News
Sepsis-2, sepsis-3, or sepsis-2.5? Varying definitions lead to denials
By Brian Murphy Sepsis is back in the news. I doubt many in the CDI and coding communities are surprised. Sepsis remains at the most frequently posed query among CDI professionals. The most recent ACDIS CDI Week Industry Overview Survey had sepsis topping the list, followed by respiratory failure and malnutrition. Sepsis a difficult condition…
Read MoreCMS Hospital Readmissions Reduction Program: Inadvertent cause of patient harm?
By Brian Murphy Financial incentives are a powerful tool. If you want someone to perform in a certain way, you can encourage, threaten, or cajole them to do so… or you can tangibly reward them with payment for good outcomes, or penalize them for poor behavior. CMS understood this when it implemented the Hospital Readmissions…
Read MoreAHIMA Clinical Validation practice brief (2023 update): Should we code diagnoses documented by the provider if they do not meet any established definition or clinical criteria?
I disagree with one portion of the recently released AHIMA practice brief, Clinical Validation (2023 Update). And agree with the rest. That does not mean it’s wrong. Just that I have a different take on a complex and contentious issue. My concerns are with this paragraph: When contracting with payers, organizations should…
Read MoreNorwood cracks top 100 in 2023 Inc. 5000 list
With a three-year revenue growth of 5,189 percent, Austin-based company ranks no. 90 among America’s Fastest-Growing Private Companies; no. 10 in Texas. NEW YORK, August 15, 2023—Inc. magazine revealed that Norwood ranks No. 90 on the 2023 Inc. 5000, its annual list of the fastest-growing private companies in America. This prestigious ranking provides a…
Read MoreHealth equity, paying for quality outcomes the focus of 2024 IPPS final rule
By Brian Murphy CMS released the 2024 IPPS final rule Tuesday August 1. I covered the proposed rule when it was released back in April and as near as I can tell all its proposals were finalized. The emphasis is on health equity, measuring and paying for quality outcomes, and a little on bringing…
Read MoreThe Importance of Risk Adjustment in Value-Based Care Contracts
Tuesday, August 15, 1-2 p.m. EST Speaker Jason Jobes, BA, MSPA, SVP Solutions, Norwood Register here: https://my.demio.com/ref/598koA0hE1w2zFHB It’s no secret—healthcare reimbursement is evolving before our eyes, from traditional fee-for-service to value-based care/pay for performance. Medicare Advantage is poised to surpass traditional Medicare this year in the number of covered lives. Good…
Read MoreOIG targeted audits yield more immediate overpayments, but random audits may have more impact from extrapolation
Continuing the review of my findings from the OIG’s review reports (you can find links to parts 1 and 2 below), in this month’s issue of Mid-Revenue Cycle Minute I am turning my attention to random audits. Overall, there were only three random audits concluded and shared by the OIG in 2022-2023. In fact, the…
Read MoreNew CMS proposed rules increase transparency, mental health treatment, but provide little additional payment
CMS on Thursday July 13 released the 2024 outpatient prospective payment system (OPPS) and Medicare Physician Fee Schedule (MPFS) proposed rules … and as expected these were met with howls of outrage from the two leading impacted stakeholders, the American Medical Association (AMA) and the American Hospital Association (AHA). I can’t say I blame…
Read MoreOIG audits of Medicare Advantage reveal four eye-opening stats
Part 2 of an ongoing series Before I delve into part 2 of this ongoing series on my review of Medicare Advantage audits, I want to say thank you for all of the support, and for the warm reception of part 1 of this ongoing series. Please continue to like, comment, or share. The dialogue…
Read MoreSix Reasons Why Contract CTR Work Might be the Right Move for You
By Celeste Austin There is a lot of flexibility in being a contract Certified Tumor Registrar (CTR). It opens doors of possibilities when people are able to take their expertise and hard-earned certification into the project market! Here are six reasons why some people choose to do project-based contracting as opposed to working directly for…
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