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:
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:
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.
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:
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:
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)
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
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
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
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:
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:
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:
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:
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.
