OIG Home Health Audit: The Case for Coding Automation
OIG’s Deistic Home Health audit found 37% of sampled claims failed billing, coding, or documentation rules. Here’s what automated coding validation would have caught.
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CMS RAPID Coverage Pathway: The Medical Coding Gap
CMS’s RAPID pathway can post a Medicare coverage decision the same day a device wins FDA authorization — but HCPCS codes and payment rules still take months to catch up.
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CMS’s Malnutrition Mandate Raises Coding Audit Stakes
CMS is mandating malnutrition quality reporting by 2028 while OIG audits keep finding malnutrition codes unsupported. Here’s what coders need to know.
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CMS Q2 2026 HCPCS Update: 15 New Drug Codes for Oct. 1
CMS’s Q2 2026 HCPCS decisions add 15 new drug and biosimilar codes for October 1 and deny two closely watched revision requests.
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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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