CMS Audits Are Rising HCC Coding Errors Can End Careers and Cost Employers Contracts
Medicare Advantage Audits Are Changing — My Advice After 21 Years in Medical Coding By Dr Santosh Guptha In my 21 years of working in medical coding, auditing, and compliance, I have seen many regulatory shifts. Some created noise. Others quietly changed the entire direction of the industry. The CMS announcement in May 2025 falls firmly into the second category. This is not just another policy update. This is a structural reset of how Medicare Advantage risk adjustment will be reviewed, audited, and enforced going forward. What CMS Has Clearly Communicated CMS has stated its intent to expand and normalize audits across all Medicare Advantage plans. For years, audits were limited, delayed, and selective. That phase is over. CMS has publicly committed to: Completing all pending audits from payment years 2018 through 2024 by early 2026 Conducting annual audits for every Medicare Advantage plan Increasing medical record reviews from 35 […]