SALARY SURVEY: Pay Climbs for Credentials

Transcription

1 January SALARY SURVEY: Pay Climbs for Credentials Grasp Wrist Coding Complexities: 30 Knowing the intricate structures is a must Eliminate A/R Holdup: 42 Get claims paid in a timely manner Avoid Whistleblowing: 51 Promote a compliant healthcare environment

2 JANUARY Certification Training Starts Now! Save through Jan Visit aapc.com/exam-prep

3 Healthcare Business Monthly January 2017 COVER Hot Topic Salary Survey: Pay Climbs for Credentials David Blackmer, MSC, and Michelle A. Dick, BS [contents] Coding/Billing Practice Management Auditing/Compliance 20 Three Tidbits for Better MRSA Dx Coding Sheri Poe Bernard, CPC, COC, CPC-I, CDEO, CCS-P 42 Quick Tips for Managing A/R Ellen Maura Wood, CPC, CMPE OIG Work Plan: Part A Risk Areas Michael D. Miscoe, JD, CPC, CASCC, CUC, CCPC, CPCO, CPMA [continued on next page] January

4 Healthcare Business Monthly January 2017 contents 22 Coding/Billing 22 Proper Wrist Coding Takes Coordination Ken Camilleis, CPC, CPC-I, COSC, CMRS, CCS-P 26 Details Matter for Time-based E/M Services Suzan Hauptman, MPM, CPC, CEMC, CEDC, and John Verhovshek, MA, CPC 30 Common Billing Compliance Pitfalls 30 Maryann C. Palmeter, CPC, CPCO, CENTC, CHC Auditing/Compliance 44 Step into the Shoes of a Whistleblower Elin Baklid-Kunz, MBA, CHC, CPC, CPMA, CCS 46 Five Lessons Learned from HIPAA Penalties Mike Semel 51 Do Tell! Encourage Internal Reporting of Compliance Issues Ann M. Bittinger, Esq. 46 See pages for program details. On the Cover: See if you take the prize when David Blackmer, MSC, and Michelle A. Dick, BS, explain what the 2016 AAPC Salary Survey reveals about members pay, and what influences it. Cover image istock/oatawa and design by Michelle A. Dick. COMING UP: 2017 CPT Cardio Updates Primary Care s Future Perfect Nail Coding OIG Work Plan Part B Category III Codes DEPARTMENTS 7 Letter from Membership Leader 8 Letters to the Editor 8 Kudos 9 I Am AAPC 10 AAPC Chapter Association 12 AAPC National Advisory Board 41 Alphabet Soup 49 MACRA Trivia 66 Minute with a Member EDUCATION 58 Newly Credentialed Members Online Test Yourself Earn 1 CEU healthcare-business-monthly/archive.aspx 4 Healthcare Business Monthly

5 I m going to get certified! What s your 2017 resolution? Visit aapc.com/exam

6 Serving 161,000 Members Including You! Go Green! Why should you sign up to receive Healthcare Business Monthly in digital format? Here are some great reasons: You will save a few trees. You won t have to wait for issues to come in the mail. You can read Healthcare Business Monthly on your computer, tablet, or other mobile device anywhere, anytime. You will always know where your issues are. Digital issues take up a lot less room in your home or office than paper issues. Go into your Profile on and make the change! HEALTHCARE BUSINESS MONTHLY Coding Billing Auditing Compliance Practice Management Publisher Brad Ericson, MPC, CPC, COSC brad.ericson@aapc.com Managing Editor John Verhovshek, MA, CPC g.john.verhovshek@aapc.com Editorial Michelle A. Dick, BS Renee Dustman, BS January 2017 Advertiser Index HealthcareBusinessOffice, LLC The Coding Institute... 13, 49 ZHealth Graphic Design Renee Dustman, BS Michelle A. Dick, BS Advertising Jon Valderrama jon.valderama@aapc.com Address all inquires, contributions, and change of address notices to: Healthcare Business Monthly PO Box Salt Lake City, UT (800) Healthcare Business Monthly. All rights reserved. Reproduction in whole or in part, in any form, without written permission from AAPC is prohibited. Contributions are welcome. Healthcare Business Monthly is a publication for members of AAPC. Statements of fact or opinion are the responsibility of the authors alone and do not represent an opinion of AAPC, or sponsoring organizations. Ask the Legal Advisory Board From the HIPAA Privacy Rule and anti-kickback statute, to compliant coding, to fraud and abuse, there are a lot of legal ramifications to working in healthcare. You almost need a lawyer on call 24/7 just to help you make sense of all the new guidelines. As luck would have it, you do! AAPC s Legal Advisory Board (LAB) is ready, willing, and able to answer your legal questions. Simply send your health law questions to LAB@aapc.com and let the legal professionals hash out the answers. Select Q&As will be published in Healthcare Business Monthly. Medical Coding Legal Advisory Committee: Timothy P. Blanchard, JD, MHA, FHFMA Julie E. Chicoine, JD, RN, CPC Michael D. Miscoe, JD, CPC, CPCO, CPMA, CASCC, CCPC, CUC Christopher A. Parrella, JD, CPC, CHC Robert A. Pelaia, Esq., CPC Stacy Harper, JD, MHSA, CPC CPT copyright 2016 American Medical Association. All rights reserved. Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein. The responsibility for the content of any National Correct Coding Policy included in this product is with the Centers for Medicare and Medicaid Services and no endorsement by the AMA is intended or should be implied. The AMA disclaims responsibility for any consequences or liability attributable to or related to any use, nonuse or interpretation of information contained in this product. CPT is a registered trademark of the American Medical Association. CPC, COC TM, CPC-P, CPCO TM, CPMA, and CIRCC are registered trademarks of AAPC. Volume 4 Number 1 January 1, 2017 Healthcare Business Monthly (ISSN: ) is published monthly by AAPC, 2233 South Presidents Drive, Suites F-C, Salt Lake City UT , for its paid members. Periodicals Postage Paid at Salt Lake City UT and at additional mailing office. POSTMASTER: Send address changes to: Healthcare Business Monthly c/o AAPC, 2233 South Presidents Drive, Suites F-C, Salt Lake City UT Healthcare Business Monthly

7 Letter from Membership Leader Be the Change new year is always an exciting time, but it A can be an anxious time, as well. Changes we ve been preparing for are here, with more on the way. Payers, providers, and facilities must gear up for what lies ahead. Fortunately, we re not in this alone. Stay Tuned to the Latest in Coding Correct coding is always essential, and Healthcare Business Monthly will help you to stay current with yearly changes. AAPC members who are experts in their field generously share their understanding of latest coding guidance in this member magazine. This month, for example, you can learn the latest on coding common wrist procedures (page 30) and diagnosis coding for Methicillinresistant Staphylococcus aureus (page 20). You can also get a heads up on the areas of Medicare Part A compliance the Office of Inspector General will target in 2017 (page 54). NAB Works for You A new year is a time to reflect and make plans, as well. The AAPC National Advisory Board (NAB) does this by listening to members and bringing their concerns to our meetings. We then work closely with AAPC management to make any necessary changes. One NAB committee that worked very hard last year, and produced excellent results, is highlighted in the article Hospital Committee Supports the Growing Need for Inpatient Coders on page 12. Some years the healthcare industry generates more questions than answers, such as determining the impact of MACRA and the new Merit-based Incentive Payment System and Alternate Payment Models. As members, we are fortunate to have a team at AAPC who works so hard at staying current on changes that will potentially affect us. Make Your Voice Heard The success of this organization is not due to any one person; it s a group effort. Aristotle said, The whole is greater than the sum of its parts. Together, we can make this the best year yet. Reach out to your NAB representative: Ask questions, make suggestions, and be heard! Happy New Year! Jaci Johnson Kipreos, CPC, COC, CPMA, CPC-I, CEMC President, NAB The success of this organization is not due to any one person; it s a group effort. January

8 Letters to the Editor Please send your letters to the editor to: There s No Defense for an Obvious Typo In the November 2016 article Avoid Being the Next Kickback & False Claims Defendant, the column headings on page should have been spelled Defendant. Thanks to Nancy Romano, BS, RDH, CPC, for bringing this to our attention. We Choked on This Illustration There appears to be an error in the anatomy diagram in the December 2016 issue on page 30, CPT 2017: Big Changes that Won t Put You to Sleep. The esophagus is labeled as epiglottis. Jeffery Lee, MD, CPC This should be labeled Esophagus, not Epiglottis. Heart Illustration Is Misleading I noticed in the December 2016 issue of Healthcare Business Monthly, that the human heart schematic on page 32 is physiologically incorrect. Four pulmonary veins emerge from bronchial veins (from both left and right side of lungs) and all of four pulmonary veins connect to left atrium (from left and right side of left atrium), which is called pulmonary veins ostia. The right pulmonary veins do not enter into Mir H Mirsarraf,CPC the right atrium. The illustration is misleading. Thank you for that insight. The simpleness of the illustration makes it look like the two right pulmonary veins enter into the right ventricle. In fact, all four right and left pulmonary veins open into the left atrium. HBM Kudos By Oby Egbunike, CPC, COC, CPC-I, CCS-P Lahey Hospital and Medical Center, Burlington, Mass. It s inspiring to watch this team, with varying degrees of experience, education, and learning styles, keep swimming through the constant sea of changes within healthcare. Lahey s Coding Team Just Keeps Swimming As the associate director of the coding team at Lahey Hospital and Medical Center, I honor the efforts of my fellow coding professionals, who work together to support the mission of Lahey: Patient Centered Care. It s inspiring to watch this team, with varying degrees of experience, education, and learning styles, keep swimming through the constant sea of changes within healthcare. With a little over a year of experience with a new electronic health record system and ICD-10, these coders understood the importance of collaboration and mentoring, which lead to a cohesive team. This has resulted in disappearing silos across the coding team and a better revenue cycle. I look forward to working with this great team in I m confident that, together, we ll continue to achieve the best possible outcomes. As I always say in my native language of Igbo: igwebuike (United we stand.). Oby Egbunike, BA, CPC, COC, CPC-I, CCS-P, is an AAPC licensed ICD-10-CM trainer, with more than 10 years of experience in healthcare management, coding, billing, and revenue cycle. Egbunike is associate director of professional coding and education at Lahey Health. She is a member of the Burlington, Mass., local chapter. 8 Healthcare Business Monthly

9 I Am AAPC Mary Tuohy, AAS, CPC, CMC, CMIS My coding background helps me with overturning denials and working with insurance companies. Between , I was in my early 30s, married, had a son, and lived in Atlanta, Georgia. My occupational background was in various secretarial roles for an attorney, a bank, and a life insurance company. When the insurance company closed, I applied for a position in medical records at a local hospital. This was my introduction into the medical field, and where my coding career began. I was interested in what I was learning, but I wasn t quite sure where it would lead me. Figuring Out the Next Chapter I moved to Memphis, Tennessee, in 1995 and enrolled in a local community college. I excelled, and received an Associate of Arts and Sciences (AAS) degree in Health and Medical Administrative Services. My first job out of school was as a medical transcriptionist at a chiropractic office. I took classes and studied for the Certified Professional Coder (CPC ) exam and received my credential. When I received my letter stating I was certified, I was overwhelmed with emotion because this was a big accomplishment. Earning the CPC credential made me realize I would be a valuable asset to any employer in the healthcare field. I went on to code for pediatrics/neonatology and internal medicine specialties, and then a family practice office in 2004 I was the first certified coder they hired. My responsibilities were coding, charge entry, provider education, and working the accounts/receivables (A/R). It was a great feeling when staff and providers would come to me with questions, and I was able to share my knowledge with them. #IamAAPC Continuing My Coding Journey Today I work for a Fortune 500 company as an A/R specialist. My coding background helps me with overturning denials and working with insurance companies. Over the years, having a great network of fellow coders and instructors who were willing to share their knowledge with me has been a secret to my success. That, and attending HEALTHCON the knowledge you take away from conference is amazing. I also make it a rule to attend local chapter meetings. I am proud to be a certified coder and to learn everything this field has to offer. I am AAPC! #IamAAPC January

10 AAPC Chapter Association By Judy A. Wilson, CPC, COC, CPCO, CPPM, CPB, CPC-P, CANPC, CPC-I Proctoring Is Serious Business Rules preserve the integrity of AAPC credentials and prevent retakes. istock.com/katarzynablaiasiewicz When proctoring examinations for AAPC, it s critical to follow all of the rules and guidelines set forth by AAPC. The integrity of AAPC certifications are at stake. Be Clear on Expectations Chapter officers, especially the president, are responsible for ensuring proctors understand the correct procedures for administering the exam. Proctors must: Review the proctoring instructions prior to each exam. Officers can find these instructions on AAPC s website (www. aapc.com). Scroll over My AAPC, find My Chapter, and click Officer Resources and then Proctoring Information. Know what reference material is allowed for each specialty certification, as well as for the core credentials. Do not take reference material away from an examinee without checking Proctor to Examinee Instructions, in the allowed reference material sheet. Conduct themselves in a professional manner at all times. Conversations or any other type of distraction are prohibited. Be present during the entire exam, other than restroom breaks. Make sure all exams are adequately sealed and correctly returned to AAPC within the time allowed. While proctoring, it s the first proctor s responsibility to make sure the exams are given correctly and ethically. Instructions change often what was correct last month might not be correct this month so it s important for proctors to review the instructions before every exam they administer. Remember: No officer should profit from administering the exam or proctoring. No member can be charged a fee from the chapter to sit for the exam. Neither proctors nor chapters can set a minimum number of examinees to have an exam. You cannot cancel an exam due to a low number of examinees. Once an exam is scheduled, exam dates cannot be changed or cancelled. Handle Oddball Situations If you have a situation that arises the day of the exam that is not covered in the instructions, and you don t know the correct procedure, contact Wendy Willes, AAPC exams director. Proctors should never make a decision when they don t know how to handle a situation; they should always refer to Willes for guidance. Never turn an examinee 10 Healthcare Business Monthly

11 Proctoring AAPC conducts random inspections of proctors, when needed. All reported violations are investigated and taken very serious. away or confiscate something you think may be disallowed in the exam without consulting Willes. The Consequences of Poor Proctoring There are serious consequences for not proctoring correctly. AAPC conducts random inspections of proctors, when needed. All reported violations are investigated and taken very seriously. Failure to follow the rules may result in forfeiture of proctor reimbursement to the chapter. A chapter may even be disqualified from proctoring in the future. Even worse, a member s exam can be disqualified because of failure to proctor correctly. For example, if a proctor does not remove their cell phone from the exam room, as indicated in the rules, all exams are in jeopardy of being invalid. Before you bend the rules, ask yourself if it s really worth disqualification of a member s exam. Proctoring is a privilege that must be taken seriously. No one wants to retake an exam because someone didn t follow the rules. Judy A. Wilson, CPC, COC, CPCO, CPPM, CPC-P, CPB, CPC-I, CANPC, has been a medical coder/biller for more than 35 years. For the past 25 years, she has been the business administrator for Anesthesia Specialists, a group of nine cardiac anesthesiologists who practice at Sentara Heart Hospital. Wilson has served on the AAPC Chapter Association board of directors since She is also on the board of directors of Bryant & Stratton College in Virginia Beach, Va. Wilson is a PMCC instructor and teaches classes in the Tidewater area. She serves on the National Advisory Board for American Academy of Billers for AMBA, has presented at several AAPC regional and national conferences, and is a member of the Chesapeake, Va., local chapter. December

12 AAPC NATIONAL ADVISORY BOARD By the Hospital Committee Hospital Committee Supports the Growing Need for Inpatient Coders AAPC s Certified Inpatient Coder (CIC ) credential exemplifies expert knowledge in the healthcare arena. The Hospital Committee is just one of many established by AAPC s National Advisory Board (NAB) to help provide industry knowledge and expertise that promotes and supports AAPC. This committee serves as an engine to foster the growth of the Certified Inpatient Coder (CIC ) credential by raising awareness among members, as well as industry leaders who hire inpatient facility coders. Meet the Committee The committee is comprised of: Region 1 representatives Colleen Gianatasio, CPC, CPC-P, CPMA, CRC, CPC-I, and Ellen Maura Wood, CPC, CMPE; Region 2 representative Sharlene A. Scott, RHIT, CPC, COC, CPC-I, CPMA, CDEO, CCS-P, CCP-P; Secretary Ann M. Bina, CPC, COC, CPC-I; and Region 4 representative and committee chair Leonta (Lee) Williams, RHIT, CPC, CPCO, CEMC, CCS, CCDS. Committee members met monthly to discuss their goals and overall mission. To increase awareness of the credential, they collected data from members and hospital industry leaders to help cement what AAPC already knew when they introduced the credential: CICs are well-prepared to work and thrive in the inpatient setting. AAPC also provided the committee with online comparisons between the CIC and Certified Outpatient Coder (COC ). Checking for Roadblocks One of the first steps the committee took was to create a survey seeking input from members on their experience when applying and attaining employment as an inpatient or facility coder. On a local level, committee members gathered information from health information administrators, who typically hire for these positions. The committee wanted to learn about possible roadblocks members may face when looking for employment. At that time, ICD-10-CM/ PCS was approaching the starting gate, and the committee saw a tremendous opportunity to leverage the CIC credential to help fill the projected coder shortages in our country. The survey, sent to members during the summer of 2015, asked questions such as: How many years of coding experience do you have? Which credential(s) do you currently hold? More intentional questions were also posed. For example: What type of credential(s) did local facilities require for inpatient coding? What region were these facilities located? istock.com/davidcreacion 12 Healthcare Business Monthly

13 CIC the committee saw a tremendous opportunity to leverage the CIC credential to help fill the projected coder shortages in our country. Along with the rest of the NAB, the committee evaluated survey respondents answers and followed up with members who asked to be contacted. They also explored methods for telling members interested in inpatient coding and who had requested general information about the CIC. Using Data to Help Educate From the survey, it became apparent that some members interested in the CIC credential wanted and needed to learn more, and that some facilities and regions knew more about the CIC than others. With the results of the survey in hand, the committee prepared a mini presentation for the NAB entitled A Guide to Inpatient Coding: What You Need to Know to Get Started. This presentation provided information on the similarities and differences between inpatient and outpatient coding. It discussed principal diagnoses, diagnosis-related groups (DRGs), major complications or comorbidities, complications or comorbidities, and other factors related to inpatient coding. The presentation also identified soft skills a coder should have to be successful in the inpatient setting. The committee created this presentation with the intention that local chapters would use it as a visual tool to aid in educating chapter members. Preparing CICs for Success The committee compared the CIC with other industry credentials specializing in inpatient coding, and concluded the CIC validates expert-level knowledge and experience in ICD-10-CM/PCS, preparing the coder well for employment in the inpatient setting. Introducing New & Expanded Coders Specialty Guides Use coupon code GET40 for $40 off service@codinginstitute.com CPT copyright 2015 American Medical Association. All rights reserved. January

14 HOT TOPIC: 2016 SALARY SURVEY By David Blackmer, MSC, and Michelle A. Dick, BS 2016 Salary Survey: Pay Climbs for Credentials Where you work factors into pay, but credentials and experience top of the charts. The results of AAPC s 2016 Salary Survey show, once again, that our credentials equal value in the eyes of employers. The numbers also confirm that coding and billing managers, educators, and employees of healthcare systems and large group practices saw pay and employment increases last year. 14 Healthcare Business Monthly

15 2016 Salary Survey Tip: To prove you have expertise in documentation guidelines, consider the new CDEO credential. To find out more, go to: On average, annual salaries for members in 2016 were up 0.6 percent from the year before, at $49,872. Compared to the 0.5 percent increase physicians received in Medicare reimbursement last year, healthcare business professionals are holding their own. Whether you made more or less in 2016 depended on where you lived, the type of organization you worked for, how much experience you had, and the credentials you held. Let s check the numbers to see what factors will help you earn more in Rack Up Points for Credentials Worldwide, 9.2 percent of our membership hold two or more credentials and 2.2 percent hold three or more credentials. Certified Professional Coders (CPCs ), in particular, saw a significant jump in pay, from $51,454 in 2015 to $52,690 in 2016, for a 2.4 percent increase. Holders of specialty credentials also did well, with average salaries going from $56,396 in 2015 to $57,524 in 2016, for a 2 percent increase. The three credentials that earned members substantial salaries in 2016 were: No. 1: Certified Professional Compliance Officer (CPCO ) No. 2: Certified Physician Practice Manager (CPPM ) No. 3: Certified Professional Medical Auditor (CPMA ) % Increase $71,500 $75, $64,666 $67, $62,345 $64, Those who earned AAPC s new Certified Documentation Expert Outpatient (CDEO ) credential made an average of $83,654 last year. A caveat to this data is that the credential was still in beta testing in 2016, and the 13 salary survey respondents also reported an average 14.5 years of experience in the business of healthcare, which likely hikes up the average salary. It will be interesting to see how this credential affects salaries next year, especially in light of the new reporting requirements for the Merit-based Incentive Payment System (MIPS). Graph A shows the 2016 salary changes based on individual AAPC credentials. Graph A: Salary by Credential $90,000 $80,000 $70,000 $60,000 $50,000 $40,000 $30,000 $20,000 $10,000 $ CPC COC CPC- P CIC CRC CPMA CDEO CPC- I CPB CPPM CPCO On average, members received salary increases whether they held one or more AAPC credentials: % Increase Specialty credentials $56,396 $57, Any 1 AAPC credential $51,621 $52, or more AAPC credentials $58,399 $60, or more AAPC credentials $65,643 $66, January

16 2016 Salary Survey 2016 was a big year for coding and billing managers, who saw a 3.5 percent increase in wages between 2015 and 2016 (from $59,679 to $61,794). Earn Bonus Points for Experience and Hard Work As in previous years, AAPC s 2016 Salary Survey proves that experience pays off. On average, employed survey respondents said they have been working in the business of healthcare for 11.2 years. The highest pay goes to those with 31+ years of experience, with an average annual salary of $67,162. Those with one year or less of experience averaged $35,906, annually, in entry level positions. To view all of the average salaries organized by years of experience, see Graph B. Graph B: Salary by Experience $80,000 $70,000 $60,000 $50,000 Coding/Billing Managers and Educators Have the Advantage 2016 was a big year for coding and billing managers, who saw a 3.5 percent increase in wages between 2015 and 2016 (from $59,679 to $61,794). It was also a decent year for coding educators, who reported a 3.2 percent increase (from $62,290 to $64,298). The only pay decrease was reported by practice/office managers: Data show salaries went from $59,021 in 2015 to $58,438 in All in all, there has been a steady climb in salaries across the board these last four years, as shown in Graph C. Graph C: Salary by Job Responsibility $70,000 $60,000 $50,000 $40,000 $40,000 $30,000 $20,000 $10,000 $ to 1 2 to 4 5 to 9 10 to 15 More than 15 $30,000 $20,000 $10,000 $ Coding/Billing Audi7ng Prac7ce/Office Manager Coding/Billing Manager Educa7ng Members worked less overtime in 2016 than in 2015, according to survey respondents. In 2015, 15 percent of you worked more than 45 hours a week, compared to 12.2 percent in This decrease may be an indication that providers have implemented ICD-10-CM and you are getting comfortable with the new diagnosis coding system and picking up speed. Thankfully, the majority of you (75.4 percent) worked hours per week last year, which is a slight increase from Job Satisfaction Pays Off Almost 75 percent of respondents said they work on-site, while the rest reported working remotely. Roughly 60 percent of our members are content with their job, and are not looking elsewhere. Here are the percentages for those looking for another job and the reasons why: Tip: Inpatient staff is increasing. Become a certified expert in inpatient coding. Learn about AAPC s Certified Inpatient Coder (CIC ) credential at: 16 Healthcare Business Monthly

17 2016 Salary Survey It s no surprise that health systems are growing in staff, while smaller facilities are succumbing to attrition percent would like a position that pays better. 8.5 percent want to find a job with more advancement opportunities. 8.7 percent would like a position where they could work remotely. Hospitals Are the Place to Be It s no surprise that health systems are growing in staff, while smaller facilities are succumbing to attrition. It is surprising, however, that hospital outpatient staff size decreased from 10.6 percent in 2015 to 9.1 percent in 2016 (1.5 percent decrease), and the average salary for members was $47,421. Meanwhile, inpatient facility staffs increased from 5.2 percent in 2015 to 5.4 percent in 2016 (0.2 percent increase), and the average salary was $49,408. It looks like inpatient coding is a good career move. Health systems and large group practices are good places to be working right now, too. The average salary for members in health system in 2016 was $52,320, while members in large group practices made $49,452. According to the numbers: 18.3 percent of respondents work for a large health system; and 13.2 percent of respondents work for a large group practice. Graph D shows the rest of the percentages of where members are employed. Start the New Year Off Right Over 110,000 healthcare professionals hold AAPC certifications in physician offices, clinics, outpatient facilities, and hospitals. These credentials represent the gold standard in medical coding, billing, auditing, documentation, compliance, and practice management, and are nationally recognized by employers, medical societies, and government organizations. Once trained and prepared, schedule your credentialing exam to validate your expertise. Get started to day! To learn about AAPC s exam preperation options, go to AAPC Certifications CPC Certified Professional Coder COC Certified Outpatient Coder CIC Certified Inpatient Coder CPC-P Certified Professional Coder - Payer CRC Certified Risk Adjustment Coder CPB Certified Professional Biller CDEO Certified Documentation Expert - Outpatient CPCO Certified Professional Compliance Officer CPMA Certified Professional Medical Auditer CPPM Certified Physician Practice Manager Graph D: Percentage of Where Members Work Educa1onal Ins1tu1on Consul1ng Firm Payer/Health Plan Billing company Health System Hospital Inpa1ent Hospital Outpa1ent Large Group Prac1ce Medium Group Prac1ce Solo Prac1ce/Small Group Prac1ce 0.0% 2.0% 4.0% 6.0% 8.0% 10.0% 12.0% 14.0% 16.0% 18.0% 20.0% January

18 2016 Salary Survey To discuss this article or topic, go to In 2014, the pendulum swung towards big pay increases all over the United States. In 2015, it swung back. In 2016, salaries pretty much evened out. Pacific $57,005 Mountain $51,310 West North Central $48,828 East North Central $48,213 New England $53,504 Mid Atlantic $53,757 East South Central $47,587 South Atlantic $49,767 West South Central $49,765 Payout Depends on Demographics In 2014, the pendulum swung towards big pay increases all over the United States. In 2015, it swung back. In 2016, salaries pretty much evened out. There was a slight pay increase in most areas, with the mid-atlantic, Mountain, and New England regions showing the most improvement. Members in the Mid-Atlantic region (N.J., N.Y., Pa.) went from earning an average of $52,219 in 2015 to $53,757 in 2016 (a 2.9 percent increase); members in the Mountain region (Ariz., Colo., Idaho, Mont., N.M., Nev., Utah, Wyo.) went from $49,978 in 2015 to $51,310 in 2016 (a 2.7 percent increase); and those of you in the New England region (Conn., Mass., Maine, N.H, R.I., Vt.) went from $52,153 in 2015 to $53,504 in 2016 (a 2.5 percent increase). Chart E shows the average salaries in 2016 by demographic. Members in the Pacific region (Alaska, Calif., Hawaii, Ore., Wash.) came out on top, with an average salary of $57,005 in David Blackmer, MSC, is director of operations, AAPC Member Solutions at AAPC. He is a member of the Salt Lake City, Utah, local chapter. Michelle A. Dick, BS, is executive editor at AAPC and a member of the Flower City, Rochester, N.Y., local chapter. 18 Healthcare Business Monthly

19 Smart Design. Intelligent Auditing. Customize, manage, train, and simplify your audit process. We streamlined your audit process by merging audit workflow, management, and reporting capabilities into one easy-to-use, web-based solution. HEALTHICITY.COM/AUDITMANAGER

