News

Register here: https://my.demio.com/ref/Cy5EP1fPWPnkMXuq Healthcare organizations continue to be measured against the Triple Aim: improving population health, enhancing patient experience, and reducing the per capita cost of care. Yet for many, the link between revenue cycle management (RCM) and these objectives can feel indirect. The truth? CDI, coding audits, and physician queries are essential levers. Join…

By Brian Murphy Oct. 1 begins a new fiscal year and new rules and regs including the 2026 IPPS final rule and Official Guidelines for Coding and Reporting. But also a troublesome new E/M coverage policy by a major insurer that’s worth examining. And not just because of its potential payment impact, but the precedent…

75% of CDI leaders don’t know their denial rate. That should scare every CFO. The ACDIS CDI Week Industry Overview survey is out. Nearly 800 respondents answered questions related to engagement, denials, outpatient CDI, productivity, and more. Here’s a few observations. Provider engagement levels are good but not where they need to be. About 57%…

By Brian Murphy, Norwood Solutions   Cory Doctorow coined the term “Enshittification” to describe the unfortunate path many tech companies take, from greatness to ghetto. Is EHR giant Epic headed down that path? I presented a poll on LinkedIn in August to my followers, mainly mid-revenue cycle professionals. The results are included in the graph…

By Brian Murphy   It’s time to put away an old, oft-beaten strawman. CDI is way, way past the days of just CC/MCC capture. I still see this myth perpetuated, often in the context of “CDI programs are out of touch and only capture CCs and MCCs. Now buy our product!” I have no doubt…

By Brian Murphy   The AHRQ updated the Patient Safety Indicators (PSI). But before we get into them, first a reminder of what PSIs are and why they matter. PSIs provide information on potentially avoidable safety events. Each PSI has inclusion criteria (who/what gets counted; the at-risk population) and exclusion criteria (codes or conditions that…

By Brian Murphy   The American Heart Association/American College of Cardiology in June released updated guidelines on the management of acute coronary syndromes (ACS)—the first time the guidelines have been updated in a decade. I’ve summarized a few nuggets of possible interest for CDI/coding professionals. I always preface these types of updates by saying I’m…

By Jason Jobes, SVP Solutions   Nearly 70% of all Medicare lives are now in contracts that directly tie payment to patient complexity — a number that has surged from 42% in just a decade. As this shift accelerates, organizations must recognize that risk adjustment accuracy isn’t optional — it’s mission-critical. To succeed, leaders need…

By Brian Murphy   The current controversy surrounding Medicare Advantage (MA) plans and the 3-day hospital stay requirement for skilled nursing facility (SNF) care centers on disparities in coverage and potential exploitation of regulatory flexibilities. Let’s break this down. Understanding the 3-Day Rule Under traditional Medicare, beneficiaries must have a medically necessary inpatient hospital stay…

By Brian Murphy Admission: I’m pro-TEAM. It’s possibly the name but I favor the concept of the new CMS payment model, too. We keep spinning our wheels on the fee-for-service treadmill, which incentivizes volume and often results in unnecessary and fragmented care. Everyone complains about FFS, it’s hard to break free—but TEAM is a compelling…