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

Back in January I hosted newly minted medical coder Revka Stearns. For someone so new to the industry, Revka has made a big impact by the act of sharing--documenting her journey in detailed and open fashion on LinkedIn and Facebook, and a half dozen podcasts and programs.

At the time she was on the show Revka had literally been on her first job for about 3 weeks. Eight months later I asked her to come back for an update and share her successes, challenges, and unexpected side-ventures.

Revka has many strengths—smart, hardworking, diligent--but one of them is effective use of social media, creating a model for how I like to see these platforms used (and unfortunately often aren’t).

But she’s also had her share of struggles. Coding is hard.

This was a bit of a longer interview so I split it into two parts. On part 1 we cover:

• Eight months on the job as a first-time medical coder
• Specific challenges she’s encountered, including:

1. Making sure the organism causing an infection is clearly linked to that infection through documentation
2. Ensuring documentation is carried through to discharge, beyond the provider just copying and pasting
3. Recognizing query opportunities

• The reality of learning: Taking one step forward and two steps back
• Most rewarding aspects of the job
• What she knows now that she wished she knew back in January