20 CODING/BILLING By Sheri Poe Bernard, CPC, COC, CPC-I, CDEO, CCS-P Three Tidbits for Better MRSA Dx Reporting Prevent the spread of misguided MRSA claims with these tips for precise ICD-10-CM coding. Although the precision of code descriptions makes it harder to miscode an infection in ICD-10-CM, there are three tricks to coding Methicillin-resistant Staphylococcus aureus (MRSA) to prevent claims denials or questions. 1. Make Notes in ICD-10-CM About Four MRSA Codes The two main codes for MRSA infections are: A49.02 Methicillin resistant Staphylococcus aureus infection, unspecified site The infection site has not been determined, yet. B95.62 Methicillin resistant Staphylococcus aureus infection as the cause of diseases classified elsewhere The infection site is known, and reported secondarily (e.g., skin of the groin). One of these two codes usually is the first-listed code when a patient is treated for an MRSA infection. Exceptions include a patient with MRSA sepsis or MRSA pneumonia, which have specific codes: A41.02 Sepsis due to Methicillin resistant Staphylococcus aureus Only one code is needed for sepsis; additional codes are reported to capture severe sepsis and accompanying organ failure. J Pneumonia due to Methicillin resistant Staphylococcus aureusnote: No other code is needed to capture the pneumonia Other sequencing exceptions include MRSA in obstetrical or neonatal coding, for which you are instructed to report the source of infection as an additional code. 2. Never Report Z16.11 with the Four MRSA Codes To do so would be redundant. Z16.11 Resistance to penicillins [Methicillin is a form of penicillin.] Many conditions require you to report MRSA with B95.62, and a second code to identify the site/type of infection, such as the skin site or specific heart valve. The drug resistance is inherent in the MRSA code, and ICD-10-CM guidelines tell you to leave Z16.11 out. There are instances, however, when Z16.11 for staph infections is appropriate. When a newborn or neonate has MRSA pneumonia or MRSA sepsis, for example, the P code captures the staphylococcal infection, but not the penicillin resistance. P36.39 Sepsis of newborn due to other staphylococci istock.com/jarun Healthcare Business Monthly Coding/Billing Auditing/Compliance Practice Management

21 To discuss this article or topic, go to MRSA A person who has been colonized has MRSA present, without necessarily having an active MRSA infection. CODING/BILLING Report P36.39 for all staph sepsis in a child 28 days or younger, and report Z16.11 to capture the drug resistance. P23.2 Congenital pneumonia due to staphylococcus Report P23.2 for all staph pneumonia in a child 28 days or younger, and report Z16.11 to capture the drug resistance. ICD-10-CM guidelines state, If the P36 code includes the causal organism, an additional code from category B95, Streptococcus, Staphylococcus, and Enterococcus as the cause of diseases classified elsewhere, or B96, Other bacterial agents as the cause of diseases classified elsewhere, should not be assigned. Because P36.39 describes the causal agent, you can capture the penicillin resistance with Z The same logic holds true for P23, although you re not so instructed. 3. Report Colonization History, Testing, and Results MRSA lurks on the skin and in the nasal cavities of many people, increasing the risk of infection for the colonized persons and those around them. A person who has been colonized has MRSA present, without necessarily having an active MRSA infection. Patients undergoing hospitalization or outpatient elective surgery usually are tested for colonization using a nasal swab. The cost of this test is bundled into the Medicare Severity-Diagnosis Related Groups payment, but the preventive value of the test makes it financially advantageous for facilities. In some cases, provider offices test high-risk patients for MRSA. These patients may have a history of MRSA or immunodeficiency. If MRSA is found, documentation may read MRSA screen positive or MRSA swab positive. ICD-10-CM has developed codes that allow you to capture these situations. Why do payers care about drug-resistant infections so much? The presence of MRSA, or any infection resistant to common antibiotics, increases the resources required to clear the infection: The medications are usually more costly, the recovery is slower, and the chances of recurrence are higher. Because the codes you assign are the determinants for payment, or justify costlier drugs for treatment, be thorough when coding infectious disease Culture, presumptive, pathogenic organisms, screening only Report this code anytime a true screening is performed, as for hospital admission or when a skin or other accessible infection site is suspect. Report Z to show the reason for the test, whether as a true screening or to screen for a symptomatic pathogen. The test s focus is to determine if the infective agent will colonize a slide Infectious agent detection by nucleic acid (DNA or RNA); Staphylococcus aureus, methicillin resistant, amplified probe technique A polymerase chain reaction technique is employed to test nasal swab specimens. Fluorescent dyes bind with the MRSA deoxyribonucleic acid (DNA) and software reports whether MRSA is present or absent in the sample. It should be clear from the documentation which of the diagnostic codes is appropriate to report with this test. Sheri Poe Bernard, CPC, COC, CPC-I, CDEO, CCS-P, is an independent coding consultant specializing in risk adjustment, clinical documentation, and training and education. She is the author of the American Medical Association book, Netter s Atlas of Surgical Anatomy for CPT Coding. Bernard s 25-year career in coding and reimbursement includes developing coding curriculum and references for AAPC, the AMA, DecisionHealth, Elsevier, Optum360, and Staywell. She is a member of the Salt Lake City, Utah, local chapter. Z Carrier or suspected carrier of Methicillin resistant Staphylococcus aureus Z86.14 Personal history of Methicillin resistant Staphylococcus aureus infection A patient may have MRSA colonization and an active MRSA infection, in which case, code both conditions. There are two CPT codes for reporting MRSA screening or testing: January

22 CODING/BILLING By Ken Camilleis, CPC, CPC-I, COSC, CMRS, CCS-P Properly Coordinate Your Wrist Coding Grasping the anatomy of so many tiny, complex parts will aid in coding of wrist diseases and injuries. The wrist is classified as an intermediate joint, but consists of many intricate structures and bones. Accurate coding of wrist diagnoses, services, and procedures requires a solid working knowledge of wrist, hand, and distal forearm anatomy. Match Wrist Parts to Diagnosis Codes The wrist, or carpus, contains eight carpal bones. There are three bones in the proximal row (scaphoid, lunate, and triquetrum) and five bones in the distal row (trapezium, trapezoid, capitate, hamate, and pisiform). The trapezium is also known as the greater multangular, the trapezoid as the lesser multangular, and the scaphoid as the navicular bone. In ICD-10-CM, most wrist conditions coded from chapter 13 (M codes) have a 3 in the fifth position of the code such as M Primary osteoarthritis, right wrist. Common conditions of the wrist and distal radius from chapters 13 and 19 (M and S codes) are: Wrist drop (M21.33-) Contracture of wrist (M24.53-) Flail joint of wrist (M25.23-) Infective tenosynovitis of wrist (M65.13-) DeQuervain s disease (radial styloid tenosynovitis) (M65.4) Ganglion cyst of wrist (M67.43-) Crepitant synovitis of wrist (M70.03-) Abscess of wrist bursa (M71.03-) Carpal idiopathic aseptic necrosis (M87.037, M87.038) Fracture of lower (distal) end of radius (S52.5-) Physeal (Salter-Harris) fracture of lower end of radius (S59.2-) Fracture of ulnar styloid process (S52.61-) Fracture of navicular (scaphoid) bone (S62.0-) Fracture of (other) carpal bone (S62.1-) Subluxation and dislocation of wrist (S63.0-) Wrist sprain (S63.5-) Recognize Triangular Fibrocartilage Complex The triangular fibrocartilage complex (TFCC) is a band of cartilage that cushions the area in the wrist where the ulna, lunate, and triquetrum intersect. The TFCC suspends the distal radius and ulnocarpal joints from the distal ulna. A primary function of the TFCC is to facilitate forearm rotation with a flexible connection between the distal radius and ulna, stabilizing the distal radioulnar joint (DRUJ) and supporting the ulnocarpal structures. The TFCC provides a continuous gliding surface across the distal radius/ ulna for flexion, extension, supination, pronation, and radial/ulnar deviation. Damage to the TFCC is often caused by: A fall on an outstretched hand; A drill-bit injury where the wrist rotates rather than the bit; A distraction force onto the volar forearm or wrist; or A sequela of a distal radius fracture. Excessive load on the ulnocarpal joint can cause a TFCC tear. istock.com/horillaz 22 Healthcare Business Monthly Coding/Billing Auditing/Compliance Practice Management

23 Wrist Coding There are three bones in the proximal row (scaphoid, lunate, and triquetrum) and five bones in the distal row (trapezium, trapezoid, capitate, hamate, and pisiform). Trapezoid Hamate Pisiform Triquetrum Lunate Capitate Trapezium Scaphoid Illustration by Optum CODING/BILLING Synovitis of the wrist is often a byproduct of a TFCC disease or injury, and is treated during the same operative session as a TFCC repair. Signs and symptoms of a TFCC injury are ulnar-sided pain near the ulnar styloid, swelling, instability, and greatly reduced grip strength. A repair of the TFCC usually is performed arthroscopically, as reported with Arthroscopy, wrist, surgical; excision and/or repair of triangular fibrocartilage and/or joint debridement. For more severe TFCC-related cases, such as complex injuries or profound degeneration causing wrist instability, an open procedure may be necessary, such as a ligamentous reconstruction (25337 Reconstruction for stabilization of unstable distal ulna or distal radioulnar joint, secondary by soft tissue stabilization (eg, tendon transfer, tendon graft or weave, or tenodesis) with or without open reduction of distal radioulnar joint). Alternatively, a shortening of the ulnar bone (25390 Osteoplasty, radius OR ulna; shortening) may be performed to relieve pressure on the TFCC and prevent further degeneration. A shortening of the joint capsule or extensor retinaculum may improve DRUJ stability in less severe cases. Pinpoint SLAC and SNAC A wrist defect often requiring surgical intervention is scapholunate advanced collapse (SLAC.) SLAC is a condition of progressive instability that causes advanced radiocarpal and midcarpal osteoarthritis. SLAC describes a specific pattern of progressive subluxation with loss of articulation between the scaphoid and lunate bones. SLAC usually results from trauma to the wrist, but may be caused by a degenerative process such as calcinosis or as a sequela of a prior injury. SLAC is estimated to account for more than half of all nontraumatic wrist osteoarthritis cases. Signs and symptoms of SLAC include: Difficulty bearing weight across the wrist; Decreased wrist range of motion; Dorsal swelling or tenderness directly over the scapholunate ligament; A focal point of pain in the scapholunate region; and Hand weakness or stiffness, especially with regard to grip strength. A popular test to detect SLAC is the Watson scaphoid shift test, which evaluates four progressive stages of carpal arthritis. A sister disease to SLAC is a scaphoid non-union advanced collapse (SNAC), which is a classification of post-traumatic wrist arthritis. This condition is a sequela of a scaphoid fracture, and characterized as chronic non-union. SNAC manifests as sharp pain and profound weakness in the wrist, with restricted range of motion. SNAC of the left wrist caused by a displaced fracture of the distal pole of the scaphoid is reported with ICD-10-CM code S62.012K Displaced fracture of distal pole of navicular (scaphoid) bone of left wrist, subsequent encounter for fracture with nonunion. Four-corner fusion may be used to correct SLAC, SNAC, and other forms of wrist osteoarthritis. This method removes the scaphoid, followed by internal fixation of the other seven carpal bones. The main advantage, versus conventional total wrist arthrodesis, is that some intercarpal and radiocarpal function is preserved. Four-corner fusion is reported with Arthrodesis, wrist; limited, without bone graft (eg, intercarpal or radiocarpal) or Arthrodesis, wrist; with autograft (includes obtaining graft). Identify De Quervain s Disease De Quervain s disease (radial styloid tenosynovitis) is an inflammation of the first dorsal extensor compartment; this is entrapment tendinitis causing tendon thickening, which leads to restricted motion and a grinding sensation with tendon movement (crepitus). De Quervain s is diagnosed by means of a Finkelstein s Test, in which the patient makes a fist and the provider pulls the wrist away from the thumb. Pain is a typical indicator of De Quervain s. Preliminary or stop-gap treatment may include fitting to a short-arm splint or cast. For more severe cases, the practitioner may resort to a tendon release by an incision into the extensor tendon sheath ( January

24 Wrist Coding CODING/BILLING Illustration by Optum De Quervain s disease (radial styloid tenosynovitis) is an inflammation of the first dorsal extensor compartment splint (29125 Application of short arm splint (forearm to hand); static) with a surgical procedure on the wrist. Coding fracture of carpal bone (S62.1- Fracture of other and unspecified carpal bone(s)) when the diagnosis is a distal radius fracture (S52.5- Fracture of lower end of radius). Incision, extensor tendon sheath, wrist (eg, de Quervains disease)). Pay Attention to Payer Guidelines and NCCI Edits It s important to understand payer guidelines and National Correct Coding Initiative (NCCI) bundling rules. Common examples of unbundling and miscoding errors include: Reporting a ganglion cyst excision (25111 Excision of ganglion, wrist (dorsal or volar); primary) in addition to a synovectomy of the wrist (25118 Synovectomy, extensor tendon sheath, wrist, single compartment): is bundled into the Reporting a partial synovectomy (29844 Arthroscopy, wrist, surgical; synovectomy, partial) in addition to an arthroscopic TFCC repair (29846 Arthroscopy, wrist, surgical; excision and/ or repair of triangular fibrocartilage and/or joint debridement) when the synovectomy is included in the repair. Reporting Carpectomy; all bones of proximal row for a carpectomy of all proximal row bones when not all three bones (scaphoid, lunate, and triquetrum) are excised. Reporting a trapezium excision (25210 Carpectomy; 1 bone) in addition to a carpometacarpal joint arthroplasty (25447 Arthroplasty, interposition, intercarpal or carpometacarpal joints). Separately reporting bone grafts (20900 Bone graft, any donor area; minor or small (eg, dowel or button) or Bone graft, any donor area; major or large) with procedures that include these grafts. Billing for initial application of a short-arm cast (29075 Application, cast; elbow to finger (short arm)) or short-arm Learn By Example Case 1: The patient is a 49-year-old woman who presents to the ER with an acute onset of pain in her right wrist after she was chased by a dog and fell onto an outstretched hand while running for her front door. X-rays of her right hand and wrist confirmed she had sustained a Colles distal radius fracture. The orthopedist on call performed a closed reduction of the fracture. She was told to follow up in two to three weeks, or if the pain exacerbates. CPT : RT Closed treatment of distal radial fracture (eg, Colles or Smith type) or epiphyseal separation, includes closed treatment of fracture of ulnar styloid, when performed; with manipulation - Right Side Emergency department visit for the evaluation and management of a patient, which requires these 3 key components: An expanded problem focused history; An expanded problem focused examination; and Medical decision making of moderate complexity - Decision for surgery ICD-10-CM: S52.531A Colles fracture of right radius, initial encounter for closed fracture W01.198A Fall on same level from slipping, tripping and stumbling with subsequent striking against other object, initial encounter Y Garden or yard in single-family (private) house as the place of occurrence of the external cause Three weeks later, there is no improvement in her pain. A percutaneous skeletal fixative reduction is done for better stabilization of the fracture. CPT : RT Percutaneous skeletal fixation of distal radial fracture or epiphyseal separation - Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period ICD-10-CM: S52.532A Colles fracture of left radius, initial encounter for closed fracture Case 2: The patient is a 42-year-old man with the diagnosis of scapholunate advanced collapse on his right wrist, with synovitis. An orthopedic surgeon performs an arthroscopic excision, TFCC 24 Healthcare Business Monthly

25 To discuss this article or topic, go to Wrist Coding repair, debridement, and partial synovectomy (percutaneous endoscopic). CPT : RT Arthroscopy, wrist, surgical; excision and/or repair of triangular fibrocartilage and/or joint debridement ICD-10-CM: M M Other synovitis and tenosynovitis, right forearm Case 3: The patient is a 68-year-old gentleman who was woodworking in the basement workshop in his single-family home. He lost his grip on a powered sander while refinishing a table and suffered a crushing injury into the capitate and hamate of his right wrist. He underwent a flexor tendon decompression fasciotomy including extensive debridement of muscle and nerve tissue, as well as a two-bone carpectomy. CPT : RT Decompression fasciotomy, forearm and/or wrist, flexor OR extensor compartment; with debridement of nonviable muscle and/or nerve RT x 2 ICD-10-CM: S67.31XA Crushing injury of right wrist, initial encounter W31.2XXA Contact with powered woodworking and forming machines, initial encounter Y Other place in single-family (private) house as the place of occurrence of the external cause Y93.D3 Activity, furniture building and finishing Ken Camilleis, CPC, CPC-I, COSC, CMRS, CCS-P, is an educational consultant and PMCC instructor with Superbill Consulting Services, LLC. He is also a professional coder for Signature Healthcare, a health system covering much of southeastern Massachusetts. Camilleis primary coding specialty is orthopedics. Camilleis is a member of the Cape Coders local chapter in Hyannis, Mass. CODING/BILLING Our coding courses with AAPC CEUs: Charting E/M Audits (11 CEUs) Primary Care Primer (18 CEUs) E/M from A to Z (18 CEUs) Dive Into ICD-10 (18 CEUs) The Where s and When s of ICD-10 (16 CEUs) Demystifying the Modifiers (16 CEUs) Medical Coding Strategies: CPT O view (15 C s) Walking Through the ASC Codes (15 CEUs) Coding with Heart Cardiology (12 CEUs) HealthcareBusinessOffice LLC: Toll free info@healthcarebusinessoffice.com Web site: DonÊt go! Stay with the family and earn CEUs! Need CEUs to renew your CPC? Stay in town. Don t leave. Use our CD courses anywhere, any time, any place. You won t have to travel, and you can even work at home. From the leading provider of computer-based interactive CD courses with preapproved CEUs Take it at your own speed, quickly or leisurely Just 1 course can earn as many as 18.0 CEUs Apple Mac support with our Cloud-CD option Windows support with CD-ROM or Cloud-CD Cloud-CD lower cost, immediate Web access Add l user licenses great value for groups Finish a CD in a couple of sittings, or take it a chapter a day you choose. So visit our Web site to learn more about CEUs, the convenient way! (All courses with AAPC CEUs also earn CEUs with AHIMA. See our Web site.) Check out our website for the latest addition to our course line-up, Charting E/M Audits. Continuing education. Any time. Any place. January

26 CODING/BILLING By Suzan Hauptman, MPM, CPC, CEMC, CEDC, and John Verhovshek, MA, CPC Details Matter for Time-based E/M Services Documentation must meet certain conditions for you to consider time as the key factor for the E/M level. Most evaluation and management (E/M) services are coded based the level of history, exam, and medical-decision-making documented by the provider. But when the provider spends more time counseling and coordinating a patient s care than anything else, using time as the controlling factor will capture the level of service more appropriately. Know CPT Requirements To determine when you may use time as the key or controlling factor for determining the level of an E/M service, refer to specific conditions outlined in the CPT Evaluation and Management (E/M) Service Guidelines: Counseling or coordination of care must dominate (more than 50 percent) the patient encounter. The E/M service must have a reference time, identifiable in the code descriptor by the statement, Typically, X minutes are spent face-to-face with the patient and/or family. The reference time provides an objective standard to determine whether more than 50 percent of the visit is spent in counseling and/or coordination of care. In the context of office and other outpatient visits, time refers specifically to time spent face-to-face with the patient, as well as time spent with parties who have assumed responsibility for the care of the patient or decision making whether or not they are family members. Time may include floor/unit time in the hospital or nursing facility. The extent of the counseling and/ or coordination of care must be documented in the medical record. Although all of the above must be true to report E/M services based on time, the final point bears special emphasis. Providers justifiably feel bogged down by documentation or coding requirements that seemingly have little to do with patient care, but in this case the documentation requirements match clinical best practice and necessity. 26 Healthcare Business Monthly Coding/Billing Auditing/Compliance Practice Management

27 Time-based E/M Time Deserves No Less Attention than History, Exam, or MDM When a provider documents an E/M service based on the history, exam, and MDM, sufficient detail must be provided to determine the level of each of these individual components. The provider does not document, for instance, I performed a comprehensive history. The provider must document detailed information relevant to the history of present illness (HPI) descriptors, such as location, quality, severity, etc., the number of body systems reviewed, and so on. Based on these details, and using the 1995 and 1997 Documentation Guidelines for Evaluation and Management Services or another audit tool, you can determine the extent of history (i.e., problem-focused, expanded problem-focused, detailed, or comprehensive). Similarly, the extent of the exam and MDM is not based on a single statement; it is calculated based on the number and type of details the provider documents for each component. The same logic holds true when documenting time. It s not enough to note how long the service lasted, or that counseling or coordination of care dominated. The documentation must explain the content of the visit to support time as the controlling factor, as well as to support overall medical necessity for the service. The Medicare Claims Processing Manual, chapter 12, section C states: when counseling and/or coordination of care dominates (more than 50 percent) the face-to-face physician/patient encounter or the floor time (in the case of inpatient services), time is the key or controlling factor in selecting the level of service. the physician may document time spent with the patient in conjunction with the medical decisionmaking involved and a description of the coordination of care or counseling provided. Documentation must be in sufficient detail to support the claim. [emphasis added]. Both the 1995 and 1997 Documentation Guidelines for Evaluation and Management Services concur: If the physician elects to report the level of service based on counseling and/or coordination of care, the total length of time of the encounter (face-to-face or floor time, as appropriate) should be documented and the record should describe the counseling and/or activities to coordinate care. [emphasis added]. Best practice for providers documenting time-based E/M services is to note: The total time of the visit; The total time spent in counseling or coordination of care; and A synopsis of the discussion. The note within the medical record can be a thorough account of the activity with the patient, the recommendations, and the patient s concerns. The physician shouldn t limit the documentation to only the time and counseling information, but should also include information gathered from the history and examination elements, as well as MDM concerning ordered and reviewed tests, co-morbid conditions, etc., to further substantiate the level of service and the time spent counseling. Quantity of documentation, however, does not equal quality: Irrelevant or redundant details may detract from the quality of the medical record. The medical record serves many functions as a means to assign codes for payment, as a legal document, etc. but, primarily, it s is a snapshot of the patient s condition at a given moment, and a tool to communicate with other providers. Never mind what a coder or auditor sees: Would another provider (or even the same provider, referencing the record weeks or months later) be able to determine what was discussed at the visit, based on the documentation provided? A medical record lacking pertinent details about the content of a counseling session, or what coordination of care at a particular visit entailed, fails at its primary, clinical purpose. Warning! A snag that providers often get caught in is mentioning time in broad terms. Coders and auditors cannot use time to determine the level of service when providers indicate they had a lengthy discussion with the patient. Without the requirements included in the documentation, time cannot be the determining factor for the E/M service level. It s not enough to note how long the service lasted, or that counseling or coordination of care dominated. CODING/BILLING January

28 Time-based E/M To discuss this article or topic, go to CODING/BILLING An Example of Proper Documentation I saw Mr. Patient today for his continuing complaint of knee pain. His MRI illustrates a meniscus tear that was helped with a cortisone injection some months back. However, he feels the knee is unstable and although usually active, it is limiting his ability to perform all of the things he would like to. We talked about surgery, additional cortisone shots, physical therapy, and doing nothing. He is concerned about surgery because of timing with his job. He was pleased with the last cortisone shot, but doesn t want to rely on the uncertainty of needing it again and again. He has very little arthritis in the knee. Upon examination, he is having tenderness at the area of the tear. No new complaints of any other new issues around skin, neurological or circulation. But he is concerned about the decline in his mobility. After answering some more of his more basic questions regarding healing time, anesthesia complications, and driving capabilities, he decided to move forward with the surgery. We scheduled this for next week. I was with him for 45 minutes, of which 35 minutes was spent in this thorough discussion. A medical record lacking pertinent details about the content of a counseling session, or what coordination of care at a particular visit entailed, fails at its primary, clinical purpose. The provider in the above example mentions history elements around the knee, associated pain, modifying factors, timing, and severity. He discusses a review of a few systems, as well. He also touches on an examination element where the knee was sensitive. The bulk of the visit and documentation was focused on the discussion. The physician was thorough in outlining what was discussed, the patient s concerns, and the outcome. He also properly documented the time details (total visit time and time spent counseling/ coordinating care) needed to report the service using time as the controlling factor. Suzan Hauptman, MPM, CPC, CEMC, CEDC, is the senior principal for ACE Med group specializing in auditing, assessments, coding, compliance, expert opinion, writing, reporting, and education. She is experienced in leading teams of coders, auditors, and educators, as well as educating providers on medical record documentation, EHR, and HIPAA. She has served on the AAPC Chapter Association board of directors and the AAPC National Advisory Board, and sits on a number of other advisory boards throughout the industry. She is vice president of the Greater Pittsburgh, Pa., local chapter. John Verhovshek, MA, CPC, is managing editor at AAPC and a member of the Hendersonville-Asheville, N.C., local chapter. Resource CMS, Evaluation and Management Services: Downloads/eval-mgmt-serv-guide-ICN pdf Medicare Claims Processing Manual Chapter 12 - Physicians/Nonphysician Practitioners: Manuals/downloads/clm104c12.pdf 28 Healthcare Business Monthly

29 FEBRUARY 20TH-24TH FIRESKY HOTEL & SPA Order your 2017 Coding Reference Books today. We ve added one new reference book.

