News

By Brian Murphy Here’s three things I found interesting in the OPPS proposed rule, that will impact your hospital and the work you do—if passed. Between the physician fee schedule and the OPPS this was a heavy rulemaking week. Heck, it’s been a heavy rulemaking last couple of months under the new administration. But today…

By Brian Murphy Every so often—check that, on a regular basis—it pays to step back and think about the physician. We are pushing ever more complex, freighted decisions on the MD. Asking for more, and for less reimbursement. Instead of focusing on just optimal coding and documentation, we should also ask: How can we make…

By Brian Murphy Elixhauser. That’s the post. Still with me? I get it. What a name and a mouthful. I think I first heard it from Dr. James Fee in my ACDIS days. I thought he’d either busted out some piece of obscure clinical terminology or suffered an aneuryism. I later heard it from Cheryl…

By Brian Murphy For a while I felt like this was coming to a head. As far back as 2016-2017 I was monitoring reports of Medicare Advantage (MA) plans under investigation for alleged fraud related to HCC upcoding. I wondered when we’d see massive, coordinated action. That day is here. On May 21 CMS announced…

By Brian Murphy  Prior to our Off the Record podcast recording my guest Penny Jefferson shared with me a white paper she authored on admit type. I’m going to summarize a bit of it here as it was a substantive basis of our conversation. The paper begins by differentiating between admit status and admit type.…

By Brian Murphy Physicians are the lifeblood of a hospital. They provide lifesaving treatment and specialized care but also write the admission orders that keep the lights on. So how do you take 15 physicians and carve out half of their priceless time for CDI? By demonstrating return on investment (ROI). A.J. Hegg is an…

By Brian Murphy Download the CMS-HCCs V28 Survival Guide To survive in Version 28 of CMS-HCCs, you need a playbook. Check that, you need a survival guide. The good news is, we’ve put one together. Download Norwood SVP Jason Jobes’ analysis of the changes, the data and analytics underpinning the new risk model, and a…

By Brian Murphy Is a nudge, a best practice alert, or some other machine prompted question to a physician, a query? I’m risking a very contentious topic here. But it’s one that comes up a lot in conversation. According to the latest ACDIS-AHIMA query brief, the answer is yes. A query is a query is…

By Brian Murphy One of the hard truths about medical coding is that codes can only be assigned based on documentation from the patient’s provider. More specifically, a qualified physician or other practitioner who can be held legally accountable for rendering a patient’s diagnosis. This rule undoubtedly is a source of frustration and even provider…

By Brian Murphy CMS in April released the 2026 Medicare Advantage final rule. Here’s three important items you should know about. Between this and the 2026 IPPS proposed rule we’re drowning in rules, so if you hope to stay on top it’s important to read what experts have to say. One such person is Richelle…