Off the Record with Brian Murphy

In 2009 ACDIS was growing. The association’s boot camps were taking off. We were at the point where we needed to hire our first full-time instructor and CDI educator.

That person was Lynne Spryszak.

Lynne had been in CDI since 2002 and volunteered as an inaugural ACDIS inaugural advisory board member in 2007. She married experience (rare in what was then a new profession) with passion and a desire to educate.

It was a perfect fit.

Lynne worked with me for a couple great years and then moved on. But I've continued to follow her career from afar—a career that has recently come to a well-deserved retirement. Well, sort of (she’s currently looking for some supplemental part time work).

Lynne is definitely one of CDI’s “OGs” and on this show we recap her career, wisdom, and the true purpose of CDI. We cover:

• Working full-time in a grocery store, late start in healthcare, early 90s nursing days in a medical-oncology unit, and transition into CDI

• Most memorable stops of her career including ACDIS, working as a consultant, performing GEM mappings for the transition from ICD-9 to ICD-10

• Taking over the CDI boot camp line and transforming it into her own (while working alongside annoying colleagues like myself)

• Surviving a bout with bladder cancer—dark days of diagnosis, aggressive treatment, and cancer free since 2016

• Biggest changes in CDI from 2002 to today—is Lynne optimistic or pessimistic for its future?

• The meaning she derived from CDI work and thoughts on its true purpose: An important part of the chain of patient care

• Retirement plans, grandchildren, part-time work, and her Off the Record Spotify playlist selection

If you’re an aspiring medical coding professional and on LinkedIn, you might know my guest today. In fact, you probably do. She’s positively burst onto the scene.

Not necessarily as a content expert dropping coding or clinical expertise (although that’s coming, to be sure), but someone who has documented her journey to medical coding in remarkable detail and honesty.

From entrepreneurial web developer, metalsmith, piano instructor, and used book seller, to medical coder and LinkedIn motivator, and now to Off the Record (perhaps her greatest achievement to date), I am joined by the very unique Revka Stearns.

By the way, the piano intro and outro you hear on this episode? That’s hers.

On this show we cover:

• How and why the (seemingly) sudden change of direction into medical coding after a life of entrepreneurial pursuits

• Obtaining her CCS and CPC-A: Studying, exam day, and the Andrews School of Medical Coding

• A whale of a job search that ultimately landed Revka at Hospital Sisters Health System, and her motivating advice for future job seekers

• Documenting her journey on LinkedIn, and feedback she’s received from readers

• First month on the job as a new code: Training, tools, and the most challenging and rewarding aspects of the job

• Present and future plans

• What Revka does in her “spare time,” and some emotional top hit(s) for the OTR Spotify playlist

Having worked in and around medical coding and CDI for almost 20 years, I can say for certain that few topics vex coders and CDI professionals more than the dreaded recertification process.

Credential maintenance. CEUs. CEU fees. Conference CEU codes. Certificates. On and on. It’s a cottage industry unto itself. It can be frustrating and confusing, and if you’re not on top of it, costly. In my ACDIS days we had folks lapse, despite our generous grace periods. They still do.

Few things get folks more fired up than this. So, I wanted to get someone on the podcast who both understands the process deeply, and dedicated a portion of his career to making it easier.

Who better than the (self-described) Medical Coding Geek himself, Brian Cui?

Brian is the founder and owner of Medical Coding Geek, a platform that promotes and supports the medical coding, HIM, and CDI community. He creates and hosts educational and engaging content, including the Not Elsewhere Classified podcast, the Medical Coding Geek YouTube channel, and several Facebook groups.

On this show we cover:

• Brian’s background and path into medical coding, CDI, and current role as an auditor for Cotiviti

• What he finds most challenging about recertification

• What newly credentialed folks get wrong about recertification and credential maintenance

• Important recent changes to recert requirements, including the recent controversial AHIMA proposal to require more CEUs come from national

• Free resources many people overlook, including his own CEU HIT list

• Advice on getting financial support from your employer

• Being a good coder/CDI professional, work-life balance, and growing your career

Enjoy!

The turn to a new year is the time to set new goals. And who better to set them with than a person who has achieved a career far beyond many of us ordinary mortals—but has the honesty and humility to reveal where she falls short.

