

The Coder's Desk · News
HCC Buddy CMS Watch
CMS WatchOctober 15, 2026 · 9 min read
FY 2027 IPF PPS (CR 14591): corrected $912.13 per diem and 38 ICD-10-CM comorbidity code adds
CMS Transmittal R14000CP / CR 14591 (October 8, 2026) implements the FY 2027 Inpatient Psychiatric Facility PPS update at a $912.13 per diem, the figure from the October 1 correction notice. MM14591 still prints $912.40. The FY 2027 comorbidity lists add 38 ICD-10-CM codes.

87 more articles. Latest article above.

January 2027 HH CB update (CR 14639): A4453 and A4459 leave the non-routine supply list
October 13, 2026 · 8 min read
October 2026 ASC update (CR 14634): 10 Category III codes, drug PI moves, and two reprocessing windows
October 12, 2026 · 11 min read
CR 14582: CMS will reprocess 2023-2024 POS 32 claims that overlap Part A SNF stays
October 9, 2026 · 7 min read
Heal 360 to pay $20M; DOJ alleges COVID swab-only visits were billed as level 3 and 4 E/M
October 8, 2026 · 8 min read
AIDS Healthcare Foundation to pay $1.44M; DOJ alleges MA diagnosis deletes sat for years
October 7, 2026 · 7 min read
TAVR for aortic regurgitation stays at MAC discretion while CMS NCA CAG-00430R3 takes comments to Oct 10
October 6, 2026 · 7 min read
OIG: UnitedHealthcare Benefits of Texas (H0609) audit flags C78.00 mis-keys, $24.4M estimate
October 5, 2026 · 8 min read
Independence Blue Cross to pay $22.5M; DOJ alleges one-way MA chart reviews
October 2, 2026 · 4 min read
October 2026 DMEPOS fee schedule (CR 14619): new HCPCS A4228 to L8697, L8696 deleted
October 1, 2026 · 4 min read
October 2026 OPPS update (CR 14589 / R13978CP): PLA, Cat III, drugs, and I/OCE for Oct 1
September 30, 2026 · 4 min read
CMS corrects FY 2027 IPPS final rule (CMS-1849-CN3); Table 5 weights and rates for Oct 1
September 29, 2026 · 4 min read
FY 2027 IPPS: CMS adds MS-DRGs to post-acute transfer and special payment lists (CR 14592 / R13930CP)
September 28, 2026 · 5 min read
CMS pulls NCD 110.23 stem-cell coding from October 2026 CR 14464 (R13968OTN); deferred to April 2027
September 25, 2026 · 5 min read
CMS opens HCV screening NCD 210.13 reconsideration (CAG-00436R); comments through Oct 23
September 24, 2026 · 5 min read
January 2027 lab NCD edit software: ICD-10 list updates for 23 lab NCDs (CR 14614)
September 23, 2026 · 6 min read
CMS posts preliminary CY 2027 CLFS rates: private-payor medians ~16% lower
September 22, 2026 · 6 min read
OIG: Methodist Hospital (San Antonio) billed at least $12.4M in estimated Medicare overpayments
September 21, 2026 · 7 min read
OIG: UnitedHealthcare of Wisconsin (H5253) risk scores drove $46.9M in estimated unsupported diagnosis overpayments
September 18, 2026 · 7 min read
OIG: HumanaChoice (H5216) risk scores drove $130.9M in estimated unsupported diagnosis overpayments
September 17, 2026 · 7 min read
CMS DMEPOS probationary prior auth starts October 15 for new and CHOW suppliers
September 15, 2026 · 5 min read
CMS bars 11 DMEPOS suppliers from MA after $3.4B in suspected fraud
September 11, 2026 · 5 min read
CMS finalizes TAVR coverage: study requirement dropped for symptomatic AS, added for asymptomatic
September 11, 2026 · 4 min read
What clinicians correct most in AI scribe drafts is orders and meds, a 2026 study finds
September 9, 2026 · 4 min read
CMS CR 14580: Clotting factor furnishing fee rises to $0.270 per unit for CY 2027
September 9, 2026 · 4 min read
CMS CR 14574: Medicare payer-only claim codes update takes effect September 28, 2026
September 8, 2026 · 5 min read
AI scribe drafts can read more certain than the visit was, a 2026 study finds
September 8, 2026 · 5 min read
In a coding study, AI hit 91.5% on CPT but 23.9% on ICD-10, with laterality the top error
September 7, 2026 · 5 min read
CMS CR 14553: Part A MSP claims will reject, RTP, or suspend on named CARCs from January 1, 2027
September 7, 2026 · 5 min read
CMS opened PY2024 RADV audits built to extrapolate. Records are due February 5, 2027.