30 CODING/BILLING By Maryann C. Palmeter, CPC, CPCO, CENTC, CHC Common Billing Compliance Pitfalls istock.com/andrey Popov Part 2: Takeaways to help you avoid over-documentation and comply with LCDs and NCDs. Compliance officers face several major issues in today s healthcare arena. Besides HIPAA, Stark Law, and Anti-Kickback concerns, certain billing compliance issues continue to appear in federal government false claims settlement agreements and audit reports. We discussed two of those issues last month: incident-to and shared billing. This month, we re going to look at another hot topic: medical necessity. How Medical Necessity Fails From a government program perspective, there are two areas where medical necessity may fall short: 30 Healthcare Business Monthly Coding/Billing Auditing/Compliance Practice Management

31 Compliance Pitfalls Shadowing a provider is a great way to observe what a provider is doing (or not doing) compared to what they are documenting. 1. Over-documenting evaluation and management (E/M) services, or documenting the same thing for every patient (e.g., cloning). 2. Not adhering to local coverage determinations (LCDs) or national coverage determinations (NCDs) set by the payer or medical practice standards. Avoid Over-documenting and Cloning If using a template, the provider should document only what was done, and edit out what was not done at that particular encounter. For example, even though a provider s documentation template may include a 14-system review, it may not be necessary to perform a complete review of systems (ROS) every time a patient presents to the office. Is the provider really asking every patient all of those questions at every encounter, or is the provider merely marking the ROS from a previous encounter as reviewed? You may not know the answer to this unless you tag along with the provider. obtained at the initial encounter, with no update on how a patient is responding to treatment plans? Does the physician examine every patient s feet, regardless of the presenting problem or risk factors? Do other providers of the same specialty in your practice document in this fashion? Do other providers of this specialty in other practices document in this fashion? Consider E/M Utilization Data It can be difficult to obtain detailed information at the subcomponent level, so Medicare provides E/M utilization data by provider specialty. Use this data as a tool to compare what is going on at a national level with what your physicians are billing. If you identify E/M documentation issues, perhaps E/M educational efforts need to be addressed to the NPP and not the physician. CODING/BILLING Ask to Shadow the Provider Shadowing a provider is a great way to observe what a provider is doing (or not doing) compared to what they are documenting. When you shadow a provider, consider what is being asked of the patient. For example, is it reasonable for a physician to ask a patient who presents with sinus problems whether they have been experiencing rectal bleeding? Before an auditor asks that question, determine whether this information carried over from a previous encounter, or if it was included to bump up the level of service billed. Is the physician truly asking the specific questions listed in the ROS template (e.g., denies: blurring, irritation, vision loss, or discharge), or only asking generic, system-related questions such as, Are you having any problems with your eyes? In the physician s clinical mind, this question means blurring, irritation, vision loss, or discharge (and those are the boxes listed in the electronic template), but in the patient s mind this question might mean, Can you see OK? The physician may miss that the patient is experiencing itchy eyes because, in the patient s mind, itchy eyes means something entirely different, such as allergies. If a physician or NPP does not ask the specific questions, they must not document as if they did. Other questions you may ask to determine over-documentation or cloning include: Does the history of present illness (HPI) actually provide a history of the present illness, or is it regurgitated information Make Sure the Service is Reasonable and Necessary Providers should document what they did, but bill according to what was medically reasonable and necessary to evaluate and treat the patient. According to the Medicare Benefit Policy Manual, Medicare will not cover services that are not reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member. If the standard of practice is to perform a screening mammogram once a year for asymptomatic woman aged 40 and over, for example, but a physician orders one every six months for these patients, it may be alleged that this physician is not following the standard of practice. This is such a complicated issue that it is governed and policed by the physicians, themselves. Billers and coders, and even auditors, cannot make these determinations unless they are clinically trained in the particular specialty in which the physician is practicing. If you come across a situation like this, have a discussion with the physician. Share with the physician the information you located on clinical practice parameters, and ask the physician what is different about their patients. If you are still not satisfied, it may be time to involve your compliance team. A peer review may be necessary. Adhere to Coverage Policies Payers do not cover everything, and coverage varies by payer and by payer plan. Some services are covered only if they meet a specified January

32 Compliance Pitfalls To discuss this article or topic, go to From an auditor s perspective, make sure you apply the LCD or NCD version in effect at the time of service. CODING/BILLING list of conditions. Check your payer policies and coverage documents for medical necessity indications. The Centers for Medicare & Medicaid Services has an online search tool, called the Medicare Coverage Database, that allows users to check Medicare LCDs or NCDs. But coverage determinations are more than just a list of covered diagnoses: Some detail what must be documented for a service to be covered. For example, one Medicare administrative contractor s LCD for cataract extractions requires the documentation to support not only a diagnosis of cataract, but also: Visual acuity (best corrected Snellen chart); Visual acuity during glare or contrast sensitivity testing when the best corrected Snellen chart visual acuity is 20/40 or better; Symptomatology directly related to the presence of the cataract; Physical evidence of the existence of a cataract (e.g., slit lamp examination) and no evidence of other ocular disease (e.g., retinal disease) that would prevent vision improvement when the cataract is removed; There is a reasonable expectation the cataract removal will improve the patient s visual acuity; The use of conservative treatment including current refraction is no longer satisfactory; Degree of functional impairment (This can be in any form; e.g., narrative or assessment tool as long as it supports how the cataract affects the patient s activities of daily living.); and Risk and benefit of the procedure. As you can see, the documentation would not specify all of the above simply using a diagnosis code. This is why, from a compliance perspective, it is advisable to avoid providing physicians with diagnosis cheat sheets. These sheets only provide a list of covered diagnoses, but leave out other pertinent information necessary for coverage. Keeping up with LCDs and NCDs is difficult to do in a large, multispecialty practice; the responsibility should be shared with billing managers, office managers, managed care or contract department representatives, or even physician leaders. These individuals should know how to access the Medicare Coverage Database, as well as payer policies. Examine Risks and Utilize Coverage Resources From a compliance risk perspective, run a report on the top 50 procedure codes billed within your organization. Consider separating out laboratory procedures and focus on these, in addition to the top cross-organizational procedure codes, as there are numerous coverage policies for lab tests. Check for coverage policies on these procedures from the top payers, and convey this information to respective departments who bill for or order these services. The following year, add any new procedure codes and look at the next 50 procedure codes, based on billing volumes. Subscribe to list serves or mailing lists that provide notification s when policies change or are added. From an auditor s perspective, make sure you apply the LCD or NCD version in effect at the time of service. This is particularly important when performing retrospective reviews. Be Tactful and Respectful with Physicians When having a conversation with a physician about medical necessity, make sure you are not alleging that the physician is providing services that are not medically necessary. Simply point out that, from your perspective, the documentation does not appear to support the need for the volume of services, the level of service, or the frequency of services according to the payer s policy. Be sure to provide official guidelines and copies of coverage policies when having these conversations. Maryann C. Palmeter, CPC, CPCO, CENTC, CHC, has 30+ years of experience in the healthcare industry, with emphasis on government billing and compliance regulations. She is employed with the University of Florida Jacksonville Healthcare, Inc., as the director of physician billing compliance, providing professional direction and oversight to the Billing Compliance Program of the University of Florida College of Medicine Jacksonville. Palmeter served on the National Advisory Board and served as the secretary from She serves the Jacksonville, Fla., local chapter as education officer and served as president, president-elect, and member development officer. Palmeter was AAPC s 2010 Member of the Year. 32 Healthcare Business Monthly

33 Vegas is full of regret. Not attending HEALTHCON 2017 might be yours. 25 th Anniversary 3,000 Attendees 90+ Educational Sessions 0 Regrets (maybe) May 7-10 Rio Hotel Las Vegas, Nevada Register now for early-bird pricing: HEALTHCON.com $1395 $895

34 Las Vegas, NV Ӏ Invitation from Bevan Erickson Dear AAPC Members: I look forward to seeing you at HEALTHCON 2017, May 7-10, at the Rio Hotel in Las Vegas. Choose from 90 education sessions, including deep dives on MACRA and quality based payment, the future of the Affordable Care Act, and emerging technology in documentation and billing. This year s HEALTHCON will have more facility-related education than ever, along with our popular Anatomy Expo and Legal Trends and isuues. Plan on networking with your peers, sharing experience and knowledge, while having fun at events like our Member Appreciation Luncheon and the Run4One. Make and renew friendships, expand your career opportunities, and prepare to leave as a more knowledgeable and valuable healthcare professional. Bevan Erickson President, AAPC Ӏ Event Details Dates May 7-10, 2017 Location Rio All-Suite Hotel & Casino 3700 W. Flamingo Road Las Vegas, NV Ӏ Hotel Details Rio All-Suite Hotel & Casino Private Room Shared* Room $210/night $105/person/night Ӏ Cost Early Bird Price though January 13 Registration AAPC Member $1,395 $895 Packages Registration + 3 Nights Shared* Hotel $1,710 $1,210 Registration + 3 Nights Hotel $2,025 $1,525 *Shared room is based on TWO attendees purchasing shared hotel on conference

35 Ӏ General Session Ӏ BROUGHT TO YOU BY AAPC Emotional Intelligence or EQ : Brian Ingles What is emotional intelligence or EQ? Where is your current EQ level? This session will provide an overview to emotions in our lives and careers and the competence behind awareness and management of them. Ӏ Codes - It's Not Always About Payment: Raemarie Jimenez, CPC, CPB, CPMA, CPPM, CPC-I, CANPC, CRHC Reimbursement models are ever changing and now emerging models will change how we get paid but does that mean the use of codes will change too? Learning how valuable data obtained from codes and how it can support any payment model (eg, MACRA and MIPS) can help transform your practice, your documentation and your physician buy in. Ӏ Legal Trends and Issues: AAPC s Legal Advisory Board This panel discussion, led by AAPC s Legal Advisory Committee, offers insights into today and tomorrow s most pressing legal concerns for medical practices and facilities facing increased financial scrutiny and regulation. Join us for this perennial favorite! Ӏ E/M Ambiguities Panel: Michael Miscoe, JD, CPC, CPCO, CPMA, CASCC, CCPC, CUC Jaci Kipreos, COC, CPC, CPMA, CPC-I, CEMC Jonnie Massey, CPC, CPC-P, CPMA, CPC-I Michael Warner, DO, CPC A panel of industry experts including auditing, compliance/legal, physician and payer representatives will host an interactive discussion of the most common problems with proper reporting of E/M services. The perspective of each panel member provides attendees with valuable insight that can be applied when developing internal compliance policies for resolving these concerns. Ӏ Pound, Hashtag, and Business in the 21st Century: Stephanie Cecchini, CHISP, CPC, CEMC Healthcare has gone from medicine bags and house calls to the virtual world of telemedicine in less than 100 years. At the same time the new ways to conduct business, operate efficiently in our personal lives, and keep up with the Jones s ---typically become outdated before the majority of us can learn about them, let alone adopt them. Stephanie Cecchini will identify the six pillars of 21st century success for the men and women serious about making their #mark. Ӏ Keynote: Governor Mike Leavitt Founder and chairman of Leavitt Partners, Governor Mike Leavitt, helps guide healthcare organizations navigate through today s healthcare challenges as they transition to new and better models of care.governor Leavitt former Secretary of Health and Human Services, Administrator of the Environmental Protection Agency, and three-time elected governor for the state of Utah will bring insight into the future of healthcare in an evolving landscape.

36 Las Vegas, NV Ӏ Breakout Sessions Visit for a listing of 90+ Educational Sessions -Coding General - Navigating NCCI and its Modifiers Pediatric Coding Challenges Presenter: Angela Clements, CPC, CPC-I, CEMC, CGSC, COSC Presenter: Sandra Giangreco, RHIT, CCS, CCS-P, COC, CPC, CPC-I, COBGC Modifier 59 is the most abused modifier. Stop relying on software edits to tell you to place the modifier on a CPT code. Learn how to look up NCCI edits and appropriately apply modifier 59, XE, XP, XS, and XU. - Implementing the CMS Toolkit for EHRs in your Practice Presenter: Jill Young, CPC, CEDC, CIMC Electronic Health Records have forever changed the content of medical documentation, and coders must grapple with new challenges brought on by the high volume of data. The risks associated with EHRs are everywhere! This session will help coders and providers identify common compliance problems, offer guidance from CMS, and provide solutions for your medical office. - CPT Assistant and How to Use It Presenter: Mark Synovec, MD -Coding Specialty The Ins and Outs of Urologic Coding Presenter: Stephanie Stinchcomb, CPC, CCS-P We will look at new and existing technology in urologic treatments. Endoscopy, robotics, laparoscopy, and other surgical procedures. We will discuss necessary ICD-10-CM urologic diagnosis coding to report these procedures. Bundling issues and policies from Medicare and commercial insurers will be presented. - Infertility, is your Coding Reproductive Presenter: Stephanie Sjogren, CPC, CPMA, CCS, CPC-I - Top 10 Errors in ENT Coding and Documentation Presenter: Candice Fernillo, CPC, CPB, CPMA, CPC-I, CENTC Kimvberly Huey, MJ, CPC, CPCO, CHC, CCS-P, PCS Primary Care presents several coding challenges with the sheer number of services provided, limited time to provide them, and the complexity of the codes involved. Many primary care physicians end up undercoding leaving out valuable codes that results in thousands of dollars of lost revenue every year. How can coders work with physicians to find missed codes, develop a plan for accurate coding and ensure maximum reimbursement? -Outpatient Facility Revenue Cycle/OPPS in the Facility Presenter: Janet Hodgdon, CPA, CPC, CRC Get an outline of the changes to APC for 2017, with emphasis on increased bundling of services. We will cover financial and operational impacts; Provider-based entity site-neutral payment provisions; New CPT and HCPCS codes, Add-on codes, Composite vs. Comprehensive APCs and Compliance concerns. You will have understanding of APC reimbursement. - Infusions in the Facility Presenter: Lisa Hornick, CPC, CPMA, CEDC - Outpatient Documentation Improvement in the Facility Presenter: Pamela Brooks, MHA, COC, PCS, CPC -Inpatient Facility Trending Issues in Inpatient Coding Presenter: Peggy Turner, BS, RHIT, CDIP, CCS, CCS-P This presentation will cover issues which are currently trending in inpatient coding.

37 BROUGHT TO YOU BY AAPC - Registry Coding: Use Your Coding Experience to Enhance Your Career Presenter: Marianne Durling, MHA, RHIA, CDIP, CCS, CPC, CPCO, CIC -Compliance Understanding Your Non-Physician Practitioners Presenter: Stacy Harper, JD, MHSA, CPC - The UPIC Revolution Presenter: Stephen Bittinger, JD This presentation will teach the essentials of the UPIC program and how you can prepare. Be fully aware of the many changes with the unification of CMS integrity work to a single contractor for each zone. The many compartmentalized processes will be streamlined and integrated into single auditor activities, meaning increasing cross-referrals and multi-purpose reviews. These changes will requires practices to heighten their level of compliance for all reviews. - Accommodating Patient Request to Access and Amend the Health Record Presenter: Michael Warner, DO, CPC Are you ready for patients to read and correct their health records? Do you understand the HIPAA Privacy Rule and patient rights? Are you ready to empower patients to take an active role in their healthcare? Are you ready for Patient Generated Health Data (PGHD)? This presentation will prepare you for the the digital age! - Deeper than the Headlines: Deep Dive into Recent DOJ and OIG Settlements Presenter: CJ Wolf, MD, CHC, CCEP, CIA, COC, CPC -Billing Payer Communications Denials & Appeals Presenter: Angela C Boynton, COC, CPC, CPC-P, CPMA, CPC-I Ever been frustrated by the wall payers tend to surround themselves with? Ever seem like payers speak a foreign language? In this session we'll cover claims issues, denials and appeals, basic communications, and the importance of policy in the payer world. We'll discuss strategy and tactics of how we can begin to break down barriers to successful payer communications. -Auditing Forensic Auditing vs Compliance Auditing Understanding the Difference Presenter: Michael Miscoe, JD, CPC, CPCO, CPMA, CASCC, CCPC, CUC Understand the type of audit you have been asked to perform and how you characterize and communicate the results. Forensic Auditing differs from Risk Auditing based on the criteria that can be applied and the significance of the results. This program outlines the difference between these two types of audits and clarifies the types of criteria, how to delineate conditions of participation from conditions of payment, and the difference between coding and reimbursement rules. - Attorney Client privilege, self-reporting...what am I protecting myself from? Presenter: Christopher Parrella, JD, CHC, CPC, CPCO - Creating an Audit Plan for Physician Offices Presenter: Katherine Abel, CPC, CPB, CPMA, CPPM, CPC-I -Practice Management Practice Management Do s & Don ts for Success Presenter:Michelle Richards, BSHA, CPC, CPCO, CPMA, CPPM

38 Las Vegas, NV Ӏ Breakout Sessions (Continued) - How Healthy is Your Practice? Presenter: Peggy Stilley, CPC, CPC-I, CPMA, CPB, COBGC This session will look at a case study showing a practice making changes in policies and procedures to improve the bottom line. We will look at reports for a variety of areas where tracking and monitoring can identify where the practice is healthy and areas where changes may need to be made. -Technology Pathway to Success for a Regional HIE Presenter: Yvonne Hughes We will define the role of HIE in care coordination across providers: acute, emergency services, ambulatory, public health, and long term post-acute facilities, review interoperability and workflow enhancement opportunities and challenges, list lessons learned and best practices for systems integration. Network with 75+ Exhibitors While Learning About their Latest Products & Services - 5/7 - Welcome Reception Breakfast, Lunch, and Break - 5/8 5/9 Breakfast, Lunch, and Break Ӏ Expo Ӏ Anatomy Expo Celebrate the wonders of human anatomy at our very popular AAPC Anatomy Expo. This event offers an in-depth look into the complex machine we call the human body. Physicians from a variety of specialties will use anatomical models, devices, and videos to provide an insider s look at the anatomic and physiologic nuances of the body. Novice and expert alike will find this session fun, informative, and exhilarating. Ӏ Luncheon Ӏ Member Appreciation Luncheon Don t miss one of the best parts of HEALTHCON! Join us as we recognize professionals who serve, in a light-hearted, entertaining way. Visit with new friends and old, and network with your fellow healthcare professionals. What a great way to end this great event!

39 Ӏ Additional Events (Separate Registration Required) Ӏ Teach the Teacher $195 8 CEUs/CTUs Saturday, May 6 8 am 4 pm This workshop provides certified instructors with tools to improve their teaching and communication skills. This is also a great opportunity to network with other instructors. Earn 8 CTUs or 8 CEUs for participation in this workshop. Ӏ Examination Prices vary by certification Saturday, May 6 8 am 1:40 pm AAPC certifications are the gold standard for the business of healthcare and are held by more than 96,000 professionals. Those who obtain these credentials are critical to compliant and profitable medical practices/facilities. These credentialed individuals also typically earn 20% more than non-certified employees. AAPC credentials increase your chances of being hired and retained in a competitive job market. Ӏ Local Chapter Officer Leadership Training Free 3 CEUs Saturday, May 6 5:30 pm 8:30 pm All officers and prospective officers are invited to meet with members of the AAPC Chapter Association on Saturday, May 6 from 5:30 pm to 8:30 pm. It's a great way to kick off HEALTHCON 2017 and we will have all of the information you need to govern your chapter successfully in This is a chance to meet with other officers just like you, ask lots of questions and compare the way that you get things done... what works and what might be better. Take home ideas for presentations, find ways to identify the best speakers for your meetings and join in a great opportunity for networking with your peers. HEALTHCON is a great place to meet people, and officers can be some of your best networkers. Bring your ideas to share and plan to soak up information while you are in the entertainment capital of the world! Hope to see you there. BROUGHT TO YOU BY AAPC and quality measures and will review questions that mimic those on the CDEO TM certification exam. This review is a greatopportunity to gauge your readiness and identify competencies that you need tofocus on. This is an accelerated review for coders with professional andoutpatient coding experience. Ӏ Run4One $20 Donation Wednesday, May 10 7 am 8 am AAPC is on a mission to promote better health, education, and wellness... and to nudge you a little left of your comfort zone! HEALTHCON 2017 will feature our third annual AAPC Run For One walk/run. This event will give you a chance to network, meet AAPC leadership, and of course, donate to a worthy cause. Having fun is a key part of this event all skill levels are invited! From seasoned runner to sight-seeing stroller, there's room for everyone. Registrants will receive a wristband which can be proudly worn throughout the conference. Contact one of your representatives on the National Advisory or Chapter Association Board to arrange participating with others from your region. Ӏ Transportation AAPC has arranged discounted airport transportation to and from the Rio Hotel through LAS Express. Go to to book transportation and see options. Ӏ CDEO Review Class $299 8 CEUs Saturday, May 6 8 am 5 pm This review will cover the competencies tested on the CDEO TM certification exam, which include medical record documentationrequirements, provider communication and compliance, diagnosis coding,payment models, procedure coding See You in Vegas

40 Early Bird Price through January 13 Members: $1395 $895 Register at The educational information at HEALTHCON is invaluable. The healthcare environment is extremely fluid and changing rapidly. Staying current with the industry changes is critical. AAPC provides a venue which allows us to come together to share the latest information to grow professionally and to stay at the top of our game.... Tracy Dixson, CPB, CPEDC May 7-10 Rio Hotel Las Vegas, Nevada

41 ALPHABET SOUP Become Familiar with MACRA Lingo Here are some acronyms you will run across if you are participating in the new Quality Payment Program, beginning Jan. 1, What does MACRA stand for? Look below: ABC - Achievable Benchmark of Care APM - Alternative payment model BPCI - Bundled payments for care improvement CAH - Critical access hospital CAHPS - Consumer assessment of healthcare providers and systems CBSA - Non-core based statistical area CDS - Clinical decision support CEHRT - Certified electronic health record technology COI - Collection of information CPIA - Clinical practice improvement activity CPOE - Computerized provider order entry CPR - Customary, prevailing, and reasonable CPS - Composite performance score CQM - Clinical quality measure ecqm - Electronic clinician quality measure EC - Eligible clinical FQHC - Federally qualified health center MACRA - Medicare Access and CHIP Reauthorization Act of 2015 MIPS - Merit-based Incentive Payment System OCM - Oncology Care Model PFPMs - Physician-focused Payment Models PTAC - Physician-focused Payment Model Technical Advisory Committee QP - Qualifying APM Participant TCPI - Transforming Clinical Practice Initiative VM - Value-based payment modifier VPS - Volume performance standard To learn more about MACRA, go to: SPOILER ALERT! MACRA Trivia Answers (Quiz on page 49) 1. The answer is B. Rationale: Merit-based Incentive Payment System (MIPS) eligible clinicians or groups should report at least six measures for 2017, including at least one outcome measure. If an applicable outcome measure is not available, report one other high priority measure. If fewer than six measures apply, report on each measure that is applicable. The requirement that one of the measures must be a cross-cutting measure was not finalized. 2. The answer is C. Rationale: Clinicians who achieve a final composite performance score of 70 or higher will be eligible for the exceptional performance adjustment in The answer is A. Rationale: Weighting of the cost performance category was lowered in the final rule to 0 percent for The answer is B. Rationale: For full participation in the improvement activities performance category, clinicians can engage in up to four activities, rather than the proposed six activities, to earn the highest possible score of The answer is A. Rationale: For improvement activities, attesting to at least one improvement activity will be sufficient to meet the MIPS performance threshold in January

42 PRACTICE MANAGEMENT By Ellen Maura Wood, CPC, CMPE Quick Tips for Managing A/R When claims are not getting paid in a timely manner, eliminate the holdup. Accounts receivable (A/R) is the bread and butter of an office. To support the livelihood of your practice, ask your employees to think about uncollected balances from a personal point of view. For instance, would they wait 120 days to receive reimbursement for a service they provided? Probably not. Nor would they likely give up on collecting payment after the first claims denial. Reducing the patient aging report takes more than just visualization tactics, however. Putting a strict review process in place can actually lower the 120 days in A/R within six months. Begin with an A/R Review Process All monthly reports should show the A/R data of your practice. Track this on a separate Excel sheet (such as that shown on page 43) listing each payer in a column and the corresponding days in A/R. Initially, concentrate only on those balances of $1,500, or more. Supervise the employees who are making the calls for the first few weeks, so you can coach them on what questions to ask, and when to push the insurance representative to go beyond their boilerplate answer. Communicate Results to Improve Your Bottom Line Require office staff to report to you weekly, and to work on specified accounts during week 1, week 2, etc. There is a comments section on each patient/date of service; review these notes with your staff so you can share ideas and instruction about how to handle the insurance carrier and how to get the answers you need about the status of the claim. Track each employee s work so you can show each one their success while working in A/R. Employees become self-motivated when they see the dollars in A/R decrease, indicating that their hard work is getting results. Speed Up Slow Claims Many claims even clean claims are held by insurers. Unlisted procedure claims often are tied up by the insurer. istock.com/nspimages 42 Healthcare Business Monthly Coding/Billing Auditing/Compliance Practice Management

43 To discuss this article or topic, go to Managing A/R The best way to submit unlisted procedure claims is to call the carrier prior to billing the service, and inquire about their policy. If you re unable to get their policy in writing or from the outsourced insurance representative, submit the claim electronically first (to avoid a denial for filing limits) and follow up with a paper claim, operative note, and letter explaining why you used the unlisted procedure code. Medicare does not accept paper claims, so be sure to work with your Medicare processor (for example, ours is National Government Services) and your software company to free text in an agreed loop area where the information can be accessed. Employees become self-motivated when they see the dollars in A/R decrease, indicating that their hard work is getting results. All monthly reports should show the A/R data of your practice. PRACTICE MANAGEMENT Keep Track of Appeals, Collections Appeals are part of our business. Keep a record of all appeals even those that are paid so you have historical data of the results. For example, where I work, nearly 80 percent of our initial appeals are paid and 95 percent of our second level appeals are paid. Collections are part of our business, too. Patients with serious issues (e.g., breast and colon cancers) should be given as many concessions as possible. Understand that patients might have a period of three to six months when it s impossible for them to pay any outstanding bills. Ask those patients to keep you up to date on their intentions. After an account goes to collections, you should no longer have contact with the patient about their outstanding claims. Ask them to pay the collection agency directly. Many hospitals have generous charity programs. If you work in a hospital, consider that as an option for patients who need financial aid to pay medical bills. Note that it may require patients to submit lots of paperwork, tax records, pay stubs, and other records. If the patient is approved for financial aid, honor that decision. Ellen Wood, CPC, CMPE, has worked in the medical field for most of her career and has been a certified coder for over 14 years. She served as a medic in the U.S. Navy. Today, Wood is the practice manager for Seacoast General Surgery and is an adjunct professor at a local community college. Her experience includes mentoring employed coders, daily management of a busy surgical practice, and oversight of meaningful use policies and objectives, PQRS, and eprescribing programs, and now MACRA. Wood helped to start the first New Hampshire local chapter, Seacoast-Dover, and served on its board. She is the AAPC National Advisory Board Region 1 Northeast representative. January

44 AUDITING/COMPLIANCE Step into the Shoes of a Whistleblower istock.com/kzenon Before you blow the whistle, know your options and understand the consequences. In March 2014, on the eve of trial, Halifax Health a 678-bed public hospital system in Daytona Beach, Florida agreed to pay $85 million to settle allegations that it had violated the Stark physician referral law and submitted False Claims to Medicare. Four months later, Halifax Health agreed to pay an additional $1 million to settle allegations that it had billed Medicare improperly for inpatient care. Both settlements resulted from a whistleblower complaint filed in 2009 by Halifax s Director of Physician Services Elin Baklid-Kunz, MBA, CHC, CPC, CPMA, CCS. Here, she shares some advice for those questioning compliance within their own organization. Healthcare Business Monthly (HBM): Tell us about yourself and your career. Baklid-Kunz: I came to the United States from Norway right after high school to learn English and attend college. Four years later, in 1994, I started working at Halifax Health. After completing my Master of Business Administration in 1998, I transferred to the finance department, where I held several positions including financial analyst, budget coordinator, and revenue coordinator. Before being promoted to my director role in 2008, I worked nearly four years in the compliance department, with responsibility for revenue integrity. This included auditing and teaching other employees about the scope and mechanics of the False Claims Act. I had worked at Halifax Health for over 20 years when I resigned, in July HBM: What advice would you give to anyone questioning the compliance of an organization? Baklid-Kunz: Certified healthcare professionals are held to a higher standard. Stay true to your values and ethics. Review AAPC s Code of Ethics, as well as your employer s Code of Conduct and Code of Ethics. You don t need to be a lawyer to know that something feels wrong. If you suspect fraudulent coding at your practice, make sure you are 44 Healthcare Business Monthly Coding/Billing Auditing/Compliance Practice Management

