News
Three new rules/regulations to watch, effective Oct. 1
By Brian Murphy Thursday, Oct. 1 is the start of three big changes hitting the mid-revenue cycle all at once. 1) Updated ICD-10-CM Official Coding Guidelines, 2) New/deleted/revised ICD-10 codes, 3) new IPPS regulations. Here’s a summary with added focus on the OCG because I’ve covered 2 and 3 prior. Official Coding Guidelines…
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 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…
Read MoreOIG offers clinical scenarios that can illuminate your own audit vulnerabilities
The recent Office of Inspector General (OIG) audits of three acute-care hospitals offer a goldmine of clinical/coding examples that you should be using for pre-emptive audit defense. Validating DRG assignments, reviewing medical necessity documentation completeness, and educating providers before an auditor comes knocking—and uses extrapolation to greatly increase recoupments. Here are examples taken from the…
Read MoreInpatient Audit Storm Clouds
Download the report on our resource page. The Office of Inspector General (OIG) never rests. After taking on Medicare Advantage organizations and aggressive risk adjustment coding practices from 2023-2025, the sights of the nation’s regulatory watchdog have shifted. The new target? Acute care hospitals and inpatient admissions. Plus some other outpatient odds and ends. This…
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 MoreYou should be billing G2211 in heavy volume, per CMS
Who remembers G2211? Starting in 2024 this CPT code took the mid-revenue cycle by storm. Despite paying very little ($16.04) it was intended to be used in quantity. It has been. A new study by the Journal of the AMA found that its first year of full use, calendar year 2024, G2211 was billed 26…
Read MoreNew 2027 ICD-10 codes are out (effective Oct. 1)—what you need to know
By Brian Murphy The 2027 ICD-10-CM (diagnosis) and ICD-10-PCS (procedure) codes are out. You can view them on the CMS website at the link below. They take effect Oct. 1, 2026. So what do we have? At a high level: ICD-10-CM: 190 new codes, 30 deletions, 4 code revisions ICD-10-PCS: 101 new codes, 38 deletions,…
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