Posts by Brian.m
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. …
Read MoreIt’s OK to ask direct (but not leading) queries to the provider, CDI professionals
By Brian Murphy Ask direct queries. It’s OK. Sometimes we get so fixated on query format we fail to see forest through the trees. The point of a query is to ask a pointed, clinically relevant question and allow the physician to exercise his/her independent judgement. We should be asking direct no-nonsense queries, especially in…
Read MoreDownload The State of Value-Based Care, our latest white paper.
We’re kicking off 2026 with a special report on The State of Value-Based Care. This paper shows where we are nationally with CMS’ stated goal of Every Traditional Medicare beneficiary in an accountable care relationship by 2030. It also offers critical tips and strategy on compliant risk adjustment, depiction of patient illness, and compliance with…
Read MoreHow do CDI professionals review the medical record (and how has tech changed the game)?
By Brian Murphy I’m always amazed at how little the core function of CDI gets discussed. I’m talking about medical record review. How it’s actually done, the process. For example: Where do you begin when reviewing the record? What steps do you take, and in what order? For inpatients, how long do you wait…
Read MoreThis is what a good outpatient CDI program looks like
By Jason Jobes This, right here. You should be focused on risk score accuracy by simultaneously evaluating how to maximize revenue and mitigate risk. We believe that every organization should get every penny it deserves, just not a penny more. Many organizations have started outpatient, or ambulatory, CDI programs focused solely on risk score maximization. Don’t do that. If you aren’t trying to ensure the…
Read MoreClosing out 2025 with its biggest story: Artificial intelligence
Listen to the episode here. Here we are, our last episode of Off the Record this year. I hope you’ve had a great 2025. Just my voice today. I’m ending with a solocast, a reading/summary of a paper about the biggest news story of the year: The explosive growth and proliferation of artificial intelligence, or AI. You might recall my poll from a couple weeks ago; you all confirmed it. 44% of respondents chose AI, beating…
Read MoreDon’t sleep on two important new changes hitting Jan. 1: Mandatory TEAM model and CMS-HCC V28 full payment shift
By Brian Murphy January 1 is rapidly closing in, and 2026 is bringing new rules and regulations impacting the mid-revenue cycle. Here’s two you shouldn’t forget about. Consider this a public safety announcement. V28 of CMS-HCCs Say goodbye to V24, and hello (fully) to V28. This one feels manageable. We’ve all been dealing…
Read More2026 OPPS final rule does no favors for our nation’s hospitals
By Brian Murphy The OPPS final rule, incredibly late this year, is finally out. Here I piece together some thoughts on (generously) four hours of sleep after a late night trip to Boston to pick up my daughter from a weekend getaway, so excuse any illogic. You can read the fact sheet easily enough (see…
Read MoreAI and the (Hu)man: The role of people in a technology dominated world
We hear it every day: Artificial intelligence including generative AI is the biggest technological breakthrough of our age. Bigger than the internet and color TV. The promises (and hype) are omnipresent, and there to be appear to be some slam-dunk use cases. But fewer are asking about its impact on humans, or paying attention to…
Read MoreTrump administration’s appeal of vacated RADV rule indicates Medicare Advantage audits not going away
By Brian Murphy Nothing is over. We’re still deep in the wild west of Medicare Advantage (MA). In case you missed the breaking news over the Thanksgiving break, the Trump administration on Friday appealed a crucial court decision. In September a TX judge ordered the 2023 Risk Adjustment Data Validation (RADV) rule vacated, removing CMS’…
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