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How Norwood changed an organization’s CMI trajectory–to the tune of $2.56M

A drop in case mix index (CMI) isn’t necessarily indicative of a problem. A high-performing surgeon leaves your hospital, observation cases tick up seasonally, and you get a short-term drop.   But flagging CMI over time warrants a closer look.   Last…

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CC/MCC changes in 2027 IPPS final rule: We summarize them for you

The 2027 IPPS final rule includes several CC/MCC reimbursement changes to diagnoses you should be aware of. Watch for these in the documentation and report…

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The OIG audited 21 specific DRGs—and found heavy error rates with these four

The Office of Inspector General (OIG) released results of three acute care hospital audits with a combined $35M in recommended recoupments. 21 specific DRGs were…

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Lessons from loss: A look from the inside of value-based care with Rose Bernards

Listen to the podcast. Rose Bernards is a believer in value-based care. It’s been a driving force in her career.  But it was put to the test…

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OIG offers clinical scenarios that can illuminate your own audit vulnerabilities

The recent Office of Inspector General (OIG) audits of three acute-care hospitals offer a goldmine of clinical/coding examples that you should be using for pre-emptive…

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