For decades, case mix index (CMI) has been the default metric used by hospitals to evaluate the financial impact of clinical documentation integrity (CDI) departments. While CMI once served as a reasonable proxy for documentation improvement and reimbursement opportunity, it has become increasingly disconnected from today’s healthcare environment. Hospitals can no longer assu...

The U.S. Department of Health and Human Services (HHS)

As we move deeper into analysis of the upcoming proposed rule changes by the Centers for Medicare & Medicaid Services (CMS), many hospitals are still grappling with the unintended consequences of what initially appeared to be strengthened patient protections under

Recent guidance from the Centers for Medicare & Medicaid Services (CMS) on Medicaid State Directed Payments (SDPs) has been widely interpreted as a tightening of federal oversight. That interpretation is correct, but incomplete. Over the past 30 days, new developments have introduced a critical nuance: hospitals may first experience a temporary surge in supplemental payme...

When the U.S. Supreme Court overtur...