I’ve been in the coding and CDI worlds since 2004, and in that time watched the rise of Facebook, YouTube and other social media. And as early 2011 or so I began to wonder, will anyone pair these two together?

When will see our first social media creator in the world of medical coding, making it his or her full-time gig?

I’m pleased to say that the day has arrived. Victoria Vo is a Medical Coding Educator, Auditor, YouTuber, Entrepreneur, and founder of Contempo Coding, LLC. Her YouTube channel has 187,000 subscribers and she's created close to 600 videos, some of which have racked up more than half a million views.

If you’ve met or seen Victoria you know this did not happen by chance. She’s a natural educator, charismatic and personable. But she’s also very knowledgeable about coding, passionate about the profession, and an outspoken industry advocate. We get into all this and more in a very social episode of Off the Record.

On this show we discuss:

• Victoria’s coding origin story
• Contempo Coding, the business and what it’s about
• Becoming a creator: Challenges and early side-hustle successes, timeline to earning her first $, and how she left coding to become full-time entrepreneur
• Three times she was recognized as a coding celebrity outside of AAPC conferences
• Advice for someone who wants to pursue content creation
• A joint ChatGPT rant (we both sound off on how we use it, and see it abused)
• What makes for a good coding professional
• Other fun stuff including her top resources and Off the Record Spotify playlist selection

Even if you’ve never seen The Godfather, you've probably heard its iconic line: “Just when I thought I was out, they pull me back in!"

That certainly applies to Sheila Duhon, National Director of Clinical Documentation Integrity for Steward Health Care. A year ago Sheila was headed toward semi-retirement, but changing events on the ground in the beleaguered healthcare system prompted her to get back into the game with her old organization.

Sheila is a 2022 CDI Professional of the Year award winner, a published author and passionate educator, but above all possesses a strong moral compass and a willingness to do what’s right for her CDI team and the patients they serve—one which has served her well in a tough spot.

On this show we cover:

• Sheila’s second act in CDI, from semi-retirement to full-time leadership role
• The cloud over Steward: How she puts that aside and focuses on the task at hand
• Her formative experiences as a nurse thrust into the ICU at age 19
• What makes for a good CDI educator, including her story of a challenging first educational session for a group of providers
• CDI as she sees it: A clarification that hospitals still miss, pros/cons of the current state of the profession
• Timeline toward retirement part 2 and final words of advice. Plus of course Sheila’s selection for the Off the Record Spotify playlist.

We all get excited—and rightfully so—at the rapid advance of clinical medicine. New treatments, therapies, and drugs save lives. But when you work in the revenue cycle, you know that payment mechanisms can significantly lag new technologies.

When codes don’t exist, or reimbursement is woefully inadequate, you have to take action. Petition, sometimes at the highest levels of government.

Jugna Shah is fighting for improved coverage and reimbursement for CAR-T and other cell and gene therapies, a trip that recently took her all the way to Capitol Hill. On this episode she talks about exciting work underway to improve healthcare accessibility and reimbursement, shaking hands with popular politicians, and of course some can’t miss documentation and coding tips.

On this show we cover:

• Jugna’s mission and the mission of Nimitt Consulting
• CAR-T and other cell and gene therapies: Current reimbursement mechanisms, insurance and coverage issues, and regulatory guidance
• Jugna’s advocacy efforts at the recent White House Cell and Gene Therapy Forum
• What came out of the Forum and what’s next given the recent change in administration
• What hospitals can do today to receive appropriate reimbursement for these life-saving therapies (she offers up some great advice on setting appropriate charges, citing the regulations)
• Where are we with drug administration (i.e., coding of injections/infusions)

We hear about lawsuits and false claims acts regularly, but did you know that many of these begin with someone working from inside the organization? Calling out bad behavior or noncompliance, sometimes again and again without being heard—before deciding to call on a third party for help?

You might have seen the recent headlines about New York insurer Independent Health, which agreed in December to pay $100M to settle allegations it had upcoded claims to inflate Medicare Advantage payment. But did you know the basis of the lawsuit was a whistleblower, and 12 years in the making?

My guest on Off the Record knows this very well. Mary Inman is a Partner at Whistleblower Partners LLP, and Head of International Whistleblower Practice for the firm. She also served as legal counsel in this very case.

I continue my “law and coding” start to 2025 with a fascinating guest and topic. On this show we discuss:

Who/what is a whistleblower, and the concept of qui tam

The mechanics/process of a whistleblower engaging a lawfirm: Are they working for their employer throughout reporting, discovery? Is gathering evidence to support their case without employer knowledge illegal?

What happens to a whistleblower who wins—or loses? How much can they stand to make, and is their career over?

New DOJ whistleblower project to encourage additional reporting

What some whistleblowers get wrong/false report or misunderstand

What hospitals/healthcare organizations can do to lessen the risk

Mary’s Off the Record Spotify playlist selection (I was disappointed it was not Judas Priest’s Breaking the Law)

Medicare Advantage. It’s everywhere you turn. From upcoding to denials, the huge and growing program—which now covers more lives than traditional Medicare, but is increasingly the target of local and federal scrutiny and a stream of endless OIG audit reports—seems to be in the news daily.

