CY2027 ESRD Payment Rule: What It Means for Dialysis Coding
CMS’s CY2027 ESRD rule shifts dialysis facility payments. Coding teams that miss case-mix and add-on documentation will leave money – and compliance – on the table.
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Black Book’s 2027 Categories Split Out Autonomous Coding
Black Book split mid-revenue-cycle AI into distinct categories for 2027. For coding teams, that breakdown matters more than the vendor rankings themselves.
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Blue Cross’s $942M AI Coding Report: Audit Risk Ahead
Blue Cross ties $942M in added costs to AI-assisted hospital coding. Revenue cycle and compliance teams should expect more scrutiny of secondary diagnoses.
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CMS Flags Improper Payments: A Warning for Coding Teams
CMS’s September 2026 MLN alert found a 32.6% improper payment rate on a routine DME code — a reminder that documentation, not fraud, drives most denials.
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CMS-0057-F Prior Auth Rule: What RCM Teams Must Know
CMS-0057-F’s January 2027 API deadline is approaching fast — here’s what the prior authorization rule really means for medical coding and RCM teams.
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Agentic AI Revenue Cycle: What GenHealth.ai’s $16.5M Signals
GenHealth.ai raised $16.5M to scale AI agents that act inside payer portals on billing and denials — a preview of how far agentic AI in RCM is moving.
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Arintra’s $25M Raise Signals a Denial-Prevention Shift
Arintra’s $25M Series B points to AI-driven coding accuracy, not just claims-processing speed, as the real lever against payer denials this year.
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Prior Auth Automation Raises the Bar on Coding Accuracy
R1’s Humata Health deal shows prior-auth automation is tightening the link between coding accuracy and claims approval — and raising the cost of coding errors.
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ModMed’s Agentic RCM Launch Signals Where AI Coding Is Headed
ModMed’s agentic RCM platform folds coding guidance into denial prevention and appeals — a sign that coding accuracy and revenue recovery are converging.
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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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