Explore every episode of the podcast Off the Record with Brian Murphy

When you work deep in the hospital mid-revenue cycle there can be an unfortunate but understandable tendency to divorce your work from the patient. To become separated from clinical care and outcomes, and even, in the case of value-based care, from its intended objective of improving affordability and quality.

Those points are not lost on Dr. Sunita Varghees or Carrie Horn, who spearheaded an outpatient CDI program at Baylor Scott & White Health. One that is truly patient-centric and focused on reducing ER utilization and delivering the right level of service, not just the most profitable.

Listen in as we discuss:

• Baylor Scott and White Health—Lay of the land of the organization and how and when they got started in outpatient CDI.
• “Successful risk adjustment starts with the patient”--the why of OP CDI and how their work ties into chronic condition management, not just capture. We discuss KPIs and financial metrics, too.
• New heart disease screening initiative—what it is, what it entails, and early successes.
• Is knocking down ER visits and IP admissions and getting the right level of care at the right price at odds with hospital revenue gains? Are they making it up with shared savings or care funding?
• Tech enabled/tech forward approach including ambient AI.
• Biggest success and biggest do-over, if they could do it all over again.
• What’s next on the OP CDI roadmap?
• Favorite song for the Off the Record Spotify playlist...

Cheryl Ericson is a veteran, in every sense of the word. Someone who has seen and experienced a lot in the CDI profession—and so has a wealth of knowledge and wisdom to confer. 

I go back a long way with Cheryl, to early ACDIS days when she was the lead educator of the CDI Boot Camp and developed the organization’s educational curriculum. She’s had a few stops since then but settled in nicely as Senior Director of Clinical Policy and Education at The Brundage Group. 

Cheryl is a shrewd, incisive observer of the CDI field, with a rich history of where we’ve been but also where we need to go. Recently she’s weighed in on some big mid-revenue cycle topics for ICD-10 Monitor which I read with avid interest (and recommend you do too).  

In this week’s episode we hit on a few of those topics, along with a bit of a look into her life and career. Listen in as we discuss: 

• Formative background in nursing and entry point into CDI at MUSC. 

• Thoughts on the new/2026 ACDIS/AHIMA query brief (currently in draft stage)--concerns with clinical indicators, her belief they are unique to each patient and may not meet guidelines established by payers: “It is not about determining if a condition exists; it should be about deciding if the physician has a reasonable expectation to treat the condition,” she writes. “Rather than asking if the condition exists, CDI and coding professionals should determine if it ‘was it reasonable for the provider to diagnose and treat the condition as if it exists.’” 

• Pushing query compliance down to the end user—is this how the new brief reads, and if so, is it a fair expectation? 

• Artificial intelligence: State of current tools and limitations. “GenAI tools show great promise in many areas, but for now, it does not appear capable of performing the type of complex critical thinking required for accurate inpatient coding and billing,” Cheryl observes. 

• (Incorrect) payer allegations of hospital “upcoding,” using the example of acute blood loss anemia 

• ACDIS heydays: A look back on teaching and educating. 

• Her personal health journey, story of breast cancer and her husband’s simultaneous serious illness, and how it transformed her outlook on life.  

• Sharing wisdom and lessons learned: Career advice to a new or young CDI professional—what has she learned to pass along to the next generation?

Medicare Advantage is undergoing a reckoning ... and that reckoning is coming from within. 

In January Kaiser Permanente affiliates agreed to pay $556 million to resolve allegations that it violated the False Claims Act by submitting invalid diagnosis codes for their MA Plan enrollees in order to receive higher payments from the government.  

The case was instigated by what is known as whistleblowers. 

Regular listeners might recall my podcast on this topic back in January 2025 with Mary Inman, a Partner at Whistleblower Partners LLP, and Head of International Whistleblower Practice for the firm. We had a fascinating conversation about the process of whistleblowing and New York insurer Independent Health, which agreed in December 2024 to pay $100M to settle allegations it had upcoded claims to inflate MA payment. 

We’ve now more than 5x-ed that fine with Kaiser. Per the Department of Justice the claims resolved by the settlement are allegations only and there has been no determination of liability. But it was a major wakeup call for MA. 

Mary is back for today’s show along with her colleague Liz Soltan, a senior associate in the firm’s NYC office. Listen in as we discuss: 

• Key terms: What is whistleblowing and the concept of qui-tam? 

• Kaiser case origins which began more than 12 years ago, and Mary and Liz’s evolving roles in the case 

• The facts on the ground, as alleged by the whistleblowers and the DOJ, specifically the issue of addenda to the medical record 

• Unfolding of the case, a behind the scenes look as new whistleblowers joined, and reaching of the settlement 

• What can we learn from a medical coding/reimbursement perspective? 

• What can healthcare organizations do to ensure their employees don’t blow the whistle and avoid similar fines and headlines? 

I’m consistently surprised at how few CDI or IP coding professionals talk about their most basic job function. The very reason they are hired, and what most do for eight hours a day:

I'm talking about chart review.

Go on Linkedin or Facebook and it’s rarely discussed.

Yet it’s ... everything. Nuanced, complex, clinical, critical to the quality of financial health of hospitals. It’s how patient acuity is expressed in coded data, how hospitals get paid, and why CDI and coding professionals are employed.

I’ve heard it described as akin to detective work, puzzling together the pieces and presenting an informed query to the provider. Yet like detective work it often remains a mystery.

Dr. Tarman Aziz joined me to open up that conversation. He is founder and CEO of CDIQ Consulting, LLC, a physician-led healthcare education and consulting firm focused on closing the gap between clinical reality and coded data. On this episode of #OTR we discuss:

• Is chart review unique to the individual/healthcare organization/assistive tech, or are there underlying principles everyone can follow?
• How evolving clinical indicators in a case drive a concurrent CDI workflow—the differences of reviewing a chart at 24 vs 72 hours as clinical indicators morph
• How early is too early to look at an inpatient chart?
• Underutilized and underrated areas of the health record
• Review strategies for encephalopathy, dehydration, hyper- and hyponatremia, and cerebral edema/compression
• Tarman’s work consulting and educating non-traditional CDI candidates
• The remarkable story of Tarman’s fiancé Anna, an 11-year survivor of Stage 4 breast cancer

And we’re off! The first episode of #OTR of 2026, From Risk to Revenue Clarity: How One Health System Transformed OP CDI Performance.

I continue to beat the drum of outpatient CDI because I believe in it.

Risk adjustment and capitated payments are a superior reimbursement mechanism than fee-for-service. Certainly not perfect, but I believe they are better aligned with keeping patients healthy.

It’s also an exciting new avenue for CDI and coding professionals to work.

Making it work isn’t easy. Success requires new workflows, new metrics, and an even greater level of physician education/buy-in than acute care settings.

We get into all of this on today’s show.

My guest Jason Jobes, SVP of Norwood Solutions, is a whiz when it comes to value-based care, you will be hard-pressed to find a more informed speaker.

Note: You can download the slides referenced on the show here, though they are not needed.

Here we are, our last episode of Off the Record this year. 

I hope you’ve had a great 2025. 

Just my voice today. 

I’m ending with a solocast, a reading/summary of a paper about the biggest news story of the year: The explosive growth and proliferation of artificial intelligence, or AI.  

You might recall my poll from a couple weeks ago; you all confirmed it. 

Where do people fit with this tech? None of us really know, but I offer my opinion here. 

Outpatient CDI is still in its pioneer-”ish” stage. Why do I say that? Per the most recent ACDIS survey data, only 31% of respondents indicated their organization had a dedicated OP CDI program.  

Progress, but not enough, and still a minority. 

So when you find an “OG” who has been working in risk adjustment for well over a decade, you need to pay attention. Odds are they’ve got some lessons to share and wisdom to confer. That certainly describes Amy Campbell, Director of Outpatient CDI for LifePoint Health.  

Listen in as we discuss:  

• “Building the airplane as we were flying...” Her start and early days in OP CDI. 

• A “day in the life of” her role as OP CDI Director today for a large and growing healthcare organization 

• Dashboard for success and most impactful/important KPIs 

• Manual chart reviews (yes, they do this—no assistive tech). What does a pre-visit review look like/how is it conducted, and what common clarifications and dx opportunities are her team finding? 

