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By Brian Murphy   Are we headed for a healthcare AI arms race? A hellish AI dystopia?   Some days I wonder.   I was reading a breathless interview with the chief technology officer of a revenue cycle management technology company. The CTO states:   “Think of genAI as giving coders superpowers. It’s helping them…

By Brian Murphy   “Additionally, Humana did not agree with our audit methodology or overpayment estimation methodology.”   Take the above line from the OIG’s latest audit report, remove “Humana.” Fill in the blank with another payer.   The result is the same. No Medicare Advantage (MA) payer agrees with the OIG’s audit methodologies.  …

A large physician group responsible for more than 175,000 lives across 300 locations doesn’t have a lot of time for self-reflection. Nor should it. Its focus is where it needs to be—providing care for a range of complex patients across more than 30 specialty services.    But when it realized its quality scores and reimbursement…

Detection of early cognitive decline the latest benefit of covered Medicare/Medicare Advantage service By Brian Murphy Medicare Annual Wellness Visits (AWVs) are an important piece of patient wellness and appropriate capture of acuity/severity of illness. But they’re also underutilized. You can now add another reason why you should be working to use them as a…

We know about the bad examples.    Insurance companies adding diagnoses solely to inflate risk scores and payment. We’ve seen the Office of Inspector General (OIG) audit reports, and a recent damning story in the Wall Street Journal (see below).   Fraud should be called out, fined, and punished, when it occurs.   But let’s…

By Brian Murphy   CDI Week might be winding down … but I’m keyed up for the ACDIS Industry Overview Survey.   This annual “state of the industry” special report is worth reading, providing both the big picture of the profession and interesting year-over-year trends so you can see how the times are a-changing.  …

By Brian Murphy   Z59 and other social determinants of health (SDOH) are difficult to capture in ICD-10. How are you doing it? A recent study published in the Journal of the American Medical Association (JAMA) demonstrated that housing instability, as captured with the Z59 series, is not being accurately assigned. At all. The JAMA…

By Brian Murphy   File this under reason 1,227 to diligently work to capture malnutrition.   Medscape recently covered a study published in Aging Clinical and Experimental Research. The study followed 319 patients aged 65+, hospitalized for the first time with COPD in Southwest China. Median age was 76 days and patients averaged five comorbidities.…

High-quality coding and CDI professionals are costly. Labor expenses as a whole comprise over 50% of a facility’s expenses. But strategic staffing can actually boost your ROI. One of our partners saw a significant return by optimizing coverage rates. Download the full article and uncover the secrets to maximizing your staffing investment.

Even with the rapid growth of risk adjusted payments, Medicare Severity DRGs (MS-DRGs) remain the principal reimbursement mechanism for most healthcare organizations.   But despite their relative maturity there is always room to improve MS-DRG assignment. Missed complications/comorbidities (CC) and major CCs, inaccurate principal diagnosis assignment, and non-specific/symptom DRGs lead to underreported severity of illness.…