News
How do you handle “unable to determine” query responses?
By Brian Murphy Unable to determine. Love it? Hate it? Or do you understand why it must (usually) be offered as a query option? The latest ACDIS-AHIMA guidance, Guidelines for Achieving a Compliant Query Practice, imply that “unable to determine” should typically (but crucially, not always) be offered to the physician in a traditional multiple-choice…
Read MoreMajor Depressive Disorder: Report accurately, and shore up the medical record against denial
By Brian Murphy Large caveat to the following: I am not a clinician, nor a coder, though my work frequently brushes up to clinical coding. I was having a recent conversation with my colleague Jason Jobes for an upcoming episode of Off the Record, during which we touched on OIG audits of HCCs and unsupported…
Read MoreForeign Medical Graduates: Finding a Clinical Calling, and a Career, Through CDI
By Brian Murphy Sulaiman Rasheed (“King Solomon,” or “Sully,” as his colleagues call him) took the long way to CDI. Literally and figuratively. A native of Pakistan, Rasheed is a graduate of Gandhara Medical University. He once dreamed of being a doctor. Today he has realized a dream he never knew he had—CDI professional. Rasheed…
Read MoreStruggling to land a job? Learn and avoid these common reasons for rejection
By Celeste Austin, Business Development Manager, Norwood Are you on the job market but struggling to land a job—even after what seems like an eternity? If you get a vague rejection after an interview, there’s always a valid reason behind it that your recruiter may not be able to share in detail—either out of respect…
Read MoreShore up the medical record and your hospital with these denials-busting documentation strategies
By Brian Murphy If you’re a CDI specialist these days, odds are you will be involved in denials. According to the 2022 ACDIS Industry Overview Survey released in February, 68% of respondents indicated that they were involved in the denials or appeals process—10% higher than in 2021 (1). We wanted to get some tips and…
Read MoreExplosive growth of Medicare Advantage covered lives requires organizational mindset shifts
By Jason Jobes, SVP Consulting How do you incorporate the growth of rate of Medicare and/or Medicare Advantage in your organizations operational plans? Do you monitor changes in market share when considering population changes moving forward? As of April, 2023 there are 64.4 million Medicare beneficiaries in the country. This has grown from 57.9 million…
Read MoreCMS 2024 IPPS proposed rule reclassifies homelessness SDOH codes as CCs
CMS released the 2024 Inpatient Prospective Payment System (IPPS) proposed rule on Monday, April 10. Links to the summary and the rule in full below. I love that homelessness, which was already a reportable code, will now be paid as a complication/comorbidity (CC). Homelessness CCs include: Z59.00 Homelessness unspecified Z59.01 Sheltered homelessness Z59.02…
Read MoreRules and rules: CMS releases burdensome Medicare Advantage final rule with three-year phase-in
By Jason Jobes CMS has once again shown that it has no concept of the administrative burden it places on providers that ultimately detracts from their ability to provide quality care. There simply is so much to say about the final CMS Medicare Advantage rule. Let me start by saying I don’t think anything in…
Read MorePositive or negative reinforcement… which works best? HAC and HRRP vs. Meaningful Use
By Brian Murphy The recent release of the 2024 IPPS proposed rule got me thinking about the Hospital Acquired Condition (HAC) and Hospital Readmissions Reduction (HRRP) programs. Both are built upon the precept that hospitals will respond positively to the threat of penalties by improving their quality of outcomes. Quick refresher on these programs: Hospitals…
Read More2024 Final Medicare Advantage Rate Announcement phases in V28 changes, ICD-10 code removals
By Brian Murphy The 2024 Medicare Advantage Rate Announcement (aka., final rule) is out. As CMS loves to do with big policy announcements, it was released under cover of darkness, i.e., late Friday afternoon as the weekend was upon us. My colleague Jason Jobes has started a running thread on LinkedIn that I recommend you…
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