On Demand: Digital Health and AI in 2026: Coding, Compliance and Revenue Opportunities-Presentation Slides

Presentation Slides

Pdf Summary

The 2025 MedAxiom presentation by Nicole Knight focuses on the transforming role of digital health and artificial intelligence (AI) in cardiovascular (CV) care, emphasizing coding, compliance, and revenue cycle opportunities for 2026. AI is revolutionizing diagnostics, predictive analytics, and longitudinal care through machine learning (ML), deep learning (DL), and generative AI. The AMA’s Appendix S categorizes AI applications as assistive, augmentative, or autonomous based on the level of machine involvement and clinical decision-making, influencing accurate coding and reimbursement. <br /><br />CMS is expanding telehealth and digital service coverage but maintains strict documentation and oversight requirements. Telehealth flexibilities from the COVID-19 era continue into early 2026, including home-based telehealth services and virtual direct supervision via real-time audiovisual technology, although some flexibilities are scheduled to expire or require legislative renewal.<br /><br />Payment and coding challenges persist, especially for AI-related CPT codes, many of which remain Category III, lacking standard valuation and facing variability in reimbursement. The AMA’s Specialty Society RVS Update Committee (RUC) provides resource-based recommendations to CMS for valuation, but issues with practice expense valuations for AI software complicate sustainable payment models.<br /><br />AI applications in revenue cycle management (RCM) span patient scheduling, insurance verification, clinical documentation, coding, audits, billing, denial management, and financial forecasting, enhancing efficiency and compliance. However, risks such as bias, hallucinations, data drift, liability, and overreliance require governance and human oversight, positioning coders in a more strategic safety-check role.<br /><br />2026 CPT code updates include new AI-assistive and augmentative procedure codes, especially in coronary computed tomography angiography (CCTA) and cardiac risk assessment. Virtual care and remote patient monitoring services continue expanding, with defined reimbursement rates for clinical staff and physicians.<br /><br />Key takeaways underscore the importance of understanding regulatory requirements, ensuring documentation integrity, monitoring payer policies, and thoughtfully integrating AI to support strategic business goals while ensuring compliance and patient safety.

Keywords

Digital Health

Artificial Intelligence

Cardiovascular Care

Coding and Compliance

Revenue Cycle Management

Telehealth Expansion

AI CPT Codes

Machine Learning

Deep Learning

Regulatory Requirements