Under the Microscope: AI Is Auditing Your Claims - Is Your Practice Truly Ready?

Payers are no longer reviewing claims manually. They are using artificial intelligence to scan billing patterns, flag documentation gaps, and trigger recoupments - faster and at a scale that most physician practices are completely unprepared for.

What was once buried under the weight of everyday administrative burden is now a front-line revenue threat. Major national insurers have begun publishing their own research, openly announcing they are deploying data tools to identify coding discrepancies across provider billing - and the findings are driving billions of dollars in scrutiny. The message from payers is clear: the era of AI-driven auditing is not coming. It is here.

And it is not just payers. The OIG is equally active. New audit initiatives targeting physician billing are being launched right now - and if your practice has not reviewed its documentation practices recently, the risk of being in scope is higher than most physicians realize.

What makes this moment different is the speed. AI does not review one claim at a time. It reviews everything - simultaneously - looking for patterns, outliers, and gaps that a human auditor would take months to find. By the time a recoupment letter arrives, the audit is already complete. Most practices only find out they were in scope after the damage is done.

For physicians who see Medicare Advantage patients, expanded risk adjustment audits are adding another layer entirely - quietly examining whether your documentation truly supports every diagnosis you submit. And a broader technology shift is already underway - payers are building digital systems with direct access to your practice data, feeding the very AI engines now reviewing your claims.

The real question is not whether your practice will face scrutiny. It is whether your practice is equipped to withstand it - from an external payer audit, an OIG review, or even an internal compliance assessment. Most physicians assume they are fine. Many are not.

If an AI audit hit your practice today - would your documentation hold up? Would you even know where your greatest exposure is?

This webinar is built to help you answer those questions honestly, close the gaps before they are found, and protect your revenue in an audit environment that is only getting more aggressive.

Webinar Objectives

By the end of this session, you will be able to:

• Understand how AI payer audit tools work and why no practice - regardless of size or specialty - is outside their reach
• Recognize what the OIG is actively targeting in physician billing right now and assess your own exposure
• Know what Medicare Advantage auditors look for in your documentation and where most physicians unknowingly fall short
• Honestly evaluate whether your practice is prepared for an external audit or internal compliance review
• Identify the coding errors and claim patterns that make practices the easiest targets
• Leave with a clear, practical action plan to protect your revenue before an audit finds you first

Webinar Agenda

• The AI Audit Threat How payers are using AI to review physician claims at scale - and why most practices do not know they are being scrutinized until it is too late
• OIG - What Is Active Right Now The newest physician-targeted audit priorities and how to assess whether your billing patterns are in scope
• RADV & Medicare Advantage What risk adjustment auditors are examining in your patient documentation and what adequate support actually looks like
• Is Your Practice Audit-Ready? How to conduct an honest internal assessment of your compliance posture before a payer or vendor does it for you
• The Digital Shift How new payer data access rules are giving insurers deeper visibility into your practice - and what that means for audit exposure going forward
• Common Coding Errors The documentation and coding mistakes that open the door to audits - patterns that affect rookies and experienced physicians alike
• Top 10 Audited & Denied Claims The claims being targeted most aggressively, why documentation is always the root cause, and what to fix first

Webinar Highlights

• Why AI has made every physician practice a potential audit target - right now
• What the OIG is actively pursuing in physician billing and how to know if you are exposed
• The Medicare Advantage documentation standard most physicians are not meeting
• A practical framework to assess your own audit readiness - before a payer does
• The top coding errors creating the greatest compliance risk across specialties
• The 10 claim types being denied and recouped most aggressively
• Concrete steps you can take immediately - no jargon, no theory, just action

Who Should Attend?

• Physicians - All Specialties
• Primary Care, Internal Medicine & Family Medicine
• Specialists Seeing Medicare Advantage Patients
• Nurse Practitioners & Physician Assistants
• Practice Administrators & Office Managers
• Medical Coders & Billing Specialists
• Revenue Cycle Managers
• Compliance Officers
• Chief Medical Officers