News

By Brian Murphy   CDI Week might be winding down … but I’m keyed up for the ACDIS Industry Overview Survey.   This annual “state of the industry” special report is worth reading, providing both the big picture of the profession and interesting year-over-year trends so you can see how the times are a-changing.  …

By Brian Murphy   Z59 and other social determinants of health (SDOH) are difficult to capture in ICD-10. How are you doing it? A recent study published in the Journal of the American Medical Association (JAMA) demonstrated that housing instability, as captured with the Z59 series, is not being accurately assigned. At all. The JAMA…

By Brian Murphy   File this under reason 1,227 to diligently work to capture malnutrition.   Medscape recently covered a study published in Aging Clinical and Experimental Research. The study followed 319 patients aged 65+, hospitalized for the first time with COPD in Southwest China. Median age was 76 days and patients averaged five comorbidities.…

High-quality coding and CDI professionals are costly. Labor expenses as a whole comprise over 50% of a facility’s expenses. But strategic staffing can actually boost your ROI. One of our partners saw a significant return by optimizing coverage rates. Download the full article and uncover the secrets to maximizing your staffing investment.

Even with the rapid growth of risk adjusted payments, Medicare Severity DRGs (MS-DRGs) remain the principal reimbursement mechanism for most healthcare organizations.   But despite their relative maturity there is always room to improve MS-DRG assignment. Missed complications/comorbidities (CC) and major CCs, inaccurate principal diagnosis assignment, and non-specific/symptom DRGs lead to underreported severity of illness.…

By Brian Murphy   Attention coders and mid-revenue cycle professionals: CMS has released a frequently asked questions (FAQ) document for new HCPCS add-on code G2211.   Link below.   My colleague Crystal May wrote an article about this interesting but troublesome new code (which went into effect Jan. 1), summarizing the guidance we had to…

Latest OIG report: $59M reasons to ensure accurate HCC capture   By Jason Jobes   Want $59M worth of reasons to ensure accurate HCC capture? Read the latest OIG audit report of Medicare Advantage, this time of MMM Healthcare.   While the penalty was only $165k, had extrapolation started in 2017 (the time period of…

By Brian Murphy   In the 2025 IPPS final rule CMS finalized its proposal to replace PSI-4 (Death Rate Among Surgical Inpatients with Serious Treatable Complications) with a new claims-based measure: The Thirty-day Risk-Standardized Death Rate among Surgical Inpatients with Complications (Failure-to-Rescue).   In fact, this change has already taken place.   This new measure…

By Brian Murphy   The traditional authority granted to institutions has been steadily eroded in recent years, and in the wake of the landmark Chevron ruling it’s been dealt another blow. Could medical coding be next?   I draw your attention to this thoughtful article by HIM expert Rose Dunn, on the blog of Libman…

By Brian Murphy   Medicare improperly paid hospitals an estimated $79 million for patients who received mechanical ventilation.   Is your healthcare organization among them?   The OIG released a new report taking aim at MS-DRGs 207 and 870. It selected for review a random, stratified sample of 250 claims submitted between 2015-2021 with payments…