September 6, 2026 · 4 min read
The 2026 ACDIS/AHIMA query standard is final: the outpatient and HCC query rules it sets
September 5, 2026 · 5 min read
CMS October 2026 MPFSDB CR 14588: 10 J-codes not valid for Medicare October 1
September 4, 2026 · 6 min read
Monogram Health to pay $2.4M over four flagged HCCs; malnutrition and stable angina no longer map under V28
September 3, 2026 · 6 min read
Hospice G0679: report telehealth F2F recertification on claims from January 1, 2027
September 3, 2026 · 3 min read
The Villages Health's $541.5M FCA Settlement: What Makes a Record Amendment an Invalid Diagnosis
September 3, 2026 · 4 min read
CMS October 2026 NCD CR 14464 adds PET tracers, 0554T-0558T, and 0648U
August 31, 2026 · 5 min read
CMS NCD 210.3 adds ColoSense (0421U) for colorectal screening
August 28, 2026 · 4 min read
October 2026 SNF CB update: therapy codes stay on File #4
August 27, 2026 · 4 min read
October 2026 CLFS update: new PLA codes are contractor-priced
August 26, 2026 · 3 min read
October 2026 HCPCS file adds G0685 for algorithm-based ASD assessment
August 25, 2026 · 3 min read
CMS FY2027 MS-DRG V44 errata adds 2 ICD-10-PCS codes on October 1
August 24, 2026 · 3 min read
Ambient AI scribes omit more than they invent, and an omitted chronic condition is a lost HCC
August 21, 2026 · 6 min read
FY2027 IPPS adds 3 MS-DRGs to the replaced-device credit list on October 1
August 21, 2026 · 3 min read
CMS: ASC Encelto claims use J3403, LU + 76, and 1 unit per eye per day
August 20, 2026 · 3 min read
CMS January 2027 NCD CRs add FY2027 ICD-10 codes to coverage edits
August 19, 2026 · 4 min read
FY 2027 IPPS Table 6A-6K is posted. Download it before October 1
August 18, 2026 · 5 min read
FY2027 IPPS moves 10 housing Z codes from CC to NonCC on October 1
August 14, 2026 · 4 min read
CPT 2027 sharpens the AI taxonomy. How a tool's role is classified decides how it's coded.
August 14, 2026 · 5 min read
PY2020 RADV records are due August 28. PY2024 audits start this month.