• Rapid fire round: Biggest OP CDI pet peeve (a doozy), RN vs. HIM staffing decisions, and the hardest part of managing people 

• Interesting career stops, from critical care nurse and neurological intensive care nurse, to consulting, to content reviewer for Lippincott. 

• Being a mother of an adult child with autism 

No matter how great your CDI program is—its spectacular workflow, outstanding chart review team, on-point KPIs, shiny new AI tools—nothing works if you don’t have engaged physicians. 

It still all comes down to provider engagement. Without a physician staff who is bought in and willing to participate and document with specificity in the health record, all these efforts are for naught.  

But with great engagement, great things are possible. 

So where are we today with the big daddy of all CDI topics? Joining me on this episode of #OTR are two physicians with considerable experience and plenty of war stories. Trey LaCharite, Medical Director for CDI and Coding and Clinical Associate Professor for University of Tennessee Medical Center, and Vaughn Matacale, director of the physician advisor group for ECU Health in North Carolina, open up for a frank, no-holds barred discussion on the following topics: 

• What is overrated when it comes to provider engagement--and what is underrated? 

• The best high-tech solution each recommends, and a great low-tech solution that stands the test of time. 

• An ultimate success story winning over a difficult provider or service line. 

• Notable failures others can learn from. 

• RUSH reunion tour in 2026—yay or nay? Spoiler alert: Of course the answer is yes... 

• And other fun stuff you really shouldn't miss... 

Fans of Off the Record may recall my recent episode with Chris Petrilli, Director of Revenue Cycle of Operations at NYU Langone, who joined me to discuss his experience delivering a TEDx Talk on artificial intelligence. 

Chris was well prepared and delivered a great lecture, which you should definitely check out on YouTube. And on the podcast he sang the praises of a coach brought in to prep him and other NYU Langone staff for the big day on the big stage. 

My wheels started to spin, I reached out... and landed that coach for OTR.  

Susanna Baddiel is an actress, director, voice over artist and TEDx Speaker Coach. She works in both the UK and the US and is a founder member of Actors Shakespeare Company where she continues to act, direct and coach. She has more than 17 years of experience teaching public speaking, personal impact, presentation skills, leadership development, and executive coaching. 

It was my honor to host her in a bit of an offbeat show than the usual mid-revenue cycle topics. But I picked up a few pointers about public speaking that helped me, and I think you will too. 

This special episode kicks off November, a month in which I’ll be taking a deep delve into provider engagement. Odds are if you’re trying to engage providers you’ll have to present or educate, and Susanna offers some great advice and practical tips and takeaways. 

On this show we cover:

• Her background as an actress in Britain, transition into coaching, and eventually working with niche clients in science and medicine 

• Working with the team at NYU and Chris Petrilli—preparing them, building them up, and getting them ready for the big day. 

• Why preparation is everything in public speaking, as is gratitude for the opportunity 

• Balancing authenticity vs. general principles of good presentation 

• The differences between in-person and presenting on camera. Susanna offers some GREAT suggestions for being better on Zoom. 

• Books and other resources Susanna recommends 

Erin Kreider gives me hope for the future of the CDI profession. That’s a pretty positive first impression for someone I recently met. Why do I say this?

Erin is a newly-minted clinician who returned to medical school after nursing and CDI to become a nurse practitioner (NP), and now sees patients once a week. Her “welcome mat” on LinkedIn lists her core passions, which include clinical honesty and ethical integrity in the final code set, advocating for patients’ rights and best interests, and education and thought leadership.

Today the majority of her work is with a technology company, Ambience, where she is helping build out ambient listening technology that assists with documentation and coding.

Prior to that she had lengthy stop at Kettering where she was a CDI professional and a case manager.

How’s that for achievement—and purpose?

We get into all this on this episode of Off the Record, covering:

• Erin's first day on the job as an NP and what becoming a clinician taught her about documentation/coding/the mid-revenue cycle that she didn’t know or fully appreciate prior.
• CDI in the ED: Missed opportunity to improve documentation for admitted patients and strengthen Medical Decision Making (MDM)
• Best practices for leveraging APPs: Support system for MD physician advisors, second level chart reviews, educators, and more—a topic she recently wrote about for ACDIS’ CDI Journal
• UR/UM synergies with CDI and coding
• CDI pet peeves: Queries for the sake of metrics, and perception of CDI as an easy retirement job for fatigued bedside nurses
• How ambient listening can help with documentation, provider burnout, and surface additional missed diagnoses/HCCs

Many healthcare organizations know they need an outpatient CDI program, but are tripped up by the most fundamental question: What is the expected return on investment after a considerable upfront investment of time, human capital, training, and technology? 

Discover the tangible impact of outpatient CDI on revenue, risk capture, provider alignment, and compliance in this special session of Off the Record. Jason Jobes, Senior Vice President, Solutions, Norwood, and Carol Ann Hudson, AVP of Quality and Clinical Operations and Population Health for Lifepoint Health first presented this popular session at the ACDIS 2026 national conference and later for a select virtual audience, and I’m pleased to bring it to my listeners. 

You’ll walk away with a big picture understanding of OP CDI and concrete, operational strategies for transforming your program. If you haven’t started yet, consider this your blueprint. 

Note that “ROI” doesn’t only equate to revenue. Return on investment can also come in the form of denials resistant documentation, coding compliance, and improved patient care and value based care alignment through a greater emphasis on patient scheduling. All of which Lifepoint Health experienced. 

• Note: Jason and Carol Ann refer to slides at points of this session; the audio can stand alone but if you prefer you can also download them on the Norwood website (free with registration): https://www.norwood.com/resource/the-roi-of-outpatient-cdi-slide-deck/  

If you’ve been in the CDI space for any length of time you probably know the name Fran Jurcak. 

After a memorable stint as an ER/trauma nurse, CDI and then consulting, Fran made an impact in ACDIS, serving on the CCDS certification committee and later the ACDIS advisory board. She authored and continues to author the CCDS Exam Study Guide.  

But what makes Fran unique is that she’s never afraid to share her opinion—or make a big career move. 

Fran made the successful leap from traditional consulting into technology. And in the same manner that marked the rest of her career climbed the ladder all the way up to her current role as Chief Clinical Strategist at Iodine. 

So yeah, you might very well know Fran. But, what you might NOT know is she is winding down her career—she plans to retire from the industry in October. 

This episode is a fantastic, wide-ranging conversation recapping her full career. Fran brings a seasoned perspective on technology and CDI few can match, so it seems only natural to debut this episode in conjunction with CDI Week. Listen in as we talk about: 

• Career progression from bedside to CDI to consulting to tech. How did she make the jump—and then advance? 
• What does a fully AI tech enabled CDI position look like?
• How does the modern CDI professional work in this setting? How much of their clinical knowledge do humans still apply vs. reviewing machine output? 
• How much of a job displacer is advanced AI, but what can’t machines do, and who will survive the new reality? What mindset and skills do they need to have? 
• The most important lesson Fran learned in her career. 
• Her stint at CDI consulting OG JA Thomas: Their place in the industry, what she learned from them, pro and con. 
• Her greatest career accomplishment, and where CDI needs to change
• Winding down and retirement plans (grandkids and cruising on the docket) 

At ACDIS 2026 I delivered an unofficial episode of Off the Record with my guest today: Tracy Ferro, Executive Director, System CDI for Medical University of South Carolina Health (MUSC).

The “podcast” was delivered on stage, at the outpatient symposium. MUSC’s OP CDI program is new and being built in flight, and Tracy and I presented on it together, running the session a bit like an episode of #OTR.

Full disclosure: Norwood partnered with MUSC, large academic health system, to implement OP CDI. That was a challenge! As was the Chicago presentation.

On today’s episode we talk not only about MUSC’s OP CDI efforts but the presentation itself, including the prep and leadup and “game day.” And much more on Tracy’s unique leadership style and the importance of storytelling to drive home lessons (she’s wonderful at this).

