AI Accountability Lawsuits and Medical Coding Compliance
Three 2026 lawsuits, including a Medicare Advantage AI-denial case against UnitedHealth, test who’s accountable for AI-driven coding and coverage calls.
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OIG Audit Flags $15.2M in Sacroiliac Injection Coding Errors
A new OIG audit found Medicare improperly paid $15.2M for sacroiliac joint injections, nearly a quarter misclassified as therapeutic instead of diagnostic.
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AI Medical Coding ROI: Why Task Volume Isn’t the Metric
A new MedEvolve report finds that AI often accelerates flawed RCM work instead of fixing it. Here is what that means for measuring true AI medical coding ROI.
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CMS’s CY2027 Rule Moves 638 Procedures to Outpatient Coding
CMS’s CY2027 proposed rule would shift hundreds of procedures out of inpatient-only status, creating a major coding and revenue-cycle readiness challenge for hospitals and ASCs.
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Agentic AI Coding Meets RADV Audit Uncertainty in 2026
CMS’s RADV extrapolation appeal is still unresolved. Here’s why risk-adjustment coding teams need agentic AI built for defensibility, not just speed.
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CMS’s New “Software as a Medical Service” Coding Category
CMS’s CY2027 OPPS rule proposes a new Software as a Medical Service category and O1 status indicator covering 36 HCPCS codes. Here’s what it means for coders.
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What Ebix’s New Coding Platform Means for Automated Coding
Ebix’s new A.D.A.M. platform maps health content to ICD-10 and LOINC at scale. Here’s what automated coding at that volume means for medical coders and RCM teams.
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AI Surgical Coding Accuracy: What Procode’s Study Shows
A new peer-reviewed study found Procode’s AI hit 86.7% surgical coding accuracy on operative reports, more than double GPT-5 and human auditors combined.
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Modifier 25 and CMS’s 2027 Same-Day E/M Payment Cut
CMS’s CY2027 proposed rule would pay same-day E/M visits billed with modifier 25 at just 50%. Here’s what the change means for coders and denial teams now.
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Coding Compliance Lessons From CMS’s $203M Fraud Recovery
CMS’s Medicaid Fraud War Room stopped $203M in improper Medicaid payments in just 88 days — here’s what it means for medical coding compliance.
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