A very bad start to the year for Medicare Advantage; whistleblowers and government officials expose questionable risk adjustment coding practices

By Brian Murphy   This has been a terrible start to the year for Medicare Advantage. Senator Chuck Grassley’s report “How UnitedHealth Group Puts the Risk in Medicare Advantage Risk Adjustment” landed like a bombshell on Jan. 12. It revealed the extent of UHG’s “robust diagnosis capture workforce,” from advanced analytics to in-home health assessments…

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From Encephalopathy to Edema: Talking chart review with Dr. Tarman Aziz

Listen to the episode here. I’m consistently surprised at how few CDI or IP coding professionals talk about their most basic job function. The very reason they are hired, and what most do for eight hours a day.  I’m talking about chart review.  Go on Linkedin or Facebook and it’s rarely discussed.   Yet it’s … everything. Nuanced, complex, clinical, critical to the quality of financial health of hospitals. It’s how patient acuity is expressed in coded data, how hospitals get paid, and why CDI and coding professionals are employed. …

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Mission-Driven Medicine: Dr. Pablo Buitron de la Vega’s SDOH crusade, from capture to care

Listen to the episode here.   Social Determinants of Health, or SDOH, are a buzzword these days—but often little more. We acknowledge their importance, but actual progress on capture (and subsequent patient support) has been slow. To be fair real barriers including technological limitations and limited financial incentives stand in the way. But my current…

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Tonya Motsinger: Surviving and thriving in an evolving CDI landscape

Listen to the episode here: https://spotifyanchor-web.app.link/e/c6FFYxoXZMb    With 25 years’ experience in medical/surgical, critical care, and emergency department medicine, Tonya Motsinger has seen her share of crises.  COVID-19 was a crisis of a far larger scale. The pandemic wreaked havoc not only on patients, but her CDI department, resulting in staff shortages. Today OhioHealth’s System…

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Five Emerging Mid-Revenue Cycle Roles

medical coder

By Brian Murphy New job functions will be needed to meet the changing nature of healthcare delivery and reimbursement. And soon. Here are five. These are my predictions but I feel good about them. Note: Many/most of these exist in some form or fashion now, but I believe the demand will grow, and explain why.…

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Rx for rural community health: CDI on a shoestring with Jennifer Cummins

Listen to the full episode here: https://spotifyanchor-web.app.link/e/uVBMHJadvIb    Small community hospitals are the backbone of healthcare for most of the country, even today in this era of sprawling healthcare organizations and massive mergers.     But while they’re critical to the health of our nation, resources are often scarce, and CDI is no exception.    Jennifer…

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