News
Code Red: CMS announces massive audit expansion of Medicare Advantage, raising risk adjustment coding questions
By Brian Murphy For a while I felt like this was coming to a head. As far back as 2016-2017 I was monitoring reports of Medicare Advantage (MA) plans under investigation for alleged fraud related to HCC upcoding. I wondered when we’d see massive, coordinated action. That day is here. On May 21 CMS announced…
Read MoreAre you assigning admit type based on NUBC guidelines—or a loose interpretation to influence quality metrics?
By Brian Murphy Prior to our Off the Record podcast recording my guest Penny Jefferson shared with me a white paper she authored on admit type. I’m going to summarize a bit of it here as it was a substantive basis of our conversation. The paper begins by differentiating between admit status and admit type.…
Read MoreStructure your physician advisor program not just for financial ROI, but work-life balance
By Brian Murphy Physicians are the lifeblood of a hospital. They provide lifesaving treatment and specialized care but also write the admission orders that keep the lights on. So how do you take 15 physicians and carve out half of their priceless time for CDI? By demonstrating return on investment (ROI). A.J. Hegg is an…
Read MoreWorried how you’ll survive in V28 of CMS-HCCs? Fear not, we’ve got the guide
By Brian Murphy Download the CMS-HCCs V28 Survival Guide To survive in Version 28 of CMS-HCCs, you need a playbook. Check that, you need a survival guide. The good news is, we’ve put one together. Download Norwood SVP Jason Jobes’ analysis of the changes, the data and analytics underpinning the new risk model, and a…
Read MoreIs a computer-generated nudge a query? According to extant guidance, yes… but do we need new guidance?
By Brian Murphy Is a nudge, a best practice alert, or some other machine prompted question to a physician, a query? I’m risking a very contentious topic here. But it’s one that comes up a lot in conversation. According to the latest ACDIS-AHIMA query brief, the answer is yes. A query is a query is…
Read MoreAssigning codes from clinicians other than the patient’s provider
By Brian Murphy One of the hard truths about medical coding is that codes can only be assigned based on documentation from the patient’s provider. More specifically, a qualified physician or other practitioner who can be held legally accountable for rendering a patient’s diagnosis. This rule undoubtedly is a source of frustration and even provider…
Read MoreGood denial news: 2026 Medicare Advantage Final Rule prevents MA plans from reopening previously approved inpatient admissions
By Brian Murphy CMS in April released the 2026 Medicare Advantage final rule. Here’s three important items you should know about. Between this and the 2026 IPPS proposed rule we’re drowning in rules, so if you hope to stay on top it’s important to read what experts have to say. One such person is Richelle…
Read More2026 IPPS proposed rule: Seven key takeaways for CDI, coding professionals
The FY 2026 IPPS proposed rule is out… what does it contain? With the change in administration I wondered if we wouldn’t see a delay or even suspension of new IPPS rules. That wasn’t the case. The rule was published Friday, April 11. Overall, no huge changes or surprises. I wouldn’t call the 2026 IPPS…
Read MoreSocial Determinants of Health (SDOH), integral to preventive medicine and cost reduction, in jeopardy under new CMS administration
By Brian Murphy Health is far more than just biology, pathophysiology, or medical facts about a patient. Non-medical factors influence health outcomes, including the conditions into which people are born and live. Think about housing instability, lack of access to care, poor food security, and (un)employment. Today we call these social determinants of health (SDOH).…
Read MoreNorwood Inpatient CDI Boot Camp approved for AHIMA, ACDIS CEUs
Norwood is pleased to announce its new Inpatient CDI Boot Camp has been approved for 18 CEUs by AHIMA* and ACDIS ** (see full details below). This three-day in-person class offers client partners in-depth training on critical CDI concepts that improve the financial and quality health of their organization, including opportunities by Major Diagnostic Category,…
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