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This is Laura Dierda with the Becker's Healthcare

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podcast.

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I'm thrilled today to be joined by Dawson

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Ballard, coding auditor and educator at Rush University

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Medical Center. Dawson, it's a pleasure to have

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you on the podcast today.

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Thanks for having me. Pleasure to be here.

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Now I'm looking forward to our discussion and

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really highlighting some of the cool things that

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you're doing at Rush as well as how

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you're thinking about the future. But before we

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dive in, I'm wondering, can you tell us

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a little bit more about yourself and your

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background?

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Absolutely.

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I have been in the coding

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HIM realm since 02/2003.

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My coding experience has always been on the

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prophy side, not the inpatient side. I I

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certainly

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understand the concepts of inpatient coding, but all

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of my experience has been on the prophy

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side.

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And I've run the gamut, everything from

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chiropractic

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to

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therapy, PT, OT, speech,

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behavioral health, risk adjustment,

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E and M, urology,

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surgery,

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you name it.

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And I've been with Rush for about a

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year now. Actually, it was a year just

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a couple of weeks ago, but I've got

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a lot of extensive background in compliance,

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coding, auditing, education,

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those types of things.

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That's amazing to hear. You know, definitely, it's

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such an important skill set to have, especially

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now given a lot of the, macro challenges

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in the health care space as well as,

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you know, hospitals and health systems really looking

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to maximize their operations and and figure out

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how they can,

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move into more financial stability in the future.

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So I'm wondering, first and foremost, what are

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some of the opportunities and headwinds that you

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have your eye on right now?

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Well, definitely

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the telemedicine

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debacle.

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That's been trending all over the news. So

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trying

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to get Congress on the back end to

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officially

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extend that before it runs out in March

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and trying to get some specific answers

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from payers about what they're going to do.

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We know Medicare won't accept the new codes

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that CPT created,

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but we can't in some instances, we've been

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unable to get some specific answers

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from the commercial payers as to what direction

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they're going to go, if they're going to

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take the new codes or they're going to

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follow CMS.

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So that's one thing that is definitely

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trending out there that I'm keeping my eye

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on.

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And another is the price transparency.

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As we know, we have something called the

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no surprises act

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to where patient or hospitals and entities have

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to be upfront with patients

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specifically

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about what their potential out of pocket cost

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could be so they don't get slammed with

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a $10,000

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bill later on. And I know there's been

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some issues to where some hospitals and health

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care entities have not been in compliance

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with that.

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So definitely following to see what the federal

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government is is going to be doing to

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handle that piece of it.

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Well, that's fascinating to hear. And I think

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on both fronts, as you mentioned, just looking

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at telemedicine

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in virtual care has been such a boon

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in access, I know, for so many across

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the country. And, health systems have built and

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invested a lot in that type of infrastructure.

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And so, you know, trying to get a

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clear answer from congress. I know it was

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never easy, but we're watching that very closely

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at Becker's too. And then, you know, looking

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at, price transparency,

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all the other,

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legislation that's coming down the pipe,

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Considering just the amount of uncertainty that there

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is today,

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you know, how do you kind of move

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forward and and continue to,

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keep your eye on, you know, what you

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need to do on a daily basis and

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knowing that any number of these things could

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be reversed, you know, by congress or or

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at a federal level, and you might need

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to change on drop of a dime.

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Well, I'm I'm I'm involved with my national

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MAC carrier, which is national government services for

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the region of Illinois.

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So I'm on their per, provider

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outreach and education advisory board where we meet

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quarterly

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to discuss potential changes that are coming down

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the pipe to CMS.

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And we are usually the first ones to

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know if there's changes from Medicare that is

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coming as well as

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CMS has their eye on the, of course,

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what's going on in Washington, and that trickles

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its way back down to NGS.

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So I'm pretty fortunate from that standpoint that

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I'm usually right in the know of what's

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going to be happening

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before it happens so I can get that

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information back out

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back out to my providers. But there's a

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lot of uncertainty out there. I get that

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all the time from my providers, and I

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know the

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anxiety that we went through at Rush when

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we thought that telemedicine was going to go

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away per se,

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except for those that were in rural health

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areas. But

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being where we're located at in Chicago, that's

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not a rural health area. So we were

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looking at, you know, definitely a big cut

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in our revenue

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and a huge disservice to our patients.

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So I'm able to keep up with it

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through

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my involvement in the field and to be

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kind of the eyes and ears on the

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ground for what could potentially be coming down

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the pike.

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That makes a lot of sense. And, certainly,

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it is helpful to have someone like you

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on the forefront just to, you know, prepare

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in a meaningful way,

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and understand early on how things are trended.

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Now when you look into the future, how

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are you thinking about growth and adding value

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to the RushHealth system overall?

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Well, I we are definitely

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on track for that.

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For me in particular,

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we're working on creating standardization

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across for our coding. We know there are

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ins and outs of coding all the time.

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We know that different payers have can have

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different rules,

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but we're trying to create

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processes

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to where our

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it's pretty straightforward for our providers, creation of

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templates in the EMR so they know specifically

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what the documentation

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requirements are for those procedures,

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ongoing education,

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ongoing reviews.

