Hospital reimbursement
Medicare 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 More3 things to know about the 2027 IPPS proposed rule
By Brian Murphy The 2027 IPPS proposed rule is out… here’s 3 things I found interesting. (There are more than 3 things in it… but what do you do with 1586 pages of rules? You limit to three things). As always with proposed rules, big caveat: All of this is PROPOSED, subject to a comment…
Read MoreA must watch: New CMS video signals new metric for Medicare Advantage
By Jason Jobes The 2027 Medicare Advantage final rate notice is out—and the buzz is everywhere. Let me just say I rarely pause to watch a video, much less one that is 20 minutes. This one is a MUST watch if you are in risk adjustment. Last week “Health Tech Nerds” hosted an interview with…
Read MoreThe Downgrade Era: How Payers Are Changing the Game with (My) Richelle Marting
Listen to the podcast here. Payers are constantly shifting tactics to find new and creative ways to do their favorite thing: Not pay claims. And if you can’t deny? Downgrade! We’re seeing a lot of new patterns and tactics on this front, especially on the Medicare Advantage/private payer side of the house. And so it was time to take a look at where we are on the state of denials, with…
Read MoreGrassley Report of UnitedHealth Group takes aim at these 20 diagnoses: Here’s why
By Brian Murphy The Grassley Report examining the risk adjustment practices of UnitedHealth Group (UHG) is much more than just a one-time media splash. The report is 105 pages long and contains a wealth of information and insight into how UHG does its work. This includes the criteria it uses to report diagnoses to…
Read MoreMedicare Advantage plans: Should healthcare organizations care about payer audits, fines? Hint: Yes
You are a CDI Director at a large integrated healthcare system, with oversight of staff working in acute care hospitals and clinics. You have patients with Aetna and Kaiser Permanente. Then the news hits: Kaiser agrees to pay $556M to settle false claims act (FCA) allegations for inflated risk adjustment coding. Aetna, $117M for similar…
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