News
Medicare 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 MoreCDI Suggestion: Start your reviews off right with ED/EMS Notes
By Brian Murphy There is no one true way to perform a review of the health record. Some CDI specialists prefer to start with the history and physical before beginning, often 24-48 hours post-admit until significant documentation has been generated. Others want to start immediately after admission with a review of the ED record. Regardless…
Read MoreNorwood welcomes CDI expert Deanne Wilk to Solutions team
We’d like to welcome the latest edition to our Norwood Solutions team… Deanne Wilk! If you’ve been involved in ACDIS and/or the CDI profession over the last decade, odds are you’ve seen Deanne. She served on the ACDIS advisory board (2017-2020) where she helped develop industry guidance and white papers. If you haven’t seen her…
Read MoreGood coding, CDI Practices can Reduce CMS Hospital Readmissions Reduction Penalties
By Brian Murphy Is your hospital among the nearly 2,300 dinged for excessive readmissions (“excessive” as defined by the parameters of the CMS Hospital Readmissions Reduction Program, or HRRP)? The latest HRRP numbers are out. Kaiser Health News always does a great job covering the details. Link below. Per KHN, CMS evaluated 2.5 years of…
Read MoreCoding Tip: Reporting additional diagnoses in the outpatient setting
Are you one of those coding professionals who anxiously awaits the quarterly release of AHA Coding Clinic? There’s nothing like that feeling when you open the latest issue and read through the latest and greatest nuggets of wisdom. It is like a box of chocolates; you never know what you’re going to get! Sometimes it’s…
Read MoreChatGPT, problem lists, and Recovery Auditors… oh my!
Three CDI and coding related thoughts … A dark vision of ChatGPT. In case you’ve been living under a rock, there’s a new AI-powered program called ChatGPT that can generate readable (perhaps good? At least usually quite understandable) copy from prompts entered by a human user. This development has generated angst and anxiety, but…
Read MoreAHA critiques Medicare Advantage, makes recommendations regarding sepsis criteria, SDOH, and medical necessity determinations
By Brian Murphy The American Hospital Association’s commentary to CMS on the Medicare Advantage (MA) program CY 2024 proposed rule is a good read … if you are a CDI and coding policy wonk who likes this sort of thing. As I do. Because it offers a candid look into who wields the ultimate power…
Read More