In the movie “Jurassic Park,” paleontologist Dr. Allan Grant sees himself surrounded by resurrected dinosaurs for the first time and comes to an epiphany. “I going to have to find a new job.” I’m in the same place. I’m a Certified Professional Compliance Officer—I’ve taught compliance, educated clinicians and done some expert witnessing work on request—and like so many other of my fellow certified medical coders, I’m losing part of my livelihood. If CMS’ proposed...

A report from an outside physician: At one time, the payable reports for our total-risk Medicare Advantage products consisted of printouts in thick binders—and we got them once a month.  They were bulky but immensely instructive as we tried to figure out where the money we spent on our patients went. Going over them one evening with a glass of wine, one number kept repeating itself. $256 The charge was on every CxR done as...

Too often leaders of healthcare systems who use the employment model for their medical staff mistake feedback from their medical directors for feedback from their clinicians. Medical Directors are mostly going to tell you what you want to hear. They are doing so because they want to climb the administrative latter right behind you. They lack the depth of business training, corporate socialization and experience that business leaders have, so they are much more careful...