What to check before you close for the year

Print this. Work it before you close.

• ☐ · Item: NCCI v33.0 loaded into the scrubber and tested against sample claims · Owner: Scrubber owner · Done by: Dec 19
• ☐ · Item: Modifier-indicator changes identified for your top 20 code pairs by volume · Owner: Coding lead · Done by: Dec 19
• ☐ · Item: Coders briefed on indicator changes only, limited to pairs they touch daily · Owner: Coding manager · Done by: Dec 19
• ☐ · Item: CY 2027 conversion factor and fee schedule loaded · Owner: Billing ops · Done by: Dec 19
• ☐ · Item: Every telehealth arrangement mapped to BB, BC or neither · Owner: Ops + coding · Done by: Dec 19
• ☐ · Item: Failure-signature table written for week one · Owner: Coding manager · Done by: Dec 19
• ☐ · Item: Monday January 4 staffed deliberately, not by default rota · Owner: Operations · Done by: Dec 19
• ☐ · Item: Major payers asked which prior authorization API they will offer and when · Owner: RCM lead · Done by: Jan 31
• ☐ · Item: EHR vendor confirmed on electronic prior authorization standards · Owner: IT · Done by: Jan 31
• ☐ · Item: Rework cost per denied claim calculated · Owner: Finance + RCM · Done by: Jan 31

Two numbers to set your 2027 targets against

Most coding teams carry one target into a new year: denial rate. Carry two more.

Takeback rate, as a share of accounts receivable. Kodiak Solutions reports the industry moved from 1.38% to 1.57% in the first half of 2026. If you cannot produce this number for your own book, that is the first thing to fix in January, because a denial rate with no recoupment line beside it describes a world that stopped existing this year.

Appeal recovery rate. The same data shows recovery falling to 2.21% of accounts receivable from 2.48%. You are winning fewer appeals than you did last year. That changes the arithmetic on which denials are worth chasing, and most appeal thresholds have not been revisited since they were set.

Hold those against a CY 2027 conversion factor that goes down rather than up. Lower value per claim, lower recovery per appeal, higher takeback exposure. Prevention is worth more in 2027 than it was in 2026, and by a margin you can calculate rather than assert.

What the 2026 data says about where scrutiny is going

The published data does not establish causation, and anyone telling you otherwise is selling something. What it shows: payer review is moving later in the claim lifecycle.

A plausible reading, offered as a reading. Front-end automation on both sides got better at producing claims that clear initial edits, while payer audit capability grew faster than payer front-end review. Claims that would once have been stopped now pass, and get examined afterward.

If that is directionally right, one thing follows. The traceability of a coding decision matters more than it did three years ago, and your clean claim rate matters slightly less. A claim that clears every edit and cannot be defended eighteen months later is not clean. It is deferred.

The 2027 watch list

Four things to keep in view past January.

Medicare telehealth expires December 31, 2027. The Consolidated Appropriations Act, 2026 extended geographic and originating-site waivers plus FQHC and RHC distant-site billing through that date. Behavioral health telehealth is permanent. Audio-only and the tele-mental health in-person delay carry different end dates by source, so confirm against the statute. You have a planning year rather than a quarterly cliff. Use it.

Drug prior authorization is on a separate track. CMS has proposed compliance dates beginning October 1, 2027 for electronic prior authorization for drugs. Treat it as a proposal until finalized.

The MIPS electronic prior authorization measure runs through CY 2027. A yes/no attestation on Prior Authorization API adoption, or a claimed exclusion, for MIPS clinicians, hospitals and critical access hospitals.

FY 2028 ICD-10-CM proposals surface in the spring. The March and April CMS meetings are where October 2027 gets decided. Reading them in spring beats meeting them in September.

And one quiet item from October worth a second look. FY 2027 added category QA1 for genetic and cancer predisposition syndromes, reportedly covering Lynch syndrome, BRCA1 and BRCA2 familial cancer syndromes, and Li-Fraumeni syndrome. For risk-adjusted populations this is a real gain over Z-code approximations. Confirm exact titles against the CMS FY 2027 addenda before configuring, since these came from coding education coverage rather than the addenda directly.

The question to take into your 2027 planning

Ask where your certified hours went, not what they cost. In most operations a large share landed on charts any competent process clears without a credential.

AAPC's 2026 salary report puts certified medical records specialists at $67,260 against $55,721 for non-certified, with stacked credentials reaching $81,227 at three or more certifications. Pay above band and you still wait. Recruiting a credentialed coder with the right specialty experience takes months, while new volume arrives on a contract date.

A clean, well-documented, single-condition encounter clears in ninety seconds and occupies the same queue position as the complex chart that genuinely needs a credentialed coder. That ratio is measurable in your own data, and it decides whether your 2027 growth is a hiring problem or a routing problem.

CODIO AI routes per chart. Complete charts flow through AutoPilot for fully autonomous coding. Thin or contradictory documentation stays in CoPilot, where certified coders review and finalize. Teams see 45% more output per coder, measured against a manual baseline: same team, same charts, before and after, and MediCodio AI reports cutting coding costs by up to 60–70%.

Every assigned code carries its documentation passage and the guideline behind it, which is what turns a takeback audit into a lookup. Nothing runs autonomous on day one. The lane widens only as accuracy is proven on your charts by your auditors, one specialty or case type at a time, and narrows again whenever you decide.

Qualitative practitioner observation across chart volume this quarter, not measured data.

January rejections peak in week two, not week one. Week one volume is low and skewed toward simple encounters. The complex charts people deferred over the holidays arrive in week two, and so do their rejections. Teams that declare victory on January 8 tend to revise that on January 15.

The first-ten-days habit pattern repeats at every change date. It held in October. Expect it again in January, and staff the front-end check accordingly.

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Since switching to MediCodio, my office has had more time to focus on collections and patient billing. Our coding is so streamlined, I don't even have to think about it. — Chris McMenemy, Ortmann Healthcare Consulting Services