Empathy meets AI: Rhoda Chism on Human-Machine Harmony in CDI

Listen to the complete episode here.   With 23 years and counting in CDI, Rhoda Chism has seen a lot. The rise of new regulations and reimbursement mechanisms, and the advent of new technologies that have radically transformed chart reviews.   Rhoda has not only weathered these changes and navigated the turbulent waters, but remains…

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AI arms race escalates battle of healthcare denials

By Brian Murphy   Are we headed for a healthcare AI arms race? A hellish AI dystopia?   Some days I wonder.   I was reading a breathless interview with the chief technology officer of a revenue cycle management technology company. The CTO states:   “Think of genAI as giving coders superpowers. It’s helping them…

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OIG audits of risk adjustment diagnoses running into familiar, repetitive roadblock—and resolution is needed

By Brian Murphy   “Additionally, Humana did not agree with our audit methodology or overpayment estimation methodology.”   Take the above line from the OIG’s latest audit report, remove “Humana.” Fill in the blank with another payer.   The result is the same. No Medicare Advantage (MA) payer agrees with the OIG’s audit methodologies.  …

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Living in Denial(s) with Karen Elmore, BJC Healthcare

Listen to the program here.   Karen Elmore is living in denial(s).    Her job as Senior Clinical Documentation Quality Coordinator for BJC Healthcare involves a daily battle against a never-ending tide: Payers denying diagnoses on the perceived basis of lack of clinical support. Recently she’s had to deal not only with human payers, but…

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Yet another reason to implement Annual Wellness Visits into your CDI/coding efforts

Detection of early cognitive decline the latest benefit of covered Medicare/Medicare Advantage service By Brian Murphy Medicare Annual Wellness Visits (AWVs) are an important piece of patient wellness and appropriate capture of acuity/severity of illness. But they’re also underutilized. You can now add another reason why you should be working to use them as a…

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To broaden your perspective on work and life, keep climbing

By Justin Satterfield, CEO and Founder, Norwood My colleague and friend Clayton Simons has an uncle who climbed every “fourteener” in Colorado. These are mountains with an elevation of 14,000 feet or greater. There are 58 of them. Clayton and I plan to climb them all, too. Earlier this month we knocked off four in…

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Revka Stearns: Eight months later (and wiser)—Part 2 of 2

Listen to the recording here: https://spotifyanchor-web.app.link/e/HvfKYIDsKNb  We’re happy to bring you part 2 of our interview with Revka Stearns, who joined us on Off the Record to provide an update of her first eight months on the job as a new inpatient coder. If you haven’t listened to part 1 I’d recommend starting there, since…

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Should hospitals include clinical definitions in payer contracts? Hear one legal opinion

By Brian Murphy   Establishing facilitywide diagnosis definitions is the gold standard for many organizations. If providers and the CDI/coding team agree on what constitutes postoperative respiratory failure for example, clinical disagreements should be greatly reduced, the need for queries lessened, and coding accuracy improved.   Unfortunately, payers also (appear) to have the same leeway…

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