Coding
New Norwood special report examines latest trends in payer denials
Download the report here. Denials are being turned up, not down. But they’re happening in less noticeable and more insidious ways, often under a different name. Aided by new AI technologies, payers are finding increasingly creative ways to deny claims outright or blanket reduce payments–a soft equivalent to a denial. This report examines some of…
Read MoreYou need to have it both ways: Audits must target missed coding opportunities and invalid conditions in risk adjustment
By Brian Murphy Among the alleged behaviors that led to Kaiser’s eventual $556M payout to settle false claims act allegations was its aggressive effort to only add diagnosis codes (up to a year or more after the encounter) and never remove them. This is called a one-way audit, and the Department of Justice does not…
Read MoreFive things to know about Present on Admission (POA) for hospital payment, quality
By Brian Murphy Present on admission (herein POA) for coding purposes is defined as conditions that are present at the time the order for the inpatient admission occurs. It’s important to get POA status right, as it impacts payment and quality metrics. POA conditions (as reported with a Y) count as CCs or MCCs, whereas…
Read MoreHow a baseline became a springboard to documentation, coding improvement
What gets measured, gets managed. An old business truth … but we don’t always think of the inverse. Without a baseline, you won’t know where to focus. An integrated healthcare system comprised of county-owned hospitals and clinics suspected it was leaving severity and revenue on the table, but wisely didn’t want to dive straight into education without a clear starting line. With its provider and coding teams busy delivering care and getting claims out the door it turned to Norwood for help. Our work …
Read MoreMorbid obesity vs. Class 3 obesity for medical coding: Which to use—and which is accepted?
By Brian Murphy A mid-revenue cycle professional lamented on a recent call that their CDI program is hindered because physicians don’t want to diagnose “morbid obesity.” It has become a fraught term, seen as demeaning to the patient. I get it. The good news is, Class 3 obesity has come to the rescue. Or has…
Read More