DOJ Launches FCA Self-Disclosure Pilot for Coding Compliance
A new DOJ-HHS pilot gives coding compliance teams a fixed repayment multiplier for self-disclosing billing errors before the April 2027 deadline hits.
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CMS’s Nov. 2026 HCPCS Meeting: New Codes to Track
CMS’s Nov. 2-3 HCPCS Level II meeting previews dozens of new code requests, from a spinal stimulator to 20 wound-care products — here’s what coders should watch.
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IBX’s $22.5M Settlement: A Chart Review Compliance Lesson
A $22.5M settlement shows how a chart review program meant to catch bad diagnosis codes can itself become the liability when findings aren’t acted on.
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HealthSplash’s $1B Fraud: DME Coding Compliance Lessons
A 19-year sentence in a $1B DME fraud case is a reminder of what documentation gaps CMS and OIG auditors are actively hunting for in brace and DME claims.
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OpenEvidence’s AI Coding Push: What It Means for Compliance
OpenEvidence’s Coding Intelligence suggests and sequences CPT codes in real time. Compliance teams should know what that changes — and what it doesn’t.
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UnitedHealth’s AI Chart Review: What It Means for CDI
UnitedHealth’s Q3 2026 earnings call put hard numbers on payer-side AI. CDI and coding teams should read them as a documentation deadline, not just a headline.
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CY2027 ESRD Payment Rule: What It Means for Dialysis Coding
CMS’s CY2027 ESRD rule shifts dialysis facility payments. Coding teams that miss case-mix and add-on documentation will leave money – and compliance – on the table.
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Why ASCs Are Turning to Agentic AI for Surgical Coding
Ambulatory surgery centers are quietly adopting agentic AI for surgical coding and billing. Here’s what that network-level shift means for accuracy and audit risk.
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CMS’s October 2026 OPPS Update: 58 New CPT Codes for Coders
CMS’s October 2026 OPPS update adds 58 Category III codes and 39 lab analysis codes. Here’s what coding teams need to implement now.
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Fifth Circuit’s RADV Skepticism: What It Means for Coders
A Fifth Circuit panel pressed HHS hard on its RADV audit rule during Oct. 5 oral arguments. Coding and compliance teams shouldn’t wait for a ruling to act.
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