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:

• Erin's first day on the job as an NP and what becoming a clinician taught her about documentation/coding/the mid-revenue cycle that she didn’t know or fully appreciate prior.
• CDI in the ED: Missed opportunity to improve documentation for admitted patients and strengthen Medical Decision Making (MDM)
• Best practices for leveraging APPs: Support system for MD physician advisors, second level chart reviews, educators, and more—a topic she recently wrote about for ACDIS’ CDI Journal
• UR/UM synergies with CDI and coding
• CDI pet peeves: Queries for the sake of metrics, and perception of CDI as an easy retirement job for fatigued bedside nurses
• How ambient listening can help with documentation, provider burnout, and surface additional missed diagnoses/HCCs

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. 

• Note: Jason and Carol Ann refer to slides at points of this session; the audio can stand alone but if you prefer you can also download them on the Norwood website (free with registration): https://www.norwood.com/resource/the-roi-of-outpatient-cdi-slide-deck/  

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: 

• Career progression from bedside to CDI to consulting to tech. How did she make the jump—and then advance? 
• What does a fully AI tech enabled CDI position look like?
• How does the modern CDI professional work in this setting? How much of their clinical knowledge do humans still apply vs. reviewing machine output? 
• How much of a job displacer is advanced AI, but what can’t machines do, and who will survive the new reality? What mindset and skills do they need to have? 
• The most important lesson Fran learned in her career. 
• Her stint at CDI consulting OG JA Thomas: Their place in the industry, what she learned from them, pro and con. 
• Her greatest career accomplishment, and where CDI needs to change
• Winding down and retirement plans (grandkids and cruising on the docket) 

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: 

• What Cheryl thinks about how we measure quality in healthcare, specifically through the use of coded data 
• What quality-obsessed hospitals often get wrong about impacting outcomes with documentation and coding alone (with a deep dive into healthcare acquired infections, or HAIs).  
• Borderline or unscrupulous practices done to artificially improve quality rankings 
• What concrete steps would Cheryl take were she leading a small community hospital seeking to improve its observed/expected mortality ratio 
• The recently-released 2026 OPPS proposed rule and the large number of hospitals potentially impacted by the new Safety Measures change (we both like this: presently a hospital can rank at the bottom for safety and still be 5 stars) 
• The reality of “picking your poison” among many quality programs and getting aligned with what really matters to your organization 
• Cheryl’s career north star, how she stays educated, and thoughts on her long career winding down 
• Disney craze, grandkids, and best tips for navigating the theme parks 

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) 

• Read the full CMS audit announcement. 

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 

• Why AI scribes are changing medicine and the hidden risks you must know: https://kevinmd.com/2025/02/why-ai-scribes-are-changing-medicine-and-the-hidden-risks-you-must-know.html  
• 11 Ways to Use AI in Your Practice Right Now: https://www.youtube.com/watch?v=OJLqIU2nbzc 

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 

• News coverage of the explosion: https://abc7ny.com/post/crews-responding-explosion-basement-residence-brooklyn-injuries-reported/15245371/ 
• Keisha’s telehealth e-guide available for purchase (website includes free downloadable resources as well): h⁠ttps://kwadvancedconsulting.com/e-guides/⁠  

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 

• Inconsistent ‘Admit Type’ Reporting May Inflate Hospital Quality Scores, by Nina Youngstrom/Report on Medicare Compliance: https://compliancecosmos.org/inconsistent-admit-type-reporting-may-inflate-hospital-quality-scores