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 hospital setting. Today she works on the payer side.

But here’s where things get interesting. 

New hospital-insurance plan arrangements, often in the context of Medicare Advantage contracts, require partnership rather than combat. And if all goes well, the beneficiary is the patient. 

At least, that is the belief of Colleen Gianatasio. Colleen is the Director of CDI and Coding for Capital District Physician’s Health Plan. On the show we discuss: 

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, but still driving her program forward, never settling.

Tamara Hicks is the Director of Clinical Documentation Excellence at Atrium Health Wake Forest Baptist in Winston-Salem, North Carolina. She's a two-time member of the ACDIS advisory board, served on the ACDIS CCDS certification committee, and in 2019 won CDI professional of the year from that organization.

She's also acquired the nickname Grandmother of CDI. So it behooves us to listen to her wisdom.

We get into that deep pool of wisdom on this episode of Off the Record, covering the following topics:

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 a lawyer—because she happens to be one.  

Sarah Mendiola is the senior vice president of denials management for CloudMed. She is an attorney admitted to the Maryland State Bar and a former attorney for Washington and West, LLC. Her background includes a 10-year stint as an LPN for Mercy Medical Center in Baltimore. She also served in the U.S. Army.

Coupled with coding and compliance credentials, Sarah brings a unique clinical/coding/legal perspective to the subject. One I think you’ll find compelling.

How many of you have had the opportunity to see inside an Administrative Law Judge (ALJ) hearing? Sarah has. We get into this and much more on the podcast, including: 

Enjoy!

“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 recently acquired a couple hospitals and clinics and added them to the system’s EMR last September.

Banner is HUGE. Headquartered in Phoenix, AZ, today it operates in six different states and employs more than 52,000 team members across a dizzying array of services including insurance, ambulatory health centers, urgent care, acute care including three academic hospitals, behavioral health, children’s post-acute services, pharmacy, labs, telehealth, and more.

It also employs 3,300 staff in revenue cycle alone, of which some 400 ultimately report up through Jami.

To put this all in perspective, when she started 19 years ago Banner had one hospital implementing one EMR.

“Banner is a constant state of growth,” she says, which means a lot of change and a daily dose of the unexpected. For example, Banner recently re-orged, splitting up coding, CDI, and HIM operations into three separate verticals, which changed her job completely.

Jami is now knee-deep in records management, release of information, records storage, and EMR management including data integrity audits, information blocking, SDOH, privacy and security.

She’s survived it all with a great attitude and a mindset shift, which we get into on this episode of Off the Record. We cover Jami’s strategies for change management at a basic blocking/tackling level, including establishing a change management team and communicating changes to impacted stakeholders including physicians.

We also cover her helpful personal routines (morning walks), tips and tricks like calendar blocking and meeting free times, managing

Enjoy the episode.

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 personal stories, too.

On the latest episode of OTR Mike Behringer and I start with his unique take on “sales.” I put that in quotes because it’s a word he doesn’t care for all that much, at least in the context of his work.

Sales is a transaction where a product is exchanged; what Mike does is foster partnerships, with humor and personality.

There is something to learn from his approach, whether or not you’re in “sales.” We’re all in the business of building relationships and forging partnerships.

We then switch to a very different, more painful, and personal subject—the tragic death of his son, Nick, age 21, in 2016.

If you follow Mike you know he drops the acronym WWND—What Would Nick Do—into his regular rotation of posts. But if you’re like me, you also never heard what happened that terrible night that stretched into long unknown hours, ending in the worst possible outcome. Or how Mike has rebuilt his life over the last seven years.

We get into this on the show.

I found myself at a loss for words, but was also inspired by how Mike has shown tremendous resiliency and continues to keep his son’s name and spirit alive in his work today.

I think you’ll find something in this episode that resonates.

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:

Deb is a success (in my opinion) because of her positive, engaged, and friendly managerial style, coupled with her close connections to the c-suite, including the CFO, and her ability to tell the right story with the right metrics. If you’re a leader in this space, or an aspiring HIM or CDI professional looking to learn from someone with a track record of success, she’s worth listening to.

We get into all of this—risk adjustment, metrics and reporting strategies, staff retention, leadership, and relationship building—on the latest episode of Off the Record.

We also use the word “synergy” a bit too much for either of our liking. But, we recover with some good talk about the Boston restaurant scene, the importance of happy hours (yes, I invited myself on air—awkward), and music too, including her son’s music career after graduating from the Berklee College of Music.

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, then to nursing, travel nursing, and finally CDI, which took her from her home state of Virginia to my home state of Massachusetts.

Today Downes serves as CDI director over a 3-hospital system and a staff of 21. She constantly challenges herself to learn and do new things, and is constantly learning and growing as a result.

We get a bit into her ACDIS session, CDI Mortality Reviews: Going Beyond SOI/ROM, as well as Tufts’ metrics for success and mortality review process. And a little bit about a session I plan to deliver at ACDIS about my former colleague, the late Melissa Varnavas.

We happen to share a similar love of 80s hard rock, which was an unexpected surprise. Downes’ CDI oversight includes Melrose-Wakefield Hospital, the place where I was born—another surprise. Which often occurs when speaking with my guests.

Come to think of it, I wonder if my mom’s admission and my delivery was given a proper CDI review—probably not, this was 1973. Pre-DRGs, pre-EHR, almost pre-electricity.

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 Off the Record.

One of the reasons I started this podcast was to bring more people, personality, and color into an industry dominated by sober and serious discussions on clinical and coding and compliance concerns. As it should … but behind the numbers are people, too.

Chris is a hospitalist who administered live-saving care at the height of the COVID-19 pandemic, at the epicenter of the outbreak in New York City in the spring of 2020. We talk about his experiences during that scary, wild time.

The NYU Grossman School of Medicine is one of the most heartwarming and uplifting healthcare stories of which I’m aware, offering full-tuition scholarship to all current and entering students in its MD degree program. We talk about his experiences teaching young residents in this incredible environment.

And of course, we talk CDI and coding. Chris spearheaded a project to modify EPIC to capture diagnoses at the point of documentation, bypassing the need to invest in expensive CDI software. His lessons on maximizing the tools you might not realize you already have at your disposal are worth listening to.

We discuss what a CDI professional of the future looks like, what skills they will need to succeed, and why AI still greatly lags human intuition.

Since this is OTR we wrap up with some classic rock talk. And Moonwalking. Seriously (or not so seriously).

I’m a believer in authenticity at work and Chris brings that, and more. Enjoy!

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-hospital system in New York, consolidating HIM and CDI into a seamless team led by three system director positions that, at the time, did not exist.

On this show we discuss:

Today at 60 LaRosa remains as vibrant and passionate about her career as ever, but with an eye on succession planning and preparing the next generation of leaders, to whom she wants to not only pass on the proverbial torch, but like her, be prepared for bold action and realizing colorful visions of their own.

Enjoy the episode!

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 shared by Brian’s guests, including the importance of mentorship, discussing mentors who have made a difference in our own lines. Our conversation includes a look inside the inner workings of a company striving to make a name for itself in the mid-revenue cycle by doing things differently. Learn what we’ve been up to in 2022 and what we’ve got planned for next year.

Personal stories, startling admissions, hard-earned life lessons, trials and rewards of entrepreneurship, struggles of maintaining work-life balance—you’ll get it all on this special year-end episode. Join us as we put a cap on season one of Off the Record.

Enjoy the listen, and the holidays!