Podcast
Codes, Coverage & Capitol Hill: Fighting for CAR-T and other cell and gene therapies with Jugna Shah
Listen to the episode here. 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…
Read MoreQui Tam Confidential: An Insider’s Look at Whistleblowing with Mary Inman
Listen to the episode here. 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…
Read MoreLegal Limits: What Medicare Advantage must cover (and how it often doesn’t) with Richelle Marting
Listen to the episode here. 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…
Read MoreTop 5 lessons learned in a year of Off the Record
Listen to the complete episode here. 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.…
Read MoreAI-powered coding and CDI solutions augment human beings, but do not (and cannot) replace them
By Brian Murphy Machines are a human augmenter—not a human replacement. I love the way my recent Off the Record podcast guest Rhoda Chism frames technology in her CDI practice. As an amplifier, extending her reach and allowing her to touch more patients, but not a substitute for her unique skillset. Two…
Read MoreFall reflections: Nicole Fox on career evolution, saboteurs, and fulfillment
Listen to the episode here. 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…
Read MoreUsing POA as the Guiding Star for CDI: Insights from Yale New Haven Health
Between MS-DRGs, HCCs, U.S. News and World Report rankings, Leapfrog, readmissions, mortalities, Vizient or Premier performance, and on and on, how does a CDI program know where to focus its record reviews? The choices seem bewildering. My current guest on Off the Record Leif Laframboise has settled on present on admission (POA) as the…
Read MoreEmpathy meets AI: Rhoda Chism on Human-Machine Harmony in CDI
Listen to the complete episode here. 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…
Read MoreLiving in Denial(s) with Karen Elmore, BJC Healthcare
Listen to the program here. 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…
Read MoreRevka Stearns: Eight months later (and wiser)—Part 2 of 2
Listen to the recording here: https://spotifyanchor-web.app.link/e/HvfKYIDsKNb We’re happy to bring you 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…
Read More