HCC Buddy CMS Watch

PolicySeptember 8, 2026 · 5 min read

AI scribe drafts can read more certain than the visit was, a 2026 study finds

Clinicians revising ambient-AI note drafts more often added hedging than removed it, a 2026 preprint reports, so AI text can overstate diagnostic certainty. In outpatient risk adjustment a probable or suspected diagnosis cannot be coded, so certainty in an AI-drafted note is not the same as a confirmed one.

Ambient voice-capture microphone by a laptop with a blurred clinical note, illustrating how an AI scribe draft can overstate certainty.

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A hospital billing desk shows a blank institutional claim worksheet beside a Medicare Claims Processing Manual note on payer-only codes.

HCC Buddy CMS Watch

AI scribe drafts can read more certain than the visit was, a 2026 study finds

CMS CR 14574: Medicare payer-only claim codes update takes effect September 28, 2026

In a coding study, AI hit 91.5% on CPT but 23.9% on ICD-10, with laterality the top error

CMS CR 14553: Part A MSP claims will reject, RTP, or suspend on named CARCs from January 1, 2027

CMS opened PY2024 RADV audits built to extrapolate. Records are due February 5, 2027.

The 2026 ACDIS/AHIMA query standard is final: the outpatient and HCC query rules it sets

CMS October 2026 MPFSDB CR 14588: 10 J-codes not valid for Medicare October 1

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Hospice G0679: report telehealth F2F recertification on claims from January 1, 2027

The Villages Health's $541.5M FCA Settlement: What Makes a Record Amendment an Invalid Diagnosis

CMS October 2026 NCD CR 14464 adds PET tracers, 0554T-0558T, and 0648U

CMS NCD 210.3 adds ColoSense (0421U) for colorectal screening

October 2026 SNF CB update: therapy codes stay on File #4

October 2026 CLFS update: new PLA codes are contractor-priced

October 2026 HCPCS file adds G0685 for algorithm-based ASD assessment

CMS FY2027 MS-DRG V44 errata adds 2 ICD-10-PCS codes on October 1

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FY2027 IPPS adds 3 MS-DRGs to the replaced-device credit list on October 1

CMS: ASC Encelto claims use J3403, LU + 76, and 1 unit per eye per day

CMS January 2027 NCD CRs add FY2027 ICD-10 codes to coverage edits

FY 2027 IPPS Table 6A-6K is posted. Download it before October 1

FY2027 IPPS moves 10 housing Z codes from CC to NonCC on October 1

CPT 2027 sharpens the AI taxonomy. How a tool's role is classified decides how it's coded.

PY2020 RADV records are due August 28. PY2024 audits start this month.

Solventum plans to separate its coding and CDI software unit, home to 360 Encompass

OIG: Medicare improperly paid $15.2M for sacroiliac joint injections; 72 of 100 sessions missed the LCD

New state laws bar AI-only claim downcoding: Indiana live July 1, Illinois signed July 10

Complete Health to pay $14.1M; MSO allegedly prompted doctors to add unsupported HCC diagnoses

Two ophthalmology practices pay $2.3M over allegedly false diagnoses billed for transcranial Dopplers

CMS retires G2025 for RHC and FQHC telehealth on October 1: bill the individual code plus a modifier

Access DX will pay $36.4M over alleged genetic-testing kickbacks and unbundled billing codes

CMS adds 8 DMEPOS codes to its prior authorization list and 22 to the face-to-face list, effective October 28

Draft ACDIS/AHIMA brief: AI-generated queries must meet the same compliance rules as human queries

OIG: WPS overpaid providers $140K on 138 Part B lines that paid more than the charge billed

General-purpose AI coded complex surgery at 5% to 12.5% exact-match, a new study reports

Magnolia Diagnostics will pay $24M to resolve claims its COVID tests carried unneeded respiratory panels

OIG's first MA compliance guidance since 1999 names AI EHR prompts: verify every AI-surfaced diagnosis

Coding errors now drive nearly 7 in 10 completed payer-audit denials, MDaudit reports

PEPPER relaunch wraps in September, and staff coders can now download the report themselves

An ICD coding model scored 0.709 on a 50-code subset and 0.527 across all 15,761 codes

UnitedHealthcare commercial adds five lab policies September 1, and four cap how often it will pay

AI summaries often drop a note's diagnostic hedges. Outpatient rules make that a coding problem.

OIG: 91 of 150 nursing home Part B patient-months missed Medicare requirements at Novitas

AAPC's new CPC-M exam puts reviewing AI coding output on the blueprint

GAO: AI coding tools may capture more diagnoses, and few studies have checked their accuracy

CMS delays the audio-only and unlinked CRR exclusions to the CY2027 Midyear model run

OIG flagged all 399 sampled optometry E/M lines. The SMRC is now reviewing 99309 and 99310.

Labcorp will pay $14.5M after admitting it billed 80307 and G0483 on the same urine sample

CMS's CY2027 PFS would halve the lower-cost same-day E/M or procedure, and turn G2211 into a modifier

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An AI hit 91% predicting ICD categories. Its scoring counted sepsis for a UTI as correct.

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CMS's July NCCI update adds 2,199 practitioner edit pairs. No modifier will bypass 424 of them.

Coding intensity is climbing where AI documentation landed, and payers have started downcoding

Medicare's WISeR AI prior-auth model still binds your claims while Congress moves to repeal it

Elevance pays CMS $342M to avoid a Medicare Advantage risk-adjustment sanction

Aetna pays $117.7M to settle FCA case over one-way chart reviews and unsupported obesity codes

Matrix and HealthFair pay $56.5M over in-home assessment diagnoses the records didn't support

OIG: $462M in Potential MA Overpayments Tied to Unsupported Acute Stroke Codes

Kaiser's $556M FCA Settlement: What the Addenda and Query Allegations Mean for Working Coders

CY2027 Rate Announcement: Audio-Only and Unlinked CRR Diagnoses Out of MA Risk Scores

550 Plans, Quarterly RADV Audits, Five Months to Submit: What the Jan 2026 CMS Memo Means at Your Desk