In a sea of online anger and noise, there’s a few voices of reason, reminding us about the regulations and guidelines and how MA should be conducting itself—at least in theory.

One such person is Richelle Marting. Richelle is an RHIA and a JD and owner of a host of coding credentials besides. As a Healthcare Reimbursement Attorney and Founder of Marting Law, LLC, she brings a unique legal viewpoint to medical coding, coverage, and payment. She knows what regulations bind Medicare Advantage plans—and how these are often skirted.

On this show we cover:

• Richelle’s start to 2025, personally and professionally

• What MA plans must cover and pay for, by law

• Prior authorization

• Under which circumstances MA plans can use internal coverage criteria

• How MA plans game the system: three sneaky tactics you won’t want to miss

• The latest on automated denials/use of AI

• Richelle’s answer to the question: Medicare Advantage: Yay or Nay?

• An interesting new year’s resolution and latest addition to the OTR Spotify playlist

Richelle’s desktop MA policy links:

Governing rules for Medicare Advantage: Code of Federal Regulations 42 Part 422: https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-B/part-422/subpart-C

Final rule for MA plans (April 2023), 4201-F: https://www.federalregister.gov/documents/2023/04/12/2023-07115/medicare-program-contract-year-2024-policy-and-technical-changes-to-the-medicare-advantage-program

Medicare Internet-Only Manuals: https://www.cms.gov/medicare/regulations-guidance/manuals/internet-only-manuals-ioms

Medicare Advantage 2026 proposed rule: https://www.federalregister.gov/documents/2024/12/10/2024-27939/medicare-and-medicaid-programs-contract-year-2026-policy-and-technical-changes-to-the-medicare

Here we are, at the end of the year. And the end of another season of Off the Record.

For reasons that will soon become clear, I wanted to wrap up 2024 by pushing myself out of my comfort zone. Because this episode is about personal growth.

So here I am, doing my first ever solocast.

I bring you the Top 5 lessons learned over the year of Off the Record. These apply to mid-revenue cycle leaders, our core audience for #OTR, but they’re broad enough for anyone to adopt.

This is a tidy episode, just 26 minutes of distilled wisdom from several guests that I was honored to host.

Enjoy, Merry Christmas and Happy Holidays, and I’ll see you in 2025.

Last month I wrote a post about the four stages of a career, using the analogy of seasons. I was inspired by the wonderful fall weather I was experiencing while on a walk here in New England, but also by changes I have been experiencing in my life and how these have caused me to re-evaluate what’s important in my career.

The post got a good reaction, including from Nicole Fox, Associate Chief Medical Officer, Medical Director of Pediatric Trauma, Medical Director of CDI, at Cooper University Health Care. Which led to this show.

Nicole and I are in the “fall-ish” of our careers. Which might sound like we’re getting ready for pasture, but not really. I’m 51 and Nicole is 48, so we have many more years to work—but our priorities are changing. You might say, they are better aligning with the new people we are becoming, as human works in progress.

Nicole has done a lot with career coaching, both as recipient and mentor, and we get into all that on today’s show—and bare our souls a little bit about what is holding us back.

This was a terrific conversation with an amazing person and I suspect you’ll enjoy it, and maybe come away a bit more reflective about your own career and priorities.

On this show we discuss:

• An update on Nicole’s work as a pediatric trauma surgeon and hospital executive—and the need for changes

• Her experience with a career coach and what she learned about herself

• Career “saboteurs”—how do you discover them, and what can you do to diminish them? I highly recommend taking the free assessment linked below (my top 3 saboteurs are avoider, hyper achiever, and pleaser)

• Is it possible to shape your career, and how does that look in practice?

• The “seasons” of a career and using it as a framework for discovering what is most important (with an emphasis on the fall season)

• Nicole’s forays into coaching and mentorship, and prioritizing health and work-life balance in a demanding clinical career

Show notes

• Four stages of a career: https://www.linkedin.com/posts/brian-murphy-13800b11_i-love-the-fall-especially-here-in-new-england-activity-7253050994937212932-2QFY?
• Career saboteurs assessment: https://www.positiveintelligence.com/saboteurs/

With 23 years and counting in CDI, Rhoda Chism has seen a lot. The rise of new regulations and reimbursement mechanisms, and the advent of new technologies that have radically transformed chart reviews.

Rhoda has not only weathered these changes and navigated the turbulent waters, but remains as warm and personable, and pro-person, as you will ever meet.

But not anti-technology.

Today she is the Director of Clinical Excellence and Adoption for the software company Iodine, a new position she’s held for just two months. But I think she could be called Chief People Officer. We get into the blending of human and machine, discussing the following:

• Rhoda’s journey into healthcare and nursing at the tender age of 19.

• The transition from bedside nursing to CDI in 2001

• Melissa Varnavas and the lasting impact of a simple message of encouragement and belief

• Using authentic, personal stories to communicate difficult CDI concepts and education, including heart failure and AKI

• How technology has radically transformed CDI over the last two decades

• AI driven technology as human amplifier, not replacement, and the importance of emotional intelligence in CDI work

• Career advice for young professionals in a world of rapid change