Listen in as we discuss:

• Tracy's healthcare background, a memorable nursing experience, and path into CDI.
• The art of leadership: Style and lessons learned from childhood and beyond
• MUSC’s outpatient CDI origins: The why behind the program
• What a pre-visit review looks like, including the use of Epic’s Enhanced Risk Adjustment Framework.
• Governance, workflows, reporting, and early outcomes.
• Outpatient CDI impact and next steps for the new program
• Presenting at ACDIS 2026, including tips on prep and combatting stage nerves
• An unexpected Sharpie arm signature and a song for the OTR Spotify playlist...

Cheryl Manchenton and I go back a long way—I once took a ride from a Las Vegas casino to the airport with her after an ACDIS conference well over a decade ago. And I’ve learned over the years she also happens to be as sharp—and as outspoken—as anyone I’ve ever met regarding the subject of healthcare quality, specifically measuring hospital quality with coded or abstracted data and how it all relates to the work of mid-revenue cycle professionals. 

I think we even talked quality on the way to the airport. 

So I was thrilled to get her on Off the Record to go deep on this topic, along with her Disney World obsession and other fun asides (Gandalf the Gray makes his way in to the conversation). This was a fabulous, wide-ranging talk on quality. Tune in and listen to: 

• What Cheryl thinks about how we measure quality in healthcare, specifically through the use of coded data 
• What quality-obsessed hospitals often get wrong about impacting outcomes with documentation and coding alone (with a deep dive into healthcare acquired infections, or HAIs).  
• Borderline or unscrupulous practices done to artificially improve quality rankings 
• What concrete steps would Cheryl take were she leading a small community hospital seeking to improve its observed/expected mortality ratio 
• The recently-released 2026 OPPS proposed rule and the large number of hospitals potentially impacted by the new Safety Measures change (we both like this: presently a hospital can rank at the bottom for safety and still be 5 stars) 
• The reality of “picking your poison” among many quality programs and getting aligned with what really matters to your organization 
• Cheryl’s career north star, how she stays educated, and thoughts on her long career winding down 
• Disney craze, grandkids, and best tips for navigating the theme parks 

Some of us dream of being able to say, “Thank you for Coming to my Ted Talk.” Others wilt at the thought of getting on stage to deliver not just a lecture on a complicated or sensitive topic, but a performance.  

My guest today Dr. Chris Petrilli has delivered. My first Ted Talk alumni on Off the Record (of which I’m aware) recently presented How AI could help doctors detect patterns before a Ted Talk audience. 

This show delves behind the scenes of a Ted Talk. But it does a lot more: We get deeply into the subject of Chris’ talk itself, one I think about all the time—artificial intelligence, how we interact with it, what it means for the future of the mid-revenue cycle (and our humanity), and how AI and humanity can be reconciled. Chris practices internal medicine at NYU Langone where he is also tasked for developing AI solutions for the health system. This is his second appearance on the podcast. 

On this show we cover: 

• Ted Talk details: How it came about, preparation, and delivery: How many dry runs? Coaching, nerves, and tech assistance 

• Impact of the talk. 

• Humor and entertainment as a teaching tool and effecting change at work (including physician buy-in) 

• How can humanity coexist with this powerful new technology—is Chris an optimist or pessimist or some blend of the two? 

• Pattern recognition: Similarities and differences between humans and machines 

• AI as an overcaffeinated intern, powerful and full of energy but with no idea what’s happening...  

• Emerging clinical and mid-revenue cycle applications 

Watch Chris’ Ted Talk on YouTube: https://www.youtube.com/watch?v=M0qIyowPr0E 

I don’t know this with certainty, but I probably have more than one listener dreaming of starting their own business, in the mid-revenue or elsewhere. Others might be content in their current roles as CDI, coding, or mid-revenue cycle professionals, but are also looking forward to their big trip in August. 

Today’s guest is living the best of both worlds.  

Melanie Kiss started Chicas Abroad in 2021 with a small group of friends who shared a joint love for travel and adventure. Prior to that she had been a longtime HIM professional with stops ranging from the hospital setting to college classrooms to consulting, and even a long stint with AHIMA. 

Today she’s leading worldwide curated travel. How does one go from HIM to Havanna, coding to Cebu? Listen to Off the Record as we discuss: 

• Chicas Abroad: How it started and when Melanie realized it was time to go all in 

• Melanie’s innovative marketing strategy (I learned a thing or two that I will adopt!) 

• Entrepreneurship: Melanie’s words of wisdom and what learned about herself while taking risks and launching a business 

• Following your bliss: When do you know it’s time to pursue something new? 

• The coolest place she's ever been 

• Off the beaten path experiences with difficult clients and other fun stuff. With a little HIM/coding talk, too, because this is a serious mid-revenue cycle podcast... 

For this week’s episode I’m bringing you something a little different, but of such importance that I had to share it with my Off the Record audience: The massive audit expansion of Medicare Advantage announced by CMS. 

In case you missed it, CMS in May rocked the mid-revenue cycle industry with the unveiling of a startling mandate. It will hire 2000 medical coders, beef up its audit technology, and expand its current limited auditing scope from 60 Medicare Advantage Plans to some 550 plans nationwide in an attempt to check widespread allegations of HCC upcoding. 

My colleague Jason Jobes has been closely following the news and presented this topic in June—the most attended webinar Norwood has ever hosted. This is a replay of that very well-received show. It covers: 

• The evolving risk adjustment landscape and the rise of Medicare Advantage 

• CMS broad and bold audit scope and strategy  

• Best practice techniques to survive in risk adjustment and avoid potential risks 

Jason refers to several slides during the presentation, which you don’t necessarily need, but if you’d like to follow along or see the exact references and data we’ve posted them to the Norwood website with a link in the show notes. 

Enjoy the show! 

Show notes and resources 

• View the webinar slides here (free; requires registration) 

• Read the full CMS audit announcement. 

In 1990 the heavy metal band Queensryche asked its listeners, “Is there anybody listening?”, a lament for not being heard in a world of overstimulation, noise and artificially.  

In healthcare in 2025, the answer is yes: someone is listening. But the listener just might be a machine. 

Ambient AI is one of the most promising applications of the recent AI wave, in my opinion anyway and possibly that of my guest, Dr. David Canes. Dr. Canes is a Boston-area urologist, owner of WellPrept, and a self-described tech enthusiast.  

Recently David put out the YouTube video 11 Ways to Use AI In Your Practice Right Now, which I link to in the show notes. But he’s also the author of “Why AI scribes are changing medicine and the risks you must know.” I’d describe him as an early adopter and enthusiast but with his eyes open to potential shortcomings. 

We cover the pros and cons of ambient AI and other forms of AI, and how it is impacting documentation, coding, and the revenue cycle, on this episode of Off the Record. We discuss: 

• David’s path into medicine and ultimately urology 

• Why he chose to adopt a positive mindset in the use of new technologies rather than fear or resistance 

• Ambient AI: How it operates and what a patient encounter looks like using this tech, start to finish 

• Positive impacts on provider burnout, charting, E/M professional billing, and CPT 

• Cons of the new tech, including hallucinated answers and inaccurate summaries 

• Use of generative AI large language models in patient diagnosis 

Show notes 

• Why AI scribes are changing medicine and the hidden risks you must know: https://kevinmd.com/2025/02/why-ai-scribes-are-changing-medicine-and-the-hidden-risks-you-must-know.html  
• 11 Ways to Use AI in Your Practice Right Now: https://www.youtube.com/watch?v=OJLqIU2nbzc 

Regular listeners of Off the Record will recall Keisha Wilson, whom I hosted on the program in June 2024 to talk about telehealth as well as her story of entrepreneurship. She was a bright light and a great guest, so I asked her to return to the show a couple months ago. 

Keisha accepted, and is here today, but it’s a near miracle. 

Eight months ago Keisha suffered an unimaginable tragedy, the loss of her home following a gas explosion and subsequent fire at a neighbor’s home. This included the loss of essentially all but a small handful of her worldly possessions. 

Somehow she’s kept her business afloat and managed to stay on top of the many changes in telehealth, SDOH, and more, and even present on these topics at the recent AAPC Healthcon. It felt a bit odd to pivot to these topics but you’d be hard-pressed to find someone more in the know and ready to educate about telehealth and medical coding than Keisha. 

