Articles

CMS Proposes Strict Pre-Enrollment Verification for ACA Marketplaces to Combat Fraud: What Medical Billers Need to Know

On October 23, 2026, the Centers for Medicare & Medicaid Services (CMS) released a sweeping proposed rule aimed

The rapid growth of Remote Patient Monitoring (RPM) has hit a regulatory speed bump, and the healthcare industry is pushing back.…

On October 9, 2026, the Centers for Medicare & Medicaid Services (CMS) released its highly anticipated first annual

Tech Giants and CMS Partner to Bring Electronic Prior Authorization to Self-Funded Plans Ahead of 2027 Mandate

On October 21, 2026, the Centers for Medicare & Medicaid Services (

Slaying ‘Ghost Networks’: How CMS’s Proposed Rule on MA Directories and PBM Transparency Impacts Medical Billing

If there is one phrase that universally frustrates patients, providers, and medical billers alike, it is the dreaded "ghost networ…

In a major legal move that highlights the high-stakes intersection of regulatory compliance, medical coding,

The Centers for Medicare and Medicaid Services (CMS) is deploying artificial intelligence to stop fraudulent Medicaid billing in i…

CMS Adds 10 New Procedure Codes to October 2026 ASC Payment System: A Coding & Billing Guide

On October 8, 2026, the Centers for Medicare & Medicaid Services (CMS) issued Transmittal 13983 (Change Request 14634), outlining…

ASCP Urges Congress to Pass RESULTS Act as CMS Proposes 15% Cuts to 775 Lab Codes in 2027

In a move that could

** Maine Hospitals Sue HHS Over 340B Rebate Shift: A $1 Billion Administrative Nightmare for Medical Coding and Billing

On October 9, 2026, the Maine Hospital Association, the

The medical coding and billing landscape is bracing for a seismic shift. According to a stark new analysis published in October 20…

CMS Publishes Official Participant List for the Mandatory CJR-X Payment Model: What Medical Coders Need to Know Ahead of the 2028 Rollout

On October 6, 20

(LEHI, Utah and LOUISVILLE, Ky.) — Healthcare providers spend a staggering $20 billion annually fighting denied claims, a financia…

On October 7, 2026, the Centers for Medicare & Medicaid Services (CMS) issued a special alert to state survey agencies and healthc…

GLP-1 Prescriptions and AI-Driven Medical Coding Fuel 12% Spending Surge, BCBSMA Study Finds

BOSTON, MA — A new study published on October 5, 2026, in the national journal

The End of an Era: CMS Officially Retires G2025 Telehealth Code for RHCs and FQHCs

The "catch-all" era of telehealth billing for rural and underserved communities has

WASHINGTON, D.C. — In a rare display of unified momentum on Capitol Hill, a powerful bipartisan coalition of lawmakers

UnitedHealthcare Slashes Prior Authorization for 1,700 Codes: What Medical Billers and Coders Need to Know

Effective October 1, 2026, UnitedHealthcare (UHC) implemented a massive policy shift,

ANAHEIM, Calif. — In an era where the demand for behavioral health services is at an all-time high,

Aptarro Launches Prism: A Network-Effect Approach to Stopping Claim Denials Before They Happen

TALLAHASSEE, Fla. (October 7, 2026) — In a major move for healthcare revenue cycle management (R

WASHINGTON, D.C. — In an effort to rein in the escalating costs and administrative bottlenecks of the No Surprises Act (NSA

CMS Finalizes Price Transparency Overhaul: Killing "Ghost Rates" and Mandating Executive Verification

October 6, 2026 — The era of bloated, unusable healthcare pricing data is officially coming to a close. On October

On October 1, 2026, the American Medical Association (AMA) CPT Editorial Panel announced

Beyond the Copilot: AKASA Launches Autonomous AI Platform to Revolutionize Inpatient Medical Coding and CDI

October 5, 2026 — For years, the "holy grail" of healthcare revenue cycle management has been fully automating

** Elevance Health Cracks Down on Hospital Markups with New Site-of-Care Billing Policies

October 4, 2026 — In a major move toward site-neutral payments, Elevance Health has announced a sweeping new

CMS Finalizes Mandatory GLOBE Payment Model: What Medical Billers and Coders Need to Know About Part B Drug Pricing Changes

On September 30, 2026, the Centers for Medicare & Medicaid Services (CMS) finalized a groundbreaking new initiative aimed at