Dr. Nicole Fox is Associate Chief Medical Officer, Associate Professor of Surgery, Medical Director of pediatric trauma, and Medical Director of CDI for Cooper University Hospital, a level 1 trauma facility in Camden, NJ.

She made for a great guest to kick off season 3 of Off the Record. This was one of my favorite interviews to date, very personal and revealing for the both of us. I keep trying to get Nicole to start her own podcast and if you listen you’ll understand why.

On the show we discuss:

• Nicole’s biggest accomplishments of 2023 and progress on the path of Ikigai (a Japanese concept related to finding purpose and reason for being)

• Nicole (and my own) process for annual review and goal-setting, both personal and organizational

• Striking the balance: Developing goals that challenging and therefore worthwhile, but also reachable/achievable.

• Cooper Health’s Q1 2024 CDI goal: In-depth department audit, aligning people with interests and strengths. You’ll want to hear this.

• Making goals “sticky” so they don’t fall off Feb. 1

• Failures, getting “smacked upside the head” at age 40 and moving from personal accomplishments to mentoring and growing others as we age

• Other tidbits from her interesting life, including the first OTR Spotify playlist entry of 2024 (Willie Nelson makes a first and long-overdue appearance).

The end of the year is a time to reflect, to look back on what we’ve accomplished and learned.  

And enjoy the time away from the office and have some fun.  

On today’s show I’m joined by couple of guests and friends from my home base at Norwood for remembrance, lessons learned, and some meaningful personal and professional successes. We also talk about the major themes that emerged over a year of podcasting. 

Sandra Love, Director of Solutions, and Joanne Wilson, Senior director of Solutions, join me on the final episode of 2023 to discuss: 

In closing, the world is more than ever full of noise, endless content streams, endless voices competing for our time, eyeballs and ears. I hope Off the Record has provided something more. 

Thank you for taking this journey with me. I look forward to bringing you more thought-provoking discussions with great guests in 2024.  

Merry Christmas and Happy Holidays! 

Generative AI in healthcare is … truly wild. A technology in bloom with little to no regulations, with all the messiness and breathless optimism that entails.

The accuracy of these products including ChatGPT are a work in progress. As this podcast debuts ChatGPT outperformed humans on a mock version of the American Board of Psychiatry and Neurology (ABPN) boards, but in another study nearly 75% of its answers to drug-related questions were incomplete or wrong, including some outright hallucinations.

But like it or not this technology is here on our doorstep. A Dec. 6 KLAS report said that 58% of healthcare executives said their organization will implement or acquire a generative AI solution in 2024.

In fact, if you’re a CDI or coding professional, you may already be coding from an AI generated history and physical, or progress note. Also, the headline for this show was written by… ChatGPT. I wrote the rest.

Joining me to discuss the topic is Dr. Harvey Castro. Dr. Castro is a serial entrepreneur, a physician who in the course of his work taking care of patients quickly saw the power of AI and decided to go all in. His Linkedin profile lists him as a “ChatGPT Healthcare Advisor.” He’s the CEO of Medical Intelligence Ops, an assistant professor at the University of Texas at San Antonio, an author, and a national speaker, including a keynote at this week’s HIMSS conference “AI in Healthcare Forum.”

Listen in as we discuss:

• A self-indulgent turn into podcasting software (Castro’s setup is far better than mine)

• Why is my cup half empty and Castro’s overflowing with optimism—what makes him so damned positive about generative AI?

• Emerging AI powered healthcare technologies that excite Castro, and you should probably know about

• Applications in the coding/billing/mid-revenue cycle space

• A plunge into the deep end, and beyond—Elon Musk conspiracy theories and The Singularity

• How a CDI and coding professional could use these tools today, and in the future

• Existential threats posed to work

Technology. I’m of a mixed mind.

Broadly, I think technology is a blessing for humanity. It saves lives. In my small corner of the world I interview guests from across the nation over Zoom, and deliver the final product via the magic of podcast.

That may or may not be a blessing depending on your opinion of Off the Record. But it goes to show you its reach and impact.