Pretty inspiring stuff, and we get into all of it on the program. We discuss:  

• The house fire: How it happened, fallout, and dramatic life impacts on Keisha and her mother 

• Keisha’s personal experience with social determinants of health (SDOH) including housing instability and food insecurity after the catastrophic loss 

• Finding new levels of resiliency and using the experience to fuel her AAPC presentation 

• Congress’ extension of telehealth flexibilities through Sept. 30, 2025: What they are, what it means 

• How healthcare organizations should be leveraging telehealth in coding and mid-revenue cycle practice 

• Telehealth as a tool to address and improve SDOH (medication adherence, transportation and patient scheduling)  

• Impact on billing—did you know that moderate medical decision making can be met due to diagnosis or treatment significantly limited by SDOH? 

• What’s next for Keisha including the search for a new permanent home—and of course her selection for the Off the Record Spotify playlist. 

Show notes 

• News coverage of the explosion: https://abc7ny.com/post/crews-responding-explosion-basement-residence-brooklyn-injuries-reported/15245371/ 
• Keisha’s telehealth e-guide available for purchase (website includes free downloadable resources as well): h⁠ttps://kwadvancedconsulting.com/e-guides/⁠  

I’m recently back from the 2025 ACDIS national conference, and as usual flush with the latest in CDI trends, education, and breaking news. And right at the top of my takeaways is a seemingly innocuous classification with big ramifications: admit type. 

What makes this a big deal? Some hospitals appear to be playing a bit fast and loose with  guidance from the National Uniform Billing Committee (NUBC) in order to classify surgical admits as “urgent” rather than the more accurate “elective.” Doing so removes them from certain PSIs that negatively impact quality metrics and indirect revenue. 

My guest is Penny Jefferson, manager of clinical documentation integrity at UC Davis Health. Penny co-presented the session with Cheryl Ericson at the ACDIS conference. On this show we discuss: 

• What is admit type, why is it important, and common misunderstandings (admit type is very different than admit status--IP/OP/observation) 

• Who is the NUBC, and what are the current rules as they stand around elective, urgent, and emergent? 

• Compelling data—deidentified, but real—presented at ACDIS that shows what appears to be clear gaming by some healthcare organizations of the assignment of admit type, specifically opting for urgent over elective 

• The dramatic impact this seemingly small change can have on quality scores: Reclassifying an elective procedure as urgent effectively circumvents PSI exclusions, allowing the case to be excluded from elective-only quality measures, such as PSI 10, 11, or 13. 

• Possible solutions including Penny’s ongoing work with the NUBC and request for additional rigor 

• Optimal way to ensure admit type accuracy in the current climate, from use of coding or CDI staff to additional training for admission staff 

• Why is her boss Tami Gomez so awesome, and Penny’s selection for the Off the Record Spotify playlist 

For additional reading 

• Inconsistent ‘Admit Type’ Reporting May Inflate Hospital Quality Scores, by Nina Youngstrom/Report on Medicare Compliance: https://compliancecosmos.org/inconsistent-admit-type-reporting-may-inflate-hospital-quality-scores  

Until about 6-7 years ago A.J. Hegg had little idea what the acronyms CDI or UM were, much less what they did or how they helped hospitals.  

Today the Essentia Health hospitalist is leading a new physician advisor program and making a big impact on his organization. Both from a quality and financial perspective, but also on the personal lives of a diverse team of physician advisors who have managed to incorporate life balance into their work. 

Listen in as we cover: 

• Hegg’s origin story into CDI, fueled (or perhaps pushed) by director Tracy Boldt  

• His role today—CDI vs. medicine, and division of responsibilities 

• Essentia Health’s physician advisor program—services covered, scope of work, and core responsibilities including UM and CDI simultaneously 

• Bringing back old-school CDI as it was once practiced (and still is in some corners)—at the elbow clarifications, conversations, provider education. And how it all meshes with Essentia’s existing CDI team. 

• Metrics, assistive technologies, and high-level dashboard

• Who the team is and how it functions—shift work and task based, structured for work-life balance and an emphasis on positive culture 

• Obtaining organizational buy-in and high-level ROI 

• A favorite hazy memory from the Encore casino in Boston, September 2021 ACDIS physician advisor exchange... 

Outpatient CDI is not a traditional discipline—and so it stands to reason that its practitioners don’t always hail from traditional backgrounds. 

One such person is Glenda Bocskovits. I’d call her a former transcriptionist, but she still practices that craft with the Mayo Clinic. But Glenda has since expanded her career into cutting edge practice as an outpatient CDI specialist with Catholic Health. 

We get into Glenda’s unique career path, the obstacles of breaking into CDI as a non-clinician, and address the eternal question: What is the ROI of OP CDI? We cover the following topics: 

• Transcription: That’s still done? It is (hear why). 

• The ROI of outpatient CDI  

• Catholic Health’s thorough process of OP CDI chart review: Prospective, current/pre-bill, and retrospective 

• Common conditions requiring clarification and what continues to trip up providers 

• A day in the life of: What Glenda’s job entails 

• Obstacles of getting into CDI as a non-nurse and strategies for landing elusive interviews 

• Glenda’s career motivations and song selection for the Off the Record Spotify playlist 

Social Determinants of Health, or SDOH, are a buzzword these days—but often little more. We acknowledge their importance, but actual progress on capture (and subsequent patient support) has been slow. To be fair real barriers including technological limitations and limited financial incentives stand in the way.

But my current guest understands better than most the major role SDOH play in patient health. He and his organization have developed a digital tool to facilitate capture and improve the lives of patients in their community. They’re making a difference.

Dr. Pablo Buitron de la Vega is Assistant Professor of Medicine, Medical Director, Preventive Medicine Residency, and Clinician Lead for the THRIVE Social Determinants of Health Program at Boston Medical Center / Boston University School of Medicine. A native of Ecuador, he’s made SDOH his mission.

On this show we cover:

• Dr. de la Vega’s long journey from Ecuador to U.S. physician, the obstacles he overcame, and how the experience shaped his mission as a provider
• Defining SDOH and common examples in his line of work as a Boston physician
• Basics of capture in ICD-10 and what makes SDOH difficult to collect
• Boston Medical Center’s SDOH capture tool, THRIVE: What it does, tangible benefits, and how your organization can get access
• Low-tech strategies for SDOH capture you can implement today
• Dr. de la Vega’s National Institutes of Health (NIH) grant to develop a triage tool to help address patients’ unmet social needs

This country does a decent job in our primary schools working with children and young adults with special needs. Certainly many improvements have been made in the last 40-50 years.  

But once neurodivergent kids become adults, that support seems to vanish. 

Tami Gomez stepped into this large breach by launching the UC Davis Neurodiversity Coding Internship Program. This new program creates professional pathways for neurodivergent individuals by offering hands-on training, mentorship, and real-world exposure to healthcare operations, specifically in inpatient medical coding. 

I’m thrilled to get her back on the program to talk about this, her greatly expanded role as Executive Director, Mid Rev Cycle, HIM, Coding, CDI Programs, & Revenue Integrity, and a cutting-edge new initiative she spearheaded that’s already making a big financial impact. 

Listen in as we discuss: 

• Origins of UC Davis Neurodiversity Coding Internship Program: Tami’s own story of neurodivergence 

• Getting started—funding, early struggles and sticking points, partnership with UCLA 

• The curriculum and beyond: What are they learning, thanks to generous donations from HCPro/AHIMA, and not just education—taking students all the way through CCS credentialing and job placement 

• Reception from attendees and the industry at large 

• What makes neurodivergent people uniquely able to code, and their real struggles interviewing and entering the workforce 

• Tami’s new busy day job as Executive Director, Mid Rev Cycle. HIM, Coding, CDI Programs, & Revenue Integrity at UC Davis Health.  

• New Initiative: High-Pay Huddles and its financial impact 

• Increasingly tech-enabled coding and CDI professions—are we in danger of losing them to AI? 

• Updates on her personal life as a party planner, why her colleague Penny Jefferson rocks so much, and a new song for the #OTR Spotify Playlist... 

