Clinical Documentation Optimization and Coding Assurance
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June 15, 2026
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Ensuring quality clinical documentation and accurate coding and claims submission are essential as healthcare organizations face increased payer scrutiny, complex denial patterns, and ongoing margin pressure. Accurate, defensible documentation and coding across inpatient, outpatient and professional settings are critical to supporting medical necessity, reducing audit risk, and ensuring appropriate reimbursement.
In Federal Fiscal Year ending 20251 there was a record breaking $6.8 billion in recovery under the False Claims Act (“FCA”) with health-care related settlements accounting for over $5.7 billion, or 84% of the total2. This was driven by coding, billing and kickback violations, reflecting a focus on improper payments by Medicare and Medicaid. As government continues to expand its regulatory enforcement activities, providers are forced to focus their resources on ensuring accurate clinical documentation, coding, billing and reimbursement for services to avoid becoming the target of a whistleblower complaint or payer investigation.
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Published
June 15, 2026
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Senior Managing Director
Senior Managing Director
Managing Director