Posts by Norwood Staffing
CDI-ing like its 1999: A conversation with Atrium Health Wake Forest Baptist director Tamara Hicks
How long have you been in CDI, oh listener? Three years, five, 10? Maybe as many as 16, if you started back when CMS adopted MS-DRGs and ACDIS began, in the hazy, pre-Tik-Tok days of 2007? My most recent guest on Off the Record has been in CDI for 24 years, starting in 1999.…
Read MoreCMS 2024 IPPS proposed rule reclassifies homelessness SDOH codes as CCs
CMS released the 2024 Inpatient Prospective Payment System (IPPS) proposed rule on Monday, April 10. Links to the summary and the rule in full below. I love that homelessness, which was already a reportable code, will now be paid as a complication/comorbidity (CC). Homelessness CCs include: Z59.00 Homelessness unspecified Z59.01 Sheltered homelessness Z59.02…
Read MoreRules and rules: CMS releases burdensome Medicare Advantage final rule with three-year phase-in
By Jason Jobes CMS has once again shown that it has no concept of the administrative burden it places on providers that ultimately detracts from their ability to provide quality care. There simply is so much to say about the final CMS Medicare Advantage rule. Let me start by saying I don’t think anything in…
Read MorePositive or negative reinforcement… which works best? HAC and HRRP vs. Meaningful Use
By Brian Murphy The recent release of the 2024 IPPS proposed rule got me thinking about the Hospital Acquired Condition (HAC) and Hospital Readmissions Reduction (HRRP) programs. Both are built upon the precept that hospitals will respond positively to the threat of penalties by improving their quality of outcomes. Quick refresher on these programs: Hospitals…
Read More2024 Final Medicare Advantage Rate Announcement phases in V28 changes, ICD-10 code removals
By Brian Murphy The 2024 Medicare Advantage Rate Announcement (aka., final rule) is out. As CMS loves to do with big policy announcements, it was released under cover of darkness, i.e., late Friday afternoon as the weekend was upon us. My colleague Jason Jobes has started a running thread on LinkedIn that I recommend you…
Read MoreLegal eagle: Healthcare denials through the eyes of Sarah Mendiola
Denials are a reality of life in the mid-revenue cycle. And they’re not going anywhere. As Medicare Advantage (MA) grows—MA Organizations statistically deny more care than traditional Medicare—the volume of denied claims will only keep growing. I wanted to talk about this subject with someone who not only understands the current mine-filled landscape, but knows…
Read MoreMedicare Advantage battle over rising risk scores, removal of diagnosis codes from HCC model boiling over
By Brian Murphy The battle over Medicare Advantage coding and reimbursement is coming to a head. CMS on Feb. 1 released its Advance Notice, which included removal of more than 2,200 diagnosis codes from the HCC model. Some diagnoses will be added, but per ACDIS diagnoses proposed for elimination from the model include acute kidney failure,…
Read MoreCoding Tip
Postop respiratory failure: The never-ending query By Donielle Bailey, RHIA, Norwood Senior Auditor We have all experienced the frustration of coding a complex or detailed elective operative report only to become ensnared in a postop progress note respiratory battle. Physicians provide their clinical assessment of the patient’s postop respiratory condition with documentation that includes, “intubated…
Read More“Bermuda triangle” of Medicare Advantage scrutiny signals alarm bells: Get your risk adjustment house in order
By Jason Jobes Is healthcare prepared to sustain the onslaught of changes to Medicare Advantage payments? How will it impact the industry? How does it impact you? At the beginning of this month I attended the RISE conference, which serves a community of established and emerging leaders in the Medicare Advantage and managed care space.…
Read MoreCultivating the right mindset, values will take you far in HIM (and life)
By Ken Macklem, RHIT, CCS My career in healthcare started in the medical records department, filing paper. I loved it, and that led me to abstracting labs for the coding department. I took a coding class at Mt. Saint Mary’s (this was in the pre-credential days) and learned CPT and ICD-9 by the book, before…
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