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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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.
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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.
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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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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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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.
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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.
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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.
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