Is the 16-Day RPM Rule No Longer a Revenue Barrier for OBGYNs?

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The 16-day RPM rule is becoming less of a revenue barrier for OBGYNs due to regulatory clarifications, improved device compliance, and better billing workflows. Previously, the requirement that remote patient monitoring (RPM) devices collect data for at least 16 days per 30-day period limited reimbursement opportunities. For OBGYN practices managing pregnancy-related monitoring and chronic maternal conditions, this rule often restricted consistent RPM reimbursement . Recent operational adjustments and clearer CMS guidance are changing how practices approach RPM billing for OBGYNs . What Is the 16-Day RPM Rule? The 16-day RPM rule requires that patient monitoring devices record and transmit data for at least 16 days within 30 days to qualify for monthly RPM reimbursement. This rule was designed to ensure consistent patient engagement, but it created challenges in: Short-term pregnancy monitoring Intermittent blood pressure tracking Gestational diabetes management Post...
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2026 ASC OIG Audit Preparedness Checklist

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2026 ASC OIG Audit Preparedness Checklist

Office of Inspector General (OIG) audits are becoming more targeted, more data-driven, and more frequent—especially for ambulatory surgery centers (ASCs). As 2026 approaches, ASCs must move beyond reactive compliance and adopt a proactive audit preparedness strategy. Strong ASC billing services play a central role in ensuring facilities remain compliant, accurate, and financially protected.

OIG audit preparedness is no longer about last-minute chart reviews. It requires structured documentation, accurate billing, internal controls, and continuous monitoring across clinical and financial workflows. ASC billing services that are built around compliance help facilities reduce risk and maintain audit readiness year-round.

Why OIG Audit Preparedness Matters More in 2026

OIG audits increasingly focus on:

  • Improper payments

  • Medical necessity

  • Modifier misuse

  • Implant and device billing

  • Facility fee accuracy

  • Compliance with CMS ASC payment rules

With expanded data analytics, auditors can quickly identify outliers. ASCs using specialized ASC billing services are better equipped to detect and correct risks before they trigger an audit.

Strong OIG audit preparedness protects revenue, ensures compliance, and demonstrates good-faith efforts to follow federal regulations.

2026 ASC OIG Audit Preparedness Checklist

1. Accurate CPT, HCPCS, and Modifier Usage

Coding accuracy remains one of the top OIG audit focus areas. Reliable ASC billing services ensure coding aligns with operative documentation and payer rules.

ASCs should ensure:

  • CPT codes match operative reports

  • Modifiers are used correctly and consistently

  • No unbundling or duplicate billing

  • High-acuity procedures are properly supported

2. Medical Necessity Documentation

OIG audits frequently assess whether services were medically necessary. ASC billing services rely on complete and consistent documentation to support claims.

Facilities must confirm:

  • Diagnoses support procedures performed

  • Documentation is clear, specific, and complete

  • Operative notes justify surgical complexity

  • Pre-op and post-op records are aligned

3. Facility Fee Billing Accuracy

Facility fees are a high-risk audit area for ASCs and a core focus of compliant ASC billing services.

Audit-ready facilities ensure:

  • Correct revenue codes are applied

  • Facility services are not overbilled

  • Charges align with CMS ASC payment indicators

  • Documentation supports facility-level billing

4. Implant and Device Billing Compliance

Implant billing is under growing scrutiny due to high cost and frequent errors. Effective ASC billing services help validate implant charge capture and documentation.

ASCs should verify:

  • Implant charges are captured consistently

  • HCPCS codes are accurate

  • Device documentation is complete

  • Payer-specific implant rules are followed

5. Pre-Authorization and Eligibility Controls

Front-end controls are essential for audit defensibility. ASC billing services support authorization tracking and eligibility verification.

ASCs must maintain:

  • Verified insurance eligibility

  • Documented authorizations

  • Clear payer approval records

  • Audit trails for elective procedures

6. Denial Management and Appeals Documentation

OIG auditors often review how ASCs respond to denied claims. Strong ASC billing services maintain detailed denial and appeal records.

Best practices include:

  • Tracking denial reasons

  • Correcting root causes

  • Submitting timely appeals

  • Maintaining appeal documentation

7. Internal Compliance Program

A formal compliance program demonstrates accountability and oversight—often supported by structured ASC billing services.

ASCs should have:

  • Written compliance policies

  • Regular staff training

  • Internal audit schedules

  • Designated compliance oversight

8. Timely and Accurate Claim Submission

Late or inconsistent billing patterns can raise audit flags. ASC billing services ensure claims are clean, accurate, and submitted on time.

Facilities must ensure:

  • Claims are submitted promptly

  • Data is consistent across systems

  • Corrections are documented

  • No patterns of resubmission abuse

How Medical Billers and Coders Strengthen ASC Billing Services for Audit Preparedness

Medical billers and coders provide ASC billing services that go beyond claim submission. Their expertise supports audit readiness at every stage of the revenue cycle.

They assist ASCs by:

  • Performing pre-billing compliance reviews

  • Auditing, coding, and documentation accuracy

  • Validating facility fee and implant billing

  • Monitoring denial trends

  • Aligning billing workflows with CMS and payer rules

These ASC billing services help identify risks early and correct issues before they become audit findings.

Preparing for Audits Is a Continuous Process

OIG audit preparedness is not a one-time project. It is an ongoing discipline that requires collaboration between clinical teams, billing staff, and compliance leadership. ASC billing services play a continuous role in maintaining consistency and accuracy.

ASCs that embed audit readiness into daily operations experience:

  • Fewer denials

  • Stronger compliance posture

  • Reduced financial risk

  • Faster audit resolution

Conclusion

The 2026 regulatory environment demands higher accountability from ambulatory surgery centers. OIG audit preparedness depends heavily on strong documentation, compliant workflows, and reliable ASC billing services.

By following this ASC checklist and working closely with experienced medical billers and coders, facilities can approach audits with confidence—not fear. In an era of heightened oversight, proactive ASC billing services are the strongest defense.

Location: United States

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