Posts by Norwood Staffing
Code Red: CMS announces massive audit expansion of Medicare Advantage, raising risk adjustment coding questions
By Brian Murphy For a while I felt like this was coming to a head. As far back as 2016-2017 I was monitoring reports of Medicare Advantage (MA) plans under investigation for alleged fraud related to HCC upcoding. I wondered when we’d see massive, coordinated action. That day is here. On May 21 CMS announced…
Read MoreAre you assigning admit type based on NUBC guidelines—or a loose interpretation to influence quality metrics?
By Brian Murphy Prior to our Off the Record podcast recording my guest Penny Jefferson shared with me a white paper she authored on admit type. I’m going to summarize a bit of it here as it was a substantive basis of our conversation. The paper begins by differentiating between admit status and admit type.…
Read MoreAnybody Listening? Ambient AI and the Future of Documentation with Dr. David Canes
Listen to the episode here. Back in 1990 the heavy metal band Queensryche asked its listeners, “Is there anybody listening?”, a lament for not being heard in a world of overstimulation, noise and artificially. In healthcare in 2025, the answer is yes: someone is listening. But the listener just might be a machine. Ambient…
Read MoreStructure your physician advisor program not just for financial ROI, but work-life balance
By Brian Murphy Physicians are the lifeblood of a hospital. They provide lifesaving treatment and specialized care but also write the admission orders that keep the lights on. So how do you take 15 physicians and carve out half of their priceless time for CDI? By demonstrating return on investment (ROI). A.J. Hegg is an…
Read MoreRising from ruin and talking telehealth, SDOH with Keisha Wilson
Listen to the episode here. Regular listeners of Off the Record will recall Keisha Wilson, whom I hosted on the program in June 2024 to talk about telehealth as well as her story of entrepreneurship. She was a bright light and a great guest, so I asked her to return to the show a…
Read MoreWorried how you’ll survive in V28 of CMS-HCCs? Fear not, we’ve got the guide
By Brian Murphy Download the CMS-HCCs V28 Survival Guide To survive in Version 28 of CMS-HCCs, you need a playbook. Check that, you need a survival guide. The good news is, we’ve put one together. Download Norwood SVP Jason Jobes’ analysis of the changes, the data and analytics underpinning the new risk model, and a…
Read MoreInpatient vs. outpatient coding differences place provider certainty under the spotlight, raise risk adjustment question
By Brian Murphy Why can diagnoses in the hospital inpatient setting be coded if they are possible/probable/likely/suspected, but in the outpatient world you can only code to the highest degree of known specificity? The difference is rooted in the ICD-10-CM Official Guidelines for Coding and Reporting. In the hospital inpatient setting, you are allowed to…
Read MoreWhat is your CDI chart review process in the outpatient setting? One organization’s is very thorough
By Brian Murphy Among the highlights of my interview with current Off the Record guest Glenda Bocskovits was hearing about her organization’s process of outpatient CDI chart review. Which is very thorough. The practice of OP CDI is an art, with no one right way. If I were to hazard a guess, I’d say most…
Read MoreIs a computer-generated nudge a query? According to extant guidance, yes… but do we need new guidance?
By Brian Murphy Is a nudge, a best practice alert, or some other machine prompted question to a physician, a query? I’m risking a very contentious topic here. But it’s one that comes up a lot in conversation. According to the latest ACDIS-AHIMA query brief, the answer is yes. A query is a query is…
Read MoreCMS announces massive audits of Medicare Advantage plans; time for compliance is now
By Jason Jobes, SVP, Solutions HUGE CMS AUDIT ALERT: CMS just dropped major news that they are exponentially increasing Medicare Advantage and risk adjustment audits. WOW! Our Norwood team has become an industry leader in understanding the nuances of Medicare Advantage audits, risk score accuracy, and education. Are you ready? Is your outpatient CDI program…
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