Podcast
Off the Record with Brian Murphy
Hosted by Brian Murphy · EN
The only show where today’s top mid-revenue cycle leaders share the personal stories, struggles, and successes that you won’t hear on the big stage—but made them who they are today. Join host Brian Murphy as he interviews leaders and interesting personalities from HIM/coding, clinical documentation integrity (CDI), case management, and related healthcare fields about their origins, current challenges and successes, and lessons that you can apply to grow your own career.
11episodes
Episodes
Newest firstAll episodes
Beyond the Query: Cheryl Ericson and the case for clinical judgment in CDI (and life)
5d ago00:54:54Tap to summarizeCheryl Ericson is a veteran, in every sense of the word. Someone who has seen and experienced a lot in the CDI profession—and so has a wealth of knowledge and wisdom to confer. I go back a long way with Cheryl, to early ACDIS days when she was the lead educator of the CDI Boot Camp and developed the organization’s educational curriculum. She’s had a few stops since then but settled in nicely as Senior Director of Clinical Policy and Education at The Brundage Group. Cheryl is a shrewd, incisive observer of the CDI field, with a rich history of where we’ve been but also where we need to go. Recently she’s weighed in on some big mid-revenue cycle topics for ICD-10 Monitor which I read with avid interest (and recommend you do too). In this week’s episode we hit on a few of those topics, along with a bit of a look into her life and career. Listen in as we discuss: Formative background in nursing and entry point into CDI at MUSC. Thoughts on the new/2026 ACDIS/AHIMA query brief (currently in draft stage)--concerns with clinical indicators, her belief they are unique to each patient and may not meet guidelines established by payers: “It is not about determining if a condition exists; it should be about deciding if the physician has a reasonable expectation to treat the condition,” she writes. “Rather than asking if the condition exists, CDI and coding professionals should determine if it ‘was it reasonable for the provider to diagnose and treat the condition as if it exists.’” Pushing query compliance down to the end user—is this how the new brief reads, and if so, is it a fair expectation? Artificial intelligence: State of current tools and limitations. “GenAI tools show great promise in many areas, but for now, it does not appear capable of performing the type of complex critical thinking required for accurate inpatient coding and billing,” Cheryl observes. (Incorrect) payer allegations of hospital “upcoding,” using the example of acute blood loss anemia ACDIS heydays: A look back on teaching and educating. Her personal health journey, story of breast cancer and her husband’s simultaneous serious illness, and how it transformed her outlook on life. Sharing wisdom and lessons learned: Career advice to a new or young CDI professional—what has she learned to pass along to the next generation?
Transcribe →Sharpies and stage lights: MUSC’s Tracy Ferro on outpatient CDI origins
3w ago00:50:47Tap to summarizeAt ACDIS 2026 I delivered an unofficial episode of Off the Record with my guest today: Tracy Ferro, Executive Director, System CDI for Medical University of South Carolina Health (MUSC). The “podcast” was delivered on stage, at the outpatient symposium. MUSC’s OP CDI program is new and being built in flight, and Tracy and I presented on it together, running the session a bit like an episode of #OTR. Full disclosure: Norwood partnered with MUSC, large academic health system, to implement OP CDI. That was a challenge! As was the Chicago presentation. On today’s episode we talk not only about MUSC’s OP CDI efforts but the presentation itself, including the prep and leadup and “game day.” And much more on Tracy’s unique leadership style and the importance of storytelling to drive home lessons (she’s wonderful at this). Listen in as we discuss: Tracy's healthcare background, a memorable nursing experience, and path into CDI. The art of leadership: Style and lessons learned from childhood and beyond MUSC’s outpatient CDI origins: The why behind the program What a pre-visit review looks like, including the use of Epic’s Enhanced Risk Adjustment Framework. Governance, workflows, reporting, and early outcomes. Outpatient CDI impact and next steps for the new program Presenting at ACDIS 2026, including tips on prep and combatting stage nerves An unexpected Sharpie arm signature and a song for the OTR Spotify playlist...
