News

By Brian Murphy   The American Heart Association/American College of Cardiology in June released updated guidelines on the management of acute coronary syndromes (ACS)—the first time the guidelines have been updated in a decade. I’ve summarized a few nuggets of possible interest for CDI/coding professionals. I always preface these types of updates by saying I’m…

By Jason Jobes, SVP Solutions   Nearly 70% of all Medicare lives are now in contracts that directly tie payment to patient complexity — a number that has surged from 42% in just a decade. As this shift accelerates, organizations must recognize that risk adjustment accuracy isn’t optional — it’s mission-critical. To succeed, leaders need…

By Brian Murphy   The current controversy surrounding Medicare Advantage (MA) plans and the 3-day hospital stay requirement for skilled nursing facility (SNF) care centers on disparities in coverage and potential exploitation of regulatory flexibilities. Let’s break this down. Understanding the 3-Day Rule Under traditional Medicare, beneficiaries must have a medically necessary inpatient hospital stay…

By Brian Murphy Admission: I’m pro-TEAM. It’s possibly the name but I favor the concept of the new CMS payment model, too. We keep spinning our wheels on the fee-for-service treadmill, which incentivizes volume and often results in unnecessary and fragmented care. Everyone complains about FFS, it’s hard to break free—but TEAM is a compelling…

A lot. I’m summarizing it here. See link below, p. 61, for the full monty. Short explanation: CMS conducts annual RADV audits to ensure risk-adjusted payment integrity and accuracy. They use coders to do this; the RADV Medical Record Reviewer Guidance guides their audits. Jan. 2020 is the latest version. RADV auditors are instructed to…

By Brian Murphy The IPPS 2026 final rule is out… are you ready for some TEAM-work? (ahem) Dad joke aside, the big news IMO is the finalization of a few tweaks to the TEAM model, which is moving full steam ahead for Jan. 1, 2026 implementation. I’ve included a links below for further reading on…

NEW YORK, August 12, 2025–Inc. magazine revealed on Tuesday that Norwood ranks No. 509 on the 2025 Inc. 5000, its annual list of the fastest-growing private companies in America. This prestigious ranking provides a data-driven look at the most successful companies within the economy’s most dynamic segment—its independent, entrepreneurial businesses. Microsoft, Meta, Chobani, Under Armour,…

By Brian Murphy CMS issued the Medicare Physician Fee Schedule (MPFS) proposed rule this month. Links for further reading below…or just ask ChatGPT? On second thought, don’t do that. There are a lot of proposals in the rule, but one that I wanted to highlight are changes to telehealth. I’ve always viewed telehealth as an…

By Brian Murphy U.S. News and World Report just released its 2025-26 ranking of the nation’s best hospitals. As always I’m interested in what you think of these rankings, and secondarily how much your hospital and its CDI and coding programs use the list as a barometer of success. Leave a comment below. (FYI NYU…

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…