News
New definition of Diabetic Ketoacidosis (DKA): Coding, auditing, and CDI professionals take note
By Brian Murphy The clinical definition of diabetic ketoacidosis (DKA) is changing. CDI and coding professionals take notice. A recent article on Medscape (link below) says a forthcoming definition will “de-emphasize glucose from the diagnostic criteria for DKA, along with many other updates to the last statement on the topic, which was published 14 years…
Read MoreACDIS and AHIMA add Important new Addendum to Physician Query Brief
New guidance recommends adding clinical validation language into payer contracts to head off denials By Brian Murphy ACDIS and AHIMA addended the guidelines all CDI and coding professionals should be using to write effective, compliant queries. Link below. This new addendum (you can find it on p. 27 of “Guidelines for Achieving a Compliant Query…
Read MoreNorwood takes a retreat—watch the highlights from Camp Norwood III
As a wise man once said, all work and no play make Jack a dull boy. We feel that here at Norwood too. Sometimes we all need a little retreat. The entire team at Norwood took a few days off to head to the Lucky Arrow resort in Dripping Springs, TX, Nov. 1-3. A few days…
Read MoreNew Role for Mid-Revenue Cycle Professionals: Patient Advocates
OIG report points to need for helping victims of abuse and neglect, through coded data By Brian Murphy While you’re looking for diagnoses and procedures to clarify and code to their highest level of specificity you should also be looking out for the best interests of the patient. That includes evidence of suspected abuse or…
Read MoreWhat’s in it for the physician in value-based care arrangements?
By Jason Jobes, SVP Solutions, Norwood What’s in it for me? It’s an age-old question. I feel like this also comes up a lot in the value-based care space when partnering with physicians and other providers. How do you respond to the “what’s in it for me” when a provider asks why they…
Read MoreCMS Inpatient Only List: 10 new codes added, 11 surgical codes added to ASC-covered list
By Brian Murphy CMS does not seem too interested in the practice of medicine. Nor should it; that is best left to medical school graduates and associations like the American College of Cardiology. But CMS does exert itself in this space, sometimes with backlash. See for example the hue and cry against its adoption of…
Read MoreMedicare vs. Medicare Advantage: Which will (and which should) come out on top?
By Brian Murphy Is anyone else as interested as I am in the ongoing power struggle of Medicare vs. Medicare Advantage (MA)? Established in 1965, Medicare has been dominant for decades. But MA, introduced in 2003, is its 20th year set to surpass Medicare in number of covered lives. We’re possibly at a tipping point,…
Read MoreSevere Sepsis/Septic Shock Early Management Bundle part of HVBP on Jan. 1: Are you ready?
By Brian Murphy Hospitals are about to have (additional) reasons to get sepsis documentation and coding right. As if they didn’t already. Hospitals have been implementing and documenting the Severe Sepsis/Septic Shock Early Management Bundle, aka., SEP-1 for years through the Inpatient Quality Program. There were already incentives to document it, including payment. But CMS…
Read More$172M Cigna false claims act settlement serves as a compliance blueprint
By Jason Jobes $172.3M should get attention. The Justice department settled a false claims case with Cigna surrounding its chart review program from 2014-2019. See link to the news release below. As always, thank you for liking, commenting, and sharing these posts. To succeed in risk adjustment an organization needs to ensure that risk…
Read MoreDenials Prevention: Strategies for Success
Norwood webinar Denials prevention: Strategies for success Thursday, Oct. 26, 1-2 p.m. EST. Register here: https://my.demio.com/ref/1ieRImvdUAmWsxA0 Denials can bleed your organization dry. A recent independent Kaiser Family Foundation survey found that insurers deny, on average, 18% of all claims. And for some private insurers, that number is far higher. How can you make your organization…
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