Mentioned on today’s show: 

• UC Davis Neurodiversity Coding Internship Program: https://health.ucdavis.edu/him/Coding/Neuro.html  

• AHIMA video featuring Tami: https://contentwithpurpose.co.uk/ahima/healthinformation/videos/tami-mcmasters-gomez/ 

I’ve been in the coding and CDI worlds since 2004, and in that time watched the rise of Facebook, YouTube and other social media. And as early 2011 or so I began to wonder, will anyone pair these two together?

When will see our first social media creator in the world of medical coding, making it his or her full-time gig?

I’m pleased to say that the day has arrived. Victoria Vo is a Medical Coding Educator, Auditor, YouTuber, Entrepreneur, and founder of Contempo Coding, LLC. Her YouTube channel has 187,000 subscribers and she's created close to 600 videos, some of which have racked up more than half a million views.

If you’ve met or seen Victoria you know this did not happen by chance. She’s a natural educator, charismatic and personable. But she’s also very knowledgeable about coding, passionate about the profession, and an outspoken industry advocate. We get into all this and more in a very social episode of Off the Record.

On this show we discuss:

• Victoria’s coding origin story
• Contempo Coding, the business and what it’s about
• Becoming a creator: Challenges and early side-hustle successes, timeline to earning her first $, and how she left coding to become full-time entrepreneur
• Three times she was recognized as a coding celebrity outside of AAPC conferences
• Advice for someone who wants to pursue content creation
• A joint ChatGPT rant (we both sound off on how we use it, and see it abused)
• What makes for a good coding professional
• Other fun stuff including her top resources and Off the Record Spotify playlist selection

Even if you’ve never seen The Godfather, you've probably heard its iconic line: “Just when I thought I was out, they pull me back in!"

That certainly applies to Sheila Duhon, National Director of Clinical Documentation Integrity for Steward Health Care. A year ago Sheila was headed toward semi-retirement, but changing events on the ground in the beleaguered healthcare system prompted her to get back into the game with her old organization.

Sheila is a 2022 CDI Professional of the Year award winner, a published author and passionate educator, but above all possesses a strong moral compass and a willingness to do what’s right for her CDI team and the patients they serve—one which has served her well in a tough spot.

On this show we cover:

• Sheila’s second act in CDI, from semi-retirement to full-time leadership role
• The cloud over Steward: How she puts that aside and focuses on the task at hand
• Her formative experiences as a nurse thrust into the ICU at age 19
• What makes for a good CDI educator, including her story of a challenging first educational session for a group of providers
• CDI as she sees it: A clarification that hospitals still miss, pros/cons of the current state of the profession
• Timeline toward retirement part 2 and final words of advice. Plus of course Sheila’s selection for the Off the Record Spotify playlist.

We all get excited—and rightfully so—at the rapid advance of clinical medicine. New treatments, therapies, and drugs save lives. But when you work in the revenue cycle, you know that payment mechanisms can significantly lag new technologies.

When codes don’t exist, or reimbursement is woefully inadequate, you have to take action. Petition, sometimes at the highest levels of government.

Jugna Shah is fighting for improved coverage and reimbursement for CAR-T and other cell and gene therapies, a trip that recently took her all the way to Capitol Hill. On this episode she talks about exciting work underway to improve healthcare accessibility and reimbursement, shaking hands with popular politicians, and of course some can’t miss documentation and coding tips.

On this show we cover:

• Jugna’s mission and the mission of Nimitt Consulting
• CAR-T and other cell and gene therapies: Current reimbursement mechanisms, insurance and coverage issues, and regulatory guidance
• Jugna’s advocacy efforts at the recent White House Cell and Gene Therapy Forum
• What came out of the Forum and what’s next given the recent change in administration
• What hospitals can do today to receive appropriate reimbursement for these life-saving therapies (she offers up some great advice on setting appropriate charges, citing the regulations)
• Where are we with drug administration (i.e., coding of injections/infusions)

We hear about lawsuits and false claims acts regularly, but did you know that many of these begin with someone working from inside the organization? Calling out bad behavior or noncompliance, sometimes again and again without being heard—before deciding to call on a third party for help?

You might have seen the recent headlines about New York insurer Independent Health, which agreed in December to pay $100M to settle allegations it had upcoded claims to inflate Medicare Advantage payment. But did you know the basis of the lawsuit was a whistleblower, and 12 years in the making?

My guest on Off the Record knows this very well. Mary Inman is a Partner at Whistleblower Partners LLP, and Head of International Whistleblower Practice for the firm. She also served as legal counsel in this very case.

I continue my “law and coding” start to 2025 with a fascinating guest and topic. On this show we discuss:

Who/what is a whistleblower, and the concept of qui tam

The mechanics/process of a whistleblower engaging a lawfirm: Are they working for their employer throughout reporting, discovery? Is gathering evidence to support their case without employer knowledge illegal?

What happens to a whistleblower who wins—or loses? How much can they stand to make, and is their career over?

New DOJ whistleblower project to encourage additional reporting

What some whistleblowers get wrong/false report or misunderstand

What hospitals/healthcare organizations can do to lessen the risk

Mary’s Off the Record Spotify playlist selection (I was disappointed it was not Judas Priest’s Breaking the Law)

Medicare Advantage. It’s everywhere you turn. From upcoding to denials, the huge and growing program—which now covers more lives than traditional Medicare, but is increasingly the target of local and federal scrutiny and a stream of endless OIG audit reports—seems to be in the news daily.

In a sea of online anger and noise, there’s a few voices of reason, reminding us about the regulations and guidelines and how MA should be conducting itself—at least in theory.

One such person is Richelle Marting. Richelle is an RHIA and a JD and owner of a host of coding credentials besides. As a Healthcare Reimbursement Attorney and Founder of Marting Law, LLC, she brings a unique legal viewpoint to medical coding, coverage, and payment. She knows what regulations bind Medicare Advantage plans—and how these are often skirted.

On this show we cover:

• Richelle’s start to 2025, personally and professionally

• What MA plans must cover and pay for, by law

• Prior authorization

• Under which circumstances MA plans can use internal coverage criteria

• How MA plans game the system: three sneaky tactics you won’t want to miss

• The latest on automated denials/use of AI

• Richelle’s answer to the question: Medicare Advantage: Yay or Nay?

• An interesting new year’s resolution and latest addition to the OTR Spotify playlist

Richelle’s desktop MA policy links:

Governing rules for Medicare Advantage: Code of Federal Regulations 42 Part 422: https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-B/part-422/subpart-C

Final rule for MA plans (April 2023), 4201-F: https://www.federalregister.gov/documents/2023/04/12/2023-07115/medicare-program-contract-year-2024-policy-and-technical-changes-to-the-medicare-advantage-program

Medicare Internet-Only Manuals: https://www.cms.gov/medicare/regulations-guidance/manuals/internet-only-manuals-ioms

Medicare Advantage 2026 proposed rule: https://www.federalregister.gov/documents/2024/12/10/2024-27939/medicare-and-medicaid-programs-contract-year-2026-policy-and-technical-changes-to-the-medicare

Here we are, at the end of the year. And the end of another season of Off the Record.

For reasons that will soon become clear, I wanted to wrap up 2024 by pushing myself out of my comfort zone. Because this episode is about personal growth.

So here I am, doing my first ever solocast.

I bring you the Top 5 lessons learned over the year of Off the Record. These apply to mid-revenue cycle leaders, our core audience for #OTR, but they’re broad enough for anyone to adopt.

This is a tidy episode, just 26 minutes of distilled wisdom from several guests that I was honored to host.

Enjoy, Merry Christmas and Happy Holidays, and I’ll see you in 2025.

Last month I wrote a post about the four stages of a career, using the analogy of seasons. I was inspired by the wonderful fall weather I was experiencing while on a walk here in New England, but also by changes I have been experiencing in my life and how these have caused me to re-evaluate what’s important in my career.

The post got a good reaction, including from Nicole Fox, Associate Chief Medical Officer, Medical Director of Pediatric Trauma, Medical Director of CDI, at Cooper University Health Care. Which led to this show.

Nicole and I are in the “fall-ish” of our careers. Which might sound like we’re getting ready for pasture, but not really. I’m 51 and Nicole is 48, so we have many more years to work—but our priorities are changing. You might say, they are better aligning with the new people we are becoming, as human works in progress.

