Value-based care
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 MoreLessons 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 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 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 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…
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