45 To discuss this article or topic, go to Whistleblower not mistaken. Do your research, review documentation, and write up a rational explanation as to why the current coding practice is incorrect. Always include references: It s not enough to say, This is how it should be done. Citing examples of ethical coding is important. Follow the steps outlined in your organization s compliance plan and follow the chain of command. When teaching workshops, I emphasize the importance of having a coding network you can rely on. Online conferences are great, but also attend some live sessions so you can network. If you exhaust all options and decide to file a lawsuit, try to line up another job, first. I would not recommend filing a qui tam suit and continue working at the business you are suing. HBM: In your experience, what can someone expect should they decide to blow the whistle on fraud in their organization? Baklid-Kunz: I think it s very important for other coders to understand what whistleblowing entails. The role of a whistleblower takes its toll in the form of disillusionment, isolation, and mental and emotional strain. It s lonely because you cannot discuss your case with anyone other than your attorneys. There are many misconceptions that it s all about a guaranteed payday. Most of the time, there are better solutions available. I m asked for advice on cases all the time, and almost 100 percent of the time I recommend not filing a lawsuit, especially for coding issues. HBM: Do you regret acting as a whistleblower? Baklid-Kunz: I don t regret my choice to speak up, although I often wish somebody else had done so. For me, validation came a few days after the settlement. During opening remarks at the HCCA conference in San Diego, Daniel Levinson, Office of Inspector General, U.S. Department of Health & Human Services said of the case: I don t regret my choice to speak up, although I often wish somebody else had done so. I subscribe to the notion that everybody in compliance should be leaning in Another validation was the Taxpayers Against Fraud Whistleblower of the Year Award I received in September HBM: What are you doing, now? Baklid-Kunz: I m a self-employed compliance and coding consultant, and I teach and speak about coding compliance and ethics. I very much enjoy teaching AAPC quarterly workshops, which I have been doing in Florida for the past nine years. I m also engaged by a tech company with offices in the United States and Europe to assist in developing their healthcare linguistic software, working with their software engineers in Germany. European companies perceive whistleblowers in a positive light, and are not afraid to work with me. This is in contrast to U.S. companies that have offered me jobs, only to later retract the offer, stating that the risk of hiring a whistleblower is too great. I also serve as head judge for Stetson University s Southeast Regional Business Ethics Case Competition (SERBECC), and I speak to students and healthcare professionals about my experience as a whistleblower. Elin Baklid-Kunz, MBA, CHC, CPC, CPMA, CCS, is a national speaker and published author on topics related to her 20 years of experience in medical practice compliance, coding, reimbursement, chart audits, and federal regulations. Baklid-Kunz is an approved ICD-10- CM/PCS trainer, presents workshops for AAPC, and delivers keynote presentations for Eli Research Coding Institute and Audio Educator. Her experience includes freelance writing for HCPro and curriculum development as adjunct professor at Seminole State College, where she has taught courses on healthcare reimbursement and data analysis and served on the advisory committee for the health information management program. Baklid-Kunz earned her master s degree in business administration from Stetson University. She is a member of the Daytona Beach, Fla., local chapter. AUDITING/COMPLIANCE The $85 million settlement resulted because a compliance official who raised the issue about payments to physicians looking like they violated the Stark Act [was] not really being listened to. It struck me that what [Elin Baklid- Kunz] was doing was that she was leaning in to her work. Resource Remarks to HCCA Compliance Institute, March 31, 2014 (citing Lean In: Women, Work, and the Will to Lead by Sheryl Sandberg (March 11, 2013)): and Susan Gouinlock presentation at the TAF 2014 Conference in Washington, DC. January

46 AUDITING/COMPLIANCE By Mike Semel Five Lessons Learned from HIPAA Penalties Pay attention to Privacy and Security Rules, or you may pay out of your pocket. enforcement is skyrocketing. In 2015, there were $6.1 HIPAA million in HIPAA penalties. By the end of the third quarter in 2016, there was more than $20 million. A single $5.5 million penalty in August 2016 nearly eclipsed the total for Why the leap in activity? Patient rights are civil rights. HIPAA protects a patient s civil rights to confidentiality and privacy. That s what motivates the new management at the U.S. Department of Health & Human Services (HHS) Office for Civil Rights (OCR) to get tough on organizations that don t follow HIPAA rules and that breach patient confidentiality. Looking at the recent penalties and the new HIPAA audit program, there are critical lessons your organization can learn. Some of this isn t new. It goes back to 2003 and 2005, when the HIPAA Privacy and Security Rules were enacted. Some is new, based on the HIPAA changes in the 2013 HIPAA Omnibus Final Rule and the appointment of Deven McGraw as the deputy director for privacy at OCR. Not paying attention to these changes may be costly to your healthcare organization. istock.com/catalin Healthcare Business Monthly Coding/Billing Auditing/Compliance Practice Management

47 HIPAA Lessons LESSON 1: Patient Paperwork Is Important The new HIPAA audit program has started. OCR announced that the first organizations being audited for the Privacy Rule must submit their Notice of Privacy Practices for review, must have it posted in their offices and available for patients, and have it posted prominently on their website. The wording in the Notice of Privacy Practices must comply with changes in the 2013 HIPAA Omnibus Final Rule. What is commonly seen during client assessments are: Notice of Privacy Practices that have not been changed since 2003, when HIPAA began; Notice of Privacy Practices that are given to new patients, but are not displayed in waiting areas; and No current Notice of Privacy Practices on an organization s website. Practices also sometimes use a generic form on the internet, and only add their name. Some practices have a set of downloadable New Patient forms on their websites with a release that says the patient has been offered a Notice of Privacy Practices. This will not do! Your complete notice must be on the website, and new patients should receive a copy during their first visit. The government has created model notices that are available for free: Use them. Action Point: Check to be sure your Notice of Privacy Practices meets the 2013 standards, is displayed and available in all your waiting areas, and is prominently displayed on your website. LESSON 2: Vendor Management Is Critical Recent fines of $1.55 million, $2.7 million, and $400,000 were assessed to organizations that shared protected health information (PHI) with vendors without having a current Business Associate Agreement in place. Those fines make it worthwhile for you to identify each of your business associates, and to create or update contracts that include the required wording that changed in Make sure your vendors understand that the 2013 HIPAA Omnibus Final Rule makes them liable for data breaches, and requires each business associate to implement a full HIPAA compliance program. In June 2016, the first-ever penalty against a business associate was $650,000 for losing 412 nursing home resident records. In September 2016, a $400,000 fine was assessed against a business associate that lost a client s backup tapes. If your healthcare organization is selected for a HIPAA audit, your business associates may be audited, too. If they fail, it might result in consequences for you. Action Point: Have proper contracts for each of your business associates, indicating their commitment to HIPAA compliance. If a vendor won t sign a Business Associate Agreement, or think they don t have to do anything beyond signing the agreements, find another vendor. LESSON 3: Security Is Not Optional No one likes the inconveniences required to secure data, any more than we like going through checkpoints at airports, government buildings, and sporting events. But it s now a part of our lives, and we have to get used to it. The HIPAA Security Rule is a framework of information technology (IT) security requirements designed to protect health data against loss, theft, unauthorized access, or lack of availability. In today s world of increasing cyber threats, including ransomware, you can no longer get away with using an unsecured network that fails to incorporate strict requirements for auditing, data backups, and end-user security. The first requirements in the HIPAA Security Rule are a security risk analysis and risk management. These are the two items the OCR is requesting in their Security Rule audits. January AUDITING/COMPLIANCE The government has created model notices that are available for free: Use them.

48 To discuss this article or topic, go to HIPAA Lessons AUDITING/COMPLIANCE No one likes the inconveniences required to secure data, any more than we like going through checkpoints at airports, government buildings, and sporting events. A $2.75 million penalty was assessed against an organization that allowed users to log in to their network using generic user names, in violation of the HIPAA requirement for unique user identification. A $2.7 million penalty was assessed for storing patient data with a consumer-class cloud service that would not sign a HIPAA Business Associate Agreement. Other penalties occurred for lost devices and lost backup tapes. Most of these penalties noted that the organizations had not done a security risk analysis to identify the threats and vulnerabilities that could affect the security of their data. Some penalties were against organizations that did risk analyses, but failed to remediate the identified problems. Action Point: Conduct a security risk analysis and fix identified problems. Check for weak points your in-house staff and IT vendors may have missed. Whether you have an IT staff or outsource your IT services, hiring an independent certified professional to conduct your risk analysis and compliance assessment is a good idea. LESSON 4: Encrypt Your Devices and The aforementioned penalties for data loss could have been prevented if the data had been encrypted. HIPAA (and state data breach laws) exempt encrypted data loss from data breach reporting (as long as the encryption keys were not taken with the data). New, business-class Windows 10 computers and new servers include encryption at no extra charge. Windows 7 computers can be encrypted for approximately $100, each. Cell phones and tablets can be easily encrypted. Portable media, such as thumb drives and universal serial bus (USB) hard drives, can be purchased with encryption. should always go through a secure system. When sending PHI internally within your organization, you do not have to encrypt messages; however, all PHI sent outside of your internal system must be encrypted. encryption is usually an add-on that must be configured by an IT professional, and requires users 48 Healthcare Business Monthly to be trained and audited to ensure they always encrypt messages containing PHI. Action Point: Have an IT professional configure encryption on all of your computers, servers, mobile devices, and portable media. Set up encryption; and make sure your users are trained and know they must encrypt all messages containing PHI that are sent outside of your organization. Encryption is the least-expensive way to prevent a reportable breach. LESSON 5: Don t Ignore Paper Records Some of the aforementioned 2016 penalties were for confidentiality and privacy breaches caused by the mishandling of paper records. Some records were sent to the wrong recipients. Others were sent to mailing services that had not signed Business Associate Agreements. Action Point: Review your processes for handling paper records, mailing bills and other correspondence, and storing records to comply with retention requirements. These are all fairly small changes that can prevent very large penalties. We are all patients, so these changes will protect your civil rights, too. Mike Semel is president and chief compliance officer for Semel Consulting. He has owned IT businesses for over 30 years, and has served as the chief information officer for a hospital and a K-12 school district. Semel is recognized as a HIPAA thought leader throughout the healthcare and IT industries, and has spoken at numerous conferences including AAPC, NASA Occupational Health, and the New York State Cybersecurity conference. He has written HIPAA certification classes and consults with healthcare organizations and business associates to help build strong cybersecurity and compliance programs. Semel can be reached at , ext. 101 or mike@semelconsulting.com. Resource Model Notices of Privacy Practices may be found on the HHS website:

49 MACRA TRIVIA Test Your Knowledge of MACRA Requirements This is a fun, short quiz to see how well you know Medicare Access and CHIP Reauthorization Act (MACRA) requirements. You will not earn continuing education units (CEUs) for taking it, but you will earn bragging rights! The answers are on page MIPS eligible clinicians or group should report at least how many measures in performance year 2017? a. 4 b. 6 c. 6 plus one outcome measure and once cross-cutting measure d. 14 in all 2. Clinicians who achieve a final composite performance score of or higher in 2017 will be eligible for the exceptional performance adjustment in a. 10 b. 25 c. 70 d Weighting of the cost performance category is percent for the transition year. a. 0 b. 10 c. 15 d For full participation in the improvement activities performance category, clinicians can engage in up to how many activities to earn the highest possible score of what? a. 2 activities for a score of 20 b. 4 activities for a score of 40 c. 6 activities for a score of 40 d. This category does not factor into the score for TRUE or FALSE: For improvement activities, attesting to at least one improvement activity will be sufficient to meet the MIPS performance threshold in the transition year. a. True b. False PREPARE YOURSELF FOR 2017 CPT UPDATES Join AudioEducator s audio conferences by top industry experts Choose from 25+ Specialty Coding Updates Any 3 for $399 Any 5 for $599 Time is Running Out ACT NOW! Visit: audioeducator.com or Call: customerservice@audioeducator.com Use Code AAPC50 to Get $50 OFF 10+ YEARS OF EXCELLENCE 100+ EXPERT SPEAKERS 250+ WEBINARS 25+ SPECIALTIES 150+ AAPC CEUs PER YEAR 100,000+ SATISFIED CUSTOMERS January

50 All-in-one Compliance For All We reinvented compliance management through a complete, flexible solution that complies with all seven OIG recommendations to ensure you re compliant when audited. HEALTHICITY.COM/COMPLIANCEMANAGER

51 By Ann M. Bittinger, Esq. AUDITING/COMPLIANCE Encourage Internal Reporting of Compliance Issues istock.com/utah778 Promote a compliant environment within your organization, before the whistle is blown. Coding/Billing Auditing/Compliance Practice Management The most notable Medicare fraud cases in the last five years have been whistleblower cases in which someone with inside knowledge of a health system or physician practice (usually an employed physician or administrator) files suit against the employer under the federal False Claims Act. There are things you can do in your practice right now to prevent becoming the next whistleblower case defendant. How Whistleblowing Has Grown Essentially, a whistleblower files a case on the government s behalf, claiming fraud against the government. The plaintiff blows the whistle on activities considered inappropriate under federal healthcare laws. The U.S. attorney for the district in which the case was filed can choose to intervene in the case. The case remains secret, or under seal, for at least 60 days; although, extensions are granted for much longer periods while the government investigates and decides whether to intervene. January

52 Compliance Issues AUDITING/COMPLIANCE Organizations may be able to contractually require employees to report concerns internally before blowing the whistle to the government. Whistleblowers are incentivized to file because they receive a portion of the settlement or judgment amount often as much as 25 percent of what the government recovers if the government intervenes. If the government does not intervene, the whistleblower can continue the case and is entitled to 25 to 30 percent of the recovery. These cases also called qui tam cases deal mostly with Medicare billing fraud (e.g., upcoding, double billing, and similar bad acts). Of late, more cases have involved physician compensation. These usually allege that a system is paying employed or contracted physicians too much money, with the too much part alleged to be kickbacks for referrals of ancillary services. According to the Nolan Auerbach law firm, since 1986 there have been 5,279 healthcare whistleblower actions filed, with awards totaling $3.2 billion. Thirty-eight percent of those actions were filed in just the past five years (an average of 399 a year), along with nearly half of the total awards paid. Internal Reporting Provides a Solution With whistleblower activities rampant, the key to not becoming the next whistleblower case defendant is making sure the accusing employee visits your office to make a complaint, rather than the office of a whistleblower attorney. How do you promote internal reporting? Knowledge. Show employees that you have your legal ducks in a row. Implement a compliance program and train employees on legal issues. Bring in outside counsel. Create a high standard of legal knowledge for your organization to use. Culture. Empower those in charge of compliance to keep current on legal issues. Create a culture in which conversations about compliance issues are encouraged, not shunned. Communicate clear lines for reporting concerns. Have regular compliance training and messages. Organizations also may be able to contractually require employees to report concerns internally before blowing the whistle to the government. A 2013 case in the Northern District of Illinois gives some legal credence to employers requests that employees sign statements requiring them to report internal compliance concerns before disclosing them. In U.S. v. AARS Forever, Inc., and THH Acquisition LLC 1 a motion to dismiss was put before the court. Two employees of the healthcare company had signed an Employee Confidentiality, Non-Compete and HIPAA Agreement. It covered the usual confidentiality terms: I will not copy, reproduce, or take with me the original or any copies of said Confidentiality Information, and I will not disclose any of said Confidential Information to anyone. This is an attempt to prohibit whistleblower actions. To further prevent it, the agreement required the employees to turn over any whistleblower rewards to the company: I agree that I cannot receive any monetary reimbursement for involvement or assistance in a Qui Tam or Whistleblower action against the Company. If I am awarded such directly or indirectly, I will immediately disclose it to the Company and turn it over to the Company immediately. Furthermore, I agree that I am in violation of this agreement if I release company information that reveals suspect practices or investigations or if I use knowledge of such information to harm the Company reputation. I agree that the company cannot be responsible for suspect practices that it would otherwise be unaware if not made specifically aware of them by staff. I agree to notify the Company in writing immediately if I suspect practices that may be of concern. The whistleblowers also signed a company form attesting they were unaware of any suspect business practices, and agreeing that the istock.com/rostislav_sedlacek 52 Healthcare Business Monthly

53 To discuss this article or topic, go to Compliance Issues employer can t be responsible for suspect business practices of which it s not informed. Despite signing these forms, the whistleblowers never reported any suspect Medicare billing fraud activities to the employer. In response to the whistleblower lawsuit, the employer counterclaimed, alleging breach of contract. The employer argued that the employees had agreed contractually not to file whistleblower claims. The employer sought indemnification and damages for the breach. The whistleblowers responded by asking for a motion to dismiss based on only the pleadings, saying that agreements like those quoted above are against public policy and are not enforceable. They argued that the detection and exposure of potential fraud against the United States is important, and that allowing these types of agreements to be enforced thwarts that interest by chilling would-be [whistleblowers] from coming forward with evidence of fraud, thereby hindering investigations. The judge cited precedent allowing previous employers to sue whistleblowers, where the conduct at issue is distinct from the conduct underlying the whistleblower case, as well as in situations of libel, defamation, malicious prosecution and abuse of process by the employees. Because the employer pleaded facts that place their counterclaims comfortably in at least one of the two categories, the counterclaims cannot be dismissed on the pleadings as contrary to public policy. Require Reporting as Part of a Comprehensive Compliance Program Put simply, the court decision shows it may be worthwhile for employers to require employees to sign agreements like those described above. I ve created similar contracts for healthcare provider clients to implement as part of their comprehensive compliance programs. I usually include internal reporting mandate provisions within a confidentiality and security attestation document. The employee acknowledges they are bound to keep company financial practices secret, as well as required to report concerns to the employer before reporting them to others. The burden is contractually on the employee to report internally. Failing to do so constitutes a breach of contract, which at least one court has said is different enough from a whistleblower suit that it agrees with public policy. Mandating this contract in isolation, however, is not advisable. It should be part of a robust compliance program, in which employees a company can t fix compliance problems that it doesn t know about, and a good way for a company to know about the issues is to require employees to disclose them. are taught to detect and prevent legal improprieties. The idea is that a company can t fix compliance problems that it doesn t know about, and a good way for a company to know about the issues is to require employees to disclose them. A good compliance program is based on the Office of Inspector General s seven pillars of an effective compliance program: 1. Designating a Compliance Officer 2. Implementing Compliance Practice Standards 3. Conducting Internal Monitoring and Auditing 4. Conducting Appropriate Education and Training 5. Responding Appropriately to Detected Offenses and Developing Corrective Action 6. Developing Open Lines of Communication 7. Enforcing Disciplinary Standards Through Well-publicized Guidelines Implementing mandatory reporting requirements promotes pillar number five, and supplements regular monitoring and auditing in pillar four. Contracts with employees to mandate internal reporting are a bit like nuclear weapons: No one ever wants to use them, but they send a message of strength and promote discussions about issues and conflicts. Resources Ann M. Bittinger, Esq., represents physicians nationally in transactions with other entities and with compliance with federal healthcare laws (Stark law, Anti-kickback Statute, HIPAA) and in structuring their independent practices, agreements, and compliance programs. Contact: ann@bittingerlaw.com. Nolan Auerbach & White, Latest DOJ Statistics: latest-doj-statistics/ U.S. District Court for The Northern District of Illinois Eastern Division, U.S. v. AARS Forever, Inc., and THH Acquisition LLC 1: AUDITING/COMPLIANCE January

54 AUDITING/COMPLIANCE By Michael D. Miscoe, JD, CPC, CASCC, CUC, CCPC, CPCO, CPMA 2017 OIG Work Plan: Part A Risk Areas Time to give your facility s compliance plan an annual preventive exam. The Office of Inspector General s (OIG s) annual work plan reveals its plans for new, revised, and ongoing reviews and audits of U.S. Department of Health and Human Services (HHS) programs and operations. This year, OIG has set its sights on 24 significant new issues, plus five revised and approximately 40 ongoing problem areas that investigators have identified within the Medicare Part A and Part B programs. Providers who furnish services to Medicare beneficiaries can expect a trickle-down effect from these activities. The best recourse is to conduct internal reviews and audits of the applicable focus areas, and resolve any noncompliant issues before someone else does. To get you started, here s a synopsis of the new and revised focus areas for Part A in the 2017 OIG Work Plan (focus areas pertaining to Part B providers will be addressed next month). HOSPITALS NEW! Hyperbaric oxygen (HBO) therapy services: HBO is primarily compensable as an adjunct treatment for managing certain non-healing wounds, as indicated in the National Coverage Determinations (NCD) Manual, IOM Pub , chapter 20, 54 Healthcare Business Monthly section 20.29(A). OIG believes patients have received treatment for non-covered conditions, medical documentation did not support the necessity of HBO treatments, and there is overutilization (an excess of treatments per patient). HBO providers should expect OIG and/or integrity contractor scrutiny. NEW! Incorrect medical assistance days claimed by hospitals: Disproportionate share payments are made to hospitals that provide a disproportionate share of services to low-income patients. The amount is based on the number of Medicaid patient days a hospital furnishes. OIG says it will determine if Medicare administrative contractors calculated disproportionate share payments correctly. NEW! Inpatient psychiatric facility outlier payments: OIG notes a 28 percent increase from 2014 to 2015 in the number of claims with outlier payments to inpatient psychiatric facilities (freestanding hospitals or specialized hospital-based units) that provide active psychiatric treatment to meet the urgent needs of patients experiencing acute mental health crisis due to mental illness or alcohol- and drug-related problems. OIG also notes that total payments for stays resulting in outlier payments rose from $450.2 million to $534.6 million an increase of 19 percent. OIG will evaluate whether inpatient psychiatric facilities complied with Medicare documentation, coverage, and coding requirements for stays that resulted in outlier payments. NEW! Case review of inpatient rehabilitation hospital patients not suited for intensive therapy: As part of a separate study of inpatient rehab hospitals, physician reviewers identified a small number of cases where the patient appeared unsuited for intensive therapy. OIG will assess a sample of rehabilitation hospital admissions to determine whether patients participated in and benefitted from intensive therapy. For patients who were not suitable candidates, OIG will identify the reasons the patient was not able to participate and benefit from therapy. REVISED! Intensity-modulated radiation therapy (IMRT): IMRT is provided in two treatment phases: planning and delivery. Certain services should not be billed when performed as part of an Coding/Billing Auditing/Compliance Practice Management

55 OIG Work Plan istockphoto AlexRaths IMRT development plan. Prior OIG reviews identified hospitals that incorrectly billed IMRT services. OIG will review Medicare outpatient payments for IMRT to determine compliance with federal coverage requirements. For facility billing and payments, the OIG will focus on: Outpatient outlier payments for short-stay claims Comparison of provider-based and freestanding clinics Reconciliations of outlier payments Hospital s use of outpatient and inpatient stays under Medicare s Two-midnight Rule. Medicare costs associated with defective medical devices Payment credits for replaced medical devices that were implanted Medicare payment for overlapping Part A inpatient claims and Part B outpatient claims Selected inpatient and outpatient billing requirements Duplicate graduate medical education payments Indirect medical education payments Outpatient dental claims Nationwide review of cardiac catheterizations and endomyocardial biopsies Payments for patients diagnosed with kwashiorkor Review of hospital wage data used to calculate Medicare payments The Centers for Medicare & Medicaid Services (CMS) validation of hospital-submitted quality reporting data Long-term care hospital adverse events during post-acute care for Medicare patients Hospital preparedness and response to emerging infectious diseases This year, OIG has set its sights on 24 significant, new issues, five revised, and approximately 40 ongoing problem areas Nursing Homes NEW! Nursing home complaint investigation data brief: Nursing home complaints categorized as immediate jeopardy or actual harm must be investigated within a two-day and 10-day time frame, respectively. A prior OIG report (2006) found that state agencies did not investigate these serious complaints within the mandated time frame. OIG will investigate whether this problem continues. NEW! Skilled nursing facilities (SNFs) unreported incidents of potential abuse and neglect: Ongoing OIG reviews indicate the potential for unreported instances of abuse and neglect. OIG will assess abuse and neglect incidents among Medicare patients receiving skilled nursing care in a SNF, and determine if such incidents were properly reported. NEW! SNF reimbursement: OIG has expressed concern of potential overpayments to SNFs based on the belief that SNFs are billing higher levels of therapy than were provided or medically necessary. OIG will review documentation to ensure SNF use of the Long Term Care Minimum Data Set tool has appropriately classified each patient into the appropriate resource utilization group. AUDITING/COMPLIANCE January

56 OIG Work Plan AUDITING/COMPLIANCE NEW! SNF adverse event screening tool: OIG developed the SNF adverse event trigger tool as part of a 2014 study conducted with assistance of the Institute for Healthcare Improvement. The screening tool will describe the purpose, use, and benefits of the SNF adverse event trigger tool. Fraud, Waste, and Abuse Expenditure Studies at a Glance The Office of Inspector General (OIG) reports that total federal spending for Medicare, Medicaid, and Children s Health Insurance Program (CHIP) was nearly $1 trillion for Over 50 percent of this amount was spent on Medicare, which included payments for inpatient hospital, skilled nursing, home health, hospice, physician services payments, and electronic health record incentive payments. Breaking with tradition, OIG did not report total recoveries, the number of civil or criminal referrals, civil monetary penalty settlement figures, or exclusions for OIG highlighted the completed, new, revised, and removed areas of study in a more obvious manner than in past years. For example, OIG published a report (OEI , June 2016) outlining common characteristics of OIG home health fraud cases; a report suggesting hospice providers should improve election statement and certifications of terminal illness (OEI , September 2016); and a report identifying concerns regarding escalation of ventilator claims (OEI , September 2016). Reviewing these studies, in addition to OIG s annual work plan, should be a part of your organization s risk analysis process. REVISED! National background checks for long-term care employees mandatory review: Grants are provided to the states under the Affordable Care Act (ACA) to implement background check programs of prospective long-term care employees and providers. The ACA also requires OIG to evaluate this grant program. OIG is also focusing on SNF prospective payment system requirements and potentially avoidable hospitalizations of Medicare and Medicaid eligible nursing facility residents. HOME HEALTH SERVICES HOSPICES NEW! Medicare hospice benefit vulnerabilities and recommendations for improvement: A portfolio: OIG has identified vulnerabilities in payment, compliance, and oversight, as well as quality of care concerns. OIG will summarize its evaluations, audits, and investigative work and highlight key recommendations for protecting patients and improving the program. NEW! Review of hospices compliance with Medicare requirements: Hospice provides palliative care for terminally ill patients and supports family and other caregivers. OIG will review hospice medical records and billing documentation to identify inappropriate payments. NEW! Hospice home care frequency of nurse onsite visits to assess quality of care and services: OIG noted that in 2013, more than 1.33 million Medicare patients received hospice services from over 3,900 providers. Expenditures exceeded $15 billion. Medicare requires that a registered nurse make an onsite visit to the patient s home at least every 14 days to assess the quality of care by the hospice aide and to ensure ordered services meet the patient s needs. OIG intends to evaluate compliance with the onsite visit requirement. NEW! Comparing home health agency (HHA) survey documents to Medicare claims data: OIG has concluded that the Home Health Program is prone to fraud, waste, and abuse. OIG notes that some unqualified HHAs are omitting certain patient data during submissions to state agencies. Because state agencies do not have access to Medicare claims data, state agencies are incapable of verifying Resources 2017 OIG Work Plan: NCD Manual, IOM Pub , Ch (A): Manuals/Internet-Only-Manuals-IOMs-Items/CMS html OEI , June 2016, Nationwide Analysis of Common Characteristics in OIG Home Health Fraud Cases: OEI , September 2016, Hospices Should Improve Their Election Statements and Certifications of Terminal Illness: OEI , September 2016, Escalating Medicare Billing for Ventilators Raises Concerns: hhs.gov/oei/reports/oei asp 56 Healthcare Business Monthly

57 To discuss this article or topic, go to OIG Work Plan the accuracy of submitted patient data. OIG intends to determine whether HHAs are accurately providing patient information to state agencies as part of recertification surveys. The OIG is also honing in on home health compliance with Medicare requirements. Get to Know the OIG Work Plan This is just a summary of the Part A portion of the 101-page work plan; you are encouraged to review the work plan in its entirety to ensure applicable risk areas are well understood. For each applicable focus area, be certain to review appropriate CMS interpretive guidance, local coverage determinations and other Medicare regulations, publications, and guidance referenced to ensure you completely understand and comply with government expectations, particularly with respect to documentation. OIG notes that some unqualified HHAs are omitting certain patient data during submissions to state agencies. Michael D. Miscoe, JD, CPC, CASCC, CUC, CCPC, CPCO, CPMA, is president-elect of AAPC s National Advisory Board, serves on AAPC s Legal Advisory Board, and is AAPC Ethics Committee chair. He is admitted to the practice of law in California as well as to the bar of the U.S. Supreme Court, the Third Circuit Court of Appeals, and the U.S. district courts in the southern district of California and the western district of Pennsylvania. Miscoe has over 20 years of experience in healthcare coding and over 18 years as a forensic coding and compliance expert. He has provided expert analysis and testimony on coding and compliance issues in civil and criminal cases and represents healthcare providers in post-payment audits. Miscoe is a frequent lecturer and is published widely on a variety of coding, compliance, and health law topics. He is a member and past president of the Johnstown, Pa., local chapter. AUDITING/COMPLIANCE You Wanted Low Priced CEUs? How about $2.50 per Webinar! + 12 Months of Access to 40+ Live Events & Entire Library of 100+ On-Demand Webinars + Receive 2 CEUs per Webinar (Live & On-Demand) + Topics Cover 21+ Specialties + 12-Month Subscription Starting at $295 (Volume Discounting Available for Your Office) aapc.com/webinars January

