Question 1

Is CMS-HCC V28 fully in effect?

Accepted Answer

Yes. Payment year 2026 is the first year Medicare Advantage risk scores are calculated entirely under V28, after a phase-in of 33 percent in 2024 and 67 percent in 2025. V28 pays on 115 HCCs against 86 in V24, and 7,770 risk-adjusting ICD-10-CM codes against 9,797. Related conditions inside a disease family are constrained to identical coefficients, so a vaguer code inside the family no longer costs less than a precise one — it simply may not map at all. (Source: CMS CY2024 Rate Announcement; CY2026 risk adjustment implementation.)

Question 2

What does MEAT actually require?

Accepted Answer

MEAT stands for Monitor, Evaluate, Assess or Address, and Treat. Reviewers look for at least one of the four documented at a face-to-face encounter before they accept a condition as supported. It is a review convention rather than a federal coding mandate — the official ICD-10-CM guidelines still govern — but a condition carried only on a problem list is what fails an audit. (Source: ICD-10-CM Official Guidelines; CMS RADV audit methodology.)

Question 3

What does chronic care management require each month?

Accepted Answer

CPT 99490 covers at least 20 minutes of non-face-to-face clinical staff time in a calendar month for a patient with two or more chronic conditions expected to last at least twelve months, under general supervision, with consent documented. CPT 99439 adds each further 20 minutes, up to twice. It cannot be reported in the same month as 99487 or 99491 for the same patient. (Source: AMA CPT 2026; CMS Chronic Care Management Services guide.)

Question 4

What changed for remote patient monitoring in 2026?

Accepted Answer

The device thresholds split. CPT 99454 still requires 16 or more days of transmitted data in 30 days, and new CPT 99445 covers 2 to 15 days at the same payment rate — the two are mutually exclusive. Management time splits the same way: 99457 remains the first 20 minutes, and new CPT 99470 covers 10 to 19 minutes. Setup under 99453 now expects at least 2 days of data. (Source: CMS CY2026 Physician Fee Schedule final rule; AMA CPT 2026.)

Question 5

How tight is the transitional care management window?

Accepted Answer

Interactive contact has to happen within 2 business days of discharge. The face-to-face visit has to happen within 14 calendar days for CPT 99495, or 7 calendar days for 99496 where medical decision making is high. The service period runs 30 days from the date of discharge, and only one provider may report it for that discharge. (Source: AMA CPT 2026; CMS Transitional Care Management Services guide.)

Question 6

When is principal care management the right program instead of CCM?

Accepted Answer

Principal care management covers a single complex condition expected to last at least three months, where chronic care management requires two or more. It is billed in 30-minute monthly increments: CPT 99424 and 99425 for physician or qualified health professional time, 99426 and 99427 for clinical staff time. It cannot be billed in the same calendar month as CCM for the same patient, but it can run alongside remote monitoring. (Source: AMA CPT 2026; CMS Care Management Services guidance.)

Question 7

What has to be in an annual wellness visit?

Accepted Answer

G0438 is the initial visit, once per lifetime and only after twelve months on Part B; G0439 is each subsequent visit, at least twelve months apart. Both require a health risk assessment, medical and family history, a list of current providers and suppliers, height, weight, body mass index and blood pressure, cognitive and functional screening including fall risk, and a written personalized prevention plan. It is not a routine physical, and the separate Welcome to Medicare visit is G0402. (Source: CMS Medicare Learning Network: Annual Wellness Visit.)

Question 8

How much did the code set change this year?

Accepted Answer

The FY2026 ICD-10-CM update took effect on October 1, 2025 with 487 new codes, 38 revisions, and 28 deletions. Every one of those changes lands in a place where a code that was correct last year quietly is not this year, which is exactly the kind of drift a person reading a chart at speed cannot be expected to track. (Source: CMS FY2026 ICD-10-CM code update files.)

Question 9

Does OptimIQ replace our existing systems?

Accepted Answer

No. The platform reads the record you already keep and writes back into it. Nothing is submitted from a finding on its own — a person reviews every one, accepts or rejects it, and the accepted evidence lands in the chart with the sentence that supports it. (Source: Product design constraint.)

Encounter	Codes	Edits	Approved by	Note to provider
M. Torres · office visit	99214 · E11.65 · I10	Passed	K. Ortiz, CPC	—
R. Chen · procedure	11102 · 11103	MUE corrected	K. Ortiz, CPC	Units reduced to what the note supports
A. Gomez · office visit	Held	Query	S. Lin, CCS	Time or MDM not documented for the level billed
D. Kapoor · surgery	29881	NCCI corrected	S. Lin, CCS	Bundled procedure removed

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