HEALTHCARE. BUSINESS MONTHLY Coding Billing Auditing Compliance Practice Management. MS-DRG May Spell TROUBLE: 32. Rock the Mock Audit: 48

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1 HEALTHCARE BUSINESS MONTHLY Coding Billing Auditing Compliance Practice Management April MS-DRG May Spell TROUBLE: 32 CMS looks at time for mechanical ventilation billing Rock the Mock Audit: 48 Don t let an external audit keep you up at night The Doctor Said What? 52 Have a laugh at ridiculous physician notes

2 Anaheim September 19-21, 2016 Disneyland Hotel $695 $345 THROUGH MAY CEUS 2.5 DAYS Atlantic City October 6-8, 2016 Harrah s Atlantic City

3 Healthcare Business Monthly April 2016 COVER Coding/Billing 35 Balance Billing: Is It Legal? By Mary Pat Whaley, FACMPE, CPC [contents] Coding/Billing Auditing/Compliance Practice Management 28 CPT 2016: Percutaneous Biliary Interventional Coding David Zielske, MD, CIRCC, CCVTC, COC, CCC, CCS, RCC 48 Rock the Mock Audit Lisa Jensen, MHBL, FACMPE, CPC 58 What (Not) to Wear While Job Hunting John Verhovshek, MA, CPC [continued on next page] April

4 Healthcare Business Monthly April 2016 contents Added Edge 16 Search Online for Healthcare Business Monthly Articles Michelle A. Dick Coder s Voice 20 CMS EHR Toolkit Gives a Glimpse into Potential Compliance Issues Sheri Poe Bernard, CPC, COC, CPC-I, CCS-P Coding/Billing 18 Examine Integumentary and Musculoskeletal Coding Changes John Verhovshek, MA, CPC 26 Conquer Common Billing Errors Judy A. Wilson, CPC, CPCO, CPPM, CPB, CPC-P, COC, CPC-I, CANPC 32 MS-DRG May Spell TROUBLE for Mechanical Ventilation Billin Leonta (Lee) Williams, RHIT, CPC, CPCO, CCS, CCDS 38 The Ins and Outs of Inpatient Psychiatric Facility Perspective Payment System Heather Greene, MBA, RHIA, CPC, CPMA Auditing/Compliance 42 The Latest on HIPAA: The Gun Check Rule Sue Miller OIG Work Plan: Part B Risk Areas Michael D. Miscoe, JD, CPC, CASCC, CUC, CCPC, CPCO, CPMA Practice Management 52 The Doctor Said What? Lori A. Cox, MBA, CPC, CPMA, CPC-I, CEMC 54 The Nine Cs of Clinical Documentation Improvement Ken Camilleis, CPC, CPC-I, COSC, CMRS, CCS-P COMING UP: Member of the Year MIPS Is Coming New Chapter Association Category III Codes Influence Providers On the Cover: To avoid the pitfalls of balance billing, Mary Pat Whaley, FACMPE, CPC, explains how to stay in line with private carrier rules and follow updated Medicare and Medicaid guidance. Cover image by istock. com/dny59. Cover design by Kamal Sarkar. DEPARTMENTS 7 Letter from CEO 8 Letters to the Editor 8 Chat Room 9 I Am AAPC 10 AAPC National Advisory Board 12 AAPC Chapter Association 13 Local Chapter News 14 Ethics Committee 66 Minute with a Member EDUCATION 60 Newly Credentialed Members Online Test Yourself Earn 1 CEU healthcare-business-monthly/archive.aspx 4 Healthcare Business Monthly

5 Looking to get certified? Students that complete our courses are TWICE AS LIKELY to pass the certification exam. ICD-10 integrated and interactive lectures with all coding and billing courses. CPC COC CIC CRC CPB CPMA CPPM CPCO For more information or to enroll visit:

