News
HIV, hypertension with heart disease, BMI and more updated in ICD-10-CM Official Guidelines for Coding and Reporting effective Oct. 1, 2025
The new ICD-10-CM Official Guidelines for Coding and Reporting are out. Let’s take a closer look. … but before we do, know that these are effective Oct. 1, 2025. So until then stick with the current guidelines. I’m listing here just the major highlights; this summary is not exhaustive and there are many small changes…
Read More2026 OPPS proposed rule: Three things you should know about
By Brian Murphy Here’s three things I found interesting in the OPPS proposed rule, that will impact your hospital and the work you do—if passed. Between the physician fee schedule and the OPPS this was a heavy rulemaking week. Heck, it’s been a heavy rulemaking last couple of months under the new administration. But today…
Read MoreMid-revenue cycle professionals must ask: What would make our physicians’ lives easier?
By Brian Murphy Every so often—check that, on a regular basis—it pays to step back and think about the physician. We are pushing ever more complex, freighted decisions on the MD. Asking for more, and for less reimbursement. Instead of focusing on just optimal coding and documentation, we should also ask: How can we make…
Read MoreElixhauser: A mouthful to say, but a must know concept in understanding hospital quality and performance
By Brian Murphy Elixhauser. That’s the post. Still with me? I get it. What a name and a mouthful. I think I first heard it from Dr. James Fee in my ACDIS days. I thought he’d either busted out some piece of obscure clinical terminology or suffered an aneuryism. I later heard it from Cheryl…
Read MoreCode Red: CMS announces massive audit expansion of Medicare Advantage, raising risk adjustment coding questions
By Brian Murphy For a while I felt like this was coming to a head. As far back as 2016-2017 I was monitoring reports of Medicare Advantage (MA) plans under investigation for alleged fraud related to HCC upcoding. I wondered when we’d see massive, coordinated action. That day is here. On May 21 CMS announced…
Read MoreAre you assigning admit type based on NUBC guidelines—or a loose interpretation to influence quality metrics?
By Brian Murphy Prior to our Off the Record podcast recording my guest Penny Jefferson shared with me a white paper she authored on admit type. I’m going to summarize a bit of it here as it was a substantive basis of our conversation. The paper begins by differentiating between admit status and admit type.…
Read MoreStructure your physician advisor program not just for financial ROI, but work-life balance
By Brian Murphy Physicians are the lifeblood of a hospital. They provide lifesaving treatment and specialized care but also write the admission orders that keep the lights on. So how do you take 15 physicians and carve out half of their priceless time for CDI? By demonstrating return on investment (ROI). A.J. Hegg is an…
Read MoreWorried how you’ll survive in V28 of CMS-HCCs? Fear not, we’ve got the guide
By Brian Murphy Download the CMS-HCCs V28 Survival Guide To survive in Version 28 of CMS-HCCs, you need a playbook. Check that, you need a survival guide. The good news is, we’ve put one together. Download Norwood SVP Jason Jobes’ analysis of the changes, the data and analytics underpinning the new risk model, and a…
Read MoreIs a computer-generated nudge a query? According to extant guidance, yes… but do we need new guidance?
By Brian Murphy Is a nudge, a best practice alert, or some other machine prompted question to a physician, a query? I’m risking a very contentious topic here. But it’s one that comes up a lot in conversation. According to the latest ACDIS-AHIMA query brief, the answer is yes. A query is a query is…
Read MoreAssigning codes from clinicians other than the patient’s provider
By Brian Murphy One of the hard truths about medical coding is that codes can only be assigned based on documentation from the patient’s provider. More specifically, a qualified physician or other practitioner who can be held legally accountable for rendering a patient’s diagnosis. This rule undoubtedly is a source of frustration and even provider…
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