Off the Record with Brian Murphy

CDI and coding professionals typically recoil from the dreaded word, “payer.” After all, provider-payer relationships are often adversarial at best, hostile at worst. Clarify the diagnosis or procedure with the physician, apply the medical code … only to have the payer downcode or outright deny the claim.  My guest on today’s podcast understands the frustration because she once worked in the hospi...

How long have you been in CDI, oh listener? Three years, five, 10? Maybe as many as 16, if you started back when CMS adopted MS-DRGs and ACDIS began, in the hazy, pre-Tik-Tok days of 2007? My most recent guest on Off the Record has been in CDI for 24 years, starting in 1999. Longer than she served at the bedside as a nurse. It’s possible some of my listeners are 24. She’s been there, done that, bu...

Denials are a reality of life in the mid-revenue cycle. And they're not going anywhere. As Medicare Advantage (MA) grows—MA Organizations statistically deny more care than traditional Medicare—the volume of denied claims will only keep growing.   I wanted to talk about this subject with someone who not only understands the current mine-filled landscape, but knows how to overturn a denial like...

“The pessimist complains about the wind. The optimist expects it to change. The leader adjusts the sails.” – John C. Maxwell    It’s been said that there is no constant in life except for change. Jami Woebkenberg is proof. Jami is the Senior Director of HIM operations at Banner Health. Or at least, that’s her title now. She has had a few twists and turns over 19 years at the organization, which re...

When I started Off the Record, I wanted to launch a program that served the broader industry that serves the health record. That means, most of my guests work in the HIM/coding, CDI, case management, and trauma/oncology registry fields. But I also host folks who support the mid-revenue cycle—consulting, staffing, sales, legal, tech, and from time-to-time, members of my own company. And share their...

Since taking on the CDI director role at Brigham at Women’s Hospital in October 2017, Deb Jones has made big changes with big impact. These include: A deep focus on risk adjustment and mortality reviews. Boston is an incredibly competitive healthcare environment with 25 hospitals operating within the city. Patients have a choice of where to shop for care, which makes rankings in the likes of U.S....

CDI Director for Tufts Medicine. Recently went back to school to earn her MBA. Contributor to, and co-author of, the latest ACDIS-AHIMA physician query practice brief. Speaker at the upcoming ACDIS conference. And all-around cool person. Keisha Downes, BSN, RN, CCDS, CCS , joined me recently to talk about her impressive career in healthcare, a path that started from humble beginnings at Wal-Mart,...

Chris Petrilli is the Medical Director of Strategic Initiatives and Operations at NYU Langone Health. He’s an Associate Professor of Medicine at the NYU Grossman School of Medicine. … and he happens to have been a one-time stand-up comedian, whose gift for gab and comedic timing I can attest to. And may have been on the butt end of, a time or two. We get into all of this on a memorable episode of...

You’ll find few CDI/coding personalities as big and colorful as Adelaide LaRosa—and fewer still with a broader and bolder vision for what mid-revenue cycle professionals can do, and should do, to improve the quality and financial health of their organizations. Catholic Health’s VP of HIM, CDI, EMPI, and DRG Appeals reordered the entire heart of coding, compliance, and reimbursement at the six-hosp...

For our final episode of 2022 we’re going off the record (even for Off the Record) with a couple interesting guests you may recognize from Brian’s home base at Norwood. This week we’re joined by CEO and Founder Justin Satterfield, and VP of Consulting Jason Jobes. As you might expect at the holidays the conversation is reflective, expansive, and personal. We look back at some of the common themes...

What the heck is a cancer registry professional? How can they impact quality (and even revenue, indirectly) in your hospital? And why do Harley Davidson and Indian owners despise each other (and is it possible to like both brands)? If you’re at all curious about these incongruous questions, the latest episode of Off the Record has answers. This week I’m joined by the one and only Ren Garcia, Oncol...

HIM professionals and nurses can get along, after all. There has long been a divide in the clinical documentation integrity (CDI) profession over who can/should serve in the CDI role. Though it has lessened with the passing of years, that divide still exists today. Recent ACDIS survey data shows that 72% of CDI professionals are nurses. Nothing wrong with that; nurses make wonderful CDI profession...

Twitter is an … interesting place right now, due to the purchase of the platform by the lightning rod known as Elon Musk. Love or hate the platform, there is some great content being produced in some corners. Light, rather than heat. Which speaks to me. One such lantern-bearer in the storm is Dr. Robert Oubre, my guest on this week’s episode of Off the Record. Dr. Oubre is a hospitalist and part-t...

What prompts a nurse working at the bedside to get into clinical documentation integrity (CDI)? Long, draining shifts, and burnout, are among a few that I’ve heard. Others include a desire to put their clinical acumen and physician communication skills to work in a different, less physically demanding capacity, but one that still engages the intellect. Robin Jones’ origin story is one worth hearin...

“I like unique. Tell me something I don’t know.” That certainly describes this week’s guest. Tracy Boldt is the Director of CDI and Utilization Management at Essentia Health in Minnesota. Since September 2016 Boldt’s role has included providing leadership, direction and support in the development and management of CDI and UM at multiple Essentia Health sites. In this role Boldt collaborates closel...

Tami McMasters-Gomez, BS, CCS-P, CDIP, CCDS, (MHL), is the Director of CDI and Coding Operations at UC-Davis Health in California. She has ultimate oversight of 80 employees, a team that is busy querying, coding, and abstracting data for a huge organization that includes its flagship 646-bed multispecialty academic medical center. Tami is a bright light in the field in all respects, and the accola...

To say LifePoint Health is a large healthcare system is like saying Nashville has a few good country music bands. Per its website, LifePoint’s healthcare delivery network spans 29 states and includes 62 community hospital campuses, 33 rehabilitation and behavioral health hospitals, and more than 170 additional sites of care across the healthcare continuum including acute rehabilitation units, outp...

Susan Fantin, MSA, BSN, RN, CCDS, CDIP, is the Vice President of Integrated Care Management for McLaren Health in Grand Blanc, Michigan. A one sentence description that is a woefully inadequate descriptor of what she does. All of CDI, case management, utilization management, and denials run through Susan’s capable hands. Think, massive responsibilities. A staff of more than 300. Every new initiati...