News

A Norwood special report Download the report here. CDI trends come and go. Retrospective reviews become concurrent and then, prospective. At the elbow record review goes remote. Regulations and code sets change, too: ICD-9 gives way to ICD-10, DRGs to MS-DRGs and HCCs. Today artificial intelligence is the buzzword and the reported cure for all…

Register here: https://my.demio.com/ref/v1rDIDccDyru0SEW Only 31% of U.S. healthcare organizations have a dedicated outpatient CDI program—yet risk-based contracts, MSSP performance pressure, and documentation complexity are accelerating every year. The result? Most organizations are unknowingly leaving substantial RAF revenue unclaimed, exposing themselves to avoidable compliance risk, and missing the chance to influence performance before 2026 benchmarks lock…

By Brian Murphy Sizable changes are coming Jan. 1 to telehealth, chronic illness and behavioral health management and reimbursement, and physician payment formulas per the recently released 2026 Medicare physician fee schedule final rule. I’ve summarized a few I find interesting. Telehealth commitment. I’m most excited about these changes. In a long overdue move CMS…

By Brian Murphy We’ve got another blanket E/M downcoding policy set to take place on Monday, just after Halloween. Not a treat. Not a totally unexpected trick, either. A large insurer in my home state of Massachusetts, Blue Cross Blue Shield of MA, will review E/M claims from providers who consistently bill at levels 4…

Implementing an outpatient CDI program across a large integrated healthcare organization with nearly 80 physician practices and a half-dozen urgent care and community medical centers, all at once, is a daunting task. Too much for one partner organization to bite off. We agreed, and so in June 2024 got them off the runway with a…

In May CMS dropped one of the biggest announcements since the advent of ICD-10: An exponential increase of Medicare Advantage (MA) risk adjustment audits. The agency planned to hire 2,000 coders, ramp up its tools with AI and tech, and launch a full-on audit storm. We were all braced for extrapolated, multi-million-dollar recoupments of every…

Revenue category code 068.X and HCPCS code G0390 allow trauma centers to cover the high costs of keeping a trauma team on standby—surgeons, ER physicians, anesthesiologists, nurses, etc.—and the incredibly complex, specialized care needed in some of the worst emergencies you’d ever want to imagine. But with high reimbursement comes OIG scrutiny. The recent OIG…

By Jason Jobes, SVP Solutions, Norwood Breaking CMS news to report… the revised MSSP results are out. The impact? $40.4M in additional shared savings. 77% of organizations saw an INCREASE in their shared savings. My lingering question is … are these results the final ones? And are they accurate? In August CMS released MSSP results.…

By Brian Murphy, Norwood Solutions   The latest episode of Off the Record dropped last week and the call to action couldn’t be clearer: Outpatient CDI is the missing ingredient in your healthcare organization. We packed a lot into this episode, but here are three takeaways right off the top to get you moving. Aggressively…

By Brian Murphy   Score a major win for Medicare Advantage (MA).   A Texas district court ruled on Thursday, Sept. 25 that CMS must vacate the final risk adjustment data validation (RADV) rule of 2023.   The court ruled that the CMS rule did not give adequate notice nor comment period to a groundbreaking…