronic remittance advice.
- An Illinois State Medical Society survey cited by the AMA found 72 percent of physicians reported automatic downcoding.
- New policy would reserve the term emergency department for EMTALA-covered facilities with 24/7 qualified physician coverage.
- The AMA will urge federal regulators to rescind policies easing restrictions on unapproved synthetic peptides.
The downcoding fix runs through the remittance file
The most practical item for billing offices came from a Board of Trustees report. “Many health plans downcode claims automatically, without first requesting and reviewing the underlying clinical record,” the report said, as quoted in the AMA's Nov. 9 article. Delegates told the AMA to ask EHR and health technology vendors to read the electronic remittance advice, detect when an E/M claim was paid at a lower level or with different modifiers, and alert staff with the billed code, the paid code, the payer's stated reason and the appeal deadline.
The same policy commits the AMA to publish guidance on documenting, appealing and reporting improper downcoding, reaffirms its support for lawsuits against insurers that downcode inaccurately, and directs it to challenge automated or AI-driven downcoding without medical review by public and private payers, Medicare Advantage plans included. The supporting numbers are survey and resolution data, not audited claims: an Illinois State Medical Society survey found 72 percent of physicians said their practices had been hit by automatic downcoding and 77 percent said it had increased over five years, and a resolution put revenue erosion at $28,000 to $74,000 a year per family physician. The AMA says more than a dozen states have introduced bills on the practice.
“Physicians should not have to fight insurers to be paid accurately for the care they provide,” AMA Trustee Michael Suk said. Practices do not have to wait for vendors. The adjudicated code is already in every 835 remittance file, and a monthly report comparing billed and paid E/M levels by payer is a query most practice management systems can run now. Our explainer on how automated payer review reads a claim covers the appeal side.
What counts as an emergency department?
Under the new policy, only a facility covered by the Emergency Medical Treatment and Labor Act with qualified physician coverage around the clock should be allowed to call itself an emergency department or emergency room. Facilities without a physician continuously on site would have to say so on signs and in advertising. The recommendations came from a Council on Medical Service report that cited more than 155 million emergency department visits and more than 17 million admissions from emergency departments in 2025, according to the AMA's Nov. 9 article.
The same article reports two related scope positions: opposition to “the independent, unsupervised establishment and operation of pain clinics, pain institutes” and a requirement that physicians be listed separately from nonphysicians in directories. Both belong to the state fights we laid out in our scope-of-practice explainer, and they will be argued state by state.
Peptides, food additives and sunscreen
Three adopted policies point at the Food and Drug Administration and its parent department. Delegates directed the AMA to urge federal regulators to rescind policies that ease restrictions on unapproved synthetic peptides. AMA Trustee Ilse R. Levin said that “expanding access without adequate safeguards and oversight could expose patients to serious, preventable harm,” according to the highlights page. The obvious target is the Department of Health and Human Services' enforcement discretion policy for compounded BPC-157 and five other peptides, which we reported on Oct. 29.
On food, the AMA's Nov. 10 article says the House wants comprehensive safety testing before any additive is approved, every new determination that an ingredient is generally recognized as safe (GRAS) sent to the FDA for active review, and an independent committee to re-review additives already in use, starting with those banned elsewhere. “A loophole in federal law has allowed companies to add chemicals to our nation's food supply,” said AMA Trustee Amar H. Kelkar. The article cites an estimate of more than 10,000 additives in the U.S. food supply, without naming its source, against a little over 300 permitted in the European Union. On sunscreen, the House asked the FDA to accept real-world evidence when it reviews new active ingredients.
What it means for trainees
The education items are small and concrete. The AMA says USMLE examinees who test outside the United States pay regional fees of $210 for Step 1 and $235 for Step 2 Clinical Knowledge, and delegates directed it to seek parity. Another policy backs disclosure of mandatory away-rotation fees before students apply; the AMA cites Association of American Medical Colleges data that 25.6 percent of students spent more than $1,500 out of pocket on such rotations.
What to watch
The first federal test is close. Comments on HHS's peptide enforcement policy, docket HHS-OASH-2026-0496, are due Nov. 13, and the AMA's new position gives it a reason to file. For practices, the downcoding policy is the one to use this week: pull the last quarter's remittance files, list every E/M claim paid below the billed level by payer, and take that list to the next payer meeting or to the state medical society. Under the new policy, the AMA will work with state societies on how to report noncompliant plans to regulators.
Reported, fact-checked and edited by The Script Pad's editorial staff. See How we use AI.
This article is for professional education and does not replace clinical judgment. Treatment decisions should be based on the individual patient and current guidelines.