6 Serving 155,000 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 Director of Publishing 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 April 2016 vendor index American Medical Association...13, 53 HealthcareBusinessOffice, LLC ZHealth Publishing, LLC Graphic Design Mahfooz Alam Kamal Sarkar Advertising Jon Valderama jon.valderama@aapc.com Address all inquires, contributions, and change of address notices to: Ask the Legal Advisory Board From HIPAA s 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 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. CPT copyright 2015 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 3 Number 4 April 1, 2016 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 CEO You Are AAPC s Strength is a membership organization, a collection of peers who help to improve healthcare for AAPC the whole country through our expertise in managing the business of healthcare. Beginning this month, AAPC celebrates our roles and common goals a number of ways. Be Part of the Fellowship at Conference AAPC s annual national conference, HEALTHCON, runs April 10-13, at Disney s Coronado Springs Resort in Orlando, Florida. In addition to sharing and learning about industry trends and solutions with other industry experts, attendees get the chance to make new friends and catch up with old acquaintances. This fellowship is important to AAPC, and essential to members. Also at HEALTHCON, we will celebrate both our 2015 Member of the Year and Chapter of the Year. The Member of the Year is someone who not only exemplifies the professional values of AAPC, but also has contributed to their colleagues success. The person we re praising this year has done all that and more, and I m excited to be a part of the celebration. The honorees will be featured in upcoming editions of Healthcare Business Monthly. For those of you who can t make it to HEALTHCON this year, AAPC is also holding regional conferences in Anaheim, California, September 19-21, at the Disneyland Hotel, and in Atlantic City, New Jersey, October 6-8, at Harrah s. Local Chapters: Our Grassroots AAPC s more than 500 local chapters are unique in our industry, and it s in our chapters where most of AAPC s networking happens. Few membership organizations can boast the enthusiasm and dedication of our chapter officers and attendees. Chapter members are privy to interesting, insightful, and useful presentations; fun social events; and caring community projects put on by local chapters all over the country. This year s Chapter of the Year stands out, but does not stand alone. Get Excited for May MAYnia Next month is May MAYnia, when all chapters open doors to new and existing members through special activities and speakers. Chapters compete to increase attendance the most, so be certain to attend your chapter s meeting next month. If you haven t taken advantage of the intelligence, support, and experience of your local chapter, try it! You have nothing to lose, and everything to gain. You can find out where and when your local chapter meets on AAPC s website at Together, we are raising the business of healthcare to new levels. Support Each Other and Strengthen Healthcare I m grateful for the opportunity to meet many of you at these events. Our strength is our membership. I gather strength from you and what you do to make AAPC such a vital organization. There are many new opportunities ahead of us, such as value-based payment, ongoing code updates, clinical documentation improvement, and other movements. Together, we are raising the business of healthcare to new levels. Sincerely, Jason J. VandenAkker CEO April

8 March Letters to the Editor Please send your letters to the editor to: HEALTHCARE BUSINESS MONTHLY Coding Billing Auditing Compliance Practice Management Michael S. Mix Up Our apologies to Michael Strong, MSHA, MBA, CPC, CEMC, and Michael Stearns, CPC, CFPC, for getting their bio photos mixed up on page 37 of the March edition. Fight for Insurance Carrier Payment: 27 Have a game plan that gets you paid The NPP Scope of Practice Scoop: 48 Meet state practitioner authorization requirements Time Is Ticking on Old Accounts: 55 Manage unpaid claims now to increase revenue Speak Up and Be Heard! Do you have a question regarding information found in Healthcare Business Monthly? Or maybe you have a difference in opinion you would like to share with your peers? Write us at: letterstotheeditor@aapc.com. Michael Strong, MSHA, MBA, CPC, CEMC Even Better Bronchoscopy in 2016 On page 24 of the March issue, in the article Better Bronchoscopy in 2016, the second paragraph lists the wrong deleted code. CPT is not deleted; add-on code is deleted, effective January 1, Chat Room CHAT ROOM Spreading AAPC Love through Social Media If you post on AAPC s Facebook page, many AAPC members and employees read your threads. Our staff enjoys reading your posts and appreciates your feedback especially when you spread positive messages to fellow members. Here are two posts that caught our eye this month: On February 15, Petersburg, Va., Local Chapter President Cynthia Briggs CPC, CPMA, shared a positive experience she had with AAPC Customer Service Representative Cindy Gigante. And later that month, our very own Vice President of Strategic Development Rhonda Buckholtz, CPC, CPCI, CPMA, CRC, CHPSE, CENTC, CGSC, CPEDC, COBGYN, took a moment to share her AAPC pride. Thanks ladies for spreading the love! 8 Healthcare Business Monthly

9 I Am AAPC LEANDREA ABERCROMBIE, CPC always wanted to work in the medical field. I My original plan was to become a medical assistant and use that position to pay for nursing school. Two years into working and halfway through my bachelor s degree program, I was diagnosed with systemic lupus erythemosis. My immune system forced me to consider a new career, and medical coding seemed interesting. I finished school fairly quickly. A lot of the classes were the same as a pre-nursing major, but if anybody had bad luck, I felt like I did. Hurdle One One month before graduation, the government postponed the ICD-10 implementation; however, my school had already started teaching ICD-10 because ICD-9 was slated to be obsolete by graduation. This meant I didn t know ICD-9 well enough to sit for a certification exam. Hurdle Two My school was AHIMA accredited and encouraged us to take the Certified Coding Specialist (CCS) test; however, the test was suspended indefinitely within weeks of graduation. All of my exam preparation was in vain. Hurdle Three I had to self-teach myself ICD-9 because I racked up a huge tuition bill and ran up my credit card with books and study materials. I began to work with a medical coder. She stated that medical coding was a progressive career and that outpatient was the best way to ease into the career and find where my niche would be. I was psyched and decided to sit for the Certified Professional Coder (CPC ) exam. Although I had been out of school for a year, I was already working with codes and felt fairly confident and ready. Unfortunately, I failed by an earth-shattering 1 percent. The road seemed so long, my career advancement was once again stalled, and I began to question whether this was truly the career for me. My husband believed I could pass and encouraged me to study. For four weeks, I studied day and night. I applied my studies to the coding I was doing at work. My husband and my father bought all the study materials AAPC had available. One month later, I passed the exam! Jump Those Hurdles and Never Give Up It was all about not giving up and having a strong desire to be in the field. I believe my obstacles have shaped me to be committed to the business side of healthcare and I am extremely proud of having the letters CPC behind my name. #IamAAPC #IamAAPC Healthcare Business Monthly wants to know why you chose to be a healthcare business professional. Explain in less than 400 words why you chose your healthcare career, how you got to where you are, and your future career plans. Send your stories and a digital photo of yourself to: Michelle Dick (michelle.dick@aapc.com) or Brad Ericson (brad.ericson@aapc.com). #IamAAPC April

