Recommended CDI/coding Resources to Follow

coding resources

By Brian Murphy Someone asked me in a recent post, “I want to stay up on CDI/coding/reimbursement news to help my career… what do you recommend?” Here is what I do. Subscribe to these e-mail newsletters: Office of Inspector General (OIG). A rundown of what the chief enforcer and protector of the Medicare Trust Fund…

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Common CC/MCC diagnoses of focus

What complication/comorbidities (CC) and major CCs (MCCs) are common sources of clarification in your healthcare organization or hospital? I have a good idea of what they probably are but am genuinely curious about yours; leave a comment below. We’ve got long lists in places such as the ACDIS Pocket Guide and CDI Pocket Guide, and…

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New RADV rule coming soon; get your HCC compliance in order

The buzz is officially starting to build around the impending release of the Medicare Advantage Risk Adjustment Data Validation (RADV) final rule, which is expected to be published on or before Feb. 1 after years of delay. I hate to sound melodramatic (actually I don’t, healthcare reimbursement isn’t typically this dramatic and I need some…

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“You need to have a vision”: A conversation with Adelaide LaRosa, VP of HIM, CDI, EMPI, and DRG Appeals, Catholic Health

off the record

You’ll find few CDI/coding personalities as big and colorful as Adelaide LaRosa—and fewer still with a broader and bolder vision for what mid-revenue cycle professionals can do, and should do, to improve the quality and financial health of their organizations. Catholic Health’s VP of HIM, CDI, EMPI, and DRG Appeals reordered the entire heart of…

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ACDIS/AHIMA release new query practice brief, are you ready?


By Brian Murphy The new ACDIS/AHIMA Guidelines for Achieving a Compliant Query Practice are out. Why care about this new guidance? The Guidelines are not law or regulation, but they are the standard that the two organizations recommend everyone follow. And that means literally everyone involved in the query process—CDI and coding of course, but…

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Population Health: Eight Strategies for Success

population health

By Brian Murphy Note: This is the second in a two-part series on how mid-revenue cycle professionals can successfully operate in population health. View part 1 here. Population health is the current buzzword in healthcare. But do you know how to succeed in these environments? Population health initiatives often stall due to silos within the…

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Cigna’s OIG Takedown a Thing of Beauty in an Ugly War

oig takedown

By Brian Murphy Many on the provider side of healthcare—including coding/billing/CDI/case management professionals—are not the biggest fans of Medicare Advantage (MA), aka, the semi-privatization of Medicare. MA has been under the spotlight recently for denying medically necessary care, as well as failing to demonstrate better outcomes despite charging higher premiums. But I have to hand…

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