Posts by Brian.m
This is what a good outpatient CDI program looks like
By Jason Jobes This, right here. You should be focused on risk score accuracy by simultaneously evaluating how to maximize revenue and mitigate risk. We believe that every organization should get every penny it deserves, just not a penny more. Many organizations have started outpatient, or ambulatory, CDI programs focused solely on risk score maximization. Don’t do that. If you aren’t trying to ensure the…
Read MoreClosing out 2025 with its biggest story: Artificial intelligence
Listen to the episode here. Here we are, our last episode of Off the Record this year. I hope you’ve had a great 2025. Just my voice today. I’m ending with a solocast, a reading/summary of a paper about the biggest news story of the year: The explosive growth and proliferation of artificial intelligence, or AI. You might recall my poll from a couple weeks ago; you all confirmed it. 44% of respondents chose AI, beating…
Read MoreDon’t sleep on two important new changes hitting Jan. 1: Mandatory TEAM model and CMS-HCC V28 full payment shift
By Brian Murphy January 1 is rapidly closing in, and 2026 is bringing new rules and regulations impacting the mid-revenue cycle. Here’s two you shouldn’t forget about. Consider this a public safety announcement. V28 of CMS-HCCs Say goodbye to V24, and hello (fully) to V28. This one feels manageable. We’ve all been dealing…
Read More2026 OPPS final rule does no favors for our nation’s hospitals
By Brian Murphy The OPPS final rule, incredibly late this year, is finally out. Here I piece together some thoughts on (generously) four hours of sleep after a late night trip to Boston to pick up my daughter from a weekend getaway, so excuse any illogic. You can read the fact sheet easily enough (see…
Read MoreAI and the (Hu)man: The role of people in a technology dominated world
We hear it every day: Artificial intelligence including generative AI is the biggest technological breakthrough of our age. Bigger than the internet and color TV. The promises (and hype) are omnipresent, and there to be appear to be some slam-dunk use cases. But fewer are asking about its impact on humans, or paying attention to…
Read MoreTrump administration’s appeal of vacated RADV rule indicates Medicare Advantage audits not going away
By Brian Murphy Nothing is over. We’re still deep in the wild west of Medicare Advantage (MA). In case you missed the breaking news over the Thanksgiving break, the Trump administration on Friday appealed a crucial court decision. In September a TX judge ordered the 2023 Risk Adjustment Data Validation (RADV) rule vacated, removing CMS’…
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