But it also strikes me as naive to paint technology as a universal good. Does anyone think smartphones and social media wars have unambiguously improved the country, or how we communicate as a species? How about ransomware and AI hallucinations?

One thing that is true: Love it or hate it, technology is here to stay. And is increasingly ubiquitous, ever more powerful, and something we cannot work without.

I wanted to talk to someone whose organization is a heavy tech user. Not a vendor representative, but a customer. To get a more objective look at some of the tech we’re using in CDI and coding.

Joining me for this episode is Kory Anderson, Medical Director of Physician Advisor Services, CDI, & Quality, and Enterprise Medical Staff President at Salt Lake City, Utah based Intermountain Health. It’s an organization I consider very tech forward.

On this show we cover:

Off the Record recently featured a wide-ranging conversation with Vaughn Matacale, physician advisor for Vidant Health (now ECU Health), an organization that found itself on the receiving end of an OIG audit of severe malnutrition claims.

On this episode I’m pleased to bring you a continuation of that story from the legal team that helped the organization win the case and strike a blow for clinical truth.

It’s not every day you get to hear a lawyer’s perspective on coding and documentation. But this episode is a double-dose, featuring Anderson Shackelford and Susan Hackney with North Carolina-based K&L Gates LLP.

On this show we cover:

• Vidant case details, and fighting an uphill battle against a formidable foe

• Weaknesses exposed in the OIG’s independent audit team and lack of consistent clinical review criteria

• Broad takeaways from the case, including best practices for making your organization a harder target

• Other legal liabilities related to documentation and coding you might not be aware of

• Open discussion: Should CDI programs be worried about being “better” than their peers at capturing certain diagnoses?

Link to OIG audit report “Vidant Medical Center Incorrectly Billed Medicare Inpatient Claims with Severe Malnutrition”: https://oig.hhs.gov/oas/reports/region3/31500011.asp

As a non-clinician I can think of few things more terrifying than having responsibility for the life of a fragile newborn in your hands, and your hands alone.

Welcome to the early nursing career of Sandra Love.

Sandra served a labor and delivery nurse in rural North Carolina and survived some harrowing experiences that continue to inform her work today as Director of Solutions for Norwood. Sandra learned that infants are not just small adults—they have their own unique clinical profiles.

That same axiom holds true for documentation and coding, too, which is often why pediatric CDI programs fail. But there are some very real opportunities that you’re leaving on the table without a pediatric focus.

We talk about all of that on this episode Off the Record. If you have a pediatric CDI program or are thinking expanding into one, this is a show you’ll want to listen to.

Topics include:

• Sandra’s early experiences working in a level 2 nursery with specialty support a long way away

• Transition into adult medicine and eventually CDI at Wake Forest

• Why most hospitals are off the mark with pediatric CDI

• Documentation clarification opportunities in the pediatric space

• Suggestions for engaging pediatric providers and obtaining buy-in

• And of course, the latest addition to the Off the Record Spotify playlist

It’s often said that to be a good CDI or coding professional you have to roll up your sleeves and get clinical. If you code just what is explicitly documented you will miss opportunities; if you don’t understand A&P and pathophysiology, you will make mistakes.

But what about those who take the opposite path?

Katie McLaughlin became a registered nurse at age 23, then went back to school to earn her doctorates before becoming a nurse practitioner in 2007.

Today—at least until very recently, when her organization opted to discontinue accepting Medicare Advantage patients and shuttered its risk adjustment program—she became Population Health Clinical Advisor: Clinical Documentation Integrity, Risk Adjustment, and Epic Informatics, for Scripps Health.

A clinical path, to coding and CDI.

Today she is looking for the next opportunity. But given her clinical foundation, coding expertise, EHR savvy, and above all, passion and vision, she will be landing very well, and very shortly.

Katie joined me for this week’s episode of Off the Record, where we discuss:

• Her path into nursing, clinical medicine, and ultimately risk adjustment

• Prospective chart reviews—a 2 a.m. vision, and implementation

• Leveraging Medicare annual wellness visits

• Scaling risk capture by customizing EPIC

• Building dedicated Internal Wellness Clinics focused on screening and risk capture

• Unexpected free time and plans for her next career move