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.
·
-
-
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.
·
-
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.
·
-
AMA September 2026 CPT Panel: AI Coding Rules Take Shape
AMA’s September 2026 CPT Editorial Panel quietly added AI validation criteria to code applications — a first for the process coders rely on.
·
-
CMS’s HCPCS Level II Meeting Signals 2027 Coding Changes
CMS just set the agenda for its biannual HCPCS Level II public meeting. Here’s why coding and RCM teams should be watching, alongside CPT 2027’s new AI codes.
·
-
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.
·
-
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.
·
-
Why Quarterly NCCI Edits Expose Gaps in Static Coding Rules
NCCI PTP edits version 32.2 took effect July 1, 2026 with roughly 4.4 million edit pairs. Static rule engines routinely miss the update window — here’s what that costs coders.
·
-
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.
·
-
Elevance’s $342M MA Repayment: What HCC Coders Must Know
CMS forced Elevance Health to repay $342M in Medicare Advantage overpayments. Here’s what this landmark enforcement action means for HCC coders.
·