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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Abridge’s Pre-Bill Tool Puts Coding Compliance First
Abridge’s new pre-bill review tool flags DRG and POA mismatches against clinical documentation before claims go out — a compliance play as much as a coding one.
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CMS’s PY2024 RADV Audits Raise the Bar for Coders
CMS’s PY2024 RADV audits are underway, and a recent $2.4M settlement shows what happens when HCC codes don’t hold up. Here’s what coding teams need to know.
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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.
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