Nicole has done a lot with career coaching, both as recipient and mentor, and we get into all that on today’s show—and bare our souls a little bit about what is holding us back.

This was a terrific conversation with an amazing person and I suspect you’ll enjoy it, and maybe come away a bit more reflective about your own career and priorities.

On this show we discuss:

• An update on Nicole’s work as a pediatric trauma surgeon and hospital executive—and the need for changes

• Her experience with a career coach and what she learned about herself

• Career “saboteurs”—how do you discover them, and what can you do to diminish them? I highly recommend taking the free assessment linked below (my top 3 saboteurs are avoider, hyper achiever, and pleaser)

• Is it possible to shape your career, and how does that look in practice?

• The “seasons” of a career and using it as a framework for discovering what is most important (with an emphasis on the fall season)

• Nicole’s forays into coaching and mentorship, and prioritizing health and work-life balance in a demanding clinical career

Show notes

• Four stages of a career: https://www.linkedin.com/posts/brian-murphy-13800b11_i-love-the-fall-especially-here-in-new-england-activity-7253050994937212932-2QFY?
• Career saboteurs assessment: https://www.positiveintelligence.com/saboteurs/

With 23 years and counting in CDI, Rhoda Chism has seen a lot. The rise of new regulations and reimbursement mechanisms, and the advent of new technologies that have radically transformed chart reviews. 

Rhoda has not only weathered these changes and navigated the turbulent waters, but remains as warm and personable, and pro-person, as you will ever meet.  

But not anti-technology. 

Today she is the Director of Clinical Excellence and Adoption for the software company Iodine, a new position she’s held for just two months. But I think she could be called Chief People Officer.  We get into the blending of human and machine, discussing the following: 

• Rhoda’s journey into healthcare and nursing at the tender age of 19. 

• The transition from bedside nursing to CDI in 2001 

• Melissa Varnavas and the lasting impact of a simple message of encouragement and belief 

• Using authentic, personal stories to communicate difficult CDI concepts and education, including heart failure and AKI 

• How technology has radically transformed CDI over the last two decades 

• AI driven technology as human amplifier, not replacement, and the importance of emotional intelligence in CDI work 

• Career advice for young professionals in a world of rapid change 

Karen Elmore is living in denial(s).  

Her job as Senior Clinical Documentation Quality Coordinator for BJC Healthcare involves a daily battle against a never-ending tide: Payers denying diagnoses on the perceived basis of lack of clinical support. Recently she’s had to deal not only with human payers, but artificial intelligence denials as well. 

Karen’s organization has worked hard to stem this never ending tide, and found some success with uniform organizational clinical guidelines and consistent education and engagement.  

We talk denials, appeals, preventing future denials through provider education, and  Kansas City Chiefs football (still undefeated as of publish date), on this episode of Off the Record. 

On this show we cover: 

• Karen’s unique role as program manager for CDI at BJC, including responsibilities for physician education, engagement, and denials prevention 

• Typical denials for sepsis, respiratory failure, and malnutrition: What payers are using for ammunition 

• What payers are the worst offenders, and particularly creative (and egregious) tactics 

• AI denials—how do you spot them, and combat a machine? 

• Provider engagement strategies and relaying denials back to physicians 

• Legitimate reasons for denial and ongoing documentation shortfalls 

• Karen’s Kansas City Chiefs obsession—inside an average Sunday in the Elmore household (it’s crazy) 

Following is part 2 of our interview with Revka Stearns, who joined us on Off the Record to provide an update of her first eight months on the job as a new inpatient coder.

If you haven’t listened to part 1 I’d recommend starting there, since we pick up mid-conversation. On this show we cover:

• The mechanics of working as a remote coder. Workplace setup and helpful recommendations
• Dealing with the physical challenges of working at a desk all day and breaking up the routine
• Unexpected consulting work coming her way ... from Canada!
• Unfiltered conversation about social media. Revka’s take on the social media landscape, dealing with negativity, dispelling persistent myths (there’s no coding jobs! It’s all being outsourced! Yes there are, and not it isn't—Revka is proof), and being a consistent, positive, and helpful online presence.
• Keeping sane through work-life balance, and her latest Off the Record Spotify playlist entry

A lot has changed in the world of Faisal Hussain since he last went under the white-hot spotlight of the Off the Record podcast studios. 

A new career path, with a new company. 

Growing children, with whom he gets to spend more time. 

A surprise award, bestowed by his college alma mater. 

And many new changes in the CDI industry he continues to serve, including a new ethics paper and now a new physician query practice brief from ACDIS. 

In short, it’s a great time to have back the former Executive Director of CDI at Wellstar Health System, and now newly minted CDI System Physician Advisor at MedStar Health. We’ll get into all these topics and more on today’s show, covering: 

• New role: Who is MedStar Health and Faisal does as CDI System Physician Advisor. And why the major change?  

• New focus: Moving out of CDI operations and into creative projects and technology expansion. Faisal’s work bridging rev cycle, UM/UR, risk management/medical legal, denials and lawsuits--recruiting different leaders across all service lines to standardize and make effective documentation workflows. 

• Working in CDI/coding/healthcare in the utterly unique state of Maryland ... what’s going on there and why is every regulation “except Maryland”? 

• What might hospitals be under-leveraging in the physician advisor role?  

• New ACDIS papers Safeguarding Ethical Documentation Practices in Querying, Peer-to-Peer Discussion, and Technological Initiatives and the new physician query practice brief—his work and analysis 

• Surprise recipient of the 2026 Outstanding Alumnus Award from The University of TN Health Science Center 

• Being a father of neurodivergent daughters, whom he now gets to spend more time with. What has he learned from them. Special praise for Tami Gomez and her work starting a Neurodivergent Coding Internship Program. 

• Finally setting the record straight on “Baby Shark” and putting me, the host, in his place... 

Back in January I hosted newly minted medical coder Revka Stearns. For someone so new to the industry, Revka has made a big impact by the act of sharing--documenting her journey in detailed and open fashion on LinkedIn and Facebook, and a half dozen podcasts and programs.

At the time she was on the show Revka had literally been on her first job for about 3 weeks. Eight months later I asked her to come back for an update and share her successes, challenges, and unexpected side-ventures.

Revka has many strengths—smart, hardworking, diligent--but one of them is effective use of social media, creating a model for how I like to see these platforms used (and unfortunately often aren’t).

But she’s also had her share of struggles. Coding is hard.

This was a bit of a longer interview so I split it into two parts. On part 1 we cover:

• Eight months on the job as a first-time medical coder
• Specific challenges she’s encountered, including:

1. Making sure the organism causing an infection is clearly linked to that infection through documentation
2. Ensuring documentation is carried through to discharge, beyond the provider just copying and pasting
3. Recognizing query opportunities

• The reality of learning: Taking one step forward and two steps back
• Most rewarding aspects of the job
• What she knows now that she wished she knew back in January

With 25 years’ experience in medical/surgical, critical care, and emergency department medicine, Tonya Motsinger has seen her share of crises.  

COVID-19 was a crisis of a far larger scale. 

The pandemic wreaked havoc not only on patients, but her CDI department, resulting in staff shortages. 

Today OhioHealth’s System Director of Clinical Documentation Integrity has come out on the other side stronger. You might even call her, a survivor.  

We discuss lessons on staff retention, remote onboarding, and some great work she’s done to improve her organization’s Vizient clinical quality rankings. On this show we cover: 

• OhioHealth’s CDI department including basic KPIs and department objectives, and Tonya’s role as System Director.  

• Impact of the COVID-19 pandemic and department staffing devastation 

• Putting things back together: Salary increases and short-term weekend coverage plan 

• Challenges of remote orientation for new CDI staff 

• All things Vizient: New Vizient calculator, CDI review nuances, and impact on actual organizational quality

• Onboarding a new hospital that’s never had a CDI program (I know, such places apparently still do exist) 

• Being a new grandmother and her addition to the Off the Record Spotify playlist 

Bridging the gap between clinical and financial worlds is the goal of CDI and coding, but it’s much easier said than done. One way to reconcile this schism is through data—objective numbers that don’t lie, but can speak to both sides of this seemingly irreconcilable chasm.