FY 2027 ICD-10-CM Code Set Goes Live Today: 190 New Diagnosis Codes You Need to Know

October 1, 2026, marks the official implementation of the

** AI Will "Turbocharge" Medical Billing and Inflate Healthcare Costs, Warns CMS Administrator Dr. Mehmet Oz

ORLANDO, Fla. — Artificial intelligence is widely hailed as the ultimate cure for healthcare’s administrative bloat, but

On September 24, 2026, the Centers for Medicare & Medicaid Services (CMS

As the 2027 Medicare Physician Fee Schedule (MPFS) final rule approaches, the medical coding and billing community is bracing for…

Sweeping September 2026 Reimbursement Policy Changes: UHC, Aetna, and Molina Restrict Lab Test Coverage

September 2026 has ushered in one of the most concentrated waves of payer policy updates

As of September 1, 2026, the landscape of medical coding and billing in Michigan has fundamentally shifted. Blue Cross Blue Shield…

As the leaves begin to turn and we approach

Hartford HealthCare Boosts Primary Care Revenue 17 Percent Following Successful Pilot of Autonomous Medical Coding and Ambient Clinical Documentation

The financial landscape of healthcare is shifting, and artificial intelligence is proving to be the ultimate catalyst for revenue…

CMS Cancels ACA Coverage for 760,000 Enrollees: What the $2.2B Fraud Crackdown Means for Medical Billing

The healthcare revenue cycle is bracing for a shockwave this week following a massive federal crackdown

The $1 Billion Bot War: How AI Medical Coding Tools Are Driving Up Healthcare Costs

In the rapidly evolving landscape of healthcare revenue cycle management, artificial intelligence was promised as a silver bullet…

WASHINGTON, D.C. (Sept. 25, 2026) — The landscape of healthcare reimbursement has undergone an undeniable shift this year. For med…

HCA Healthcare Sues Independence Blue Cross Over BlueCard Claim Denials: A Medical Billing Battleground

(Published: September 25, 2026) In a legal clash that underscores the growing complexities of cross-state medical billing

On August 13, 2026 [1], the Centers for Medicare & Medicaid Services (CMS) marked a historic milestone for radiology and healthcar…

Oracle Health Unveils Native AI to Tackle Claim Denials and Streamline Revenue Cycle Workflows

The relentless battle against claim denials has long been a defining challenge for medical coding and billing professionals. On Se…

Physicians Push Back: 150+ Healthcare Organizations Urge CMS to Scrap 50% Modifier 25 Payment Cut

In a rare show of unified frustration, more than 150 healthcare organizations have drawn a line in the sand over a proposed Medica…

CMS Unveils Steep 16% Cuts to 2027 Medicare Lab Rates: What It Means for Medical Coding and Billing

WASHINGTON, D.C. — The Centers for Medicare & Medicaid Services (CMS) dropped a

All 50 States Apply for CMS's GENEROUS Medicaid Drug Pricing Model: What It Means for Medical Billing

The landscape of Medicaid prescription drug reimbursement is undergoing a historic transformation. On September 18, 2026, the

** Abridge Launches AI-Powered Pre-Bill Claim Review Tool to Revolutionize Revenue Cycle Management

San Francisco-based health-tech firm Abridge has officially bridged the gap between the exam room and the billing office. On Septe…

Protecting Approved Care Act: New Bipartisan Bill Targets Medicare Advantage "Clawbacks" and Coding Denials

On September 15, 2026, U.S. Representatives Greg Landsman (D-OH) and Bob Onder (R-MO

HHS OIG Audits Uncover $178 Million in Unsupported Medicare Advantage Diagnosis Codes by Humana and UnitedHealthcare

September 18, 2026 — The federal crackdown on Medicare Advantage (MA) billing practices is intensifying. According to newly releas…

CMS Expands ACCESS Model for Spring 2027: What Medical Coders and Billers Need to Know About the New Condition Tracks

The Centers for Medicare & Medicaid Services (CMS) has officially announced a major expansion of its value-based

September 15, 2026 — The landscape of healthcare revenue cycle management (RCM)

CMS Flexes New Muscles: $1 Billion Medicaid Deferral and Unprecedented Provider Exclusion Authority

On July 21, 2026, the federal government sent shockwaves through the medical billing, coding,