Transcribe →Different Minds, Extraordinary Strengths: The UC Davis Coding Internship Story
May 2700:52:14Tap to summarizeThis country does a decent job in our primary schools working with children and young adults with special needs. Certainly many improvements have been made in the last 40-50 years. But once neurodivergent kids become adults, that support seems to vanish. Tami Gomez stepped into this large breach by launching the UC Davis Neurodiversity Coding Internship Program. This new program creates professional pathways for neurodivergent individuals by offering hands-on training, mentorship, and real-world exposure to healthcare operations, specifically in inpatient medical coding. I’m thrilled to get her back on the program to talk about this, her greatly expanded role as Executive Director, Mid Rev Cycle, HIM, Coding, CDI Programs, & Revenue Integrity, and a cutting-edge new initiative she spearheaded that’s already making a big financial impact. Listen in as we discuss: Origins of UC Davis Neurodiversity Coding Internship Program: Tami’s own story of neurodivergence Getting started—funding, early struggles and sticking points, partnership with UCLA The curriculum and beyond: What are they learning, thanks to generous donations from HCPro/AHIMA, and not just education—taking students all the way through CCS credentialing and job placement Reception from attendees and the industry at large What makes neurodivergent people uniquely able to code, and their real struggles interviewing and entering the workforce Tami’s new busy day job as Executive Director, Mid Rev Cycle. HIM, Coding, CDI Programs, & Revenue Integrity at UC Davis Health. New Initiative: High-Pay Huddles and its financial impact Increasingly tech-enabled coding and CDI professions—are we in danger of losing them to AI? Updates on her personal life as a party planner, why her colleague Penny Jefferson rocks so much, and a new song for the #OTR Spotify Playlist... Mentioned on today’s show: UC Davis Neurodiversity Coding Internship Program: https://health.ucdavis.edu/him/Coding/Neuro.html AHIMA video featuring Tami: https://contentwithpurpose.co.uk/ahima/healthinformation/videos/tami-mcmasters-gomez/
Transcribe →The Next Chapter: Faisal Hussain on change, creativity, family, and finding balance
May 1101:06:53Tap to summarizeA lot has changed in the world of Faisal Hussain since he last went under the white-hot spotlight of the Off the Record podcast studios. A new career path, with a new company. Growing children, with whom he gets to spend more time. A surprise award, bestowed by his college alma mater. And many new changes in the CDI industry he continues to serve, including a new ethics paper and now a new physician query practice brief from ACDIS. In short, it’s a great time to have back the former Executive Director of CDI at Wellstar Health System, and now newly minted CDI System Physician Advisor at MedStar Health. We’ll get into all these topics and more on today’s show, covering: New role: Who is MedStar Health and Faisal does as CDI System Physician Advisor. And why the major change? New focus: Moving out of CDI operations and into creative projects and technology expansion. Faisal’s work bridging rev cycle, UM/UR, risk management/medical legal, denials and lawsuits--recruiting different leaders across all service lines to standardize and make effective documentation workflows. Working in CDI/coding/healthcare in the utterly unique state of Maryland ... what’s going on there and why is every regulation “except Maryland”? What might hospitals be under-leveraging in the physician advisor role? New ACDIS papers Safeguarding Ethical Documentation Practices in Querying, Peer-to-Peer Discussion, and Technological Initiatives and the new physician query practice brief—his work and analysis Surprise recipient of the 2026 Outstanding Alumnus Award from The University of TN Health Science Center Being a father of neurodivergent daughters, whom he now gets to spend more time with. What has he learned from them. Special praise for Tami Gomez and her work starting a Neurodivergent Coding Internship Program. Finally setting the record straight on “Baby Shark” and putting me, the host, in his place...