58 NEWLY CREDENTIALED MEMBERS Can t find your name? It takes about three to four months after you pass the exam before your name appears in Healthcare Business Monthly. Magna Cum Laude Alfia Asharaf, CPC-A Amanda J Patterson, CPC, CIRCC Anjali Dalvi, CPC-A Anupama Varier, CPC-A Anusha Gunapati, CPC-A Appasaheb Minde, CPC-A Brenda Schuenke, CPC-A Carrie Tanner, CPC-A Chinwen Shih, CPC-A Cindy Jones, CPC Dasari Srividya, CPC-A Dayana Santos, CPC Elisabeth Griffin St Laurent, CPC-A Elizabeth Arrington, CPC-A Elizabeth Wicklund, CPC-A Gokul Niharika, CPC-A Hemlata Unavekar, CPC-A Irina Dahl, CPC-A Jaci J Kipreos, COC, CPC, CPMA, CPC-I, CEMC Janella Marie Ramos, CPC-A Jarmila Wlaschinska, CPC-A Jennifer M Connell, CPC, CPCO, CPC-P, CPB, CPMA, CPPM, CENTC Jennifer Richardson, CPC Jessica Cliff, CPC-A Joanne VanDyken, CPC-A Jonalyn Pardo Villaflores, CPC-A Kandlakutti Chengaiah Divya Sree, CPC-A Krishnamurthy Bethu, CPC-A Kumarijyothi Manda, CPC-A Kweenie May Andres, CPC-A Lea Cruz Layug, CPC-A Leah Slingluff, CPC Lesley R Breda, CPC, CPB Lisa Faulkner, CPC-A Loliette Dominguez, CPC Lori Ann Mitchell, CPC, CPCO, CPMA, CEMC Mahesh Harale, CPC-A Maria Mailey Luz Villar, CPC-A Marionne Faye San Pedro, CPC-A Mary Arlene Pascual Bello, CPC-A Mary Thomas, CPC, CPMA Melissa Graves, CPC-A Michael Joe Montalvo, CPC-A Mindy Solecki, CPC-A Miriam C Zumbrun, CPC, CUC Natalie Veronica Ackerman, CPC, CIRCC Neha Aggarwal, CPC-A Pamela Baldoza Layco, CPC-A Parves Inamdar, CPC-A Pravin Yadav, CPC-A Pushpa Latha Gunda, CPC-A Ramesh Pattabiraman, CPC-A Robin Hamlin, CPC, COC Rochelle Lewis, CPC-A Rosellen Cariello Perlowitz, CPC-A Roxanne Faye Reyes, CPC-A Samantha Steach, CPC-A, CRC Sandra R Earnest, CPC, CEMC Sara Newhouse, CPC-A Sarah Fox, CPC, CPMA Sarath kumar reddy Gandra, CPC-A Shraddha Bhoite, CPC-A Shraddha Patil, CPC-A Suresh Gandhi Palaniyandi, CPC-A Suzanne Waldron, CPC-A Tammy Reed, CPC Tana Christensen, CPC, CIRCC Vicki Cook, CPC-A Yamily Marques De la Cruz, CPC, CRC Zeus Manalo, CPC-A CPC Adela M Garcia Martin, CPC Agnes Alina Vasallo, CPC Alex Buschmann, CPC Alexis Warren, CPC Alicia Warr, COC, CPC, CPMA Alvin R Cureton Jr, CPC Amanda Michelle Ferguson, CPC Amara Smith, CPC Ambi Anna Kurian, CPC Amy Rhoads, CPC Angela Krystin Martin, CPC Anita LaPointe, CPC Anna Hollman, CPC Anne J Pilbin, CPC AnneMarie Webb, CPC Anupama Gaji, CPC April Butler, CPC April Isaacson, CPC April Phillips, CPC Ashley M Bartlett, CPC Aurora Elizabeth Heredia, CPC Ava Antonia Johnson, COC, CPC, CPMA Barbara Goldsmith, CPC Belkis Echagarrua, COC, CPC, CPMA Beth Schleeper, COC, CPC, CPCO, CPB, CPMA, CPPM, CPC-I, CEMC Bianca Ramirez, CPC Bonnie Sherrill, CPC Brandy Wilson, CPC Cara Chavie, CPC Carolyn C McCrary, CPC Cathy Allarie, CPC, CRC Cathy Gonzalez, CPC Chaunda Mitchell, CPC Cheryl Ray Johnson RCC CPC, CPC Christina King, CPC Christine R Woelke, CPC Cindy Sue Bowman, CPC Cole Williams, CPC Coreen Harry, CPC Courtney Lane, CPC Crystal L Stein, COC Cynthia Colurciello, CPC Cynthia Sykes, CPC Danielle Hyatt, CPC Danielle Jones, CPC Danny F Calderon, CPC Darlene Jolley, CPC Darlene Knotts, CPC Darlene N McAlister, COC, CPC Darlene Wojnarowski, COC, CPC Debora Contos, CPC Deborah Stevens, CPC Denise Smith, COC, CPC, CPMA, CEMC Denise Stevens, CPC Deshika Todd, CPC Diane Claire Robbins, CPC Dominique Young, CPC Donna Blankenship, CPC Donna L Cooper, CPC Donna M Palumbo, CPC Donna Poore, CPC Dorothy Watts, CPC Ebony Cooley, CPC Elaine Brower, CPC Elizabeth Plumb, CPC Elizabeth Swanson, CPC Elizabeth Walters, CPC Emily Baisden, CPC Emily Bredehoeft, COC, CPC Eric Imhoff, CPC Erica Ann Hilburn, CPC Esmeralda Cruz, CPC, CRC Felicity Lee, CPC Finette Young, CPC Gayola Killebrew, CPC Giselle Daniel, CPC, CRC Heather Boulware, CPC Heather German, COC India Reid Reynolds, CPC Inerquis Vera Gonzalez, CPC Janelle Lynn Cox, COC, CPC Janette Michele Vestuto, CPC Jason Vann, CPC, CPB Jean Shore, COC Jeanie Ross, CPC Jenna Jerome, CPC Jennifer Haluza, CPC Jennifer Lavoie, CPC Jessica Barnett, COC, CPC Jessica Chladek, CPC Jessica Putnam, COC, CPCD Jessica Turbacuski, CPC Jill D Thomas, CPC Jill Veronica Mitchell, CPC Joann Sanchez, CPC Jocie Patterson, CPC Jodi Zolynski, CPC Jonnett Claypool, CPC Joyce M Kingsbury, CPC, CPMA Joyce Sullivan, COC, CPC Judith Bernstein, CPC Julie Hefner, CPC Kasey Pryce, CPC Kathy Pack, CPC Kayla Ahrens, CPC Keisha Thomas, COC, CPC Kelly Ayotte, CPC Kenya Guerrero, CPC Kerri P Boettcher, CPC Kim Darabaris, CPC Kim Sokolowski, CPC Kimberly Dawn Crom, CPC Kimberly Sothy Sam, CPC Krista Luttrell, CPC Kristen Treacy, CPC Kristi Quinalty, CPC Kristin Martinez, CPC Krysten Stone, CPC Kwannisha Colton, COC, CPC Kylee Orweller, CPC Lateisha Neely, CPC LaTosha Marhoon, CPC Laura Odum, CPC Leslie Sandusky, CPC Linda Cortez, CPC Linda Davis, CPC Linda O Brien, CPC Lindsay Jefferson, CPC Lindsey Blair, CPC Lisa Acuna, CPC Lisa Ann Heavlin, CPC, CPB Lisa Carter-Deloach, CPC, COSC Lisa Fahser, CPC Lisa Hoops, CPC Lisa Rochon, CPC Lora Allen, CPC Lydia Goodman, CPC Mahla Montalvo, CPC Marci Skarda, CPC Maria Cristina Ortiz, CPC Marian Jones, CPC Marilyn Fikes-Wells, CPC Marion Wawrzyniec, CPC Marla S Deneff, CPC Marlene Santos, CPC Mary Amanda Shepard, CPC Mary Lund, CPC Mary Preethika Gnanaoli, CPC Maurice Smith, CPC Melanie Florence, COC, CPC Melanie Hegg, CPC Melissa Walmer, CPC Melissa Church, CPC Melissa Grice, CPC Melissa Sylvester, CPC Melissa True, CPC Melissa Woodbury, CPC Melody Evans, CPC Mia Blackwell, COC, CPC Michael P Watkinson, COC, CPC Michele Cunningham, CPC Michelle Nail, CPC Michelle Smigel, CPC Myra McWhortor, CPC Nancy Martinez, CPC Natalia Andrea Gutierrez Alonso, CPC Natalie Carpenter, CPC Nataly L Portillo, COC Natasha Woods, COC Nathan Thomas Gant, CPC Nichole Valdez, CPC Nicole Bohnsack, COC, CPC Nicole Geier-DiCamillo, CPC Nicole Jennings, CPC Olga Lidia Diaz, CPC Oliver Cruz, CPC Pam Nelson, CPC Patricia Stief, CPC Paula Cunningham, CPC Peg Nixon, CPC Peggy Stocton, CPC Phil Blatchley, CPC Phyllis Johnson, CPC Priscilla Love, CPC Qiana Kenishe Robertson, CPC Rachael Burford, CPC Rakan Ahmad Damaso Al Hanaki, COC, CPC, CPMA Rena L Dite, CPC Rita Brozewicz, CPC, CRC Robert Saenz, CPC Robin L Hicks, COC, CPC Ronntriesse Cope, CPC Ruth Tavares, CPC SaKora Perkins, CPC Sandra Aldrich, CPC Santhalakshmi Narayanan, COC, CPC Sarah Boyd, COC, CPC Sarah Pace, CPC Shannon Bare, CPC Shauna Graham, CPC Shelley Cimino, CPC Sherisa Madej, COC, CPC Sing Lee, CPC Stacy Leitmeyer, CPC Stacy Long, CPC Stacy Oster, CPC Stephanie Bradish, CPC Steven Lee, CPC Susan Delaney Vogt, CPC Susan Kamp, CPC Susan M McGivney, CPC Susan Wahab, CPC Susanne Walker, CPC Suzanne Hauswald, CPC Tamara J Wilhelm, CPC Tania Fuentes, CPC Tarra Gist, CPC Teara Allard, CPC Teresa M Salo, CPC Terri Meighen, CPC Tessa Ingram, CPC Theresa Cameron, CPC Theresa Sheehan, CPC Tracey Bender, COC Tracey Burch, COC Vanessa Armes, CPC Veronica Marie Chapman, CPC Vicki L Baker, CPC Victoria Miller, CPC Yulia Sokolova, CPC Yurisan Ribera, CPC Zsane Harper, COC, CPC Apprentice Aaliya Banu, CPC-A Aaron Dale Carpio, CPC-A Abdul Jabbar K, CPC-A Abdul Raheem Shaik, CPC-A Abigail Huestis, CPC-A Abinaya Santhanam, CPC-A Abishek Verma, CPC-A Abraham Prince Vemula, CPC-A Adel Camba, CPC-A Aditya Shinde, CPC-A Adriana Torres, CPC-A Adrienne Browning, CPC-A Aerianne Pangilinan, CPC-A Agnes Czinege, CPC-A Aida Elnatour, CPC-A Aimee Fritz, CPC-A Aimee Stotts, CPC-A Aireddy Pramod, CPC-A Aizabelita Bare, COC-A Ajinkya Joglekar, CPC-A Ajith Krishnan, CPC-A Akhil Jallapalli, CPC-A Akshata Golatkar, CPC-A Alaina Axford-Moore, CPC-A Albert Jim Kuriakose, CPC-A Alcie Gina Gina Watson, CPC-A Aleksandar Stefanovski, CPC-A Alex Donnelly, CPC-A Alex Rhey Rogacion, CPC-A Alexandra Gonzalez, CPC-A Alexandra Mercer, CPC-A Alexis C Caldeira, CPC-A Alfreda Dennard, CPC-A Alice Lee, CPC-A Alice Park, CPC-A Alicia Lang, CPC-A Alicja Dave, CPC-A Alis Andrews, COC-A Alisha Mcilwain, CPC-A Alison Perl, CPC-A Alison Turner Burnett, CPC-A Alka Kumari, COC-A Allene Fuller, CPC-A Allison Hansen, CPC-A Allison Lennefelt, CPC-A Allison Price, CPC-A Allyson Mitchem, CPC-A Alma Corea, CPC-A Almas Karim, CPC-A Alyce McKenna, CPC-A Alyssa Ahmad, CPC-A Alyssa Dawn Santiago, CPC-A Amanda Brown, CPC-A Amanda Burkhamer, CPC-A Amanda Darlene King, CPC-A Amanda Hertig, CPC-A 58 Healthcare Business Monthly

59 NEWLY CREDENTIALED MEMBERS Amanda Hurler, COC-A Amanda Kyle Porterfield, COC-A Amanda Louise Sass, COC-A, CPC-A Amanda McCarthy, CPC-P-A Amanda Rose Piern, CPC-A Amanda Scalise, CPC-A Amanda Scott, CPC-A Amanda Suneson, CPC-A Amanda Trango, CPC-A Amanda Weaver, CPC-A Amarilis Marrero, CPC-A Amarnadh Nelavalli, CPC-A Ambala Abhilasha, CPC-A Amber Lachance, CPC-A Amber Price, CPC-A Amber Ramsey, CPC-A Amber Smith, CPC-A Amber Stevens, CPC-A Amber Taylor McDowell, CPC-A America Peltier, CPC-A Amie Schroder, CPC-A Amina Bi Shaikh, CPC-A Amira Adel Attia, CPC-A Amruta Godase, CPC-A Amsa Devi Nallusamy, CPC-A Amudala Sowmya, CPC-A Amy Ann Burkey, CPC-A Amy Bishop, CPC-A Amy Merk, CPC-A Amy Schwartz, CPC-A Amy Smith, CPC-A Ana Marie Quizon, CPC-A Ana Monegro, CPC-A Ananda Rangan Srinivasan, COC-A Andie Terry, CPC-P-A Andrea Mize, CPC-A Andrea Reynolds, CPC-A Aneesh Mohanan Nair, CPC-A Anette Jesurasa, CPC-A Angel Foret, CPC-A Angel Mills, CPC-A Angel White, CPC-A Angela Barron, CPC-A Angela Bryant, CPC-A Angela Kruse, CPC-A Angela R Holland, CPC-A Angela Schubert, CPC-A Angela Slowikowski, CPC-A Angela Steger, CPC-A Angela Stephens, CPC-A Angela Stigall, CPC-A Angela Trotter, CPC-A Angelica C Aguirre, CPC-A Angelin Ruby, CPC-A Angelina Kelzer, CPC-A Angeline Sujana Solomon, CPC-A Angella Schlothauer, CPC-A Aniket Sawant, CPC-A Anil Koyyada, CPC-A Anima Agosh, CPC-A Anita Adarsh Pai, CPC-A Anita DeFluri, CPC-A Anitha Nandagopalan, CPC-A Anitha Preethi D Costa, CPC-A Anjaiah Manthapuri, CPC-A Anjanette Gagliani, CPC-A Anju Baby, CPC-A Ankita Pawar, CPC-A Ann Cowie-Bozner, CPC-A Ann Jones, CPC-A Ann Marie Gangoo MBA HRMM CCSP, CPC-A Anna Delia Correa, CPC-A Anna Machak, CPC-A Annapaneni Sreeram, CPC-A Anne Brown, CPC-A Anne Johnson, COC-A Anne Marie Pitts, CPC-A Anne Parr, CPC-A Annemarie Ward, CPC-A Annette Fulcher, CPC-A Ansari Kausar, CPC-A Antelindev Regurajan, CPC-A Anthony DiMeo, CPC-A Antoinette Abadilla, CPC-A Antoinette Hill, CPC-A, CRC Anton Lavrentiev, CPC-A Anuja Panicker, CPC-A Anuja Thorat, CPC-A Anumeha Bhardwaj, COC-A Anupreet Kaur, CPC-A Anuradha Rao-Patel, CPC-A Anusha Anbalagan, CPC-A Anusha Kolli, CPC-A Aparamita Singha, CPC-A Appasaheb Tatyasaheb Gavasane, CPC-A April Becker, CPC-A April Vonkoenigseck, CPC-A Aravind Dantala, CPC-A Aravinda Rachakonda, COC-A, CPC-A Archana P Nair, COC-A Archana Shevde, CPC-A Arriane Sevilla, CPC-A Arvind Kumar, CPC-A Arya Satheeshkumar, CPC-A Asajyothi Y, CPC-A Asgar Khan, CPC-A Asha Chandran, CPC-A Asha Srinath, CPC-A Ashish Kumar Chaudhary, CPC-A Ashlee Cozby, CPC-A Ashlee Keith, CPC-A Ashley Bass, CPC-A Ashley Bohm, CPC-A Ashley Cunningham, CPC-A Ashley Estep, CPC-A Ashley Hayes, CPC-A Ashley Hipolito, CPC-A Ashley Holmes-Ross, CPC-A Ashley Kelly, CPC-A Ashley Lawlee, CPC-A Ashly M James, CPC-A Ashokkumar Chaudhari, CPC-P-A, CPC-A, COC-A, CPB, CPMA Ashvini Pawar, CPC-A Ashvini Thorat, CPC-A Ashwini Phalke, CPC-A Asia Wood, CPC-A Aswani Parise, CPC-A Aswathy Maria, CPC-A Atesha King Grier, CPC-A Athena Neal, CPC-A Athira P Bharathan, CPC-A Atul Chopra, CPC-A Audra J Molina, CPC-A Audra N Weiker, CPC-A Aura Danella Feliciano Gavino, CPC-A Aviance Latrice German, CPC-A Ayana Simons, CPC-A Ayesha Sultana, CPC-A B Mohammd Talha, CPC-A Babek Afshar, CPC-A Balaji Venkataperumal, CPC-A Barbara Ann Jones, CPC-A Basant Fadel, CPC-A Beatriz Melo, CPC-A Bernadette Thorwart, CPC-A Bernice Goodnight, CPC-A Berthwel Barrid, CPC-A Bertina Nelson, CPC-A Beth Krivak, CPC-A Beth Ludban, CPC-A Bethanie Naylor, CPC-A Betsi Anderson, CPC-A Betty Scott, CPC-A Beverly Conner, CPC-A Bevin Campbell, CPC-A Bhaskar Chandragiri, CPC-A Bhupesh Verma, COC-A Bianca Williams, CPC-A Bibhuti Joshi, CPC-A Billie Jean Grady, CPC-A Bismi Nair, CPC-A Bobbie J Lee, CPC-A Bonita Smith, CPC-A Bonnie Guidry, CPC-A Bonnie Walsh, CPC-A Brandi Barrett-Elkins, CPC-A Brandi Cunliffe, CPC-A Brea Thomas, CPC-A Breanne Schnetzka, CPC-A Brena Brosemann, CPC-A Brenda Murphy, CPC-A Brenda Snyder, COC-A Brenda Volden, CPC-A Brianna Yulfo, CPC-A Bridget Kimmer, CPC-A Bridget Mullen, CPC-A Bridgette Crabb, CPC-A Brittany Crews, CPC-A Brittany Hope, CPC-A Brittany Scimeca, CPC-A Brittnae Cyr, CPC-A Bronwyn Bergeson, CPC-A Brooke Bulifant, CPC-A Bryan A Moore, CPC-A Budoolu Pravalika, CPC-A Busi Swathi Mutyam, COC-A Caitlin Bortugno, CPC-A Caitlin Donahue, CPC-A Camellia Ingelin, COC-A, CPC-A Candace Lucio, CPC-A Candido Otero Arcis, CPC-A Candis Hunter, CPC-A Candy Creech, CPC-A Caren Scott, CPC-A Carey Burns, CPC-A Cari Taylor, CPC-A Carissa Schandelmeier, CPC-A Carla Ouber RN CCA, CPC-A Carla King, CPC-A Carla Metz, CPC-A Carley Pelella, CPC-A Carmen Pacheco, CPC-A Carol Lee Hawkins, CPC-A Carol Moore, CPC-A Carol Pugh, CPC-A Carol Rivers, CPC-A Carol Sewell, CPC-A Carolee Charest, CPC-A Caroline Krzywicki, CPC-A Caroline Thomas, CPC-A Carolyn Bessette, CPC-A Carolyn Burley, CPC-A Carolyn Madere, CPC-A Carrie Rogers, CPC-A Cassandra Alexander, CPC-A Cassandra Ann D Arata, COC-A, CPC-A Cassandra Ehlers, CPC-A Castelle Valerie Baladad Glorioso, CPC-A Catherine Ponio, CPC-A Cathy Dupre, CPC-A Ceaira Nicholle Coffin, CPC-A Cerissa Kimball, CPC-A Chaitanya Mandava, CPC-A Challa Mahesh, CPC-A Chandra Gross, CPC-A Chandrashekhar Sambhaji Korde, CPC-A Chandru Selvaraj, CPC-A Charla Lou Mann, CPC-A Charlene Dominique Bonnevie, CPC-A Charlene Evans, CPC-A Charles Clayton, CPC-A Charles Wray, COC-A Charlotte McCarthy, CPC-A Charmaine Dalusung, CPC-A Chassidy Griffin, CPC-A Chauncey Riche a Shider, CPC-A Chelsea Carty, CPC-A Chelsea Ellis, CPC-A Chelsea Jones, CPC-A Chelsea Phillips Dolohite, CPC-A Chelsea Roman, CPC-A Chelsea Westerfield, CPC-A Cherrie Anne Caligan De Guzman, CPC-A Cheryl Becker, CPC-A Cheryl Smith, CPC-A Chetan Suryawanshi, CPC-A Chiana Velez, CPC-A Chidugu Anjaneyulu goud, CPC-A Chilla Srinivas, CPC-A Chillapalli Narasimha Rao, CPC-A Chintakunta Premsagar, CPC-A Chintalapudi Spandana, CPC-A Chona Macalipay Zafra, CPC-A Christenia Leigh Taylor, CPC-A Christi K Mullen, CPC-A Christian Tesolin, CPC-A Christina Franey, CPC-A Christina M Cortner, CPC-A Christina Marie Hayes, CPC-A Christina Paragon, CPC-A Christina Wilson, CPC-A Christine Jean De Leon, CPC-A Christine H Bledsoe, CPC-A Christine Marie De Vero, CPC-A Christine Rockledge, CPC-A Christine Sanders, CPC-A Christopher Crocco, CPC-A Christopher Farley, CPC-A Christopher Watts, CPC-A Christy Isaac, CPC-A Christy Roberts, CPC-A Cidnei Ellison, CPC-A Cierra Martinez, COC-A, CPC-A Cindy Barnes, CPC-A Cindy Friemel, CPC-A Cindy Goebel, CPC-A Clarence Sarabia, CPC-A Clarissa Lynn, CPC-A Connie Haney, CPC-A Connie Miller, CPC-A Connie Taylor, CPC-A Constance Smith, CPC-A Cori Fisher, CPC-A Corinda Wickey, CPC-A Corinne J Whiteside, CPC-A Corliss McQueen, CPC-A, CEMC Courtney Kahler, CPC-A Courtney N Grigsby, CPC-A Craig Zach, CPC-A Cristina Brooks, CPC-A Cristina Petruta Hudson, CPC-A Crisver Ogaya Vargas, COC-A Crystal Boddie, CPC-A Crystal Freeman, COC-A Crystal Surface, CPC-A Cynde Dorzweiler, CPC-A Cynthia Cairl, CPC-A Cynthia Lobo, CPC-A Cynthia Riedel Beggins, CPC-A Daisy Ann Mesina, CPC-A Damisetty Satya Prasad, CPC-A Dana Bergerson, CPC-A Dana Heckart, CPC-A Dana M Paulson, CPC-A Dana Schwartzman, CPC-A Dana Sutton, CPC-A Dane Cooper, CPC-A Danele A Poole, CPC-A Daniel Jackson, CPC-A Daniel Pinkewich, CPC-A Daniela Terrones, CPC-A Danielle Baytosh, CPC-A Danielle Caskey, CPC-A Danielle McClure, CPC-A Danny Hubbard, COC-A Daphne Jones, CPC-A Dara Rinaldi, CPC-A Darbi Hannah, CPC-A Darcy Adele Youngberg, CPC-A Darla Barnett, CPC-A Darlene Ivory, CPC-A Darwin Jeyaraj, CPC-A Daryl Adrian Razon, CPC-A David Alvarez, CPC-A David Gooray, CPC-A Dawn Custard, CPC-A Dawn Duncan, CPC-A Dawn M Wuori, CPC-A Dawn Martin, CPC-A Dawn Mondell, COC-A Deajsha Owens, CPC-A Deanna Jessie, CPC-A Deanna Pace, CPC-A Deanne Marie Martinson Bush, CPC-A Deborah Baronowski, CPC-A Deborah Harper, CPC-A Deborah Merritt, CPC-A Deborah Salazar, CPC-A Deborah Y Pearson, CPC-A Debra Desch, CPC-A Deep Singh Rawat, CPC-A Deepak Kumar, CPC-A Deepika Thirumala, CPC-A Delores Ryan, CPC-A Deneen Hutchins, CPC-A Denise Bridges, CPC-A Denise Contreras, CPC-A Denise Johnson, CPC-A Denise Lynn Swift, COC-A Denise Stevens, CPC-A Derek Stuart, CPC-A Desarae Wayne, CPC-A Destiny Davis, CPC-A Devasena Murugan, CPC-A Dhaggula Vanisri, CPC-A Dhanabackyam Pannear, CPC-A Dhanalakshmi Bhavanam, CPC-A Dhananjay Vijay Wagh, CPC-A Dhivya Chandrasekaran, CPC-A Diana R Thompson, CPC-A Diana Shields, CPC-A Diana Thompson, CPC-A Diana Walker, CPC-A Diane Elizabeth Morse, CPC-A Diane Garrett, CPC-A Diane Manion, CPC-A Diane Noll, CPC-A Dianna Cowles, COC-A, CPC-A, CPB Diksha Kharat, CPC-A Dileep S, CPC-A Dilip Kumar, CPC-A Dilipkumar Rajendran, COC-A Dina Raju, CPC-A Dinal Tejani, CPC-A Dinesh Kumar, CPC-A Dinesh Kumar Ganesan, CPC-A Dineshkumar Vasudevan, CPC-A DineshLal Gopi, CPC-A Dion Henderson, CPC-A January