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So we're trying to do the best that

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we can, and I'm helping with that as

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well to try to streamline that process so

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providers can focus specifically on seeing patients

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and take that decoding burden off of them

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per se.

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That's helpful to know. And, you know, really,

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makes a big difference for the providers and

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and clinicians being able to have the right

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things in place and so they don't have

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to worry as much about that and and

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more on caring for patients. And I think

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it seems like there's been a a boon

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in just the types of processes, services, and

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technology available to do that. And so it

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seems like an exciting time for that perspective

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to really rethink how things are going and

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and, you know, up the ante in terms

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of what you're able to do in the

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revenue cycle process.

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Absolutely.

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And then with the dawning of AI coding,

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which is coming, I mean, it's inevitable. You

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can't stop it. It's gonna be

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here. And trying to,

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you know, work with the process to choose

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the right AI vendor when we get to

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that to that

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to that step, to that area, to that

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place in our system,

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and

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and making sure that you're asking the right

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questions, that you don't just go with the

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first thing you see, but making sure that

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the platform that you choose

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specifically meets the needs for the organization.

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So, you know, a lot of people have

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already started to implement AI. It's coming. I

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see it as a good thing, but I

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think you need to make sure you're taking

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the right steps when it comes to implementing

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that. But that's certainly one thing we have

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our eye on at Rush.

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That's amazing to hear. You know, thank you

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for spelling that out for us. And I'm

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wondering too,

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I know lots of big opportunities and things

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that are helpful, but I know there's also

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a lot of challenges ahead. And so, you

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know, when you you look at this next

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year, what do you see as a a

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risk or investment that's worth making to bring

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you, closer to overall,

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organizational

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goals?

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Well, definitely, the technological

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advances

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with the integration as AI, as I talked

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about, and the automation of of medical coding,

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that's creating new job roles. So it's creating

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new

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new opportunities

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for maybe some new newbie coders out there

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and, also for the for the seasoned coders

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like myself to be able to adapt to

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those technologies and to be able to find

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ourselves perhaps at the forefront of the industry,

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maybe help to supervising the AI driven process

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and those types of things. Also,

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remote work opportunities,

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where coders can now work anywhere providing that

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type of flexibility.

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But I would also say that

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there needs to be continuous learning and development,

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that you have to stay abreast of the

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constant changes of the coding standards,

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such as the ICD 10 updates,

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and possibly looking forward to the future prepare

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for ICD 11. We don't know when it's

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coming, but it's coming.

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So start looking at that, for example. And

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I don't think we're there yet at rush,

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but I know there has been some discussion

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around ICD 11 and trying to get ahead

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of the game, so to speak.

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Absolutely. That's such a good call. I know

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it's a big, changeover when it does happen.

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So,

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I appreciate, you know, the time and energy

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and resources it takes to get that process

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started.

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Now before we wrap up here, I'm wondering,

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you know, given some of these changes, additional

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technology, automation, and and focus on, you know,

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what really is a fast moving, health care

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industry, what do you see as being some

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of the big opportunities,

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invest opportunities

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for you personally to grow in the future?

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Well, I'm pursuing additional certifications,

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to become more specialized in for the providers

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that I that I educate and audit for.

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I'm pursuing dermatology,

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urology, general surgery.

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Even though I have experience in that, I'm

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not particularly

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specialized

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or certified in that. So I'm pursuing those.

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I'm pursuing additional educational

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opportunities.

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I'm working to

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share

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my coding

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knowledge, I guess, to call it, by presenting

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at conferences across the country and APC local

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chapter meetings.

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I guess what I'm trying to say is

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I'm trying to give back what I've been

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given in the past in terms of I

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was mentored, I was given the opportunity to

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grow. So I'm trying to foster that kind

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of relationship

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with with future coders and current coders in

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the field.

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That's amazing to hear. I I know having

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that strong pipeline of people that, you know,

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you're building up around you and the team

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around you is really helpful.

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I'm wondering, you know, what advice do you

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typically give them these days, or or, what's

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a meaningful

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thought, I guess, that you should typically share

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with new folks coming to the field hoping

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to, continue to grow, within the profession?

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Well, I give the same advice whether it's

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to newbies or to those in the seasoned

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field, and that is never stop learning.

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Coding is an ongoing changing thing. It changes

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at the drop of a hat. We know

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Medicare has rules for one thing and commercial

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say something else, and we know that all

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changes at the drop of a hat. So

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my advice is always pretty the same across

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the board, and it's to never ever

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stop learning. Continue to educate yourself

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on the trends in the industry. Continue to

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educate yourself

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on CMS

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policies and the coding rules around your specific

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specialty.

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There's always a lot there to learn, and

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you'll always find that you'll learn something that

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you didn't know.

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I love that, Dawson. Thank you so much

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for joining us on the podcast today. This

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has been a really fun and inspiring conversation,

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and I look forward to connecting with you

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again soon.

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Absolutely. Thank you for having me. I appreciate

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it.