Posts by Brian.m
CMS Failure to Rescue quality measure financial impact hitting soon
By Brian Murphy A reminder: The new CMS Failure to Rescue (FTR) quality measure is going to hit hospital pocketbooks—possibly your own—on October 1. Key details of the new CMS FTR measure (FY 2025 IPPS Update) Definition: The percentage of surgical inpatients who experience a complication and subsequently die within 30 days of their initial…
Read MoreIf a GLP-1 drops your BMI under 35, is morbid obesity off the table?
By Brian Murphy At the ACDIS conference last week, an interesting obesity coding question posed during a Q&A session at the Outpatient Symposium: Should we continue to code morbid obesity for patients who were previously morbidly obese (BMI greater than 35 with obesity-related comorbidities), but because they are on an active GLP-1 their BMI is…
Read MoreMedical Record Maestro: Reimagining CDI in the Age of AI and the Longitudinal Record
Download the episode here. We need a “human in the loop” in mid-revenue cycle work, experts say. What they fail to address is the more interesting question: Precisely where? Back-end AI fact-checker? Front-end query authorizer? Or, maybe something like my current OTR guest Penny Jefferson envisions: Medical record maestro. The end-to-end connectedness of the medical record, evolving API standards, increased use of prior authorization, episode-based reimbursement models, and review of all of this by AI and other tools makes documentation cohesion more important than…
Read MoreNew ACDIS/AHIMA physician query practice brief (2026) puts mid-revenue cycle leaders front and center in compliance
By Brian Murphy At the ACDIS conference last week, a bombshell announcement: A new physician query brief, the joint output of ACDIS/AHIMA. You can read it here on the ACDIS website. The organizations are accepting comments through June 12, and may make changes based upon them. So, give it a thoughtful read and submit your…
Read MoreGet the Norwood guide on effective, compliant use of provider incentives
This special report outlines the effective, compliant use of provider incentives in the mid-revenue cycle. Included are key references and suggested best practices. Download the guide on our resources page.
Read MoreCMS 2027 Medicare Advantage final rate announcement: What changed, what it means
Regardless of how you feel about Medicare Advantage (MA), CMS is doubling down on the embattled program with the 2027 MA and Part D Rate Announcement. CMS reversed course on the advance notice and removed a proposed risk model recalibration which would have resulted in a payment cut for most MA plans. Instead, MA plans…
Read More3 things to know about the 2027 IPPS proposed rule
By Brian Murphy The 2027 IPPS proposed rule is out… here’s 3 things I found interesting. (There are more than 3 things in it… but what do you do with 1586 pages of rules? You limit to three things). As always with proposed rules, big caveat: All of this is PROPOSED, subject to a comment…
Read MoreA must watch: New CMS video signals new metric for Medicare Advantage
By Jason Jobes The 2027 Medicare Advantage final rate notice is out—and the buzz is everywhere. Let me just say I rarely pause to watch a video, much less one that is 20 minutes. This one is a MUST watch if you are in risk adjustment. Last week “Health Tech Nerds” hosted an interview with…
Read MoreThe Downgrade Era: How Payers Are Changing the Game with (My) Richelle Marting
Listen to the podcast here. Payers are constantly shifting tactics to find new and creative ways to do their favorite thing: Not pay claims. And if you can’t deny? Downgrade! We’re seeing a lot of new patterns and tactics on this front, especially on the Medicare Advantage/private payer side of the house. And so it was time to take a look at where we are on the state of denials, with…
Read MoreGrassley Report of UnitedHealth Group takes aim at these 20 diagnoses: Here’s why
By Brian Murphy The Grassley Report examining the risk adjustment practices of UnitedHealth Group (UHG) is much more than just a one-time media splash. The report is 105 pages long and contains a wealth of information and insight into how UHG does its work. This includes the criteria it uses to report diagnoses to…
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