News
Upcoding, AI, audits, ICD-11 all keeping medical coders up at night, according to HIM survey
By Brian Murphy What’s keeping medical coders up at night? Besides a Halloween hangover of too many scary movies and candy? Topping the list are upcoding pressures, artificial intelligence, audits, value-based care coding, and ICD-11 (yikes—scary). Thanks to Becker’s Hospital Review for offering up this helpful summary of an Oct. 18 survey…
Read MoreBack from Camp Norwood, grateful and recharged
By Brian Murphy Do you remember those camping trips you took when you were a kid? Sleeping in tents, cold and uncomfortable, and maybe a little sad to be so far from home? Camp Norwood was … not any of that. Except for far from home (at least for those of us who…
Read MoreEight frequently misdiagnosed conditions can be rectified with good CDI, coding practices
By Brian Murphy What conditions are most frequently misdiagnosed, leading to patient harm? A study by the general internal medicine team at Brigham and Women’s Hospital and Harvard Medical School in Boston (yay, my backyard! No Harvard jokes please) found that 1 in 14 general medicine patients (7%) experience harm from diagnostic errors.…
Read MoreRemote patient monitoring sees huge utilization increase, but corresponding regulatory spotlight
By Brian Murphy Remote patient monitoring has incredible potential to improve the health of our population… but many providers aren’t billing it correctly, raising the specter of inappropriate utilization or fraud, waste, and abuse. Remote patient monitoring is the use of devices (think blood pressure cuffs, CPAP machines, insulin pumps, etc.) that a…
Read MoreNew pediatric respiratory failure white paper published for CDI specialists
By Brian Murphy Pediatric clinicians (of which I’m definitely not one, but I listen well) will frequently tell you: Children are not just little adults. That goes for clinical criteria used to diagnose pediatric conditions, and associated CDI and coding work. And in particular, respiratory failure. I was very glad to see…
Read MoreAI arms race escalates battle of healthcare denials
By Brian Murphy Are we headed for a healthcare AI arms race? A hellish AI dystopia? Some days I wonder. I was reading a breathless interview with the chief technology officer of a revenue cycle management technology company. The CTO states: “Think of genAI as giving coders superpowers. It’s helping them…
Read MoreOIG audits of risk adjustment diagnoses running into familiar, repetitive roadblock—and resolution is needed
By Brian Murphy “Additionally, Humana did not agree with our audit methodology or overpayment estimation methodology.” Take the above line from the OIG’s latest audit report, remove “Humana.” Fill in the blank with another payer. The result is the same. No Medicare Advantage (MA) payer agrees with the OIG’s audit methodologies. …
Read MoreNorwood partnership allows physician group to focus on optimal patient care
A large physician group responsible for more than 175,000 lives across 300 locations doesn’t have a lot of time for self-reflection. Nor should it. Its focus is where it needs to be—providing care for a range of complex patients across more than 30 specialty services. But when it realized its quality scores and reimbursement…
Read MoreYet another reason to implement Annual Wellness Visits into your CDI/coding efforts
Detection of early cognitive decline the latest benefit of covered Medicare/Medicare Advantage service By Brian Murphy Medicare Annual Wellness Visits (AWVs) are an important piece of patient wellness and appropriate capture of acuity/severity of illness. But they’re also underutilized. You can now add another reason why you should be working to use them as a…
Read MoreCompliant capture of SDOH and chronic conditions a healthy imperative
We know about the bad examples. Insurance companies adding diagnoses solely to inflate risk scores and payment. We’ve seen the Office of Inspector General (OIG) audit reports, and a recent damning story in the Wall Street Journal (see below). Fraud should be called out, fined, and punished, when it occurs. But let’s…
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