Transcribe →Medical Record Maestro: Reimagining CDI in the Age of AI and the Longitudinal Record
Apr 2700:47:06Tap to summarizeWe need a “human in the loop” in mid-revenue cycle work, experts say. What they fail to answer is the more interesting question: Where in the loop, exactly?Back-end AI fact-checker? Front-end query authorizer? Or, maybe something like my current OTR guest Penny Jefferson envisions: Medical record maestro. The end-to-end connectedness of the medical record, evolving API standards, increased use of prior authorization, episode-based reimbursement models, and review of all of this by AI and other tools makes documentation cohesion more important than ever. CDI is changing with the times, but often not fast enough. It must change, or risk stagnation and possible extinction. The ready availability of vast amounts of information in the EHR and AI-enabled reviews and audits means a slip in a diagnosis can result in a big DRG downgrade or denial of stay altogether. But an AI powered enabled CDI maestro conducting the show can make a record strong, front to back. Penny has been writing like a fiend about many of these and other related topics for LinkedIn and the likes of ICD-10 Monitor--which is what led her back to the hot seat of the Off the Record studio. Listen in as we discuss: A day in the life of: Penny’s evolving role at UCDavis Her take on today’s CDI work, where is it coming up short and/or at risk of being automated away? UR function/medical necessity and how CDI can assist case management without igniting a turf war. “Longitudinal episode integrity”: Episode-based bundled payments (TEAM, etc.) and how they shift chart review beyond discrete diagnosis review to breadth APIs and FHIR standards: Issues with fields that don’t match throughout the medical record leading to denials, bringing it home with an encephalopathy example Where does CDI need to upskill to meet these new demands? Does the “traditional” chart review/query role need to change ... or do we need an entirely new role to evolve to meet these demands? And what about productivity metrics? Addressing the elephant in the room. Where is the human in the loop? For example: should a human review every AI query before it goes out? Spend more time on high dollar, 5+ day stays? Tiebreak a co-equal dx? Updates on admit type. Listeners might recall our previous show on this topic, with loose NUBC definitions leading to urgent vs. elective categorization to minimize impact on quality metrics. Other fun stuff you only get on #OTR
Transcribe →The Downgrade Era: How Payers Are Changing the Game with (My) Richelle Marting
Apr 600:53:19Tap to summarizePayers are constantly shifting tactics to find new and creative ways to do their favorite thing: Not pay claims. And if you can’t deny? Downgrade! We’re seeing a lot of new patterns and tactics on this front, especially on the Medicare Advantage/private payer side of the house. And so it was time to take a look at where we are on the state of denials, with just the right person: Richelle Marting of Marting Law, LLC. Richelle has guested on OTR twice previously, the last time in January 2025. I’m bringing her back for the trifecta to discuss: What’s new in the life of Richelle Marting—and at the law firm? Many few faces in the last 12 months... The denials landscape, including the tactical shift from hard denials to softer downgrades. Specific examples including Aetna Level of Severity Policy, Blue Cross and Cigna E/M downgrades Short-stay and readmission audits from MA plans: Does the 2-Midnight Rule apply to Medicare Advantage and one critical difference you need to know about. Other trends Richelle is seeing including sepsis, respiratory failure, and the use of artificial intelligence Successful appeals and prevention strategies Life on the speaking circuit, Richelle’s OTR Spotify playlist selection, and Guns N’ Roses “My Michelle” serendipity...
Transcribe →ChatGPT to Chart Review: AI use cases in the mid-revenue cycle and beyond
Mar 2500:49:19Tap to summarizeAI feels like a bubble. A bubble that keeps expanding until it fills the entire room—including the Off the Record podcast studio. I remain bullish about some aspects of this game-changing technology and intensely skeptical of others. Which makes it a fascinating topic. Worthy of a fascinating guest, who not only has opinions but has real-world applications for the tech you might not have thought of. Sharon Easterling has a towering, all-consuming passion for AI, specifically bridging the gap between technology and the mid-revenue cycle and navigating a technological future that can seem overwhelming. But she also leans into its creativity. She even sent me a new OTR podcast jingle created with AI! You can hear it on this episode. Listen in as we discuss: Who is Sharon Easterling, “Fractional AI Governance and Enablement Executive | AI and Digital Transformation Leader”? Are we lost in the wild west of AI? Coders are using ChatGPT to code and pass certification exams, and employers screening employees with AI bots. How much has AI actually penetrated the mid-revenue cycle, use-wise? Can ChatGPT code? Will AI applications replace people? Where AI ais ctually making a tangible difference in the mid-revenue cycle: Denials management, surfacing diagnostic indicators, writing appeals letters, and more Some out-of-the-box suggestions of using AI in your daily workflow: From monitoring coding productivity to sending daily education to your inbox. How Sharon thinks people should view AI more broadly. Referenced on the show: Sharon’s article “The Medical Record: How Artificial Intelligence (AI) Impacts Coding”: https://icd10monitor.medlearn.com/the-medical-record-how-artificial-intelligence-aiimpacts-coding/
Transcribe →Beyond the Dashboard: Tiara Minor on Mentorship and Meaningful CDI Leadership
Mar 1100:53:04Tap to summarizeIn a day and age where we’re too often looking in the mirror and focused on our own problems and successes, Tiara Minor is all about empowering others. As the Director of CDI for University of Miami Health system Tiara makes things happen for her team, because she’s all about sharing her expertise and education, growing her staff, and now the CDI profession itself. She’s giving back on the broader stage as an ACDIS advisory board member, conference speaker, and now biggest achievement—guest on Off the Record. (I wrote that last one with a straight face, barely). One of the things that impressed me about Tiara was her observation that most training seems to be geared for CDI leaders. Her focus is on her staff, making sure that they have not just mastered the fundamentals of chart review, but also clinical nuances across service lines. We get into education, mentorship, and more on today’s episode. Listen in as we cover: Tiara’s broad responsibilities and a typical day in the life System focus, CDI metrics, and dashboard Her nontraditional journey into CDI--ER nurse to pediatrics, a foray into consulting, and return to the hospital setting. And winning over some skeptical coders along the way... Mentorship: Growing her staff and how she differentiates mentorship that from management. Her role as educator and an example of an interesting clinical query/quality opportunity she presented to the team An ACDIS splash—getting elected to the advisory board, winning both an individual award (recognition of professional achievement) and an organizational award (Diversity in CDI), and the speaking circuit.