60 NEWLY CREDENTIALED MEMBERS Dionne Loftin Shaw, CPC-A Dionne Pearce, CPC-A Dipali Gandal, CPC-A Diva Isabelle, CPC-A Diviya Neelamegam, CPC-A Divyalaxmi Chintapalli, CPC-A Dollas Markose, COC-A, CPC-A Domenique Lira, CPC-A Donda Rambabu, CPC-A Donna M Torbert, CPC-A Donna Pike, CPC-A Doris Mayse, CPC-A Douglas Allen Brown, CPC-A Dr. Menaka Chouenlai, CPC-A Dr. Rangu Srinivas, CPC-A Drew Walker, CPC-A Dung Nguyen, CPC-A Duvvuri Surya Phani Sree Vidya, CPC-A Edarlynne Pambid, COC-A Edita Church, CPC-A Eesa Chandrasekhar, CPC-A Eesarapu Janaki, CPC-A Elaine Joy Caragay, CPC-A Elisabeth Huavil, CPC-A Elizabeth Alice Sapareto, CPC-A Elizabeth Cooper, CPC-A Elizabeth Denhalter, CPC-A Elizabeth K Turner, CPC-A Elizabeth Khavasov, CPC-A Elizabeth Lubisa Dotzler, CPC-A Elizabeth M Lawson, CPC-A Elizabeth McCarley, CPC-A Elizabeth Murphy, CPC-A Elizabeth Newhall, CPC-A Elizabeth Reimers, CPC-A Elizabeth Rilett, CPC-A Elizabeth Robinson, CPC-A Elizabeth Swigart, CPC-A Elizabeth Taylor, CPC-A Elizabeth West, CPC-A Ellen Bermudez, CPC-A Ellen Leahey, CPC-A Elsa Saju, CPC-A Eluri Suresh, CPC-A Emily Freeze, CPC-A Emily Zimmerman, CPC-A Eric Klaber, CPC-A Eric Kujawsky, CPC-A Eric Kujawsky, CPC-A Erica Webster, CPC-A Erick Vincent, CPC-A Erin Marie Coghlan, CPC-A Erin Markovic, CPC-A Erin Wirzburger, CPC-A Erna van Rooyen, CPC-A Errabelli Shravan Rao, CPC-A Eryka Davis, CPC-A Esmeralda Salazar, CPC-A Esmeralda Studdard, CPC-A Esther Packiaraj, CPC-A Eugenia Lynne Hill, CPC-A Eva Gillespie, CPC-A Evelyn Borges, CPC-A Evita Klava, CPC-A Faranak Khandadia, CPC-A Faye Clavier, CPC-A Faye Torres-Loc, CPC-A Felicia Davis, CPC-A Felicia Spivey, CPC-A Feng Qian, CPC-A Fouzia Omar, CPC-P-A Francine Winslow Ramos, CPC-A Frederica Jones, CPC-A Frederick Carson, CPC-A G. Surender Reddy, CPC-A Gaby Gonzalez, CPC-A Gail Greaver, COC-A Ganeshkumar Soundhararajan, CPC-A Gangapuram Divya Jyothi, CPC-A Ganja Sucharita, CPC-A Ganta Aravind, CPC-A Gaurav Kumar, COC-A Gaurav Pitale, CPC-A Gaurav Tripathi, COC-A Gayathri Ramalingam, CPC-A Gayatri Rane, CPC-A Gayitri Devi Vinnakota, CPC-A Gayle Anne Rothenberg, CPC-A Gayle Kean, CPC-A Gayle Razorsek, CPC-A Geanie Eileen Fentress, CPC-A Genti Pacma, CPC-A Geraldine Blair, CPC-A Gerasimos Kouloumbes, CPC-A Geryl Deloris Rice, COC-A, CPC-A Gina Monaco, CPC-A Gina Pegram, CPC-A Girinath Peddangireddy, COC-A Gitalaxmi Nagar, CPC-A Glenda Darlene Nelson, CPC-A Glendia J Hudson, CPC-A Godwin Stanley, CPC-A Gokavarapu Hari Priya, CPC-A Gopalarao Nelluri, CPC-A Gordon Pickering, CPC-A Grace Sitar, CPC-A Gretchen Lynne Berger, CPC-A Guddeti Himabindu, CPC-A Guttikonda Udaya, CPC-A Hadeel Siddiq Haynes, CPC-A Hailey Brooke Laneaux, CPC-A Hannah Moreno-Correa, CPC-A Hannah Smedstad, CPC-A Hanudeep Balija, CPC-A Harikrishnan Nair, CPC-A, CIC Harsh Sharma, CPC-A Harshal Admuthe, CPC-A Harshitha Mukka, CPC-A Hasmik Matossian, CPC-A Heather Bratton, CPC-A Heather Davis, CPC-A Heather Gutierrez, CPC-A Heather Lloyd, CPC-A Heather Nottingham, CPC-A Heather Rodriguez, COC-A Heather Wilson, CPC-A Hector Daniel Medina, CPC-A Heidi Bigelow, CPC-A Heidi Holmes, CPC-A Heidi Johnson, CPC-A Helen Pearson, CPC-A HemaChandrika Sivadasan, CPC-A Hemalatha Kannan, COC-A Hemalatha Koratamaddi, CPC-A Hemalatha Paladugu, CPC-A Hemalatha Sathiyaraj, CPC-A Hilary Dubiel, CPC-A Hillary Englehardt, CPC-A Himabindu Mungar, CPC-A Himanshu Sharma, CPC-A Hiralben Shah, CPC-A Hoda Rizkalla, CPC-A Hoda Tayebi, CPC-A Holli A Lancaster, CPC-A, CPMA, CRC Holly Amanda Smith, CPC-A Holly Blake, CPC-A Holly Goodine, CPC-A Holly Holland, CPC-A Holly Hughston, CPC-A Hope Nicolas, CPC-A Hsiu Hsiu Huang, CPC-A Humaira Siddiqui, CPC-A Hyasmin Riddle, CPC-A, CRC Ian Hodson, CPC-A Ibrahim Fernandez, CPC-A Ikoh Derik Relleve, CPC-A Indhurani Solaisamy, CPC-A Indira Lezcano Triana, CPC-A Indira Rodriguez, CPC-A Irina Pilarte, CPC-A Irineo Jr. Nguyen Maines, CPC-A Iris Castillo, CPC-A Iteyana Diamond Danasa Huff, CPC-P-A Ivancho Jovanovski, CPC-A Jackie Cervantez, CPC-A Jackie Darrington, CPC-A Jacklyn Suzanne Murray, CPC-A Jaclyn Mazeika, CPC-A Jacob Santos, CPC-A Jacqueline Ciotti, CPC-A Jacqueline Haas, CPC-A Jacqueline Merino, CPC-A Jaganathan Chinnathambi, CPC-A Jahna Rice, CPC-A Jai Prakesh, COC-A Jaja Izon Briones, CPC-A Jakkidi Surendar Reddy, CPC-A Jalla Mamatha, CPC-A James Booher, CPC-A James C Higgins, CPC-A James Henry Hampton Jr, CPC-A Jamie Darby, CPC-A Jamie Dwayne Tucker, CPC-A Jamie Gruetzmacher, CPC-A Janell Nelson, CPC-A Janelle Barkdull, CPC-A Jangyaseni Sai, CPC-A Jasmine Gomez, CPC-A Jasmyne Price, CPC-A Jason Markowitz, CPC-A Jay Tiffany Joseph, CPC-A Jayabadhuri Selvaraj, CPC-A Jayanthi Kannan, CPC-A Jayanthi Neelamegan, CPC-A Jaycee Thompson, CPC-A Jayme Kaiser, CPC-A Jayvie Mayuga Bumatay, CPC-A Jean Hannon, CPC-A Jeannie Lyons, CPC-A Jeffrey Medina, CPC-A Jeffrey Pacifico Torres, CPC-A Jelayne Beckerleg, CPC-A Jenifer Jayarajan, CPC-A Jenifer Millary, CPC-A Jennie Miller, CPC-A Jennifer Allgire, CPC-A Jennifer Ballard, CPC-A Jennifer Bemisdarfer, COC-A, CPC-A Jennifer Brisbon, CPC-A Jennifer Colson, CPC-A Jennifer Connelly, CPC-A Jennifer Denton, CPC-A Jennifer Kravetz, CPC-A Jennifer Lucas, CPC-A Jennifer Mills, CPC-A Jennifer Moldenhauer, CPC-A Jennifer Moncado, CPC-A Jennifer Pendleton, CPC-A Jennifer Wichmann, CPC-A Jenny Wells, CPC-A Jeny R, CPC-A Jeremiah Movida Nagsuban, CPC-A Jerri Webber, CPC-A Jessa Acanto Alminaza, CPC-A Jessica Bauer, CPC-A Jessica Chimile, CPC-A Jessica Eaton, CPC-A Jessica Hager, CPC-A Jessica Hogan, COC-A Jessica L Garza, CPC-A Jessica Lollar, CPC-A Jessica Marie Paraiso, CPC-A Jessica Scott, CPC-A Jessica Washington, CPC-A Jessy K, COC-A Jewell Logan, CPC-A Jhansi Divi, CPC-A Jhansi Rani Attuluri, CPC-A Jill E DiNapoli, CPC-A Jill Griffith, CPC-A Jill Sajtar, CPC-A Jillian DiCarlo, CPC-A Jimarie Turla, CPC-A Jinal Shah, CPC-A Jinhee Yang, CPC-A Jitendra Sharma, CPC-A Jithin George, CPC-A Jiyad Maheen, CPC-A Jo Brannon, CPC-A Joana Beeson, CPC-A Joane Samantha Aguilar Perez, CPC-A JoAnn Kwak, CPC-A Joanna Forbes, CPC-A Joanna Mae Yamamoto, CPC-A Joanne Lipniskis, CPC-A Joaquin Carlos Ortega, CPC-A Jodie M Yorke, CPC-A Jody Mcnichols, CPC-A Joey Pratt, CPC-A John Henry Jeffries, COC-A John Karam, COC-A John Stroba, CPC-A Jolene M Phimmasone, CPC-A Jon Reynolds, CPC-A Jonalyn Cabaddu, CPC-A Jonathan Frank, CPC-A Jonathan Yellon, CPC-A Jorel Andaluz, CPC-A Jose Marie Iii Seijo, CPC-A Josiane Hulgan, CPC-A Jovita Antonisamy, CPC-A Joy Lecitivo, CPC-A Joyce Rubino, CPC-A Juan Carlos Gracia, CPC-A Juanita Clark Newson, CPC-A Juanita Williams, CPC-A Judith Vollmar, CPC-A Judy Doyle, CPC-A Judy Zuercher, CPC-A Julia Giddens, CPC-A Julia Iaconis, CPC-A Julia Kister, CPC-A Julia R Blanton, CPC-A Juliann Lee, CPC-A Julianne Ensor, CPC-A Julianne Muniz, CPC-A Julie Dubovik, CPC-A Julie Katrina Freeburn, CPC-A Julie Parker, COC-A Julie Smith, CPC-A Julie Zeisig, CPC-A Justeen Lattrell, CPC-A Jyothi Rondla, CPC-A Jyoti Chinta, CPC-A Jyoti Mann, CPC-A K. Vikram, CPC-A K.V.R.K Rao, CPC-A Kadakar Guru Raja, CPC-A Kaisar Mulani, CPC-A Kaitlin Rattanni, CPC-A Kal Sherwood, CPC-A Kalpana Jayabal, CPC-A Kalyani Sable, CPC-A Kami Bertram, CPC-A Kandi Petersen, CPC-A Kandukoori Issac, CPC-A Kara Matousek, CPC-A Karen Bradley, CPC-A Karen Carito, CPC-A Karen Carr, CPC-A Karen Cassara, CPC-A Karen Hansen, CPC-A Karen Jennings, CPC-A Karen Marie Martin, CPC-A Karen Misbach, CPC-A Karen Muse, CPC-A Karin Murphy, CPC-A Karl Krumbach, CPC-A Karla Jackson, CPC-A Karla Valentin, CPC-A Karley M Smith, CPC-A Karren Kim Legaspi, CPC-A Karthikeyan Jayapal, CPC-A Karthikeyan SD, COC-A Karunai Rajiv Gandhi, CPC-A Karvasha Mitchell, CPC-A Kasey M Kennedy, CPC-A Kasey Simmons, CPC-A Katelyn Thiele, CPC-A Katelynn Prentice, CPC-A Katesha Willis, CPC-A Katherine Gillis, CPC-A Katherine Proctor, CPC-A Katherine Riley, CPC-A Kathleen A Lepowski, CPC-A Kathleen A Meyer, CPC-A Kathleen Buttner, CPC-A Kathleen Lee, CPC-A Kathleen McShaffery, CPC-A Kathleen Oliver, COC-A Kathleen Smith, CPC-A Kathryn Gibson, CPC-A Kathryn Hopkins, CPC-A Kathryn Moran, CPC-A Kathryn Taylert, CPC-A, CPC-P-A Kathy Berven, CPC-A Kathy Chenez, CPC-A Kathy Fernandez, CPC-A Kathy Maggard, CPC-A Kathy Pohlman, CPC-A Kathy Stubrick, CPC-A Katta Dileep Kumar, CPC-A Katy Evans, CPC-A Kavana Kengeri Nagaraj, CPC-A Kayelie Hohmann, CPC-A Kayla Del Perez, CPC-A Kayla Maciejewski, CPC-A Kayla Moseley, CPC-A Kaylee Hale, CPC-A Kayleen Grajales, CPC-A Kehakshan Jabeen, CPC-A Keisha Flood, COC-A Kelie Stanclift, CPC-A Kelley Nuttle, CPC-A Kellie Herron, CPC-A Kelly Burt, CPC-A Kelly Hunziker, CPC-A Kelly Jackson, CPC-A Kelly L Oxender, CPC-A Kelly Peterson, CPC-A Kelly Witczak, CPC-A Kelsey DeHey, CPC-A Kelsey Dunn, CPC-A Kenneth Binder, CPC-A Keno Lastimoso Labrador, CPC-A Kerri Kreke, CPC-A Keshara Alleyne, CPC-A Kevin Skaggs, CPC-A Khandare Shiva Shanker, COC-A Kharess Villanueva Cantada, CPC-A Kim Candelaria Atienza, CPC-A Kim Harmin, COC-A Kim Jensen, COC-A Kim Panosian, CPC-A 60 Healthcare Business Monthly

61 NEWLY CREDENTIALED MEMBERS Kim Ratliff, CPC-A Kim Talamantes, CPC-A Kim White, CPC-A Kim Zanzot, CPC-A Kimberley Cherelle Thomas, CPC-A Kimberley Gouveia, CPC-A Kimberly Barnes, CPC-A, COSC Kimberly Duffie, CPC-A Kimberly Geriner, CPC-A Kimberly Hess, CPC-A Kimberly Hewitt, CPC-A Kimberly McLemore, CPC-A Kimberly Rosenvold, CPC-A Kinsey Webb, CPC-A Kirankumar Batchu, CPC-A Kirsten Hunter, CPC-A Kirsten Blevins, CPC-A Kirsten Leach, CPC-A Kiruthika Murugesan, CPC-A Kola. Arun Kumar, CPC-A Komal Makone, CPC-A Kona Sravanthi, CPC-A Kosika Venkata Deepthi, CPC-A Koteswaramma Yannamsetti, COC-A Krishnaveni Panneerselvam, CPC-A Krishniga Thiyagarajan, COC-A Krista Joesten, CPC-A Kristen Sica, CPC-A Kristen Zimmerman, CPC-A Kristi McDonald, COC-A Kristin Bell, CPC-A Kristin Huntley, COC-A Kristin L Britton-Isaacson, CPC-A Kristin Lynn Bassinger, CPC-A Kristin Throener, CPC-A Kristin Twombly, CPC-A Kristina Bisceglia, CPC-A Kristina Grace Piamonte, CPC-A Kristina Kull, CPC-A Kristy Weeks, CPC-A Kritzia Espinoza, CPC-A Kumaresan Velu, COC-A Kumarswamy Gaja, CPC-A Kurinji Malar Paranthaman, CPC-A Kyra Baker, CPC-A Kyrna Ball, CPC-A Labeeba Madari, CPC-A Lacey Miller, CPC-A Lakeshia Walker, CPC-A Lakshmi Prabhakar, CPC-A Lakshmi S, COC-A Lakshmi Swetha Kandanagolla, CPC-A Lakshmidevi Mullaguri, CPC-A Lamiss Rifai, CPC-A Lani Ladd-Moss, CPC-A Latha Prabhu, CPC-A Laura Beltran, CPC-A Laura Gabler, CPC-A Laura Ingram, CPC-A Laura Lattanzio, CPC-A Laura Robertson, CPC-A Laura Stebel, CPC-A Laurel Chapman, CPC-A Lauren Biba, CPC-A Lauren Harvey, CPC-A Lauren Hicov, CPC-A Lauren Nessell, CPC-A Laurie G Stasney, CPC-A Laurie Neidich, CPC-A Lavanya Rachaveti, COC-A, CPC-A Laverne Stewart, CPC-A Laya James P J, CPC-A Leah Sheehan, CPC-A Leah Tomrdle, CPC-A Leanna Gendot, CPC-A Leeann Butler, CPC-A Leigh Fowler, CPC-A Lesley Newsome, CPC-A Lesleye Edwards, CPC-A Leslie Thomas, CPC-A Leslie Ann Howard, CPC-A Leslie Fenstermacher, CPC-A Leslie Gonzales, CPC-A Leslie Thompson, CPC-A Lia Krishna May Tansinco Magno, CPC-A Ligi K J, CPC-A Lilia Ruiz, CPC-A Lillie Brower, CPC-A Limaris Ayala, CPC-A Linda Clements, CPC-A Linda Coyne, CPC-A Linda Longshore, CPC-A Linda Marie Caron-McKay, CPC-A Linda Secakuku, CPC-A Lindsay Frye, CPC-A Lindsay Robertson, CPC-A Lineva Mccullough, COC-A Lingaswamy Mukkamula, COC-A Lisa Brank, CPC-A Lisa Eleftheriou, CPC-A Lisa Ezell, CPC-A Lisa Henninger, CPC-A Lisa Horvath, CPC-A Lisa Jensen, CPC-A Lisa Jones, CPC-A Lisa Joy Baumbusch, CPC-A Lisa Love, CPC-A Lisa Schnepp, CPC-A Lisa Shortt, CPC-A Lisa Wills, COC-A Litia Dix, CPC-A Llilian Echevarria, CPC-A Lois Downing, CPC-A Lokesh Gopi, CPC-A Loraine White, CPC-A Lori Crowther, CPC-A Lori Helmen, CPC-A Lorna Weddle, CPC-A Lorrie Good-Hernandez, CPC-A Lou Ann Janney, CPC-A Lou Annie Montibon-Arnoco, CPC-A Lourdes Doncel, CPC-A Loveena Tayal, CPC-A LuAn Hobson, CPC-A Lucie Ingram, CPC-A Lucinda Hovi, CPC-A Luke Henderson, CPC-A Lura Henninger, CPC-A Lynn Coburn, CPC-A Lynne Brinkerhoff, CPC-A M. Ambica Chowdary, CPC-A M. Mounika Reddy, CPC-A Ma Clara Cas Cruz, CPC-A Ma. Isabel Raquiño, CPC-A Ma. Karren Veneracion, CPC-A Macie Leoni, CPC-A Maddarapu Venkatarao, CPC-A Madelin Morales, CPC-A Madhukar Sunkari, COC-A Madhuri Suryadevara, CPC-A Magi Sushila, CPC-A Magnus Lima, CPC-A Mahejabeen Abdul Latif Mulla, CPC-A Mahesh Devaragottu, CPC-A Makaila Evelena Johnson, CPC-A Malathi Kodithyala, CPC-A Manda Renteria, CPC-A Mandi Eisbach, CPC-A Mangesh Nikalje, CPC-A Mani Samaya Athota, CPC-A Manish Giri, COC-A Manisha Pandey, CPC-A Manivannan Govindhan, CPC-A Manivannan Selvaraj, CPC-A Manju Mohan Das, CPC-A Manjusha M, CPC-A Manoj Kumar, COC-A Mansi Nayyar, CPC-A Manzoor Pinjari, CPC-A Marci Strang, CPC-A Marcia Reed, CPC-A Marcia Steele, CPC-A Marcia Truran, CPC-A Margaux Summa, CPC-A Maria C Lopez, CPC-A Maria De Los Angeles Weber, CPC-A Maria Edith Diaz Buenavista, COC-A, CPC-A Maria Erika Salvosa Dungo, CPC-A Maria Korir, CPC-A Maria Labato, CPC-A Mariah Shook, CPC-A Marianne Webster, CPC-A Maribel Tirona, CPC-A Marie Anne Lucille Sudueste, CPC-A Marie Davis, CPC-A Marie Grecienne Dofeliz, CPC-A Marie Smith, CPC-A Marisa Steelman, CPC-A Marissa Petzold, CPC-A Maritza Tacoronte, CPC-A Marivic Ronquillo Tolentino, CPC-A Marjelice Evite Dela Cruz, CPC-A Marjorie Anne Matthews, CPC-A Mark Crider, CPC-A Mark Hall, CPC-A Marla Long, CPC-A Marlena Ramsay, CPC-A Marriah Dugger, CPC-A Martha Bundy, CPC-A Marva M Mercury, CPC-A Marvin Orquia, CPC-A Mary Agnes Smith, CPC-A Mary Borek, CPC-A Mary Campbell, CPC-A Mary Eborlas, CPC-A Mary Emersol Ramos Aviso, CPC-A Mary Freeman, CPC-A Mary Ladd, CPC-A Mary Linda Cecilraj, CPC-A Mary Lucido, CPC-A Mary Pilger, CPC-A Maryam Faghri, CPC-A Maryssa McDonald, CPC-A Matthew McGee, CPC-A Matthew Reber, CPC-A Maturi Vasavi Matha, CPC-A Mayra Moreno-Correa, CPC-A McCall Gillins, CPC-A Meagan Apple, CPC-A Meagan Muffoletto, CPC-A Meg Gullen Domingo Baja, CPC-A Megan Barnes, CPC-A Megan Haid, CPC-A Megan Johansen, CPC-A Megan Peck, CPC-A Megan Strickland, CPC-A Meghan Betz Ashburn, CPC-A Mehnaz Zaidi, CPC-A Meilyn Gallardo, CPC-A Mekala Rani, CPC-A Melissa Chacon, CPC-A Melissa Cox, CPC-A Melissa Daugaard, CPC-A Melissa Dziejman, CPC-A Melissa Kaye Billingham, CPC-A Melissa Lopp, CPC-A Melissa Renee Birdno, CPC-A Melissa Rodgard, CPC-A Melissa Rogozinski, CPC-A Melissa Scott, CPC-A Melissa Shroyer, CPC-A Melissa Stepro, CPC-A Melissa Stewart, CPC-A Melissa Sue Thar, CPC-A Melissa Vandenlangenberg, CPC-A Merrilou George, COC-A, CPC-A Meta Awuah-Offei, CPC-A Michael Laoag, CPC-A Michael Monroe, CPC-A Michele Pomeroy, CPC-A Michelle Criddle, CPC-A Michelle Crissup, CPC-A Michelle Green, CPC-A Michelle Keathley, COC-A Michelle Maner, CPC-A Michelle Moon, CPC-A Michelle Moskovich, CPC-A Michelle Tee, CPC-A Michelle Tubbs, CPC-A Michelle Viola, CPC-A Michelle Watson, CPC-A Minal Salve, CPC-A Minumol Sebastian, CPC-A Miranda Tadros, CPC-A Misty B Burkett, CPC-A Misty Gladden, CPC-A Misty Ross, CPC-A Mita A Laungani, CPC-A Mitzi Baldorado Tiberio, CPC-A Mohammad Shazib Ameen, CPC-A Mohammedthoufeeq Haneefa, CPC-A Mohanapriya Rajendran, CPC-A Mohd Abdul Majeed, CPC-A Mohit Khugshal, COC-A Molly Palone, CPC-A Monica Leftwich, CPC-A Monique Beauregard, CPC-A Monisha Muraleedharan, COC-A Monseratt Alcantara, CPC-A Montesha S Jackson, CPC-A Morgan Bailey, CPC-A Morgan Bertoch, CPC-A Muda Bhavana, CPC-A Mula Manohar, CPC-A Munoz Lacey, CPC-A Muthuganesh Madhaiyan, CPC-A Myra Jane Stack, CPC-A Myra Moreland, CPC-A Myra Wilson, CPC-A Myrna Vazquez, CPC-A N Sravani, CPC-A Nabeesathul Misiria, CPC-A Nagalarapu Indira Devi, CPC-A Nagarjunarao Eeli, CPC-A Nageshwari Balasubramanian, CPC-A Nagnath Shinde, CPC-A Nancy Carey, CPC-A Nancy Crowell, CPC-A Nancy Davis, CPC-A Nancy J Verdolini, CPC-A Nancy Serrano, CPC-A Narendhar Mohan, COC-A Narendra Kumar M S M, COC-A Naresh Sudhakar, COC-A Narmada Muthineni, CPC-A Natalie Hulett, CPC-A Natalie Knott, CPC-A Natalie Korch, CPC-A Natalie Montaruli, CPC-A Natalie Profilet Jones, CPC-A Natelia Siemonsma, CPC-A Nathan Docherty, CPC-A Nausheen Fathima, CPC-A Navaneetha Depally, CPC-A Naveen Allavula, CPC-A Naveen Kumar, CPC-A Navkiran Dhaliwal, CPC-A Nayaki Shiva Kumar, CPC-A Nazia Qureshi, CPC-A Neema Noordheen, CPC-A Neethu Maria Varghese, CPC-A Neha Satav, CPC-A Neha Singh, CPC-A Neha Tripathi, CPC-A Nelamolla Naresh, CPC-A Nelson Lustina, CPC-A Nerudi Divya Sri, CPC-A Neuma R Costanza, CPC-A Neya Johnson, CPC-A Ngawang Sonam, CPC-A Nibedita Patel, CPC-A Nicole Brown, CPC-A Nicole D Friedman Esq, CPC-A Nicole DiStefano, CPC-A Nicole Grace, CPC-A Nicole Lynn Jardine, CPC-A Nicole Smith Coleman, CPC-A Nicole Vick, CPC-A Nicole Weatherford, CPC-A Nicoline Dominguez, CPC-A Nidhi Shrivastava, CPC-A Nikhil Moreshwar Gharat, CPC-A Nikhilraju Pasaladi, CPC-A Nimain Charan Sahoo, CPC-A Ninad Nanasaheb Taigade, CPC-A Noopur Naik, CPC-A Noorjahan Begum, CPC-A Norma Karina Ramirez, CPC-A Norma Martinez, CPC-A Norman Coan, CPC-A Nuneti Mahesh, CPC-A Olga Ptashnik, CPC-A Olivia Vargas, CPC-A Pala Vikram Kumar, CPC-A Pam Casto, CPC-A Pam Chumley, CPC-A Pam Thomason, CPC-A Pamela Ogule, CPC-A Pamlea Casault, CPC-A Pampana Sathish Kumar, CPC-A Pandharinath Eknath Kakad, CPC-A Paolo Victor Olivar, CPC-A Papineni Shilpa, CPC-A Patricia A Drass, CPC-A Patricia Burns, CPC-A Patricia Libang, CPC-A Patricia Rodriguez Fernandez, CPC-A Patricia Whitman, CPC-A Patrick Mitcheff, CPC-A Paul Alberque, COC-A, CPC-A, CPC-P-A Paul Dunn, CPC-A Paul Rescaglio, CPC-A Paula Loveland, CPC-A Paula Piebenga, CPC-A Paula Rabe, CPC-A Paula West, CPC-A Paulette Holland, CPC-A Paulette Tewaheftewa, CPC-A Pavankumar Nathari, CPC-A Pawan Dhakad, CPC-A Pawar Krushikant, CPC-A Payal Jain, CPC-A Peace Olorunwa, CPC-A Peddapelli Rambabu, CPC-A Penny Verwey, CPC-A Phaedra McKinney, CPC-A Phyllis Lopez, CPC-A Phyllis Lynn Verderame, CPC-A Piremela Srikrishna, CPC-A Ponni Priyadharshini, CPC-A Potlapally Lingaswamy, CPC-A Prabu Krishnamoorthi, COC-A Pradeep Kumar Regulavalasa, CPC-A Pradeepraj Pasupula, CPC-A January

