News
Norwood MS-DRG audit results in substantial DNFB reduction, missed revenue opportunities
Even with the rapid growth of risk adjusted payments, Medicare Severity DRGs (MS-DRGs) remain the principal reimbursement mechanism for most healthcare organizations. But despite their relative maturity there is always room to improve MS-DRG assignment. Missed complications/comorbidities (CC) and major CCs, inaccurate principal diagnosis assignment, and non-specific/symptom DRGs lead to underreported severity of illness.…
Read MoreNew CMS FAQ sheds additional light on compliant use of new HCPCS add-on code G2211
By Brian Murphy Attention coders and mid-revenue cycle professionals: CMS has released a frequently asked questions (FAQ) document for new HCPCS add-on code G2211. Link below. My colleague Crystal May wrote an article about this interesting but troublesome new code (which went into effect Jan. 1), summarizing the guidance we had to…
Read MoreLatest OIG report: $59M reasons to ensure accurate HCC capture
Latest OIG report: $59M reasons to ensure accurate HCC capture By Jason Jobes Want $59M worth of reasons to ensure accurate HCC capture? Read the latest OIG audit report of Medicare Advantage, this time of MMM Healthcare. While the penalty was only $165k, had extrapolation started in 2017 (the time period of…
Read MoreNew CMS claims-based surgical quality measure is in effect; are you ready?
By Brian Murphy In the 2025 IPPS final rule CMS finalized its proposal to replace PSI-4 (Death Rate Among Surgical Inpatients with Serious Treatable Complications) with a new claims-based measure: The Thirty-day Risk-Standardized Death Rate among Surgical Inpatients with Complications (Failure-to-Rescue). In fact, this change has already taken place. This new measure…
Read MoreCould Supreme Court Chevron ruling bring chaos to medical coding and billing? Possibly.
By Brian Murphy The traditional authority granted to institutions has been steadily eroded in recent years, and in the wake of the landmark Chevron ruling it’s been dealt another blow. Could medical coding be next? I draw your attention to this thoughtful article by HIM expert Rose Dunn, on the blog of Libman…
Read MoreOIG report on mechanical ventilation raises compliance red flags
By Brian Murphy Medicare improperly paid hospitals an estimated $79 million for patients who received mechanical ventilation. Is your healthcare organization among them? The OIG released a new report taking aim at MS-DRGs 207 and 870. It selected for review a random, stratified sample of 250 claims submitted between 2015-2021 with payments…
Read MoreMake ethics the top of your operating set of principles
By Brian Murphy ACDIS recently updated its Code of Ethics. It’s worth reading; I’ve linked to it below. Even if you’re an industry old-timer I recommend a refresher, to remind yourself what should be at the top of your operating set of principles. We can debate the finer points of ethics as…
Read MoreNorwood ranks No. 682 on 2024 Inc. 5000 list
For the 2nd straight year, Norwood makes the cut with three-year revenue growth of 694% NEW YORK, August 13, 2024 – Inc. revealed today that Norwood ranks No. 682 on the 2024 Inc. 5000, its annual list of the fastest-growing private companies in America. This prestigious ranking provides a data-driven look at the most…
Read More2025 IPPS final rule has something for everyone in CDI, inpatient coding
New CCs and MCCs, TEAM model implemented, and new quality measures among other changes By Brian Murphy The 2025 Inpatient Prospective Payment System (IPPS) final rule is out, and takes effect Oct. 1, 2024. These rules are always long and this one is no exception, but here’s some interesting bits I pulled out for CDI…
Read MoreMeet MEAT criteria to shore up your risk adjustment coding against denial
By Joanne Wilson, RN, ASN, CCDS, Senior Director, Solutions Monitoring, evaluating, assessing, or treating—also known as MEAT—is a well-known and helpful concept organizations and coding professionals should use in the risk adjustment space. Adequate MEAT criteria can shore up claims from denial and prevent costly takebacks from auditing agencies—and remove the bullseye from your organization’s…
Read More