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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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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AHA Rebuts BCBS’s $942M AI Coding Claim: What It Means
AHA says BCBS’s $942M AI-coding intensity analysis skipped the medical records entirely. For coding and compliance teams, the underlying test still matters most.
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OIG’s Q3 2026 Work Plan: What It Means for Coding Teams
OIG’s Q3 2026 Work Plan additions touch AI governance, ventilator-event coding, and MCO denials. Here’s what coding compliance teams need to know.
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UnitedHealthcare’s $24.4M RADV Audit: A Coding Lesson
OIG found 172 of 230 sampled UnitedHealthcare Texas diagnosis codes unsupported, projecting $24.4M in overpayments. Here’s what it means for coders.
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CMS’s AI Claims Overhaul: What It Means for Coding Teams
CMS is backing AI-driven claims review with billion-dollar contracts to catch documentation errors before they become improper payments. Coders should take note.
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CPT 2027 ABA Codes: The Compliance Clock Coders Face
The AMA’s 2027 CPT set splits code 97155 in two and retires two Category III codes. Coders have about 15 weeks to update systems before the Jan. 1 deadline.
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CMS WISeR AI Prior Auth Pilot: A Compliance Warning
FOIA documents reveal CMS rushed its AI prior-authorization pilot despite vendor warnings — a compliance signal coders and RCM teams shouldn’t ignore.
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