Key Highlights from the Board of Governors (BOG) Spring 2026 Meeting
The Spring BOG meeting featured updates on recent activities, two substantive panel discussions, and a live forum with the Academy’s President-elect candidates.
AAO-HNS/F
The BOG has been active on multiple fronts since the AAO-HNSF 2025 Annual Meeting & OTO EXPO. Advocacy coordination has been a centerpiece of that work, with the BOG strengthening its regional representative structure and restructuring its committees to better align with member priorities. BOG committee members have contributed to Clinical Practice Guidelines (CPGs) and helped develop graduate surgical education modules.
2026 Momentum in Advocacy
In March 2026, the BOG was well represented at the OTO Forum in Louisville, Kentucky. Panel discussions covered both state and federal advocacy, with a focus on the burdens of prior authorization, the need for peer-to-peer reviews, and broader Medicare payment reform. Immediate Past AMA President Bruce Scott, MD, and current AMA President Bobby Mukkamala, MD, both otolaryngologists, spoke on the Medicare Economic Index and stressed the importance of organized medicine in physician payment policy.
That same month, the Academy hosted Congressional Advocacy Day in Washington, DC, bringing 40 physician advocates to Capitol Hill to meet with more than 70 congressional offices. The group lobbied on legislative issues, including Medicare physician payment reform, congenital cytomegalovirus (cCMV) screening, and insurance coverage for osseointegrated hearing devices. Two residents participated in the event through an AAO-HNS scholarship program designed to engage early-career physicians in the advocacy process.
The discussion also underscored the importance of state-level advocacy. The Academy’s new coordinator for member engagement, Cristina Baldassari, MD, highlighted a recent legislative win in Virginia prohibiting insurers from denying claims based solely on artificial intelligence (AI)-generated decisions without requiring human review and an appeals process. The hope is to replicate this legislative model in other states.
Artificial Intelligence in Coding and Reimbursement
The first panel of the day examined the growing role of AI across both private insurers and federal agencies, including what this means for otolaryngology practices. For example, the Wasteful and Inappropriate Service Reduction (WISeR) Model, which went live in January across six states, introduced AI-powered prior authorization into traditional (fee-for-service) Medicare for 13 specific procedures and services. Of direct relevance to the otolaryngology community: hypoglossal nerve stimulation for obstructive sleep apnea is among the services included in the model.
The panel also raised concerns surrounding data privacy and security, including the need for transparency when third-party AI tools are used during clinical encounters. Panelists emphasized that poorly implemented AI systems can create significant operational and patient safety risks, citing recent examples in which system failures led to major data losses.
The discussion further explored the impact of AI-assisted documentation and coding tools. Panelists noted that practices using AI scribes have reported revenue increases of 6% to 10% but emphasized that these gains more likely reflect more complete documentation and appropriate coding of services that may previously have been underreported, rather than inappropriate “upcoding.” At the same time, panelists acknowledged that some insurers’ use of AI-based denial systems has produced inaccurate coverage determinations and led to patient harm. Panelists emphasized the need for human review in all medical necessity decisions.
The overarching message from the panel was that AI is a useful tool but not a replacement for experienced physician judgment. Regulatory protections are lagging, the data underlying many AI systems is imperfect, and otolaryngologists should be both curious and cautious.
President-Elect Candidate Forum
The two candidates for the Academy’s 2026 President-elect position also participated in a live Q&A session, each presenting their vision for the Academy and responding to three questions from the BOG Chair. Both candidates spoke to the urgency of legislative advocacy, growing ENT PAC contributions, and ensuring the Academy responds to members’ practical, day-to-day concerns—particularly the pressures of prior authorization, declining reimbursement, and AI-enabled claim denials.
You can view the 2026 AAO-HNS President-elect Candidate Forum here.
Modifier 25 Denials and Advocacy
The meeting’s second panel examined a billing issue that is progressing across private health plans in several states: the inappropriate denial or downgrading of claims that use modifier 25. This modifier is used when a physician performs a significant and separately identifiable evaluation and management (E/M) service on the same day as another procedure or service. For example: a patient comes in for a sore throat, weight loss, and hoarseness. The physician provides a comprehensive evaluation of the patient’s history and symptoms and performs a flexible laryngoscopy to evaluate the vocal folds. Because the E/M service was above and beyond the usual pre-service work associated with the laryngoscopy, modifier 25 would be appended to the E/M code.
Insurers in several states have been implementing policies that automatically reduce E/M reimbursement by 50 percent when modifier 25 is attached, effectively penalizing physicians for providing same-day comprehensive care. Other insurers immediately reject all claims appended with modifier 25, requiring resubmission with additional documentation in order for the claims to be properly adjudicated. The panel featured perspectives from California, Michigan, and New Jersey, and the picture varied by state.
Several broader lessons emerged. First, there’s power in numbers. While otolaryngologists are particularly harmed by blanket reductions to same-day services, these policies impact many other medical specialties as well. When the Academy collaborates with the House of Medicine to combat such policies, the voice of otolaryngology is amplified. Second, internal coding compliance matters. If a practice is appending modifier 25 to every visit regardless of clinical context, it gives insurers a legitimate grievance and a pretext for blanket policies that harm all physicians. Modifier 25 should never be used automatically, and the medical record must always document that the E/M service performed was distinct and medically necessary.
Looking Ahead
The meeting closed with several calls to action: contribute to ENT PAC*, which distributes funds to supportive legislators across both parties; sign up for the State Tracker program to stay informed about legislation in your state; and consider applying to serve on a BOG committee when the application window opens in late fall.
The BOG General Assembly will be held in Los Angeles in conjunction with the AAO-HNSF 2026 Annual Meeting & OTO EXPO this October. A recording of the Spring Virtual Meeting will be shared with Academy members.
*Contributions to ENT PAC are not deductible as charitable contributions for federal income tax purposes. Contributions are voluntary, and all members of the American Academy of Otolaryngology–Head and Neck Surgery have the right to refuse to contribute without reprisal. Federal law prohibits ENT PAC from accepting contributions from foreign nationals. By law, if your contributions are made using a personal check or credit card, ENT PAC may use your contribution only to support candidates in federal elections. All corporate contributions to ENT PAC will be used for educational and administrative fees of ENT PAC, and other activities permissible under federal law. Federal law requires ENT PAC to use its best efforts to collect and report the name, mailing address, occupation, and the name of the employer of individuals whose contributions exceed $200 in a calendar year.