August 13, 2026 · 3 min read
Solventum plans to separate its coding and CDI software unit, home to 360 Encompass
August 10, 2026 · 5 min read
OIG: Medicare improperly paid $15.2M for sacroiliac joint injections; 72 of 100 sessions missed the LCD
August 5, 2026 · 5 min read
New state laws bar AI-only claim downcoding: Indiana live July 1, Illinois signed July 10
August 5, 2026 · 4 min read
Complete Health to pay $14.1M; MSO allegedly prompted doctors to add unsupported HCC diagnoses
August 3, 2026 · 6 min read
Two ophthalmology practices pay $2.3M over allegedly false diagnoses billed for transcranial Dopplers
July 31, 2026 · 4 min read
CMS retires G2025 for RHC and FQHC telehealth on October 1: bill the individual code plus a modifier
July 31, 2026 · 4 min read
Access DX will pay $36.4M over alleged genetic-testing kickbacks and unbundled billing codes
July 31, 2026 · 4 min read
CMS adds 8 DMEPOS codes to its prior authorization list and 22 to the face-to-face list, effective October 28
July 30, 2026 · 5 min read
Draft ACDIS/AHIMA brief: AI-generated queries must meet the same compliance rules as human queries
July 29, 2026 · 4 min read
OIG: WPS overpaid providers $140K on 138 Part B lines that paid more than the charge billed
July 28, 2026 · 4 min read
General-purpose AI coded complex surgery at 5% to 12.5% exact-match, a new study reports
July 28, 2026 · 6 min read
Magnolia Diagnostics will pay $24M to resolve claims its COVID tests carried unneeded respiratory panels
July 28, 2026 · 4 min read
OIG's first MA compliance guidance since 1999 names AI EHR prompts: verify every AI-surfaced diagnosis
July 26, 2026 · 4 min read
Coding errors now drive nearly 7 in 10 completed payer-audit denials, MDaudit reports
July 26, 2026 · 4 min read
PEPPER relaunch wraps in September, and staff coders can now download the report themselves
July 22, 2026 · 3 min read
An ICD coding model scored 0.709 on a 50-code subset and 0.527 across all 15,761 codes
July 22, 2026 · 4 min read
UnitedHealthcare commercial adds five lab policies September 1, and four cap how often it will pay
July 21, 2026 · 6 min read
AI summaries often drop a note's diagnostic hedges. Outpatient rules make that a coding problem.
July 21, 2026 · 6 min read
OIG: 91 of 150 nursing home Part B patient-months missed Medicare requirements at Novitas
July 21, 2026 · 6 min read
AAPC's new CPC-M exam puts reviewing AI coding output on the blueprint
July 20, 2026 · 4 min read
GAO: AI coding tools may capture more diagnoses, and few studies have checked their accuracy
July 20, 2026 · 5 min read
CMS delays the audio-only and unlinked CRR exclusions to the CY2027 Midyear model run
July 20, 2026 · 5 min read
OIG flagged all 399 sampled optometry E/M lines. The SMRC is now reviewing 99309 and 99310.
July 19, 2026 · 5 min read
Labcorp will pay $14.5M after admitting it billed 80307 and G0483 on the same urine sample
July 19, 2026 · 4 min read
CMS's CY2027 PFS would halve the lower-cost same-day E/M or procedure, and turn G2211 into a modifier
July 18, 2026 · 6 min read
CMS proposes a MIPS activity for AI governance. Its example: AI-generated notes with clinician review.
July 17, 2026 · 5 min read
Insufficient documentation leads Medicare's $28.8B improper-payment bill. It's the coder's fix.
July 11, 2026 · 5 min read
An AI hit 91% predicting ICD categories. Its scoring counted sepsis for a UTI as correct.
July 10, 2026 · 6 min read
A new study graded an AI comorbidity reader against billing codes. Coders get graded against the note.
July 9, 2026 · 6 min read
CMS's July NCCI update adds 2,199 practitioner edit pairs. No modifier will bypass 424 of them.
July 9, 2026 · 7 min read
Coding intensity is climbing where AI documentation landed, and payers have started downcoding
July 8, 2026 · 6 min read
Medicare's WISeR AI prior-auth model still binds your claims while Congress moves to repeal it
July 8, 2026 · 6 min read
Elevance pays CMS $342M to avoid a Medicare Advantage risk-adjustment sanction
June 28, 2026 · 4 min read
Aetna pays $117.7M to settle FCA case over one-way chart reviews and unsupported obesity codes
June 6, 2026 · 5 min read
Matrix and HealthFair pay $56.5M over in-home assessment diagnoses the records didn't support
June 6, 2026 · 4 min read
OIG: $462M in Potential MA Overpayments Tied to Unsupported Acute Stroke Codes
June 5, 2026 · 6 min read
Kaiser's $556M FCA Settlement: What the Addenda and Query Allegations Mean for Working Coders
June 5, 2026 · 6 min read
CY2027 Rate Announcement: Audio-Only and Unlinked CRR Diagnoses Out of MA Risk Scores
June 5, 2026 · 5 min read
550 Plans, Quarterly RADV Audits, Five Months to Submit: What the Jan 2026 CMS Memo Means at Your Desk
June 5, 2026 · 5 min readRisk-adjustment enforcement and policy news for working coders.