Off the Record with Brian Murphy

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 (NU...

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 manag...

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 Healt...

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 h...

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...

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...

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...

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...

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 gui...

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, ou...

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 Medi...

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 t...

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 t...

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...

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...

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 str...

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 i...

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...

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 entr...

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 Ho...

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 ment...

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 A...

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 ne...

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 eve...

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...