Transcribe →Risk Adjustment Reality Check: What’s Working—and What Isn’t
Feb 2501:00:03Tap to summarizeThis year has been something of a reckoning for Medicare Advantage. Senator Grassley’s scathing report of UHG’s risk adjustment practices, and the Kaiser $556 million settlement to resolve False Claims Act allegations of upcoding, opened eyes, and got many in the industry talking. I wanted to get someone on the show with opinions, unafraid to speak their mind and share their perspective. I’ve found that person. Betty Stump is Senior Solution Consultant for Edifecs, a Cotiviti Business. She is in the business of risk adjustment and value-based care on the vendor side, but is never afraid to offer her opinion on the industry, pro and con. And with more than 20 years in the industry across multiple well-known companies, it’s an informed one. Listen in as we discuss: What is working in value-based care/risk adjustment—and where have we gone wrong? Recent conference disillusionment. Kaiser DOJ fine and the Grassley report taking aim at UHG’s aggressive risk adjustment strategy: Betty’s thoughts and where does this heightened era of scrutiny put risk adjustment coders. Do we need to elevate the MEAT standard? What are organizations missing with risk adjustment? Great, practical, low-tech suggestions for RAF capture including using your 2025 end-of-year roster to identify those patients with high-risk conditions and engage in proactive outreach to get patients seen. V28 of CMS-HCCs with V24 in the rear-view mirror. Truthful tech talk: How leaders can get a seat at the table, how to get a vendor’s ear to modify functionality, and truth and hype in CDI tech How should a CDI or coder interact with a machine prompt from a suspecting tool? Looking back at a colorful 20-year career in the consulting life, and a thoughtful selection for the Off the Record Spotify playlist by a fellow music enthusiast.
Transcribe →A reckoning for Medicare Advantage: Inside the Kaiser case with Mary Inman and Liz Soltan
Feb 1100:52:04Tap to summarizeMedicare Advantage is undergoing a reckoning ... and that reckoning is coming from within. In January Kaiser Permanente affiliates agreed to pay $556 million to resolve allegations that it violated the False Claims Act by submitting invalid diagnosis codes for their MA Plan enrollees in order to receive higher payments from the government. The case was instigated by what is known as whistleblowers. Regular listeners might recall my podcast on this topic back in January 2025 with Mary Inman, a Partner at Whistleblower Partners LLP, and Head of International Whistleblower Practice for the firm. We had a fascinating conversation about the process of whistleblowing and New York insurer Independent Health, which agreed in December 2024 to pay $100M to settle allegations it had upcoded claims to inflate MA payment. We’ve now more than 5x-ed that fine with Kaiser. Per the Department of Justice the claims resolved by the settlement are allegations only and there has been no determination of liability. But it was a major wakeup call for MA. Mary is back for today’s show along with her colleague Liz Soltan, a senior associate in the firm’s NYC office. Listen in as we discuss: Key terms: What is whistleblowing and the concept of qui-tam? Kaiser case origins which began more than 12 years ago, and Mary and Liz’s evolving roles in the case The facts on the ground, as alleged by the whistleblowers and the DOJ, specifically the issue of addenda to the medical record Unfolding of the case, a behind the scenes look as new whistleblowers joined, and reaching of the settlement What can we learn from a medical coding/reimbursement perspective? What can healthcare organizations do to ensure their employees don’t blow the whistle and avoid similar fines and headlines?
Transcribe →