CMS’s CPT Coding RFI: What It Means for Compliance Teams
CMS is asking whether the AMA’s CPT coding monopoly still serves patients. A copyright lawsuit filed weeks later raises the stakes for coding teams.
·
-
-
AI Upcoding and the New False Claims Act Risk for Coders
A new claims analysis puts AI-driven upcoding exposure at $2.3 billion. Here’s why evidence-linked coding is becoming a compliance necessity.
·
-
CMS’s 2025 PEPPER Flags Psychiatric Facility Coding Risk
CMS’s newly released 2025 PEPPER for inpatient psychiatric facilities flags under- and over-coded claims — here’s what it means for coding accuracy and audit risk.
·
-
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.
·
-
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.
·
-
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.
·
-
Agentic AI Tackles E/M Coding Compliance and Audit Risk
Under-documented E/M levels leave revenue on the table, and over-coded ones invite audits. Agentic AI is closing that E/M coding compliance gap for good.
·
-
Agentic AI for HCC Coding: Lessons From OIG’s $462M Audit
OIG found every sampled acute stroke HCC code unsupported, a $462M miss. Here’s how agentic AI validation can catch these HCC coding gaps before submission.
·
-
CMS Ends Unlinked Chart Reviews: HCC Coders’ 2027 Guide
CMS’s CY2027 MA announcement bars unlinked chart reviews from HCC risk scores. Here’s what this compliance shift means for coding teams and MA plans.
·
-
DOJ’s 2026 Fraud Takedown: What Medical Coders Must Know
The DOJ’s 2026 healthcare fraud takedown charged 455 defendants over $6.5B in false claims. Here’s what AI enforcement means for medical coding compliance.
·