News
Medicare 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…
Read MoreState of CDI in 2023: Outpatient CDI, sufficient staffing still a work in progress; opportunities abound!
By Brian Murphy CDI Week 2023 wrapped up in September and I thought I’d review the highlights (or at least most interesting bits) of my favorite annual ACDIS Survey: The CDI Week Industry Overview Survey. It’s always worth checking out this survey to get a handle on ongoing trends and year-over-year changes in…
Read MoreThe time for risk adjustment coding, outpatient CDI is now
By Brian Murphy In my ACDIS days we launched the CCDS-O (outpatient) certification in 2017. The response, while positive, was not nearly the same as the CCDS (inpatient) received in 2009. In hindsight we were ahead of the curve. While risk adjustment was a concern, and a big one for some facilities, for others the…
Read MoreHyponatremia and the bar of query: How much evidence before you clarify the presence of a diagnosis?
By Brian Murphy How much evidence do you need, or does your organization require, before you send a query? A broad and difficult question, and obviously much depends on the diagnosis in question. But I’m interested in the big picture. (As always with these types of posts, I stress that I’m neither a clinician or…
Read MoreBuilding and Reinventing Pediatric CDI Programs
Thursday, Sept. 21, 1-2 p.m. EST. Register here: https://my.demio.com/ref/Bvi1r8BxSduVGq0b It’s frequently been said (in the context of clinical medicine) that children are not just little adults. You can’t treat them the same way, even with a similar diagnosis. So why should pediatric CDI programs be any different? Pediatric CDI brings with it a unique array…
Read MoreImprove outpatient CDI outcomes, risk adjustment metrics with Owl by Norwood
The cat is out of the bag—or more appropriately, the Owl has flown the coop. The team at Norwood has been working behind the scenes on a piece of assistive software, and we’re ready to give it flight. Owl by Norwood was born out of a need we saw while performing chart audits…
Read MoreCutting through the confusion of CMS-HCC version 28 implementation date
By Jason Jobes When does CMS-HCC V28 take effect? Confused? You are not alone. I am going to break it down to ease some of the confusion around the new risk model. Thanks for reading. If you find this helpful, please reply with a comment, follow me on LinkedIn, or share this email as that…
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