Hospital reimbursement
Chad needs your help: How your organization can capture metabolic syndrome
By Rose Bernards “Chad” is a fictional person and moniker for cholesterol, hypertension and diabetes. Chad is 74 years old, a retired engineer, happily married. But his health tells a different story. He has a BMI of 34, wears corrective lenses and is being monitored for retinopathy. He also has high cholesterol, high blood…
Read MoreAugust audit heat: False Claims Act settlements put spotlight on upcoding
Listen to the episode here. This episode of Off the Record is a bit of a departure: A replay of the Norwood webinar August audit heat: False Claims Act settlements put spotlight on upcoding. This was our second largest attended program ever, and the topic so important—recent massive OIG audits in the Medicare Advantage/risk adjustment…
Read MoreNearly 80% of hospitals subject to HRRP hit with readmissions penalties
By Brian Murphy New data just released (see Fierce Healthcare article below) shows that CMS penalized a whopping 2,334 hospitals for excess readmissions on Oct 1—nearly 80% of all hospitals subject to CMS’ Hospital Readmission Reduction Program (HRRP). I went back and looked at Fierce’s math because I didn’t believe it. But it’s correct. 2,911…
Read MoreWould your organization stand up to a targeted HCC audit? Survey says… probably not. We can help.
By Jason Jobes We recently hosted a webinar on HCC compliance. A very hot topic. Nearly 300 registrants signed up. We were supposed to go 30 minutes … but stayed for almost 45 due to a number of fantastic questions and insights from the audience that just kept coming. If you attended and/or submitted one…
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 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 MoreThe OIG audited 21 specific DRGs—and found heavy error rates with these four
The Office of Inspector General (OIG) released results of three acute care hospital audits with a combined $35M in recommended recoupments. 21 specific DRGs were the target, four of which landed squarely in the bullseye. SVP of Solutions Jason Jobes identified the OIG’s targets, methodology, findings, explained their extrapolation methodology, and offered strategies for risk…
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