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...

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...

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...

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....

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...

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...

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...

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,...

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...

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...

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...

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,...

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...

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...

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...

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...

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...

I don’t know about you but I'm FASCINATED with Medicare Advantage (MA). Massive growth, fueled by its shrewd marketing of added benefits beyond traditional Medicare. But also chaotic, messy, a program in need of reining in.   It’s a bit of the wild west.  I like some things about MA, including its emphasis on preventative care and aligning patients outcomes with rewards. But I'm also routinely disappointed by its excesses and denial of medically necessary care.   Some days MA seems poised...

Listeners of Off the Record may recall our episodes on the OIG audit of severe malnutrition directed at North Carolina based Vidant, now ECU Health. Vidant/ECU won a landmark case against the OIG in large part because it had a multidisciplinary clinical and coding team in place to ensure that severe and other forms of malnutrition were appropriately documented in the record and captured. That effort was spearheaded by CDI and coding experts, but also by a great clinical team including my...

In 2009 ACDIS was growing. The association’s boot camps were taking off. We were at the point where we needed to hire our first full-time instructor and CDI educator. That person was Lynne Spryszak. Lynne had been in CDI since 2002 and volunteered as an inaugural ACDIS inaugural advisory board member in 2007. She married experience (rare in what was then a new profession) with passion and a desire to educate. It was a perfect fit. Lynne worked with me for a couple great years and then...

If you’re an aspiring medical coding professional and on LinkedIn, you might know my guest today. In fact, you probably do. She’s positively burst onto the scene. Not necessarily as a content expert dropping coding or clinical expertise (although that’s coming, to be sure), but someone who has documented her journey to medical coding in remarkable detail and honesty. From entrepreneurial web developer, metalsmith, piano instructor, and used book seller, to medical coder and LinkedIn...

Having worked in and around medical coding and CDI for almost 20 years, I can say for certain that few topics vex coders and CDI professionals more than the dreaded recertification process. Credential maintenance. CEUs. CEU fees. Conference CEU codes. Certificates. On and on. It’s a cottage industry unto itself. It can be frustrating and confusing, and if you’re not on top of it, costly. In my ACDIS days we had folks lapse, despite our generous grace periods. They still do. Few things get...

The turn to a new year is the time to set new goals. And who better to set them with than a person who has achieved a career far beyond many of us ordinary mortals—but has the honesty and humility to reveal where she falls short. Dr. Nicole Fox is Associate Chief Medical Officer, Associate Professor of Surgery, Medical Director of pediatric trauma, and Medical Director of CDI for Cooper University Hospital, a level 1 trauma facility in Camden, NJ. She made for a great guest to kick off...

The end of the year is a time to reflect, to look back on what we’ve accomplished and learned.   And enjoy the time away from the office and have some fun.   On today’s show I’m joined by couple of guests and friends from my home base at Norwood for remembrance, lessons learned, and some meaningful personal and professional successes. We also talk about the major themes that emerged over a year of podcasting.  Sandra Love, Director of Solutions, and Joanne Wilson, Senior director of...