Severe Sepsis/Septic Shock Early Management Bundle part of HVBP on Jan. 1: Are you ready?

sepsis documentation

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…

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A clinical vision of risk adjustment: Meet Katie McLaughlin

off the record

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…

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Denials Prevention: Strategies for Success 

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…

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Risk 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…

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A 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…

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The time for risk adjustment coding, outpatient CDI is now

outpatient CDI

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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Don’t hate on hospitals: Navigating the complexities of healthcare reimbursement with Jugna Shah, MPH

off the record

Stop hating on hospitals. It’s a sentiment most Off the Record podcast listeners would probably agree with. But not everyone. Hospitals are under assault in some corners, including the media and in the halls of government. We need a villain and hospitals often find themselves playing the role of fall guy. For example, many blame them…

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The “Risky Business” of Risk Adjustment

risk adjustment

Why risk adjustment coders are more valuable than ever   By Crystal May, CCS, CPC, CDEO, CPMA, CRC, AAPC Approved Instructor, Senior Risk Adjustment Consultant, Norwood   If you’re of a certain age, the title of this article probably conjured up the image of a popular male actor sliding across a wooden floor in a…

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