62 NEWLY CREDENTIALED MEMBERS Pradnyashankar Waje, CPC-A Praise Baby Alex, CPC-A Prajakta Prabhakar Kinare, CPC-A Prameetha Govinda Rao, CPC-A Pramila Prakash Hire, CPC-A Pranali Bugade, CPC-A Prasana Sundararajan, COC-A Prasannakumari Banala, CPC-A Prashant Dhonde, CPC-A Prashant Shelke, CPC-A Prashanthi Mamidi, CPC-A Pratik Dhuri, CPC-A Pratiksha Satish Takawale, CPC-A Pravash Kumar, CPC-A Praveen Kumar Muniyandi, CPC-A Prince Andrus, CPC-A Priya Rathod, CPC-A Priyabrata Samantaray, CPC-A Priyanga E, CPC-A Priyanka Jagtap, CPC-A Priyanka Khare, CPC-A Priyanka Parab, CPC-A Priyanka Raskar, CPC-A Priyanka Singh, CPC-A Putrevu M Narasabhargavi, CPC-A Quarshella Coles, CPC-A R. Kavya, CPC-A Racheal Aileen Eldridge, CPC-A Rachel Gargus, CPC-A Rachel Pagunuran, CPC-A Rachel Wilson, CPC-A Rachelyn Flores, CPC-A Radhika Gujjula, CPC-A Raelee Marie Slayton, CPC-A Rahana K Soudagar, CPC-A Rahini TS, CPC-A Rahul Kudukala, CPC-A Rajarajeswari Selvaraju, CPC-A Rajesh Singaraj, COC-A Rajesh Srivastav, CPC-A Rajeshkumargupta Telukunta, CPC-A Rajeshv Venkatachelam, CPC-A Rajeshwari Devi, CPC-A Raji Chandrika, CPC-A Raji KR, CPC-A Rajkumar Ajmeera, CPC-A Raju Siddi, CPC-A Rajyalakshmi Kusuma, CPC-A Rakesh Das, COC-A, CPC-A Rakesh Kumar, CPC-A Rakesh Kumar, CPC-A Rakshana Parveen, CPC-A Ram Dhole, CPC-A Rama Sankaranarayanan, CPC-A Ramadevi V, CPC-A Ramamurthy B Y, CPC-A Ramseena Kunnummal, CPC-A Ramu Gubbala, CPC-A Ramuluchannaiah Dasari, CPC-A Ramuni Sridhar, CPC-A Ramya Manohar, CPC-A Ramyakrishna Mulukuntla, CPC-A Randi Cornell, CPC-A Ranjini Sunil, CPC-A Ranjith Kumar Pasuparthi, CPC-A Rasamalla Uday Kumar, CPC-A Rasheeda MD, CPC-A Rashmi Chavan, CPC-A Rathiga Rajendran, CPC-A Raul Augusto Acosta-Diaz, CPC-A Ravi Mehra, COC-A Ravichandu Yamala, CPC-A Ravikumar Gorla, CPC-A Ravinder Mann, CPC-A Ravishankar Baburaj, CPC-A Razuddin Usmani, CPC-A Rebecca Asbury, CPC-A Rebecca Baker, CPC-A Rebecca Daskalos, CPC-A Rebecca Geist, CPC-A Rebecca Marrocchio, CPC-A Rebecca Romig, CPC-A Rebecca Taylor, CPC-A Rebecca Vess, CPC-A Rebecca Wright, CPC-A Reema Lakshmi M, CPC-A Regina Osmer, CPC-A Regina Reimann, CPC-A Rekha G, COC-A Rekhilesh Raveendran, COC-A Rene Huxtable, CPC-A Renee Abda, COC-A Renu Prasobhana, CPC-A Reshma Aziz, CPC-A Reshma Jogdand, CPC-A Resiya P M, CPC-A Revonda V Crockett, CPC-A Rhegell Cafirma, CPC-A Rhonda Barrow, CPC-A Rhonda Edwards, CPC-A Rhonda L Napper, CPC-A Richard Byington, CPC-A Rim Babu, CPC-A Rinu Shaji, CPC-A Rionel Monteiro, CPC-A Rita Crawford, COC-A Robin Brown Hairston, CPC-A Robin Dogali, CPC-A Robin Rossetti, CPC-A Robin Tomatz, CPC-A Rochelle Williams, CPC-A Rocio Barbosa, CPC-A Rohith B, CPC-A Ronald Pierce, CPC-A Rosalba Mendoza, CPC-A Rosanna Nelson, CPC-A Rose C Augustine, CPC-A Rosie Arroyo, CPC-A Roslin Amala Mary R, CPC-A Rowena Dungo Eduardo, CPC-A Rozelyn Tavarro Montablan, CPC-A Rubie Sarah Baldonado, CPC-A Ruby Harper, CPC-A Ruchira Gandhi, CPC-A Rugveda Sawant, CPC-A RuthAnn Seibel, CPC-A RyAnn Rivera, CPC-A S. Harish, CPC-A S.P. Jyoshna Prema Latha, CPC-A Sabrina Kowaleski, CPC-A Sachchidanand Singh, CPC-A Sagar Thakkar, CPC-A Sahnwaz Ahamd, CPC-A Saikrishna Tirumalasetty, COC-A, CPC-A Saima Bhatti, CPC-A Sake Chinna Narasimhulu, CPC-A Salina Lee, CPC-A Samantha Phillips, CPC-A Samantha Prock, CPC-A Samantha Tillman, CPC-A Samantha Wellner, CPC-A Sampath Jaltaru, CPC-A Sandeep Katta, CPC-A Sandeep Purushothaman, CPC-A Sandhya Bhooreddy, CPC-A Sandhya Mankuth, CPC-A Sandilya Jyothsna, CPC-A Sandra Duarte, CPC-A Sandra J Laws, CPC-A Sandra Meltzer, CPC-A Sandra Rogers, CPC-A Sandra Sadler, CPC-A Sandra Villa, CPC-A Sandra Zych, CPC-A Sandy Averill, CPC-A Sandy Kreighbaum, CPC-A SanJuana Ortiz, CPC-A Sansanee Lizano, CPC-A Santanu Jana, CPC-A Santhoshi Sridaran, CPC-A Sapna B S, CPC-A Sara Davis, CPC-A Sara Jensen, CPC-A Sara Levangie, CPC-A Sara Mayo, CPC-A Sara Thompson, CPC-A Saragandla Swathi, CPC-A Sarah Elizabeth Stanton, COC-A Sarah Giles, CPC-A Sarah House, CPC-A Sarah Krug, CPC-A Saranraj Muthukrishnan, COC-A Saranya Senguttuvan, COC-A Saraswathi Lingampalli, CPC-A Sariga Sunilkumar, CPC-A Sarita Saklani, CPC-A Saritha Kondaboina, CPC-A Saritha Madham, CPC-A Satheesh J, CPC-A Satheesh Kumar, CPC-A Sathish Janarthanan, CPC-A, CIC Sathishkumar Senguttuvan, COC-A Satish Alaganda, CPC-A Scott Miller, CPC-A Sean Carman, CPC-A Sean Kolodziej, CPC-A Sean Mckenna, COC-A, CPC-A Seethal Paul, CPC-A Selena Plata, CPC-A Semeera Abdul Kader, CPC-A Serah Muthoni Nganga, CPC-A Shabana Ali, CPC-A Shabeena Salim, CPC-A Shabeer Ali M Mohammed, CPC-A Shabnam Siddique, CPC-A Shafeer Ahmed, CPC-A Shafi Mohammed, CPC-A Shahnawaz Shah, CPC-A Shaik Nagoor, CPC-A Shaik Rafi, CPC-A Shaik Sirajunnessa, CPC-A Shaikh Kalim, CPC-A Shaikh Anjum Begum, CPC-A Shakera Begum, CPC-A Shana DuBois, CPC-A Shandi Faulk, CPC-A Shane Palmer, CPC-A Shanice Rivers, CPC-P-A Shanika Peterson, CPC-A Shanmugam S Selvam, CPC-A Shanna Fuller, CPC-A Shannon Crable, CPC-A Shannon Hawkins, CPC-A Shannon Martin, COC-A Shannon Schrock, CPC-A Shanthi Prathyusha, CPC-A Sharath Chandra Ushakoela, CPC-A Sharlene Victoria, CPC-A Sharon Bibeault, CPC-A Sharon Boyd, CPC-A Sharon Brown, CPC-A Sharon L Booth, CPC-A Sharon Michalski, CPC-A Sharon Worley Maxwell, CPC-A Shawn Depyatic, CPC-A Shawna Rapper, CPC-A Shawnacy Burchfield, CPC-A Shayla Johnson, CPC-A Sheebarani Aruldoss, CPC-A Sheila Boddie, CPC-A Sheila Lund, CPC-A Sheila Taylor, CPC-A Shelley Davis, CPC-A Shelley McGlamory, CPC-A Shelley Tester, CPC-A Shelli Hester, CPC-A Shelly Bishop, CPC-A Sheriden Skeiber, CPC-A Sherin Mathew, CPC-A Sherin Samuel, CPC-A Sherine Tulloch, CPC-A SherlyMol Raju, COC-A Sherry Parkos-Martinez, CPC-A Sherry Seay, CPC-A Sheryl Bacay Pesigan, CPC-A Sheryllbeth Manacsa, CPC-A Shilpa Kothur, CPC-A Shiney Abraham, CPC-A Shiquita Davison, CPC-A Shirisha Jammula, CPC-A Shirley Snyder, CPC-A Shiva krishna reddy Madire, CPC-A Shiva Prasad Reddy. S, CPC-A Shivakumar Aluvala, CPC-A Shruti Acharya, CPC-A Shwetha Mugulavalli, CPC-A Shyam Sunder Y, CPC-A Sidney Feltner Griffin, CPC-A Silpa Ragini, CPC-A Silvia O Luna, CPC-A Sindhu Dhanasekaran, CPC-A Siva Muthukaruppan, CPC-A Siva Prasad Ballola, CPC-A Sivagami Subramanian Shanmugam, COC-A Smital Iskape, CPC-A Sneha Jobanputra, CPC-A Sneha Sudha Kallem, CPC-A Snigdhasmita Tripathi, COC-A, CPC-A Sojan S Aykkara, CPC-A Somea Saman Dilshad, CPC-P-A Sonali Bobade, CPC-A Sondra Beatty, CPC-A Sonia James, CPC-A Sonu M B, CPC-A Sonya Greashaber, CPC-A Sowmya Sree, CPC-A Sravani Jilla, CPC-A Sravankumar Kasoju, CPC-A Sravanthi Gurrapu, CPC-A Sreenivas Reddy Gangireddy, CPC-A Srikanth Chadalavada, COC-A Srinivas Katta, CPC-A Srinivasan N, COC-A Srivani V, CPC-A Stacey Chattin, COC-A Staci Duck, CPC-A Stacy Mix, CPC-A Stefani Borja, CPC-A Stephanie Armijo, CPC-A Stephanie Goolsby, COC-A Stephanie Harjo, CPC-A Stephanie Hiatt, CPC-A Stephanie Kerley, CPC-A Stephanie Kuan, CPC-A Stephanie Lewis, CPC-A Stephanie Melissa Andrews, CPC-A Stephanie Salemi, CPC-A Stephanie Sandoval, CPC-A Stephanie Viscardi, CPC-A Stephanie Williamson, CPC-A Subsree Anand, CPC-A Sucharitha. M, CPC-A Suchitra Dhumpala, CPC-A Sudeep Xavier, CPC-A Sue Mischka, COC-A Sumathy Balakrishnan, CPC-A Sumit Kumar, CPC-A Sunday A Adesina, CPCO, CPC-P-A, CPMA Sunish M.S., CPC-A Sunitha Adepu, COC-A Supriya Nagabhushana, CPC-A Supriya Patel, CPC-A Surekha Darisi, CPC-A Suresh Cheera, CPC-A Suresh Laxmanan, CPC-A Surya Panappattu, CPC-A Suryakant Rajendra Kakade, CPC-A Susan Alexander, CPC-A Susan Carrigan, CPC-A Susan Koenig, CPC-A Susan Krukowski, CPC-A Susan L Ward, CPC-A Susan Osterberg, CPC-A Susie Guzman, CPC-A Susy Woo, CPC-A Suzanne Galloway, CPC-A Swapna Bogula, CPC-A Swapnil Ghanekar, CPC-A Swapnil Pawar, CPC-A Swarnalatha Surukanti, CPC-A Swathi Ayyala, CPC-A Swati Rane, CPC-A Swetha Bandaru, CPC-A Sydney Avis Machia, CPC-A Syed Mubashir Uddin Hussaini, CPC-A Syed Murdhuja Ameer, COC-A Syeda Nazhath Ara, CPC-A Tabatha Hill, CPC-A Taiya Turgeon, CPC-A Takilla Diggs, CPC-A Tamara Moon, CPC-A Tameka Hogues-Hagans, CPC-A Tamera Gray, CPC-A Tami Davis, CPC-A Tammie L Johnson, CPC-A Tammy Bosco, CPC-A Tammy Rakes, CPC-A Tammy Sprouse, CPC-A Tandra Laxman, CPC-A Taneka Zone, CPC-A Tanvi Gujarathi, CPC-A Tanya Clemens, CPC-A Tanya Mackey, CPC-A Tara Behrends, CPC-A Tara Desher, COC-A Tarah Vanhooser, CPC-A Tarika Wadhwani, CPC-A Tawny Meikle, CPC-A Tawnya Hammonds, CPC-A Teann Hillary, CPC-A Teena Louis, CPC-A Tejas Jadhav, CPC-A Tejaswini Kempagangaiah, CPC-A Tekula Radhika, CPC-A Telethia Johnson, CPC-A Teresa Buccanero, CPC-A Teresa Gabriel, CPC-A Teresa Peniston, CPC-A Teresa Shipman, CPC-A Terissa Keller, CPC-A Terri Balaich, CPC-A Terri Reeves, CPC-A Tetyana Zomenko, CPC-A Thadishetti Ramu, CPC-A Thanigaivel Sivaji, CPC-A Thanikki Divya Lavanya, CPC-A Tharanraj Dhuraisamy, CPC-A Theresa Collins, CPC-A Theresa Koehler, CPC-A Thomas Jones, CPC-A Tiffany Burchette, CPC-A Tiffany DeCarr, CPC-A Tiffany Sumter, CPC-A 62 Healthcare Business Monthly

63 NEWLY CREDENTIALED MEMBERS Timothy King, CPC-A Tina Davis, CPC-A Tina Frazier, CPC-A Tina Goldman, CPC-A Tina Lowers, CPC-A Tina Thurman, CPC-A Todd Wilk, CPC-A Toni Stone Marsh, CPC-A Tonya Abbott, CPC-A Tonya Johnson, CPC-A Tonya Lloyd, CPC-A Tonya Poppen, CPC-A Tracey Lowcher, CPC-A Tracy G Fitzgerald, CPC-A Tracy Hancock, CPC-A Tracy Thompson, CPC-A Trena Andrews, CPC-A Trinette Hagood, CPC-A Tripti Jha, CPC-A Trudy Lilley, CPC-A Tyradarcil Mobley, CPC-A Uddaraju Vineetha, CPC-A Uma Morade, CPC-A Umashankar Idulapuram, CPC-A Usha Rajesh, CPC-A V. Deepak, CPC-A Valeen Bell, CPC-A Valencia Brown, CPC-A Valerie Green, CPC-A Valerie Sacchitello, CPC-A Valerie Williams, CPC-A Valeriya Abshire, CPC-A Vamshikrishna Arshanapelli, CPC-A Vandana Kumari, CPC-A Vanessa Bailey, CPC-A Vanessa Justus, CPC-A Vani Venugopal, CPC-A Vashanth Ganesh, CPC-A Vasthari Santosh, CPC-A Veena Channappa Bangalore, CPC-A Veena D.Nair, CPC-A Veenu Sahai, COC-A Veera venkata Raju, CPC-A Velpula Swetha Meghana, CPC-A Venkata Santosh kumar Choudary, CPC-A Venkata Suresh Babu Kompala, CPC-A Verina Rogers, CPC-A Vernesa Reed, CPC-A Versula Weaver, CPC-A Vi Kindness, CPC-A Vicki Downing, CPC-A Vicki Toomey, CPC-A Vickie Marie Dimond-Lopez, CPC-A Victoria Breedlove, CPC-A Victoria Hunter, CPC-A Vidhya Selvaraj, CPC-A Vidhyashree Gurunath, CPC-A Vidya Samantha Bacchus, CPC-A Vinaya Sreekumar, COC-A Vinukonda Meena Priyanka, CPC-A Violette Beshara, CPC-A Vipin Misra, CPC-A Vishwas Radhakrishnan Deshpande, CPC-A Vision Lan, COC-A Vivek Gnanadhas Harry, CPC-A Vivek Singh, CPC-A Wella Arevalo, CPC-A Wendi O Connor, CPC-A Wendy A Liput, CPC-A Wendy Adams, COC-A Wendy Mae Dubois, CPC-A Whitney Hunter, CPC-A William Murphy, CPC-A William Stapinski, CPC-A Winnie Bravo, CPC-A Y.Yashpal Goud, CPC-A Yaima Abreus, CPC-A Yamila Ramos, CPC-A Yamunabai K, CPC-A Yanira Echevarria Torruella, CPC-A Yaqi Li, CPC-A Yash Zanane, CPC-A Yatin Karalkar, CPC-A Yihong Shu, CPC-A Yogalakshmi Babu, CPC-A Yolanda D Williams, CPC-A Yolanda Lawson, CPC-A Yukio Diwa, CPC-A Yvonne Frye, CPC-A Zachary R Booher, CPC-A Zzyzx Mize, CPC-A Specialties Abby Halstead, CPB Abdul Rahman Syed, CIC Abigail Carroll, CRC Adianet Rivero, CPC, CPMA, CRC Adriana Gonzalez, CRC Adrianna DePuy, CPB Adrianne Metzger, CPC, CPB Adrienne Floyd, CPC, CPMA Agnes Egbe, CPPM Aisha Ali, CPC, CPB Aishwarya M Ganesan, CPC, CPMA Akisha Burgett, CPCO Akubathini Raju, CIC Alberto Rando Sous, CPC, CPMA, CRC Alexi Ruiz, CPC, CRC, CPC-I Alia Davis, CPC, CPB, CCPC Alicia Warr, COC, CPC, CPMA Allen Mae Gumabao Aralar, COC, CPMA Amaechi Lawrence Ofunne, CPC, CPMA, CEDC, CEMC, CENTC, CGSC, CPRC Amanda Seitz Thrift, CPC, CPMA Amanda Andruscavage, CPC, CIMC Amanda Guzman, CPC, CPMA Amanda Leigh McClaskey, CPC, CPCD, CPRC Amanda S Donovan, CPC, CRC Amanda Stansbury, CRC Amarnadh Maram, CIC Amber Clemons, CIRCC Amit Kumar, CIC Amparo Calderon, CRC Amy Ates, CPC, CPMA Amy Harrell, CPC, CRC, CEMC Amy Losiewski, CPC, CPPM Amy Love, CPC, CPC-P, CPMA, CPPM, COBGC Amy Marie Howard, CPC, CPB Ana Medan, CPC-A, CPMA Anabela Antunes, CPMA, CPPM, COSC Andrea E Moore, COC, CPC, CPMA, CRC Andrea Marie Dixon, CPC, CRC Andrea Mecey, CPC, CANPC Andrew Knight, CPPM Andy J Allensworth, CPMA Angela B Clements, CPC, CPC-I, CEMC, CGSC, COSC Angela C Boynton, COC, CPC, CPCO, CPC-P, CPMA, CPC-I Angela H Thompson, CPC, CPRC Angela Marie Snowman, CPC, CHONC Angela Mellin, CPC, CRC Angela Paine, COC, CPC, CPCO, CPB, CPMA, CPPM, CPC-I, CEMC, CRHC Angelica M Stephens, COC, CPC, CPMA, CIMC, COSC Anissa Silman, CPC-A, CIC Anita Meraz, CPC, CRC Anitha Kumaradhas, CIC Anitha Neelamegam, CIC Ann E Blanchard, CPC, CPMA Ann Filchak, CPC, CRC Ann Petersen, CPC, CPMA, CRC Ann Theno, CPPM Anna Barnes, CPC-A, CPMA Anna Milewski, CPC, CPMA Anna Trom, CPC, CPB Anna Tuck, CPC, CPMA Anne Heiman, CPC, CPB Anne M Hartman, CPC, CPB Annette Hussey-Barsness, CPPM Annette Telafor, CPC, CPB, CRC Anthony Drozd, CPC, CCVTC, CGSC, CUC Anup Sunil Yede, CPC-A, CIC Aparna Suresh, CPB April Smith-Martin, CPCO Aramis Paz, CPC, CRC Ariel R. Portilla, CPC-A, CPMA, CRC Arlene Diaz, CPC, CPEDC Arlene Soriano, CPC, CPPM Arounmaly Emily Chanthavong-Urbanek, CPC, CCVTC Artemio B Castillejos Jr, CPC, CCVTC Ashley Fernandez, CPC-A, CRC Ashlie Hess, CUC Ashok Garg, COC-A, CIC Ashokkumar Chaudhari, COC-A, CPC-A, CPC-P-A, CPB, CPMA Athena B Warden, CPC, CRC, CCC, CCVTC Audra P Swafford, CPC, CRC Aundrea Pacheco, CPPM Autumn Mortimore, CRC Ava Antonia Johnson, COC, CPC, CPMA Avuladoddi Saidulu, CIC Ayesha RC Hampton, COC, CPC, CPMA Aylin Garcia, CPC, CRC Babitha Moidunny, CPC-A, CPMA, CEMC Babu Chandrasekar, CIC Balakrishnan Devaraj, CIC Barbara Ann Marion, CPC, CRC Barbara Lennon, CRC Beatriz Martinez, CPB Becky Bertrand, CPC, CEMC, CENTC Becky Priest, CPC-A, CPB Belkis Espinosa, CPC, CRC Belkis Garcia Vazquez, CPC, CRC Benjamin Westberg, CPPM Bennie K Shepherd, CPC, CPMA Bethany Stoltz Smith, CPB Betty Vu-Fulmer, CPPM Bikash Kumar Pradhan, CIC Boga SreeTeja, CIC Bonnie Wilson, CPC, CRC, CIMC Brandy L Nyberg, CPC, CRC Brenda Bloom, CPC, CPPM Brenda Castro, CRC Brenda L Anderson, CPC, CRC Brenda Mastandrea, CRC Brenda Nardone, CHONC Brenda Xiomara Chavez, CPC, CPMA, CRC Brent Davis, CPC, CRC Brian Forrest, CPC, CEMC Bridgett Bowling, CPC, COSC Bridgette Knoll, CPC, CEMC Brina Post, CIRCC Brittany Mellon, CPC, COSC Burle Sivakumar, CIC Caren J Swartz, COC, CPC, CPB, CPMA, CRC, CPC-I, CPCD Carla Rinehart, CPB Carlo Ancheta, CRC Carlos Arias, CPC, CPCO Carlyle Diaz, COC, CPMA Carmen Brooks-Turner, COC, CPC, CDEO, CPB, CPMA, CPC-I Carmen G Perez Fundora, CPC, CRC Carmencita Rubin, CPC, CPMA Carol G McHale, CPC, CPPM Carole Devos, CPC, CPMA, CHONC Carolina Ricaurte, CPC, CRC Carolyn S White, CPC, CDEO, CPMA, CRC, CCC, CGSC, COSC, CUC Carrie Rusch, CRC Catalena Cachat, CPC-A, CUC Catherine Gavin, COC, CPC, CRC Cathy Allarie, CPC, CRC Cathy M Stover, COC, CPC, CPMA, CEDC Charlene Johnson, CPC, CPPM Charlene K Richers, CPC, CPMA, CRC Chenecca Oden Olige, CPC, CRC Cheri McQuiston, CPC, CGSC, CUC Cheripelly Kamalaker, CIC Cheryl L Smith, CPC, CGSC Cheryl Lynn Harris, CPC, CRC Chris Atkinson, CPC, CPB Christie Diegel, CHONC Christina Ciatti, CPC, CPB, CPC-I Christina E Camacho, CPB Christina Gonzalez, CPMA Christina S Skalka, CPC, CPMA, CRC Christina Smith, CPB Christine Hurley, CPC, CPMA Christopher Boc, CPC, CPMA, CHONC Christy A MacPhedran, COC, CPC, CPMA Cindy L Miller, CPC, CIC, CPMA Claudia Rodriguez, CPC, CRC Connie L Thweatt, CPMA Connie Whitesides, CPCO, CRC Courtney Steely-Voetberg, CPC, CPMA Crisanta Zamora Wampole, COC-A, CPC-A, CIC Crista J Kelley, CPC, CDEO, CPMA, CRC Cristina Martinez, CPC, CPMA, CEMC Crystal Barrett, CPMA Cynthia Chester, CPC, CPB Cynthia Collison, CPC, CPMA, CPPM, CCC Cynthia Leigh Jones, CPC, CPMA, CPC-I Dan Nevels, CPC, CPB Dana Gentile, CPC-A, CPB Dana Lee Shade, COC, CPC, CPC-P, CPMA, CRC Dania Leon, CPC, CRC Darcy Tyler, CPC, CPMA Darlene Willis, CPC, CPB Darling E Melendez, CPC, CRC Davetta Latrel Turner-Mootoo, CPC, CPMA, CASCC David Bramlett, CPCO David James Wright, CPC, CGSC David Letizia, CPB David Reynolds, CPB Dawn Chapman, CPC, CPMA, CEMC, COSC Dawn R Holliday, CPC, CEMC De Andra Simley, CPB DeAnna Garner, CHONC Debbie Perasso, CPC, COBGC Debra Braden, CPC, CRC Debra Devine, CPC, CPRC Debra Knight, COC, CPC, CPB Debra Mitchell, CIC Debra Vitale, CPC, CPMA Deeidria Y Huffman, CHONC Della R Canter, CPC, CCVTC, CEMC Deni Adams, CPC, CPB, CEMC Denise Ehrensberger, CPC, COBGC Devarajulu V, CIC Devin Walker, CPC-A, CPMA Devivani Gandrakota, CIC Dharanidharan Selvam, CIC Dhivya Jagadeesan, CIC DhivyaBharathi Raveendiran, CIC Dia Duncan, CPC, CPPM Diamela Valdes, CPC, CRC Diana Turner, CPC, CASCC Diane Lovely, CPB Diane Rincon, CPB Dianne Clarke, CPC, CPCO Dianne Taiste, CRC Donna Attery-Grant, CPC, CGIC Donna W Baker, CPC, CPMA, CEMC Dorothea Marie Lashua, CPC, CPMA Dorothy Beth Goodell, CPC-A, CIC Dr MadhuSudhanRao Kotha, COC, CPC, CPC-P, CIC, CPMA, CANPC, CEDC, CGIC, CGSC, CPCD, CPEDC, CUC Dr. Lynnet John, CPC, CPMA Dunia Aljure, COC, CPMA, CRC Eden Cabalu, CPC, CRC Edith Baker, CRC Edwin Concepcion, CRC Elena M Luzarraga, CPC, CDEO, CPMA, CRC, CPC-I Elena Vargas, CPB Elina Sabilova, CPMA, CFPC Elisa Hennessy, CPPM Elizabeth Alvarez Torres, CPC, CRC Elizabeth Rosy Paul Raghu, CPC, CRC Ellie Kamkar, CPC, CRC Emily Wende, CPC, CPCO Enosh Balasubramani, CIC Erica June Gonzalez, CPC, CPMA Eriko Leland, CPC, CCC Eva Dirst, CEMC Felicia Cardoz Noronha, CPC, CPMA Felicia Frazer Jones, CPC, CPMA Fernando David Silva, CPC, CRC Filiberto Alejandro Donald Perez, CPC-A, CRC Gabriela Rodriguez, CPC-A, CRC Gagan T Kadahalli, CPC, CPMA, CRC Gayla J McGraw, CPC, CGIC, COBGC Gene S Loretz, CPC, CEDC Geoffrey Stoller, CPC-A, CPB, CPPM Geraldine K Slawek, CPC, CRC, CPC-I, CEDC Ginger L Hashbarger, CPC, CPMA Ginger S Heier, CPC, CRC Gisela Garcia, COC, CPMA, CRC Giselle Leonard, CRC Gladybell Rivera, CPMA Glenna Tate, CPB Gloria Jensen, CPPM Gowrikumari Bhoopathy, CIC Greidys Maleta, CPC, CPMA, CRC, CGIC Grether Elias, CPC, CPMA Guadalupe Jurado, CPC, CDEO, CPMA, CPC-I Hannah McCarthy, CPC-A, CPMA Harold Brandt, CRC Harvey Bair, CRC Hayat A Freeman-Lutes, CPC, CPMA, CEMC Hazel M Miller, COC, CPC, CPC-P, CPMA, CPC-I Heather Fraelich, CRC Heather Michele Murphy, CPC, CEDC Heather Murphy, CPC-A, CPMA Heather Pender, CPB Heather TyLynn Smolinski, CPC, CPMA, CRC Heather Wheeler, CPB Hemachand Tatineni, CPC-P-A Henrietta E Comrie, CPC, CPCO, CRC Herb Bruss, CPC, CIRCC Holly Williams, CPC, COSC Ila Sapra, CPC, CPMA January

