Hospital reimbursement
Lessons from loss: A look from the inside of value-based care with Rose Bernards
Listen to the podcast. Rose Bernards is a believer in value-based care. It’s been a driving force in her career. But it was put to the test when she suffered a family tragedy in late 2025. She wrote about that experience in a three-part series for LinkedIn I highly recommend: The Good, the Bad, and the Ugly. Link in the show notes. We get into those ups and downs, Rose’s wide-ranging educational career, and expert insights and…
Read MoreOIG offers clinical scenarios that can illuminate your own audit vulnerabilities
The recent Office of Inspector General (OIG) audits of three acute-care hospitals offer a goldmine of clinical/coding examples that you should be using for pre-emptive audit defense. Validating DRG assignments, reviewing medical necessity documentation completeness, and educating providers before an auditor comes knocking—and uses extrapolation to greatly increase recoupments. Here are examples taken from the…
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…
Read MoreTwo reasons why the 2027 OPPS proposed rule hurts your hospital
By Brian Murphy The 2027 OPPS (outpatient) proposed rule landed just prior to the July 4 holiday weekend. CMS’ timing is conspicuous, presumably to dodge the tomatoes hurled at it from the likes of the American Hospital Association. Not a whole lot of great news in here for healthcare orgs; here are two and…
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 MoreMedicare Annual Wellness Visits (AWVs) a fantastic risk adjustment tool–but don’t sleep on FFS
If you work in outpatient CDI you might have already reached the conclusion that the Medicare Annual Wellness Visit (AMW) is your friend. You’d be right. The AWV is first and foremost a tool for preventive screening and health. But it’s also a powerful tool in the arsenal of mid-revenue cycle work. For Medicare Advantage…
Read MoreOne Norwood Auditor, Outsized Returns
One good, highly skilled inpatient coding auditor with a fresh perspective and broad experience can deliver outsized returns for your healthcare organization. We have a great example. A large, integrated healthcare organization was missing justified secondary diagnoses and properly sequenced principal diagnoses in the documentation. The result? Underrepresentation of its severity of illness/risk of mortality, and diminished revenue. All confirmed via independent audit. Norwood partnered to provide a seasoned, credentialed, and skilled inpatient coding auditor to help right the ship. …
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 MoreGet the Norwood guide on effective, compliant use of provider incentives
This special report outlines the effective, compliant use of provider incentives in the mid-revenue cycle. Included are key references and suggested best practices. Download the guide on our resources page.
Read MoreCMS 2027 Medicare Advantage final rate announcement: What changed, what it means
Regardless of how you feel about Medicare Advantage (MA), CMS is doubling down on the embattled program with the 2027 MA and Part D Rate Announcement. CMS reversed course on the advance notice and removed a proposed risk model recalibration which would have resulted in a payment cut for most MA plans. Instead, MA plans…
Read More