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

Karen Elmore is living in denial(s).

Her job as Senior Clinical Documentation Quality Coordinator for BJC Healthcare involves a daily battle against a never-ending tide: Payers denying diagnoses on the perceived basis of lack of clinical support. Recently she’s had to deal not only with human payers, but artificial intelligence denials as well.

Karen’s organization has worked hard to stem this never ending tide, and found some success with uniform organizational clinical guidelines and consistent education and engagement.

We talk denials, appeals, preventing future denials through provider education, and Kansas City Chiefs football (still undefeated as of publish date), on this episode of Off the Record.

On this show we cover:

• Karen’s unique role as program manager for CDI at BJC, including responsibilities for physician education, engagement, and denials prevention

• Typical denials for sepsis, respiratory failure, and malnutrition: What payers are using for ammunition

• What payers are the worst offenders, and particularly creative (and egregious) tactics

• AI denials—how do you spot them, and combat a machine?

• Provider engagement strategies and relaying denials back to physicians

• Legitimate reasons for denial and ongoing documentation shortfalls

• Karen’s Kansas City Chiefs obsession—inside an average Sunday in the Elmore household (it’s crazy)

Following is part 2 of our interview with Revka Stearns, who joined us on Off the Record to provide an update of her first eight months on the job as a new inpatient coder.

If you haven’t listened to part 1 I’d recommend starting there, since we pick up mid-conversation. On this show we cover:

• The mechanics of working as a remote coder. Workplace setup and helpful recommendations
• Dealing with the physical challenges of working at a desk all day and breaking up the routine
• Unexpected consulting work coming her way ... from Canada!
• Unfiltered conversation about social media. Revka’s take on the social media landscape, dealing with negativity, dispelling persistent myths (there’s no coding jobs! It’s all being outsourced! Yes there are, and not it isn't—Revka is proof), and being a consistent, positive, and helpful online presence.
• Keeping sane through work-life balance, and her latest Off the Record Spotify playlist entry