When you more than double your CDI staff AND turn around a culture of skeptical physicians, you’ve made an impact. That kind of transformation takes a leader who blends curiosity, initiative, and fearlessness.

That describes my guest today, who has always been fearless about trying new things. Jenna Prisciandaro is the Manager of Quality Documentation and Inpatient Coding for Fort Myers, Florida based Lee Health. She's relatively new on the CDI scene, at least to me, but has already made a big impact on her organization.

Listen in as we discuss all of this, and Billy Strings:

• Her incredible (and at first, reluctant) healthcare origin story from teacher to nurse, a fateful ride with her grandmother, and what it says about Jenna the person and her leadership stye

• Wearing two hats as Manager of Quality Documentation (CDI) and Inpatient Coding—her biggest challenge managing two departments historically at odds, while balancing quality outcomes, productivity, and revenue demands

• Organizational/department KPIs, and the challenges of a caseload that includes huge numbers of snowbirds to the Fort Meyers area.

• Rapid rise into the leadership ranks, and her role in the rapid growth of a CDI department that went from 12 to 31 staff.

• Winning over skeptical providers, including one who welcomed her as the “unnecessary hair I have to pluck.” Turning things around with a dedicated provider education team, patience, and CME offerings.

• Current initiatives and future roadmap

• Jenna’s love of live music which includes following bands around the country, and a great OTR Spotify playlist selection

This episode of Off the Record is a bit of a departure: A replay of the Norwood webinar August Audit Heat: False Claims Act settlements put spotlight on upcoding.

This was our second largest attended program ever, and the topic so important—recent massive OIG audits in the Medicare Advantage/risk adjustment space resulting in over $550M in financial recoupments—that I wanted to share it with the broadest possible audience.

The presenter/guest, Norwood SVP of Solutions Jason Jobes, refers to a few slides during the show but does a good job explaining them here. You don’t need visuals…but if you want the slides I’ve provided them on our website. You can find them in a link in the show notes.

Listen in as we cover:

• What happened in two big False Claims Act settlements: $541M assessed against The Villages Health, and $14.1M against Complete Health Partners Holdings to resolve allegations of submitting false diagnosis codes/inflated HCCs.

• That’s not all: More OIG audits in the risk adjustment space

• How these recoupments impact healthcare providers—not just MA organizations

• “Mining” for diagnoses vs. appropriate capture

• Blueprint for staying on the right side of compliance

• Audit strategy for proactive defense

View the slides (free with registration): https://www.norwood.com/resource/august-audit-heat-webinar-slides/

View the results and analysis of the live webinar polls: https://www.norwood.com/would-your-organization-stand-up-to-a-targeted-hcc-audit-survey-says-probably-not-we-can-help/

Trey LaCharite has seen it all during his time as physician advisor. The debut of ICD-10. The growth of value-based care and CMS pay for performance initiatives. And the rise of EHRs and the dreaded RACs.

For more than a decade he’s brought that distilled wisdom to the ACDIS national pre-conference, teaching a popular seminar for physician advisors. And now he’s authored a new book from HCPro/AHIMA, The Physician Advisor’s Guide to Clinical Documentation Integrity, third edition.

So yeah, Trey’s seen a lot.

He’s also seen a lot of heavy metal concerts. Which is where I come in.

As Trey was pouring his heart and soul and wisdom into his new book I was pouring myself into a book of my own: Growing Up Metal: The Story Of A Fan Who (Kind Of) Rocked. Now available on Amazon.

This unlikely union of metalheads talk all things physician advisors, CDI, and heavy metal, as well as the trials and travails of writing, on what is a very out of the box episode of Off the Record. Listen in as we cover:

• Trey and his current multi-hat role as physician advisor for the University of Tennessee Medical Center.
• The Physician Advisor's Guide to Clinical Documentation Integrity, Third Edition ... What’s in the book and what’s new? Heavy rewrites from prior editions and a new focus on practicality.
• Trey’s favorite section on sepsis, and how his organization is navigating the minefield of sepsis-2 vs. sepsis-3.
• Trey's process of writing... “pantser” over “plotter,” and how he tackled the book with his own writing and voice (no AI, thank the lord)
• Working with a pair of terrific contributors—Dr. Nicole Fox and Dr. Deepa Velayadikot
• Documentation in the age of AI—is writing notes still important, either to a physician’s thought process or the practice of care? Trey's thought on the state of technology as useful tool vs. potential loss of autonomy.
• What has changed most over the years in the role of the PA: Biggest difference in job responsibilities of a PA circa 2008 and today
• Talking metal: Growing Up Metal questions and general metal banter, concert stories, favorite bands, and more

Order Brian's book Growing Up Metal: https://www.amazon.com/Growing-Up-Metal-Story-Rocked/dp/B0HHJP531W/ref=tmm_pap_swatch_0⁠

Order Trey's book The Physician Advisor's Guide to Clinical Documentation Integrity: https://hcmarketplace.com/subject/clinical-documentation-integrity/physician-advisors-guide-to-cdi-third-edition