Associate Director of Coding and CDI at Yale New Haven Health (YNNH) Leif Laframboise believes in the power of data and uses it to structure the work of the coding and CDI departments under his oversight. But he marries that with a candidness and leadership style I admire, and an inner strength that has allowed him to persevere with a disability that might have ended the career of another.

Leif is not just a data lover but an all-around good dude that I got to know a little bit during my ACDIS days, and I’m pleased to have him on this episode of Off the Record. We discuss:

• An overview of the CDI and coding departments at YNNH

• Broad departmental KPIs, with present on admission as a north star in a sea of competing quality programs

• YNNH’s unique reporting structure to both finance and the chief medical officer, and how that works in practice

• Why and how Leif embraces data—what he looks for, how he uses it to drive improvements, educate providers, and focus his team’s chart reviews

• His thoughts on how CDI and coding must evolve with changing times

• His disability and how he’s worked around it in a visible leadership role

• Our first Foreigner selection on the OTR Spotify playlist (about time)

Robin Jones moved to Florida at the tail end of 2017 to pursue a burgeoning career in CDI. And ever since has done nothing but climb the professional ladder.

Leaving behind her home in Cincinatti Ohio and a decorated career in CDI at Mercy Health, Robin started over as Division Director of CDI at AdventHealth West Florida in November 2017. A few years later she was promoted to Director of Clinical Excellence. You might recall that she joined me for an episode of Off the Record in November 2022 to talk about this change.

Three months ago she was promoted again, this time to Vice President of Clinical Excellence & Education. And I knew it was time for a return visit. We get into her flourishing career and the broader CDI program at AdventHealth West Florida on today’s Off the Record.

On this show we cover:

• Promotion to VP of Clinical Excellence and Education and what it entails
• New VP level leadership responsibilities, and what new skills Robin had to cultivate to meet them
• What she had to give up to accept this new role, and the challenges of delegation
• Commitment to hybrid onsite/remote CDI and a unit-based model of coverage
• Winning a Leapfrog Emerald Award, AdventHealth’s emphasis on public report cards and how CDI can make an impact
• Retaining and building the workforce of tomorrow

Our two-part “Podcast on the Pirogue” miniseries concludes in this installment of Off the Record, recorded live in the backwoods of Pierre Part, Louisiana. 

Here I wrest back my traditional host seat (after the takeover in part 1) and interview Jason Jobes, Senior Vice President of Solutions at Norwood, and Dr. Robert Oubre, aka, The Doctor of Documentation. We discuss their newfound roles as entrepreneurs in the throes of growing a business. 

Jobes is building the Solutions arm of Norwood, driving new consulting engagements and managed services, while Oubre has launched a series of physician e-learning CDI courses and (most recently) a new online community. We cover lessons learned, mistakes made along the way, proudest achievements, the importance of mentorship, recommended resources, and ultimate goals and aspirations. 

If you are looking to start your own business, take up a side hustle, or build your personal brand in the mid-revenue cycle, this is one you’ll want to listen to. Some great talk with two good dudes “BS-ing on the Bayou” with occasional lapses into profundity. 

Enjoy! 

I’ve hosted the Off the Record podcast since September 2022. Over that time I’ve recorded dozens of interviews with scores of great guests, with episode 50 right around the corner.

But I’ve never had the microphone turned on myself. Until now.

This past April I was hanging out at the ACDIS conference with my colleague Jason Jobes and Dr. Robert Oubre, CDI physician advisor at St. Tammany Parish Hospital. There the three of us hit on the idea of a podcast recorded in person in Louisiana, where both Jason and Robert live.

What would we talk about? Dr. Oubre decided it was time for me to go under the spotlight.

On this episode we talk about my unlikely career path from odd jobs and journalism to healthcare and Director of ACDIS, and eventually here to Norwood. It’s a revealing interview that made me sweat—and not just from the Louisiana heat.

So, I hope you enjoy this unconventional and very unscripted episode about my origin story, the early days of CDI and ACDIS, and some personal lessons learned along the way.

Pardon the sound quality. You will hear the authentic sounds of the Bayou on this episode. We recorded in Jason’s screened porch in Pierre Part, best known as home of the reality TV show Swamp People.

No guests were harmed by alligators during this recording.

I have to say it’s very inspiring being around my guest on today’s show. Prior to this episode of Off the Record I had never met Keisha Wilson ... and within minutes I felt like we were friends.

Something about her warmth and spirit that grabbed me right way. I hope you will feel it too.

Keisha is an entrepreneur, the founder and CEO of KW Advanced Consulting. But she’s also a volunteer and a mentor to many in the coding industry and beyond. And she’s made a niche for herself in telehealth, recently presenting a well-received session on the topic at the recent AAPC National Conference.

We talk about all this and more on the episode, covering:

• Keisha’s unique life journey into the U.S. and eventually healthcare and coding
• Getting pushed by life circumstances to start her own business—much earlier than planned
• Working with early telehealth adopters, the explosion of telehealth utilization during the public health emergency (PHE) of COVID-19, and future projections of the service
• Coding fundamentals and nuances of telehealth, missed opportunities, and compliance issues
• Using telehealth to augment risk adjustment, including the requirement for “face-to-face encounter” to capture HCC diagnoses—does a computer screen count?
• Keisha’s recommendations: One book and one song

It’s often been said that the only constant in life is change. And the mid-revenue cycle is no exception.

As new regulations emerge and new technologies develop, professions get radically transformed—or even erased altogether. The antidote is a commitment to lifelong learning, and embracing the discomfort that accompanies growth.

That describes the mindset of Crystal May, my colleague and a Risk Adjustment Consultant for Norwood.

This program was originally broadcast as a webinar interview but was just too good not to share with a broader audience. So I’m pleased to publish it on the podcast.

On this show we discuss:

• Crystal’s unique career path that began in transcription, profee coding, and ultimately risk adjustment
• Her current work including audits of organizational documentation and code assignments
• Common documentation and coding pitfalls (strokes are a major source of error—hear why)
• How organizations can use findings from audits to drive continuous learning and improvement
• MEAT criteria—examples of adequate MEAT criteria (and what happens if you’re MEAT-less)?
• Getting comfortable with discomfort to grow your skillset and insulate yourself from industry layoffs
• Our joint heavy metal obsession and recommended bands

What the heck is a trauma registrar, anyway?

Once upon a time even my guest asked that question. After starting a career in nursing in 1987, Stefanie Arp became a trauma nurse specialist in 2001. And quickly became tasked with the responsibilities of trauma coordinator, a position she knew very little about but found herself immersed in, whether she wanted to or not.

Trauma registry opened up a new world of data abstraction, quality improvement, trauma center designation, high-pressure American College of Surgeons site surveys, and much more, including medical coding and the use of trauma activation codes. And opened Arp’s eyes (and now, mine) to an under the radar profession that plays a huge impact on patient outcomes and organizational quality.

We get into all of that on today’s Off the Record, covering:

• What is a trauma registry professional and why should an organization invest in them?
• The nitty-gritty of the role including data abstraction process, record review and productivity expectations
• American College of Surgeons and facility specific requirements, including trauma center designation levels
• Revenue implications including the use of trauma activation HCPCS code G0930
• Arp’s fascinating origin story, from nurse to national consultant
• What makes for a good trauma registrar--desired background, skills, and mindset, and Arp’s advice for folks looking to break in
• Finding meaning in her work (no shortage of that)

Earning your RHIA (Registered Health Information Administrator) is a huge accomplishment, and for some marks the end of a four-year academic journey and an entry into HIM.

For Richelle Marting, it was only the beginning.

In pursuit of her RHIA, which she eventually earned, my guest on today’s episode took a class on the legal aspects of HIM. That course planted the seed for a career in law—and eventually led her to start her own law firm.

All while raising two twin girls.

I don’t know how she managed all this, but that’s why I got Richelle on Off the Record.

