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

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 managed to incorporate life balance into their work.

Listen in as we cover:

• Hegg’s origin story into CDI, fueled (or perhaps pushed) by director Tracy Boldt

• His role today—CDI vs. medicine, and division of responsibilities

• Essentia Health’s physician advisor program—services covered, scope of work, and core responsibilities including UM and CDI simultaneously

• Bringing back old-school CDI as it was once practiced (and still is in some corners)—at the elbow clarifications, conversations, provider education. And how it all meshes with Essentia’s existing CDI team.

• Metrics, assistive technologies, and high-level dashboard

• Who the team is and how it functions—shift work and task based, structured for work-life balance and an emphasis on positive culture

• Obtaining organizational buy-in and high-level ROI

• A favorite hazy memory from the Encore casino in Boston, September 2021 ACDIS physician advisor exchange...

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 Health.

We get into Glenda’s unique career path, the obstacles of breaking into CDI as a non-clinician, and address the eternal question: What is the ROI of OP CDI? We cover the following topics:

• Transcription: That’s still done? It is (hear why).

• The ROI of outpatient CDI

• Catholic Health’s thorough process of OP CDI chart review: Prospective, current/pre-bill, and retrospective

• Common conditions requiring clarification and what continues to trip up providers

• A day in the life of: What Glenda’s job entails

• Obstacles of getting into CDI as a non-nurse and strategies for landing elusive interviews

• Glenda’s career motivations and song selection for the Off the Record Spotify playlist

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 health. He and his organization have developed a digital tool to facilitate capture and improve the lives of patients in their community. They’re making a difference.

Dr. Pablo Buitron de la Vega is Assistant Professor of Medicine, Medical Director, Preventive Medicine Residency, and Clinician Lead for the THRIVE Social Determinants of Health Program at Boston Medical Center / Boston University School of Medicine. A native of Ecuador, he’s made SDOH his mission.

On this show we cover:

• Dr. de la Vega’s long journey from Ecuador to U.S. physician, the obstacles he overcame, and how the experience shaped his mission as a provider
• Defining SDOH and common examples in his line of work as a Boston physician
• Basics of capture in ICD-10 and what makes SDOH difficult to collect
• Boston Medical Center’s SDOH capture tool, THRIVE: What it does, tangible benefits, and how your organization can get access
• Low-tech strategies for SDOH capture you can implement today
• Dr. de la Vega’s National Institutes of Health (NIH) grant to develop a triage tool to help address patients’ unmet social needs