Sepsis and HCCs – Too Many or Too Few?

Published: Thu, 05/08/25

Updated: Thu, 05/08/25

Link to all things medical coding & billing

Sepsis and HCCs – Too Many or Too Few?

Like many of you, I am deathly allergic to clinical documentation integrity (CDI), but do not worry; I premedicated with prednisone and an antihistamine prior to writing this article. I know it is critically important that doctors use the right terminology for diseases so that all those agencies – both governmental, like the Centers for Medicare...

Beyond Coding: How CDI is Reshaping Compliance and Revenue

Clinical documentation integrity (CDI) has matured beyond its initial focus on coding accuracy and Diagnosis-Related Group (DRG) optimization. In 2025, it is central to payer compliance, audit defense, risk adjustment, and sustainable revenue. This article will explore how CDI professionals are bridging gaps between clinical care and financial strategy by...

CMS sets up real-time medical fraud center with DOGE; Federal contractor rolls out commercial tool

The Centers for Medicare & Medicaid Services (CMS) has launched the Fraud Detection Operation Center (FDOC) to fight waste, fraud and abuse, the agency announced this week. Listed on a new webpage are a list of “recent success stories.” They include taking action against improper enrollment in Affordable Care Act (ACA) plans, cracking down on false billing of...

Breaking the ‘intellectual bottleneck’: How AI is computing the previously uncomputable in healthcare

Whenever a patient gets a CT scan at the University of Texas Medical Branch (UTMB), the resulting images are automatically sent off to the cardiology department, analyzed by AI and assigned a cardiac risk score. In just a few months, thanks to a simple algorithm, AI has flagged several patients at high cardiovascular risk. The CT scan doesn’t have to...

The Comprehensive CDI Report

As the healthcare industry changes, there needs to be a shift from a growth perspective to an efficiency perspective. Most hospitals had their highest case mix index (CMI) during COVID, but most also had negative margins. What COVID confirmed is that CMI is not a great measure, because a hospital can have a very high CMI and still be losing money. It is far...

Taking the Pain out of Pain Coding – Part I

Continuing with our look at areas of coding confusion, let’s today examine pain. According to Medline Plus Magazine from the National Institutes of Health (NIH), pain is the most common reason people seek medical care. We all have felt some type of pain. Let’s look to the Official Guidelines, as we always do when we experience confusion or want more information.

P.O. Box 3824
Youngstown OH 44513
USA

Unsubscribe | Change Subscriber Options