On this show we discuss:

• Richelle’s story from RHIA to JD. How difficult was the bar exam?
• Becoming an entrepreneur and starting her own law firm
• Most frequent type of healthcare cases: Clinical validation audits and DRG validation
• The coding guidelines she sees most frequently ignored or twisted to the payer’s benefit, and other shady tactics
• What do healthcare organizations make too big a deal out of—and what are they not worried about enough?
• Qui Tam and the recent spate of cases initiated by organizational whistleblowers, in particular Medicare Advantage organizations
• Managed care contracting: Legal issues around contract negotiation, how claims get paid, timely filing, and payment policies. How quickly must plans respond to appeals, and should you put a diagnosis definition in a payer contract?
• What advice would she give to someone who is in HIM and considering a career in law—what does she know now that she wishes she knew then?

We need a “human in the loop” in mid-revenue cycle work, experts say. 

What they fail to answer is the more interesting question:  

Where in the loop, exactly?

Back-end AI fact-checker? Front-end query authorizer? Or, maybe something like my current OTR guest Penny Jefferson envisions: Medical record maestro. 

The end-to-end connectedness of the medical record, evolving API standards, increased use of prior authorization, episode-based reimbursement models, and review of all of this by AI and other tools makes documentation cohesion more important than ever.  

CDI is changing with the times, but often not fast enough. It must change, or risk stagnation and possible extinction. The ready availability of vast amounts of information in the EHR and AI-enabled reviews and audits means a slip in a diagnosis can result in a big DRG downgrade or denial of stay altogether. 

But an AI powered enabled CDI maestro conducting the show can make a record strong, front to back. 

Penny has been writing like a fiend about many of these and other related topics for LinkedIn and the likes of ICD-10 Monitor--which is what led her back to the hot seat of the Off the Record studio. Listen in as we discuss: 

• A day in the life of: Penny’s evolving role at UCDavis 

• Her take on today’s CDI work, where is it coming up short and/or at risk of being automated away? 

• UR function/medical necessity and how CDI can assist case management without igniting a turf war. 

• “Longitudinal episode integrity”: Episode-based bundled payments (TEAM, etc.) and how they shift chart review beyond discrete diagnosis review to breadth 

• APIs and FHIR standards: Issues with fields that don’t match throughout the medical record leading to denials, bringing it home with an encephalopathy example 

• Where does CDI need to upskill to meet these new demands? Does the “traditional” chart review/query role need to change ... or do we need an entirely new role to evolve to meet these demands? And what about productivity metrics? 

• Addressing the elephant in the room. Where is the human in the loop? For example: should a human review every AI query before it goes out? Spend more time on high dollar, 5+ day stays? Tiebreak a co-equal dx? 

• Updates on admit type. Listeners might recall our previous show on this topic, with  loose NUBC definitions leading to urgent vs. elective categorization to minimize impact on quality metrics. 

• Other fun stuff you only get on #OTR 

One of the more promising developments I’ve seen over my career watching the CDI profession bloom is the creation of the CDI educator role.

CDI is often labeled by its critics as reactive, sending queries to the provider after he or she has already documented in the chart. This is an integral but limited part of CDI work.

The main work is getting physicians to document correctly in the first place.

It’s the kind of work being done by Kalee Vincent, my guest on today’s program. Kalee is the CDI Educator for WVU Medicine, West Virginia’s largest health system and largest private employer comprised of 23 hospitals.

Kalee joins me to discuss her path into healthcare, her important work and impact as an educator, and some proven strategies for teaching documentation lessons that stick with providers.

Listen in as we discuss:

• Shifting from CDI chart reviewer to educator in January 2023—challenges and rewards, advice for those considering a similar move
• CDI as an RHIA: Addressing misconceptions about clinical knowledge as a non-nurse (Kalee dissected a cat in college—for real—as part of her studies)
• Keys to being a good physician educator: What works in a 1:1 setting vs. a medical staff meeting, how to get time with busy docs
• Lots of interesting examples where gaps exist and education is needed—CKD, sepsis 2.5, ASPEN, shock, heart failure and more (Kalee came PREPARED)
• New WVU malnutrition coalition: Why this initiative began, what the work includes, and her role on the coalition
• Hamming it up with ex-ACDIS directors, what downtime in the Vincent household looks like, and her Off the Record Spotify playlist selection (Taylor Swift has cracked the lineup—you knew it had to happen sooner or later)

Sepsis it seems is always in the news, never far from anyone who works in CDI or coding circles. And here we are again, back in the headlines due to its inclusion in the Office of Inspector General (OIG) Work Plan.

Sepsis has been discussed so much due to the complexity of disease, the cost of treatment, complexity of coding, and increased regulatory spotlight. What else is there to say? But with it back in the spotlight I wanted to turn from the usual insular conversations in the mid-revenue cycle to someone working on the front lines of care.

Amanda Hart is an ED nurse and a sepsis clinical nurse specialist at Tower Health, a regional integrated healthcare system based out of Pennsylvania. She spends a substantial amount of time battling this deadly disease, and her work has much to offer anyone who works to get it accurately documented and coded.

On this episode we discuss:

• Amanda’s background in the military and EMS, path into nursing and eventually the ED

• Her role as sepsis clinical nurse specialist and how it overlaps with CDI/coding

• Pathophysiology—clinical indicators of sepsis and what makes it such a deadly disease

• Problems inherent in lack of uniform definitions, what Tower Health uses, and her own take on Sepsis-2 vs. Sepsis-3 debate

• The importance of early screening, including processes, technologies and people. Are EHRs and alerts helping or hindering?

• Tower Health’s home-grown protocol that resulted in a 32% reduction in relative mortality rate in non-POA cases.

• Life on the front lines of care and how it changed Amanda as a person

If you’ve ever been a member of ACDIS you’ve almost certainly encountered Dr. Trey LaCharite’. ACDIS advisory board member? Check. Regular columnist for CDI Journal? Check. Author of the CDI Field Guide to Denial Prevention and Audit Defense? Check. Speaker at the physician advisor pre-conference every year since (at least) 2010? Yes, put a checkmark there, too.

Trey is the Medical Director for CDI and Coding and Clinical Associate Professor for University of Tennessee Medical Center. He’s got the holy trinity of credentials—a MD, plus CCS and CCDS (and others). On this show he brings his unique clinical and coding perspective, combined with real-world applications and trademark tell it like it is/no-nonsense perspective, in a candid interview.

Note: This show was recorded prior to the 2024 ACDIS conference in Indianapolis last week, where Trey presented the session “Beyond Problem Lists: How to Document Is Just as Important as the What.”

On this show we discuss:

• Trey’s path from hospitalist to CDI

• Problem lists: How UTMCK uses them and keeps them updated

• Denials and creating a “defendable narrative” using the patients’ clinical story

• Trey’s opinion on sepsis-2 vs. sepsis-3, now back in the news due to the recent OIG Work List update

• What ACTUALLY resonates with MDs, regarding the eternal question “what’s in it for me”?

• CDI pet peeves, proudest career accomplishment, things to do in TN, and an unexpected OTR playlist addition

Small community hospitals are the backbone of healthcare for most of the country, even today in this era of sprawling healthcare organizations and massive mergers.

But while they’re critical to the health of our nation, resources are often scarce, and CDI is no exception.

Jennifer Cummins, BSN, CCDS, is one of just two CDI professionals covering a 222-bed not-for-profit community hospital in rural Kentucky. Advanced technology and sophisticated AI are not in her toolbox, but that doesn’t mean Jennifer doesn’t take pride in her work.

In fact, she and her colleague are making a big impact with some old-school methods. Their CDI work helped the hospital earn the title of one of the 100 Greatest Community Hospitals in America. Proof that determination, creativity, and teamwork are still more important than tech, even in this day and age.

On this show we cover:

• Jennifer’s origin story—ICU and ER nurse, finding her way into CDI with the help of a nursing colleague

• CDI program--when it began, focus of reviews, and success metrics

• Conducting chart reviews with a basic encoder, books, creativity, and the help of other departments

• Logistical challenges as a small community hospital, including weekend coverage and PTO in a department of two, and rising to meet new initiatives with limited resources

• Expansion to mortality reviews: Identifying the need, process, early successes, and conducting deeper, more intensive reviews

• Fun things to do in Kentucky (aka., Bourbon Trail). Plus Jennifer’s addition to the Off the Record Spotify playlist (Kentucky bluegrass? Find out)