Posts by Norwood Staffing
Medicare vs. Medicare Advantage: Which will (and which should) come out on top?
By Brian Murphy Is anyone else as interested as I am in the ongoing power struggle of Medicare vs. Medicare Advantage (MA)? Established in 1965, Medicare has been dominant for decades. But MA, introduced in 2003, is its 20th year set to surpass Medicare in number of covered lives. We’re possibly at a tipping point,…
Read MoreBreathing life into pediatric CDI: Meet Sandra Love
Listen to the full episode here: https://spotifyanchor-web.app.link/e/bW3gRsyzlEb As a non-clinician I can think of few things more terrifying than having responsibility for the life of a fragile newborn in your hands, and your hands alone. Welcome to the early nursing career of Sandra Love. Sandra served as a labor and delivery nurse…
Read MoreSevere Sepsis/Septic Shock Early Management Bundle part of HVBP on Jan. 1: Are you ready?
By Brian Murphy Hospitals are about to have (additional) reasons to get sepsis documentation and coding right. As if they didn’t already. Hospitals have been implementing and documenting the Severe Sepsis/Septic Shock Early Management Bundle, aka., SEP-1 for years through the Inpatient Quality Program. There were already incentives to document it, including payment. But CMS…
Read MoreA clinical vision of risk adjustment: Meet Katie McLaughlin
It’s often said that to be a good CDI or coding professional you have to roll up your sleeves and get clinical. If you code just what is explicitly documented you will miss opportunities; if you don’t understand A&P and pathophysiology, you will make mistakes. But what about those who take the opposite path? Katie…
Read More$172M Cigna false claims act settlement serves as a compliance blueprint
By Jason Jobes $172.3M should get attention. The Justice department settled a false claims case with Cigna surrounding its chart review program from 2014-2019. See link to the news release below. As always, thank you for liking, commenting, and sharing these posts. To succeed in risk adjustment an organization needs to ensure that risk…
Read MoreDenials Prevention: Strategies for Success
Norwood webinar Denials prevention: Strategies for success Thursday, Oct. 26, 1-2 p.m. EST. Register here: https://my.demio.com/ref/1ieRImvdUAmWsxA0 Denials can bleed your organization dry. A recent independent Kaiser Family Foundation survey found that insurers deny, on average, 18% of all claims. And for some private insurers, that number is far higher. How can you make your organization…
Read MoreState of CDI in 2023: Outpatient CDI, sufficient staffing still a work in progress; opportunities abound!
By Brian Murphy CDI Week 2023 wrapped up in September and I thought I’d review the highlights (or at least most interesting bits) of my favorite annual ACDIS Survey: The CDI Week Industry Overview Survey. It’s always worth checking out this survey to get a handle on ongoing trends and year-over-year changes in…
Read MoreRisk adjustment coding and HEDIS measures: Birds of a feather
Can the work of a CDI specialist or risk adjustment coder impact HEDIS measures? It’s a question growing in importance, as reimbursement is tied to quality outcomes, and transparency and star ratings allow patients to shop for providers and health plans. Some believe HEDIS measures are impacted/satisfied only through the provision of clinical…
Read MoreA win for clinical truth: How Vaughn Matacale and Vidant prevailed against the OIG
Listen to the episode here: https://spotifyanchor-web.app.link/e/PrC1cbFXCDb Severe malnutrition is a major predictor of mortality/morbidity. In a five-year observational study cited by the National Institutes of Health, malnourished patients showed an eight times greater risk of harmful falls during hospitalization as compared to well-nourished patients. Further, malnutrition is associated with increased risk for septic shock, acute…
Read MoreThe time for risk adjustment coding, outpatient CDI is now
By Brian Murphy In my ACDIS days we launched the CCDS-O (outpatient) certification in 2017. The response, while positive, was not nearly the same as the CCDS (inpatient) received in 2009. In hindsight we were ahead of the curve. While risk adjustment was a concern, and a big one for some facilities, for others the…
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