Unlocking the Code: PatientRightsAdvocate.org Sues AMA Over CPT Copyright in Historic Push for Billing Transparency

On August 13, 2026, a groundbreaking lawsuit was filed in the Illinois Northern District Court (Docket No. 1

GAINESVILLE, Fla. — As the United States healthcare system grapples with administrative burnout, complex payer negotiations, and a…

CMS Shakes Up Lab Billing: Algorithm-Only Tests Reclassified as Medical Devices in 2027 Proposed Rule

In a move that has sparked widespread alarm among clinical laboratories, the Centers for Medicare & Medicaid Services (CMS) is fun…

CMS Drops the Hammer: 11 DME Suppliers Banned in $3.4 Billion Medicare Advantage Fraud Scheme Involving Deceased Patients

In one of the most brazen healthcare fraud schemes in recent history

The AMA’s 2027 CPT Code Set is Here: 299 New Codes, Clinical AI Expansion, and Major Maternity Overhauls

On September 9, 2026, the American Medical

Federal Court Vacates 2023 CMS Rule on Medicare DSH Payments: Impact on Medical Coding and Billing

On September 4, 2026 [1], a pivotal legal development sent ripples through the

The ongoing battle over the financial impact of the No Surprises Act (NSA) has taken a new turn. A new medical coding and billing

Savista Acquires ABW Medical, Expanding Ambulatory Revenue Cycle Management Across 49 States

On August 27, 2026, Savista, a premier healthcare operations firm with over 35 years of revenue cycle management (R

In a defining moment for the future of telehealth and medical coding and billing, over 200 healthcare stakeholders have formally p…

Penguin Ai Brings Autonomous Medical Coding and RCM to AWS Marketplace to Combat Claim Denials

PALO ALTO, Calif. — In a major leap for revenue cycle management automation, healthcare-native artificial intelligence company Pen…

As the healthcare industry gears up for the fourth quarter, the Centers for Medicare & Medicaid Services (CMS) has published a sle…

CMS Releases October 2026 HCPCS Update: New SNF Consolidated Billing Rules for Angiography & Lymphatic Services

The Centers for Medicare & Medicaid Services (CMS) [1.1.

** $380 Million Oversight: How Conflicting CMS Guidance Led to Massive Medicare Overpayments for Organ Acquisition

In early September 2026, the Department of Health and Human Services Office of Inspector General

The countdown to October has officially begun for healthcare revenue cycle teams. The Centers for Medicare & Medicaid

HHS Secretary RFK Jr. Targets AMA's $300M CPT Code Monopoly: What It Means for Medical Billing

On August 27, 2026, Health and Human Services (HHS) Secretary Robert F. Kennedy Jr. released a video urging Americans to challenge…

ASCA Formally Urges CMS to Eliminate the ASC Weight Scalar in the 2027 Payment Rule Amid Threat of Severe Reimbursement Cuts

The Ambulatory Surgery Center Association (ASCA) is sounding the alarm over the Centers for

Medical coders, billers, and revenue cycle managers can finally breathe a sigh of relief. On Tuesday, September 1, 2026, UnitedHea…

Monogram Health Inks $2.4M Settlement Over Medicare Advantage Upcoding and False Diagnosis Codes

On August 24, 2026, the U.S. Department of Justice (DOJ) announced that Tennessee-based in

Half a Billion Dollar Diagnosis: The Villages Health System Agrees to $541.5M Settlement Over Medicare Advantage Coding Scheme

The tranquil golf cart paths of central Florida's massive retirement community are the backdrop for one of the most

The Centers for Medicare & Medicaid Services (CMS) is moving to close the final

AMA Accelerates Innovation: CPT Category III Early Release Schedule Expands to Three Updates Annually August 31, 2

Arintra Secures $25M Series B to Revolutionize Autonomous Medical Coding and Revenue Assurance

San Francisco, CA — The U.S. healthcare system is a $5 trillion enterprise, yet health systems and provider groups consistently he…

Waystar Unveils Agentic AI to Autonomously Resolve Denied Claims and Transform the Revenue Cycle

Healthcare providers have long battled the staggering administrative waste and lost revenue associated with denied medical claims.…

CMS Deploys AI to Crush $1.6 Billion in Medicare Lab Fraud and Up-Coded Claims

WASHINGTON, D.C. — In a massive crackdown on medical billing fraud, the Centers for Medicare & Medicaid Services (CMS) announced o…

