Earning your RHIA (Registered Health Information Administrator) is a huge accomplishment, and for some marks the end of a four-year academic journey and an entry into HIM.

For Richelle Marting, it was only the beginning.

In pursuit of her RHIA, which she eventually earned, my guest on today’s episode took a class on the legal aspects of HIM. That course planted the seed for a career in law—and eventually led her to start her own law firm.

All while raising two twin girls.

I don’t know how she managed all this, but that’s why I got Richelle on Off the Record.

On this show we discuss:

• Richelle’s story from RHIA to JD. How difficult was the bar exam?
• Becoming an entrepreneur and starting her own law firm
• Most frequent type of healthcare cases: Clinical validation audits and DRG validation
• The coding guidelines she sees most frequently ignored or twisted to the payer’s benefit, and other shady tactics
• What do healthcare organizations make too big a deal out of—and what are they not worried about enough?
• Qui Tam and the recent spate of cases initiated by organizational whistleblowers, in particular Medicare Advantage organizations
• Managed care contracting: Legal issues around contract negotiation, how claims get paid, timely filing, and payment policies. How quickly must plans respond to appeals, and should you put a diagnosis definition in a payer contract?
• What advice would she give to someone who is in HIM and considering a career in law—what does she know now that she wishes she knew then?

One of the more promising developments I’ve seen over my career watching the CDI profession bloom is the creation of the CDI educator role.

CDI is often labeled by its critics as reactive, sending queries to the provider after he or she has already documented in the chart. This is an integral but limited part of CDI work.

The main work is getting physicians to document correctly in the first place.

It’s the kind of work being done by Kalee Vincent, my guest on today’s program. Kalee is the CDI Educator for WVU Medicine, West Virginia’s largest health system and largest private employer comprised of 23 hospitals.

Kalee joins me to discuss her path into healthcare, her important work and impact as an educator, and some proven strategies for teaching documentation lessons that stick with providers.

Listen in as we discuss:

• Shifting from CDI chart reviewer to educator in January 2023—challenges and rewards, advice for those considering a similar move
• CDI as an RHIA: Addressing misconceptions about clinical knowledge as a non-nurse (Kalee dissected a cat in college—for real—as part of her studies)
• Keys to being a good physician educator: What works in a 1:1 setting vs. a medical staff meeting, how to get time with busy docs
• Lots of interesting examples where gaps exist and education is needed—CKD, sepsis 2.5, ASPEN, shock, heart failure and more (Kalee came PREPARED)
• New WVU malnutrition coalition: Why this initiative began, what the work includes, and her role on the coalition
• Hamming it up with ex-ACDIS directors, what downtime in the Vincent household looks like, and her Off the Record Spotify playlist selection (Taylor Swift has cracked the lineup—you knew it had to happen sooner or later)

Sepsis it seems is always in the news, never far from anyone who works in CDI or coding circles. And here we are again, back in the headlines due to its inclusion in the Office of Inspector General (OIG) Work Plan.

Sepsis has been discussed so much due to the complexity of disease, the cost of treatment, complexity of coding, and increased regulatory spotlight. What else is there to say? But with it back in the spotlight I wanted to turn from the usual insular conversations in the mid-revenue cycle to someone working on the front lines of care.

Amanda Hart is an ED nurse and a sepsis clinical nurse specialist at Tower Health, a regional integrated healthcare system based out of Pennsylvania. She spends a substantial amount of time battling this deadly disease, and her work has much to offer anyone who works to get it accurately documented and coded.

On this episode we discuss:

• Amanda’s background in the military and EMS, path into nursing and eventually the ED

• Her role as sepsis clinical nurse specialist and how it overlaps with CDI/coding

• Pathophysiology—clinical indicators of sepsis and what makes it such a deadly disease

• Problems inherent in lack of uniform definitions, what Tower Health uses, and her own take on Sepsis-2 vs. Sepsis-3 debate

• The importance of early screening, including processes, technologies and people. Are EHRs and alerts helping or hindering?

• Tower Health’s home-grown protocol that resulted in a 32% reduction in relative mortality rate in non-POA cases.

• Life on the front lines of care and how it changed Amanda as a person