Professional Reimbursement Network

THE TEA SIPPERS SIP EP #206
So here's this week's situation. You're a concurrent CDI reviewer. You pull up a chart for a
Medicare Advantage enrollee, seventy-eight years old, in for a routine primary care visit. The
problem list has said “CVA” for the last six years, copied forward from note to note. There's
no neuro exam documented today, no mention of new deficits, no imaging ordered, nothingto suggest anything acute happened at this visit or recently. The visit is otherwise
unremarkable, medication refills, blood pressure check, and the biller is asking whether this
visit supports coding an acute stroke diagnosis for risk adjustment, because “it's right there
on the problem list.”
So Tea Sippers, here's your question. What would you do? Do you tell the biller no, this only
supports a history code, and walk away? Do you send a query to the provider first, to confirm
whether anything acute is actually being addressed today? Or do you flag it for a broader
pattern review, because if this problem list hasn't been updated in six years, this probably
isn't the only chart doing it? Drop your answer in the comments, Tea Sippers, tell us what
you'd do and why, and next week, we just might read a few of your answers on air.

1 day ago | [YT] | 2

Professional Reimbursement Network

Happy Saturday, Tea Sippers!

This week Clarice and Mr. Jesse are tackling a question we get constantly: is AI a compliance risk or a compliance asset in coding and documentation work?

The honest answer is — it depends entirely on what you're asking it to do. This episode lays out the real distinction: AI can analyze faster than any of us. It cannot execute your judgment for you, and it definitely can't retroactively fix a documentation gap once an auditor's already found it.

We connect that framework directly to what's happening in federal enforcement right now: the HHS-OIG Spring 2026 Semiannual Report ($5.56 billion in monetary impact) and DOJ's June 2026 National Health Care Fraud Takedown ($6.5 billion, 455 defendants) — plus real behavioral health cases where the root cause traces back to a documentation process that quietly broke down.

It could all be so simple — hand someone the plain-language version of what the chart actually needs to say, and you close the gap before it ever becomes a headline.

🍵 PRN Hot Tea Sippers: quick-reference card on the analysis-vs-execution framework + the 3 HIM guardrail moves
🍵 PRN Elite: full executive briefing, 90-day roadmap, and leadership self-assessment questions

Thank you for sipping tea with us every week. This community is why this show exists.

— Clarice

4 weeks ago | [YT] | 0

Professional Reimbursement Network

Part 3 drops next week. And I need you to be ready.
We have talked about how we got here. We have talked about what it costs — in dollars, in burnout, and in human dignity.
Now we close this series the PRN way.
Claiming Our Seat: The Business Case & The Reclamation is coming — and friend, this one is going to hit different.
Because this time we are not just naming the problem. We are walking into the room.
We are talking about the $556 million False Claims Act settlement against Kaiser Permanente — the largest Medicare Advantage FCA settlement in history — announced in January 2026. We are talking about the Aetna $117.7 million settlement that same quarter — the one that began with a qui tam filed by a former risk-adjustment coding auditor who knew exactly what was wrong and put it on record. We are talking about what the OIG's brand new Medicare Advantage compliance guidance means for every coder, every CDI specialist, and every HIM professional working in this space right now. We are talking about HCC Version 28, value-based care, and why the organizations that are sleeping on their coding workforce are about to wake up the hard way.
And then — we are talking about YOU. Your authority. Your value. Your seat at the table that was always yours to claim.
Part 3 of Respect the Code goes live next week on Saturday Morning Tea.
Set your reminder. Share this with a colleague who needs to hear it. And pour your tea — because this conversation is worth showing up for.
It could all be so simple. ☕
— Clarice Warner, The Girl with the Pearls
Professional Reimbursement Network LLC | www.ohioprn.com
Patreon: bit.ly/theprnteasippers
#MedicalCoding #RespectTheCode #SaturdayMorningTea #HIMProfessionals #HealthcareCompliance #MedicalCoders #AAPC #AHIMA #FalseClaimsAct #MedicareAdvantage #HCCCoding #ClariceWarner #ProfessionalReimbursementNetwork

Are you joining us?

3 months ago | [YT] | 2

Professional Reimbursement Network

Good morning. No SMT or MATM today. Graduation.

4 months ago | [YT] | 2

Professional Reimbursement Network

#givetogain Happy International Women’s Day!!

6 months ago | [YT] | 3

Professional Reimbursement Network

Guess who made the cut!! Lil ol’ me!! Check out your girl at 06:01. Don’t miss next year’s opportunity to cruise with Rise and Rhythm, you will not be disappointed at all!! Can we talk about those Vallops?!! Hmmm hmmm good!!!

6 months ago | [YT] | 0

Professional Reimbursement Network

Did you see SMT #184? Here are some additional resources for you!! www.patreon.com/posts/smt-2-14-2026-150766983?utm_…

6 months ago | [YT] | 2

Professional Reimbursement Network

Good morning. No SMT today, I am still traveling. Let's get together next week at 9 am with ‪@thecodingnurse‬ . Pray all is well and talk real soon. P.S. Check your emails for some interesting tea!!

7 months ago | [YT] | 3

Professional Reimbursement Network

We are taking a short tea break this week.

1 year ago | [YT] | 0

Professional Reimbursement Network

1 year ago | [YT] | 2