CDI
Who Owns Sepsis? The Battle to Define a Deadly Condition
By Brian Murphy, host, Off the Record podcast Listen to the episode here. CDI, coding, and clinical medicine are involved in a tug-of-war over a complex, life-threatening medical emergency that seems resistant to all forms of consensus. I’m talking about sepsis of course, and on today’s show I got to talk about sepsis with someone…
Read MoreDownload Coding in the Gray: Why Human Judgment Still Matters (part 2 of a 2-part series)
Download the report on our resources page. There is a LOT of talk these days about automation. Autonomous coding solutions that can code with near-perfect accuracy—and no human intervention. Providers picking a code from a drop-down menu, enabled by a computer-generated prompt, and voila: Maximized billing and denial-proof revenue. We’re not buying it. We’ve been…
Read MoreHow Norwood changed an organization’s CMI trajectory–to the tune of $2.56M
A drop in case mix index (CMI) isn’t necessarily indicative of a problem. A high-performing surgeon leaves your hospital, observation cases tick up seasonally, and you get a short-term drop. But flagging CMI over time warrants a closer look. Last year Norwood was asked to partner with an organization to focus on assessing and improving CDI performance. The CFO asked for an initial focus on CMI lift after long-term financial concerns. Norwood placed a three-person team to help…
Read MoreDo hospital ratings matter? Here’s what your peers say
By Brian Murphy Hospital ratings: Does anyone care? Healthgrades earlier this year announced its top 50, top 100, and top 250 hospitals awards. Links below; do you see your home state or hospital represented? Some heavy hitters made the Top 50 Hospitals list (though none from my home state of MA, which is traditionally…
Read MoreDownload The State of Physician Queries
Download the report. The old-timers—and perhaps a few relatively recent-timers—will recall a recent past when a query was pretty straightforward. Discrete to the encounter. Fee-for-service. Reimbursement driven. Ask the question, get a response. Dusted and done. Those days are long gone. A query isn’t just a query, anymore. And that’s a good thing. This new…
Read MoreCMS Failure to Rescue quality measure financial impact hitting soon
By Brian Murphy A reminder: The new CMS Failure to Rescue (FTR) quality measure is going to hit hospital pocketbooks—possibly your own—on October 1. Key details of the new CMS FTR measure (FY 2025 IPPS Update) Definition: The percentage of surgical inpatients who experience a complication and subsequently die within 30 days of their initial…
Read MoreMedical Record Maestro: Reimagining CDI in the Age of AI and the Longitudinal Record
Download the episode here. We need a “human in the loop” in mid-revenue cycle work, experts say. What they fail to address is the more interesting question: Precisely where? Back-end AI fact-checker? Front-end query authorizer? Or, maybe something like my current OTR guest Penny Jefferson envisions: Medical record maestro. The end-to-end connectedness of the medical record, evolving API standards, increased use of prior authorization, episode-based reimbursement models, and review of all of this by AI and other tools makes documentation cohesion more important than…
Read MoreNew ACDIS/AHIMA physician query practice brief (2026) puts mid-revenue cycle leaders front and center in compliance
By Brian Murphy At the ACDIS conference last week, a bombshell announcement: A new physician query brief, the joint output of ACDIS/AHIMA. You can read it here on the ACDIS website. The organizations are accepting comments through June 12, and may make changes based upon them. So, give it a thoughtful read and submit your…
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