AHA Formally Urges CMS to Abandon 2027 OPPS Clawbacks and 340B Cuts: What It Means for Medical Billing

The American Hospital Association (AHA) is pushing back fiercely against the Centers

For healthcare organizations, the gap between clinical documentation and revenue cycle management has long been a source of admini…

CMS Shakes Up SDOH Billing: Z-Code Downgrades and Mandatory Reporting Set to Impact 2027 IPPS Reimbursement

The Centers for Medicare & Medicaid Services (CMS) has officially finalized the Fiscal Year (FY) 2027 Inpatient Prospective Paymen…

AAPC Launches Codie™: The New AI-Powered Assistant Redefining Medical Coding

The medical coding and billing landscape is undergoing a massive technological shift. On August 25, 2026, AAPC—the healthcare indu…

The landscape of medical coding and billing for maternal health is about to undergo its most significant transformation in over th…

CMS Proposes Retroactive Medicare Enrollment Revocations and Expanded Private Equity Disclosures in 2027 Rule Update

As the August 31, 2026, public comment deadline approaches, medical coders, billers, and healthcare administrators are raising ala…

OIG Exposes Ongoing Medicare DME Fraud Vulnerabilities: CMS Deploys FDOC to Suspend Suspect Claims

The federal government is intensifying its crackdown on healthcare fraud, and a newly released white paper from the Department of…

(August 23, 2026) — At its 2026 Users Group Meeting (UGM) in Verona,

AMA Sounds the Alarm: CMS Proposed 50% Cut to Modifier 25 E/M Visits Threatens Independent Practices

The medical billing and coding community is bracing for what could be one of the most disruptive regulatory shifts in

Medical coding and billing have always been the financial lifeblood of the American healthcare

CMS Launches ACCESS Payment Model: New HCPCS Co-Management Codes for Tech-Supported Chronic Care

The medical billing and coding landscape is undergoing a massive shift this summer. On July 5, 2026, the Centers for Medicare & Me…

In an era where healthcare systems are battling shrinking margins and severe staffing shortages, administrative waste remains a mu…

When the Centers for Medicare & Medicaid Services (CMS) [1] implemented the Maximum Fair Prices (MFPs) for

AMA Applauds CMS for Cracking Down on Hidden Medicare Advantage Prior Authorization Rules

In the complex world of medical coding and billing, precision is everything. Whether a billing specialist is assigning ICD-10-CM c…

CMS Eliminates Alternative NTAP Pathway for FDA Breakthrough Devices in Fiscal 2027 Rule: What It Means for Medical Coders

The Centers for Medicare & Medicaid Services (CMS) has officially published its Fiscal Year

Medical coders and billing managers are accustomed to hunting down missing documentation and fighting claim denials, but

The Affordable Care Act (ACA) marketplace is bracing for a

CMS Cracks Down on Medicare Advantage Plans Hiding Prior Auth Rules Behind 832-Page Code Walls

The Centers for Medicare & Medicaid Services (CMS) is moving to close glaring loopholes in prior authorization transparency follow…

CMS Grants Milestone NTAP Reimbursement for Aidoc's CARE Multi-Triage CT Body AI

NEW YORK — In a landmark decision for healthcare artificial intelligence and revenue cycle management, the Centers for Medicare &…

CMS Unveils RAPID Pathway: A Game-Changer for Breakthrough Device Coverage and Medical Billing

In a move set to reshape the landscape of healthcare innovation and revenue cycle management, the Centers for Medicare & Medicaid…

August 15, 2026 — As the healthcare landscape continues to evolve, staying on top of the latest

CMS Finalizes Rule Blocking Federal Medicaid & CHIP Funds for Pediatric Gender-Affirming Care: What Billers and Coders Need to Know

On August 11, 2026, the Centers for Medicare & Medicaid Services (CMS) finalized a

Paywalled Healthcare: Why PatientRightsAdvocate.org is Suing the AMA Over CPT Codes

On August 13, 2026, the non-profit transparency group PatientRightsAdvocate.org (PRA) filed a landmark

The landscape of medical coding and billing is in a constant state of evolution. Following the massive overhauls to Evaluation and…

The era of traditional fee-for-service reimbursement in orthopedics is rapidly shrinking in the rearview mirror. In its place, val…

The healthcare industry has just been dealt a staggering blow. Unlimited Technology Systems, a prominent third-party vendor that m…