News
Shore 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…
Read MoreMedicare Advantage battle over rising risk scores, removal of diagnosis codes from HCC model boiling over
By Brian Murphy The battle over Medicare Advantage coding and reimbursement is coming to a head. CMS on Feb. 1 released its Advance Notice, which included removal of more than 2,200 diagnosis codes from the HCC model. Some diagnoses will be added, but per ACDIS diagnoses proposed for elimination from the model include acute kidney failure,…
Read More“Bermuda triangle” of Medicare Advantage scrutiny signals alarm bells: Get your risk adjustment house in order
By Jason Jobes Is healthcare prepared to sustain the onslaught of changes to Medicare Advantage payments? How will it impact the industry? How does it impact you? At the beginning of this month I attended the RISE conference, which serves a community of established and emerging leaders in the Medicare Advantage and managed care space.…
Read MoreCultivating the right mindset, values will take you far in HIM (and life)
By Ken Macklem, RHIT, CCS My career in healthcare started in the medical records department, filing paper. I loved it, and that led me to abstracting labs for the coding department. I took a coding class at Mt. Saint Mary’s (this was in the pre-credential days) and learned CPT and ICD-9 by the book, before…
Read MoreTelehealth: Unrecognized CDI/coding Opportunity
By Brian Murphy Telehealth is in the news again, not all of it good. Below is a piece on Teladoc, which appears to be on the ropes after suffering a historic ($13.7B) loss in 2022. But before we declare this service dead, let’s review where we are. I believe that telehealth has its place in…
Read More