64 NEWLY CREDENTIALED MEMBERS Inbarajan Mohan, CIC Indhumathi Kalaimani, CIC Indujaponni Ravindrapandiyan, CIC InSook Schriver, CPC, CPMA Ivonne Atanacio, CPC, CPB, CPC-I Jackie Jones, CPPM Jackie Metzger, CRC Jamie Gray, CPC-A, CPPM Jan Vroman, CPC, CEDC Janelle Pervis, CPC-A, CPB Janice R Starks, CPC, CIRCC, CCVTC, CGSC Janice Rose Konchalski, COC, CPC, CPC- P, CRC, CFPC, CPEDC Jasmin Johnson, CPC, CPB, CPMA, CEDC Jasmine Spotswood, CPB Jaya Padaikathu, CIC Jayashree Lakshmanan, CIC Jayasri Krishnamoorthy, CIC Jaymie Citelli, COC, CPC, CDEO, CRC Jayson Bautista, CPC, CRC Jean Haag, CPB Jeevan Kumar, CIC Jeff Mott, CPMA Jeffrey Cross, CPPM Jenna Mirchin, CPC, CPMA, CGSC Jenna Shaffer, CPB Jennie Clark, CPCO, CPMA Jennifer B Monroe, CPC, CPPM Jennifer Bassett, CPC-A, CCC Jennifer C Lopez, CPC, CPMA, CPC-I Jennifer D Cairns, CPC, CDEO, CRC Jennifer L Squyres, CPC, CDEO, CRC Jennifer Steen, CPC, CCVTC, CEMC Jennifer Thurmond, CIC Jennifer Walsh, CPC, CPB Jerri Rowe, CPC, CRC Jessica Baker, CPB Jessica Ewing, CPC-A, CRC Jessica McHugh, CRC, CEMC Jessica Roman, CRC Jessica Winters, CPC, CPMA Jill D Conley, CPC, CPMA, CEMC Jill E Godfrey, CPC, CPPM Joan Clyne, CPC, CDEO, CPMA, CRC Joanna Cuesta, CPC, CRC Joanne Robinette, CPC, CEMC Jodi Sargent, CRC Jody Wilkins, CPC, CPCO Joe Alexander Jimenez-Belen, CRC Jonathan Corona, CPB Jose Roberto Diaz, CDEO Joseph Dougherty, CPPM Joseph Hafner, CPC, CRC Joseph Wolfe, CPPM Josh Snook, CPPM Joyce Ciskowski, CPCO Judi Roster, CPC-A, CEMC Judith Fancher, CRC Judy L Savage, CPC, CPMA Judy Linda Castonguay, CPC, CEMC, CFPC Julianne Hayenga, CGIC Julie Blanchfield, CPC, CPB, CPPM Julie Bos, CPC, CPB, CPPM Julie Engelland, CIC Julie Gilpin, CPPM Julie Weiss, CRC Jyoti Teppala, CIC Kacie Geretz, CPC-A, CPMA Kajamohaideen Alli Kamaldeen, CPC, CIC Kalidhasan Shanmugam, CPC, CRC Kalpana Vasa, CIC Kamalraj Karunakaran, CPC, CIC Kanagaraj Kandasamy, CPC-A, CRC Kanimozhi Veeran, CIC Karen Ulman, COC, CPC, CRC Karen Adams, CPC, CRC Karen Amburgey, CPC, CFPC Karen F Thurman, CPC, COSC Karen Marie Snock, CPC, CPMA, CRC Karen Y Manigault, CPC, CPMA, CRC, CEDC, CEMC Karey Gooden, CPC, CEMC Karissa Moore, CPPM Karol Bundy, CPC, CIRCC Karthik Selvaraj, CIC Katherine Honeman, CPC, COBGC Kathleen L Ralsten, CPC, CRC, CEMC Kathleen Leffers, CRC Kathleen Luellwitz, CPB Kathleen Mary Spalten, CPC, CPMA Kathryn Hartman, CPC-A, CPB Kathy Bankston, CENTC, CHONC Kathy L King, CPC, CIRCC Katie Dyche, CPC, CDEO Katie Lemoncelli, CPC-A, CEDC Katie Purpur, COC, CPC, CIC Katrina Chancey, CPPM Kavitha Perumal, CRC Kawana N Scott, CPC, CPMA, CRC, CEDC Kaysha Sabrina Virasawmi, CRC, CFPC Keicia Tamara Cornwall, COC, CPC, CPC- P, CPMA, CRC Kellie Goode, CPC, CRC Kellie McClain, CPC, CPCO Kellie Vozar, CIRCC Kelly Bell, CPC, CPCD Kelly Davis, CPC, CPMA Kelly Naddeo, CEMC Kelsey Storey, CPC, CEMC, COBGC Kenia Valle Boza, COC, CPC, CDEO, CPB, CPMA, CPPM, CRC Kerry Ann Hogan, CPC, CCC Kesavaraju Vysyaraju, CIC Khin Thein, CPPM Kiarra Camille O Neal, COC, CPC, CPMA, CRC, CEMC Kiley Ann Jeffries, CPC, CEMC Kim Collins, CPC, COBGC Kimberlee Pechnik, CPCO, CPPM Kimberly Marks, CPMA Kimberly Ann Hyatt, CPC, CPB, CCC, CCVTC Kimberly Barnes, CPC-A, COSC Kimberly Bonnaure, CPC, CEDC Kimberly C Cook, CPC, CPB, CPMA, CEMC Kimberly D Morris, CPC, CEMC Kimberly D Vegter, CPC, CRC, CPC-I Kimberly Dawkins, COC, CPMA Kimberly Hood, CRC Kimberly M Jolivette Williams, CPC, CPMA, CCC Kimberly Reid, CPC, CPMA, CPC-I, CEDC, CEMC Kimberly S Kieke, CPC, CPMA Kimya Toppazzini, CPPM Kristen Shattuck, CRC Kristi Langerud, CPC, CPMA Kristie Lynn Elfen, CPC, CRC Kristie Stokes, CPC, CPMA Kristina Cruz, CPC, CPRC Kristine Joy Bartolome, CPC, CPCO, CPMA, CRC Kristy Chesser, CPPM Kristy Kimsey Gaskins, CPC-A, CPPM Kristy Leigh Rodecker, CPC, CPMA Krystal Ashley Hanna-Campbell, CPC, CEDC Kunal Narwal, CPCO Ladonna K Schaad, CPC, CPMA, CANPC Latasha Mason, CPC, CPMA Latosha Cooley, CPC, CPMA Laura A Cirilli, CPC, CPB Laura Anderson, CHONC Laura Devries, CPC, CRC, CANPC Laura Gilbert, CPC, CPMA Laura Graham, CPPM Laura Lee Lovett, CPC, CPCO, CPMA, CPC-I, CANPC, CEMC Laura Leonard, CPC, CPMA Laura Richardson, CPC, CCC Laura Ross, CPMA Laura Villa, CPB Laura W Kersey, CPC, CPMA, COBGC Laura Wheeler, CPMA, CRC Lauren Laffranchini, CPC-A, CIRCC Lauren Stravach, CPC, CPCO Laurie Schneiderhan, CPPM Lavanya Penugonda, CPC, CIRCC Leah Gross, CPC, CPMA, CUC Leanne Marie Altman, CPC, CEMC, CRHC Leanne Walls, CPC, CPPM, CEMC Leigh Marion Lingbloom, CPC-P, CCC Leonie Esselbach, CPC, CRC Leslie Schuldt, CPC, CCC Lester Ramos, CRC Lianet Santos Mederos, CPC, CRC Lieren Barkenhagen, CPC, CEMC Lillian Casados, CPC-P, CPB Lincy Alice Jacob, CPC-9-A Linda Balawender, CPC, CIRCC Linda Gillespie, CPC, COSC Linda Jaegers, CPC-A, CRC Linda Loveday, CPC, CDEO, CPB, CPMA, CPPM, CEMC Lindsay Bryan, CPC-A, CPCD, CPRC Lisa A Smith, CPC, CPMA Lisa Annette Miller, CPC, CPB Lisa B Haden, COC, CPC, CRC, CEDC Lisa Logsdon-Seay, CPB Lisa Murphy, COC, CIRCC Lisa Pearson, CPC, CRC Lisa R Rupple, CPC, CPMA, CRC Lisa Schultz, CIRCC Lisa Sears, CPC-A, CPB Lisa Smith, CIRCC Lisbeht Barrientos, CPC, CPMA, CRC Lisney Rodriguez Sanchez, CPC, CRC Liu Cuan, CPC, CPMA, CRC Liz Loving, CPC, CPPM, CRC Liz V De La Rua, CPC, CPMA, CRC Loganathan Narayanaperumal, CPC, CRC Lori A Cox, CPC, CPMA, CPC-I, CEMC, CHONC Lori Magistrelli, CPC-A, CPB Lori Wingo, CPC, CPCO, CPMA, CPC-I Lori Y Fitzgerald, CPC, CPB Lorian Otis, CPB Louann Hamel-Brisco, CPC, CPB, CRC Lucia McKercher, CPC, CIRCC, CPMA Lucy Johnson-Dykes, CPC, CPPM, COBGC Lynn M Anderanin, CPC, CPMA, CPPM, CPC-I, COSC Lynne Folz, CPC, CPMA Lynnett McMillan, CPC, CPMA Madhankumar Raja, CRC Magesh Srinivasan, CPC, CRC Mageshwari Muthu Malai, CRC Mageswari SenthilKumar, CPC-A, CRC Mahalakshmi Pattappa, CIC Maheswari Arumugam, CIC Maikel Martinez, CPC, CPMA, CRC Manikandan Ramasamy, CIC Manimalar Ganesan, CIC Marcelle L Valentine, CPC-A, CPB Marco Unzueta, CPC, CIC Marcy Garuccio, CPC, CPMA Margaret Altimare, CPC, CCC Margaret Harris, CPC, CPMA Margaret P Leacock, CPC, CPMA, CRC Margaret Prestifilippo, CPC, CPMA Margi J Land, CPC, CPMA Marguerite Fenwick, CPB Maria Carmen Puerto, COC, CPMA, CRC Maria Nazario, CPC, CPB Maria Pilar Molina, CRC Maria Sandoval, CPC, CPMA Maria Sood, CPC, CRC MariaJose Portilla, CPC-A, CPMA, CRC Mariana Mercado-Sotolongo, CPC-A, CPPM Marianne Durling, CPC, CPCO, CIC Marianne Mao, CPPM Maricel Pedrals, CPPM Marilyn Shultz, CPC, CRC Marimuthu Subramaniyan, CIC Mariol Fernandez, CPC, CPMA Marita Linebaugh, CPC-A, CEMC Marsha Ann Jones, CPC, CPMA Martha Helena Hofmann, CPC, CRC, CFPC Martha Rockovich, CPC, CPMA Marvette Sherell Smith, CPC, CRC Mary B Freeman, CPC, CPCO, CPMA, CEDC, CEMC Mary Lewis, CPC, CPB Mary McDonald, CRC Mary Michalek, CPPM Mary Patricia Matthews, CPC, CPRC Maureen Kline, CPC, CPCO, CPMA Megan McElravy, CPC, CRC Megan Vredenburgh, CPC, COBGC Melanie Ordonez, CRC Melany Tupper, CIRCC, CCC Melina Gutierrez, CPC, CPMA Melinda Schroeder, CPC, CCVTC Melissa Caperton, CPC, CPPM, CPC-I, CFPC Melissa Davis, CPC, CPMA Melissa M De La Rosa, CPC, CPMA, CRC Mercedes Sandoval, CPC, CPB, CPMA Merjim Macawile, CPC-P, CIRCC Michael Centeno, CPC, CPCO, CPMA Michele Ann New, COC, CPC, CRC Michele Benoit, CPC, CPB Michele Hendrix, CPC, CRC, CEMC Michelle Berry, CPPM Micki Martin, CPC, CDEO, CPMA Mihir Kumar Patro, COC-A, CIC Miriam Semendy, CPC-A, CPMA Mohammad Shariq, CPC, CIC Mohamudhanarkees Shanbasha, CIC Mohana Jalaludeen, CPC, CRC Monique M Farfan, CPB Moon Ling Lee, CPC, CEMC Mumtaz Momin, CPPM Muneeswaran Karuppasamy, COC, CRC Myra Lisa Engalla, CPC, CPEDC Myra Williams, CPC, CPMA Nagarjuna SajjannaGari, CIC Nalinee Lotun, CPB Nancy H Solomon, CPC, CFPC Nancy Jodoin, CPPM Nancy Leila Kellermann, CPC, CDEO, CPMA, CRC Nancy Nelson, CPC, CPMA Naomi Pierson, CPC, CEDC Narahari Reddy Patil, COC, CIC Natasha Milligan, CPC, COSC Nathan L Kennedy Jr, CPC, CPB, CPMA, CPPM, CPC-I Nicole Bradshaw, CPC, CPMA Nicole Catanzaro, CPC, CPMA Nidhi Maheshwari, CPC, CEMC Nidhi Singh, CPC, CPCO, CPMA Nithya Sivasubramaniyan, CIC Niurys Rivero, CRC Noelle Gentile, CPMA Noelle Jean Temple, CPC, CPC-P, COBGC, CPRC Norma Lozano, CRHC Odismary Munoz, CPC, CRC Oyindamola Fasanya, CPB P M Raghava, CIC Pam Robertson, CRC Pam White, CPC, CRC Pamela Hebert, COC-A, CPC-A, CRC Pamela Jane Lungulow, CPC-A, CPB Pankaj Satyawan More, CPC-A, CIC Parthiban Palani, CIC Parul S Chandragiri, CPC, CCC, CEMC Paso L Yang, CPC, CUC Patricia A Lynch, CPC, CENTC, CFPC, COBGC Patricia Allen, CPC, CPMA, CEMC Patricia Ann Daughtry, CPC, CCVTC Patricia E Platt, CPC, CRC Paula Mada, CPC, COBGC Paula Christophersen, CPPM Paula Polek, CPC, CRC Peter Edu, CPC, CDEO, CPC-I Phillina Morrison, CPC, CHONC Phyllis Sederholm, CPC, CRC, CFPC Piyali Srivastava, CPCO Polly R Houchins, CPB Praveen K, CPC-9-A Praveen Velpula, CIC Praveenkumar Goshika, CIC Pravin Prakash Murumkar, CIC Priscilla Ann Rodriguez, CRHC Priyanka Pothireddy, CIC Rachel N Mitchell, COC, CPC, CIC Rajendran Ravichandran, CRC Rajeshwari Poorna Chandiran, CPC, CRC Rakan Ahmad Damaso Al Hanaki, COC, CPC, CPMA Rakhee Batra, CPPM Ramona J Marden, CPC, CPMA, COSC Randa Cain, CPC, COSC Raske Ramu, CRC Rebecca Ann VanZee, CPC, CPMA Rebecca Dyke, CPC, CPMA Rebecca Hazen, CPB Rebecca Herrera, CPC, CPMA, CEDC Reginald K Francis, CPC, CPMA, CGSC Rei Sugaya, CPC, CRC Rekha Roy, CPC, CPMA Relangi Venkata Durga Sai, CIC Remya Sudhakaran, CPC-A, CPMA Renee Bushmaker, CPC, COBGC Renee Kawcak, CPC, COSC Renee Marie Courtney, CPC, CRC Rhonda Vance Drinnon, CPC, CPMA Robert Molloy, CPC-A, CCC Roberta G Calcara, COC, CPC, CPMA Robin J Long, CPC, CPMA Robin M Black, CPC, CPMA, CRC, CEMC, CFPC, CUC Robyn E Chojnowski, CPC, CPMA Robyn Marie Curtin, COC, CPC, COBGC Rochelle Jones, CPC, CRC Rodrigo De Aquino, CPC-A, CRC Rosa Martin, CPC, CRC Rosanna Quesada, CPC-A, CRC Rose M Patterson, COC, COBGC Sadia Mol Alby, CIC Sally Blacke, CPC, CPB Samantha Eashak, CPC-A, CRC Samantha Murphy, CPCO Sana Mirasahab Shaikh, CPC-A, CIC 64 Healthcare Business Monthly

65 NEWLY CREDENTIALED MEMBERS Sandeep Kumar, CIC Sandra Ann Delgado, CPC, CPMA Sandra Garrett, CPC, CPB, CRC Sandra Shong, CPC, CRC Sandra Troade, CPC, CPMA, CRC Sangavi Murugan, CRC Sangeetha Arumugam, CIC Sangeetha Manickam, CIC Santha Shanmugam, CIC Sara Lynn McCurley, CPC, CRC Sara Michelle Stoll, CPC, CIRCC Sara Rawson, CPC, CRC Sarah A Jarvis, CPC, CPMA Saranya Mohan, CPC, CRC Saravana Thanigasalam, CIC Saravanan Selvam, CIC Sathish Janarthanan, CPC-A, CIC Sathishkannan Chelliah, CRC Scott Burk, CPCO Scottie Stone, CPC, CEMC, COSC Sengmany Susie Ma, CIRCC, CCC, CCVTC Shaik Ammajee, CIC Shanika L Cain, CPC, CIRCC Shannon Barker, CPC, CEDC Shannon Holby, CPC, CPMA, CEDC Shannon M Welk, CPC, CPMA, CEMC Shannon Whitlock, CPC, CPMA Shaqualya Mitchell, CPC-P, CPMA Sharon Camille Hendrick, CPC, CPMA Sharon Cullum, CPC, CRC Sharon Lynn O Bryan, CPC, CPMA Shashikumar Natarajan, COC, CPC, CPMA Shawn Marie Wade, CPC, CPMA Shellee Mellor, CPC-A, CEMC Shelley Ursel Moore, CPB Sheri L Rogan, CPC, CPMA, CEMC Sherra Collins, CPC, CPPM Sherri Olubode, CPCO, CPB Sherrvonne Jones, CPC, CIC, CPMA Sherry Wendt, CPC, CCVTC Shoshana Espin, CPC, CEMC Simran Nutter, CPC, CPMA Sivagami Rengarajan, CIC Sivaji Komara, CIC Sivanagaraju Busi, CIC Sofia Love, CPC, CPMA, CHONC Sonia Pacheco, CPC-A, CRC Stephanie A Grubich, CPC, CRC, CEMC Stephanie L Ward, CPC, CPMA Stephanie Lovato, CPC, CPB Stephanie Newman, CPC, CEMC Stephanie Pippin, CHONC Stephanie Whibley, CPB Steve Boley, CANPC Sudhakar Dhanapaul, CIC Sudhakaran Rajendran, CIC Sue Hainer, CPC, CPB Sue McBurney, CPB Suneethi Venkatesh, COC, CPC, CIRCC Suresh Gnanasekaran, CIC Suresh Kumar Krishnan, CPC-9-A Suresh Natarajan, CPC-9-A Susan Ahern, CPC, CEMC, CENTC Susan Barfuss, COBGC Susan M Shacklette, CPC, CPMA, CPC-I Susan McCambridge, CPC, CRC Susan Walden, CPC, CGSC Susithra Thirumeni, CIC Suzanne Becker, CPC, CPMA, CRC, CEDC Svitlana Glova, CPB, CPPM Swarna Maheswaran Shanmugam, CRC Tamara Parker, CPPM Tami M Barna, COC, CIRCC, CRC Tammy Foust, CPB Tammy Louise Bellamy, CPC, CPMA, CEDC Tammy Ringenary, CPPM Tammy S Shiner, CPC, CPMA Tanika Grays, CPC, CPB, CHONC Tanya L DeSimone, CPC, CHONC, COSC Tanya Noble, CCC Tara Christine Steinberger, CPC, CENTC Tara Cobb, CPC, CPMA Tara Hughes, CGIC Tatyana Blinder, CPC, CPMA, CPPM Taura Way, CPC, CCVTC Teaerra Jackson, CPC, CHONC Teresa Hodges, CPC, CEMC Teresa S St John, CPCO Teri Taylor, CPC-A, CRC Terie Lynn Charrette, COC, CPC, CPMA, CRC, CEMC Terrance Myers, CPC, CRC Terri Clarke, CRC Terri R Weatherford, CPB Terri Raso-Hart, CPC-A, CPB, COSC Theresa McDonald, CPC, CPMA Theresa Milligan, CPC-A, CRC Thilaga durga lakshmi Sundar, CPC, CPMA Thunuguri Nagesh, CIC Tiffani Dahl, CPC, CEMC Tiffany Brown, CPC, CPB, CPPM Tiffany Murriel, CRC Tiffany Widder, CGIC Tiffiny Ewan, CPC, COBGC Timothy Sean Diesel, CRC Tina Leahy, CPC, CDEO, CPMA Tina M Myers, CPC, CPMA Tiombe I Booth, CPC, CEMC Toi Walker, CPC, CGSC Tommie Lynn Romagnoli, CPC, CRC Tonia Horn, CPB Tonya Sisk, CPC, CPMA, COBGC Tracey Lynn Combs, CPC-A, CCVTC Tracey Marie Wessen, COC, CPC, CPMA, CCC, CCVTC, CEMC, CGSC, COBGC Traci Bryan, CUC Traci Mahaffey Horst, CPC, CPMA, CRC Tracye Huffaker, CPPM Trent Jackson, CRC Tri Le, CPC, CPMA, CRC Trina Alexander, CPB Trip Hairston, CPPM Udhaya Kumar Thanikasalam, CIC Uma Maheswary, CIC Valerie Calderon, CPC-A, CPB Valeriya Brown, CPC, CPB, CPMA Vanessa Jove, CPC, CGIC Verchera Abeita, CPC, CPMA, CANPC Vernessa Fountain, CPMA Vetrivel Gopal, CRC Vicci Nails, CPB, CSFAC Vicky D Constancio, CPEDC Vidya Baliga, COC, CPMA Vijayakumar Balasubramanian, CIC Vijayasamundeeswari Shanmuga Sundaram, CPC, CRC Vimal Perumal, CPC-9-A Virginia Reagan, CPC, CRC Wanda Faye Hite, CPC, CPMA, CEMC Wendy Ann Finnerty, CRC Wendy Holcomb, CPCO Wendy Karen Gray, CPC, COBGC, CRHC Wendy Morrison, CRC Wenona Lynn Mason Goc, CPC-A, CPMA, CRC Winter Milini, COSC Yadiana Travieso, CPC, CRC Yaerlin Millan Romero, CPMA Yahima Mendez, CPC, CPMA, CRC Yamiler Marrero, CRC Yan Jiang, CPC, CPMA, CRC Yanitza Sanchez, CPC, CPMA, CRC Yiset Carreno, CPC, CRC Yoel Lovelle, CPC, CPMA, CRC Yordanka Pereira, CPC, CPMA Yuleidys Ojeda, CRC Yvette Lopez, CPB Yvonne B Russell, CPC, CDEO, CPMA, CFPC Zakiyyah Wagerle, CPC, CDEO, CRC Zaynet Fernandez, CPC, CPMA, CRC Zoila Hanson, CPC, CPMA, CFPC Code 33% Faster Try AAPC Coder Free for 14 days and watch your coding fly. Two months ago I did a free trial with AAPC Coder and now I don t know how to live without it. It s my most valuable tool. Dr. Mark Dudley FREE 14 DAY TRIAL Visit aapc.com/coder or call January

66 Minute with a Member Tameka J. Duncan, CPB, CPPM Medical Biller, St. Croix, U.S. Virgin Islands Tell us about how you got into coding, what you ve done during your coding career, and where you work now. I have a bachelor s degree in Business Management and an associate degree in Computer Science, yet somehow my lifelong career is medical billing and coding. It could be because I ve always had an interest in learning new things. There is always so much to learn in this field and I am so glad I got into it. While working as the office manager/ bookkeeper in an ophthalmologist office, a medical biller position became available, and I jumped on it. I had taken a medical billing course a few years prior, but I did not have any experience. Thank God my former boss and his wife gave me a chance, and I did GOT A MINUTE? If you are an AAPC member who strives to advance the business of healthcare, we want to know about it! Please contact Michelle Dick, executive editor, at michelle.dick@aapc.com, to learn how to be featured. not let them down. I later also worked a parttime billing job at an obstetrics/gynecology office, where I work today full-time. I ve since obtained my Certified Professional Biller (CPB ) and Certified Professional Practice Manager (CPPM ) credentials, and I am working on my Certified Professional Coder (CPC ) credential. What is your involvement with your local AAPC chapter? Unfortunately, there are no local chapters on St. Croix, U.S. Virgin Islands. That is something that would be very beneficial to the healthcare business professionals on the island for resources, networking, and socializing. What AAPC benefits do you like the most? I like reading the wonderful articles in Healthcare Business Monthly magazine the most. They cover a wide variety of topics that keep me up to date, informed, and inspired. It s inspirational to read about other AAPC members and their accomplishments and journeys. I also appreciate the Member Perks discounts when I travel. How has your certification(s) helped you? My certifications have helped me to determine which area of study I love. When I initially looked into getting certifications, I noticed that everyone thought a medical biller and a medical coder were the same person. I researched both job responsibilities, and decided to obtain my CPB first and my CPPM second. I have been a biller and a practice manager for a combination of over 10 years, and my credentials confirm I have the right tools for the job. My credentials also help me to stay on top of my game, as I earn continuing education units (CEUs) every two years to stay current with the everchanging world of healthcare. Do you have any advice for those new to coding and/or those looking for jobs in the field? My advice is to never stop learning. In this field there is always something new to learn, and you need to stay on your game. Join your local chapter, read coding and billing magazines, and network with healthcare business professionals to get the information you need. There are so many areas you can go into such as billing, coding, auditing, compliance, and practice management; and the industry is always expanding. What has been your biggest challenge as a coder? My biggest challenge, which is also my greatest reward, is keeping up with all the changing government rules, payer policies, coding guidelines, and associated implementations. I want to make sure I am coding/billing correctly because I know how important my input is to healthcare statistics. If you could do any other job, what would it be? I d like to be a patient advocate. I have been on both sides of the fence, as a patient and healthcare professional, and there is a gap that needs to be filled. I think there are a lot of patients who don t understand their healthcare coverage. How do you spend your spare time? Tell us about your hobbies, family, etc. I spend my spare time working on my home-based business, making personalized pinback buttons. I have a niche for bringing people s ideas to life on a button. I also love watching YouTube videos about natural hair and learning how to make healthier lifestyle choices spiritually and nutritionally. I love hanging out with friends and family, especially my mother and sister. 66 Healthcare Business Monthly

67

68 What Is Your New Year Resolution? My new year resolution is to not have coding related denials and these books help me accomplish that. Tabitha Green, CPC Up To 74% Off 2017 Code Books For more details call: or visit: aapc.com/medical-coding-books