Coding
2027 OPPS final rule released: Three things you must know
By Brian Murphy The 2027 OPPS final rule is out; here’s three things you should know. Or at least, three I think you should know. 1.Inpatient Only List (IPO) nears the end CMS finalized the removal of 637 services from the following clinical families: auditory, digestive, endocrine, female genital, hemic and lymphatic systems, integumentary, male genital, maternity care and…
Read MoreA Rebel with a Cause: Jenna Prisciandaro on Nursing, Leadership, and CDI
Listen to the episode. When you more than double your CDI staff AND turn around a culture of skeptical physicians, you’ve made an impact. That kind of transformation takes a leader who blends curiosity, initiative, and fearlessness. That describes my guest today, who has always been fearless about trying new things. Jenna Prisciandaro is the…
Read MoreThree new rules/regulations to watch, effective Oct. 1
By Brian Murphy Thursday, Oct. 1 is the start of three big changes hitting the mid-revenue cycle all at once. 1) Updated ICD-10-CM Official Coding Guidelines, 2) New/deleted/revised ICD-10 codes, 3) new IPPS regulations. Here’s a summary with added focus on the OCG because I’ve covered 2 and 3 prior. Official Coding Guidelines…
Read MoreWhere Are We With Sepsis? Read our latest report to find out.
By Brian Murphy Download the report here. Sepsis is deadly, prevalent, and expensive to treat, and therefore capturing it in documentation and coded data among the highest priorities of mid-revenue cycle professionals. It’s also one of the most difficult diagnoses to capture and the most at-risk, prone to denials and regulatory scrutiny. And there are…
Read MoreFifth Universal Definition of Myocardial Infarction (MI) published: What it says for your CDI, coding, and clinical teams
The Fifth Universal Definition of Myocardial Infarction (MI) has been published in the Journal of the American College of Cardiology. What is the new definition? The fifth definition removes the fourth definition’s numerical classification (i.e., MI types 1, 2, 3, 4a, 4b, 4c, 5) and replaces them with three categories: Primary MI, Secondary MI, and…
Read MoreWho 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 MoreCC/MCC changes in 2027 IPPS final rule: We summarize them for you
The 2027 IPPS final rule includes several CC/MCC reimbursement changes to diagnoses you should be aware of. Watch for these in the documentation and report them and/or query if clinical indicators present. An audit now to confirm their presence or absence is a good strategy. They take effect Oct. 1. For example, hypoglycemia (i.e., low…
Read MoreInpatient Audit Storm Clouds
Download the report on our resource page. The Office of Inspector General (OIG) never rests. After taking on Medicare Advantage organizations and aggressive risk adjustment coding practices from 2023-2025, the sights of the nation’s regulatory watchdog have shifted. The new target? Acute care hospitals and inpatient admissions. Plus some other outpatient odds and ends. This…
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