Carriers are starting to discover that without professional expertise to turn disparate data into actionable optimization and measurable intelligence, data is powerless.

There is a great push within the healthcare industry to move clinical documentation integrity (CDI) into the outpatient arena. People refer to this as “outpatient CDI,” but I think this is a misnomer. If you plan on stationing CDI specialists (CDISs) in physician offices, that could be construed as “outpatient CDI,” but I believe the larger issue is whether we should start tending to conditions even if they are not risk-adjusting in the inpatient realm.

Below are a few basic guidelines about Medicare compliance and some options people have to maintain eligibility after receiving an injury settlement. When is Medicare a “Secondary Payer”?...

In the ICD-9 era, there were universally accepted benchmarks to measure coding professionals’ productivity. Now, more than 18 months after the ICD-10 implementation date, the challenge is to do the same for the new coding system. The article, “Coding Checkup,” in the June issue of the Journal of AHIMA, addresses this issue and provides direct feedback from...