Posts by Brian.m
Chad needs your help: How your organization can capture metabolic syndrome
By Rose Bernards “Chad” is a fictional person and moniker for cholesterol, hypertension and diabetes. Chad is 74 years old, a retired engineer, happily married. But his health tells a different story. He has a BMI of 34, wears corrective lenses and is being monitored for retinopathy. He also has high cholesterol, high blood…
Read MoreAugust audit heat: False Claims Act settlements put spotlight on upcoding
Listen to the episode here. This episode of Off the Record is a bit of a departure: A replay of the Norwood webinar August audit heat: False Claims Act settlements put spotlight on upcoding. This was our second largest attended program ever, and the topic so important—recent massive OIG audits in the Medicare Advantage/risk adjustment…
Read MoreNearly 80% of hospitals subject to HRRP hit with readmissions penalties
By Brian Murphy New data just released (see Fierce Healthcare article below) shows that CMS penalized a whopping 2,334 hospitals for excess readmissions on Oct 1—nearly 80% of all hospitals subject to CMS’ Hospital Readmission Reduction Program (HRRP). I went back and looked at Fierce’s math because I didn’t believe it. But it’s correct. 2,911…
Read MoreCDI chart review metrics: Worth tracking anymore?
By Brian Murphy Are CDI chart review productivity metrics outdated and in need of replacing? They’ve been the same for 10 years. (How’s that for a Monday morning shot of coffee)? I was reviewing the CDI Week industry overview survey and found something interesting: Productivity stats have essentially stayed unchanged YOY… for ten years. 2025:…
Read MoreWould your organization stand up to a targeted HCC audit? Survey says… probably not. We can help.
By Jason Jobes We recently hosted a webinar on HCC compliance. A very hot topic. Nearly 300 registrants signed up. We were supposed to go 30 minutes … but stayed for almost 45 due to a number of fantastic questions and insights from the audience that just kept coming. If you attended and/or submitted one…
Read MoreTwo authors talk shop on CDI, physician advisors … and heavy metal
Listen to the podcast here. Trey LaCharite has seen it all during his time as physician advisor. The debut of ICD-10. The growth of value-based care and CMS pay for performance initiatives. And the rise of EHRs and the dreaded RACs. For more than a decade he’s brought that distilled wisdom to the ACDIS national…
Read MoreThree new rules/regulations to watch, effective Oct. 1
By Brian Murphy Thursday, Oct. 1 is the start of three big changes hitting the mid-revenue cycle all at once. 1) Updated ICD-10-CM Official Coding Guidelines, 2) New/deleted/revised ICD-10 codes, 3) new IPPS regulations. Here’s a summary with added focus on the OCG because I’ve covered 2 and 3 prior. Official Coding Guidelines…
Read MoreWhere Are We With Sepsis? Read our latest report to find out.
By Brian Murphy Download the report here. Sepsis is deadly, prevalent, and expensive to treat, and therefore capturing it in documentation and coded data among the highest priorities of mid-revenue cycle professionals. It’s also one of the most difficult diagnoses to capture and the most at-risk, prone to denials and regulatory scrutiny. And there are…
Read MoreShould you follow the ACDIS/AHIMA query brief? I say yes: Here’s why.
By Brian Murphy Should you follow the ACDIS/AHIMA query brief? <= Not rage-bait, honest question. Earlier this year ACDIS/AHIMA issued a new physician query practice brief. It started with a draft, subject to public comment (I put in a couple myself), followed by a final brief, ACDIS/AHIMA Guidelines for Achieving a Compliant Query Practice—2026…
Read MoreFifth Universal Definition of Myocardial Infarction (MI) published: What it says for your CDI, coding, and clinical teams
The Fifth Universal Definition of Myocardial Infarction (MI) has been published in the Journal of the American College of Cardiology. What is the new definition? The fifth definition removes the fourth definition’s numerical classification (i.e., MI types 1, 2, 3, 4a, 4b, 4c, 5) and replaces them with three categories: Primary MI, Secondary MI, and…
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