10 AAPC NATIONAL ADVISORY BOARD Region 7 Mountain/Plains Two representatives team up to promote, serve, and support AAPC and its Region 7 members. A s a follow up to the January article The National Advisory Board Is Here to Serve You, we are spotlighting each of the eight regions and the National Advisory Board (NAB) members who represent them. In February, we featured Region 5 Southwest representatives; this month, we re zoning in on Region 7. Hamilton and Stephens have a one team philosophy, and they are passionate about strengthening AAPC members and paying it forward. I am passionate about everything I do, Stephens said at the first NAB meeting. That s what being a NAB member is about: loving what you do and wanting to share it with everyone. Region 7 - Mountain/Plains Glenda Hamilton, CPC, COC, CPC-P, CPMA, CEMC The Mountain/Plains region is comprised of Idaho, Utah, Arizona, New Mexico, Montana, Wyoming, Colorado, North Dakota, South Dakota, Nebraska, and Iowa. This region covers the largest number of states, with 14,662 members and 64 chapters. Glenda Hamilton, CPC, COC, CPC-P, CPMA, CEMC, and Angelica Stephens, RHIT, CPC, COC, COSC, CPMA, CCS-P, are the NAB representatives who promote, serve, and support AAPC and its Region 7 members. These representatives are unique in that they are from two totally opposite ends of the United States: Albuquerque, New Mexico, and Cherry Hill, New Jersey. When they became Region 7 representatives, it was like east meeting west. Although they hale from opposite ends of the country, they have the same professional goals. 10 Healthcare Business Monthly Hamilton has more than 26 years of experience in practice management, coding, reimbursement, education, auditing, and consulting. She joined Cooper University Hospital in 2005 as a clinical documentation educator, and is now senior compliance auditor. Hamilton also runs her own consulting business, offering expert witnessing for attorneys. Hamilton has been certified since An active member of the Cherry Hill, New Jersey, local

11 Regional Spotlight Angelica Stephens, RHIT, CPC, COC, COSC, CPMA, CCS-P Stephens also obtained her first certification in Over the past 20 years, she has accrued experience in coding, reimbursement, education, audits, and management. Her career has exposed her to several specialties, but her favorite is orthopedics. Always eager to learn, Stephens is studying home health coding and consulting for private practice. NATIONAL ADVISORY BOARD chapter, she has held multiple officer positions over the past 10 years, including vice president (twice), president (twice), member development officer, and education officer. She assists others with charitable acts and helps members to find jobs. Her professional ethics have influenced current officers with great success. Stephens worked as an auditor in a compliance department for three years before taking on the role of revenue services manager for an orthopedic practice in Albuquerque, New Mexico. She now holds the position of member development officer of the Albuquerque, New Mexico, local chapter, and is a member of the advisory board for the HIT Program at the local community college. Making Region 7 Stronger We hope you allow your NAB representatives to serve as a conduit to AAPC to ensure your voice is heard and your needs are met. Stephens and Hamilton are looking forward to meeting you at HEALTHCON in Orlando, Florida, on April Feel free to contact these representatives any time to share positive or negative feedback, seek guidance, or to just say, Hi! You can reach Hamilton at glenda.hamilton@aapcnab.com and Stephens at angelica. stephens@aapcnab.com. 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 April

12 AAPC Chapter Association By Judy A. Wilson, CPC, CPCO, CPPM, COC, CPC-P, CPB, CANPC, CPC-I Experiencing Hard Times THERE S HELP Life can throw you curve balls. Most of the time, you dodge them or knock them out of the ball park. But when one knocks you for a loop, and you need help getting back on your feet, look no further than your AAPC local chapter. Whether you find yourself homeless because of a natural disaster or experiencing financial difficulty due to illness, your chapter officers will gladly help you apply for assistance through Project AAPC and the Hardship Scholarship Fund. Project AAPC Established in 2010, Project AAPC further developed former AAPC Chapter Association Chair Jill Young s, CPC, CEDC, CIMC, vision for chapter members to help one another by donating to the American Red Cross or Feeding America after a devastating event. Project AAPC donated more than $10,000 to those organizations during the Nashville floods of 2010, all of which was collected by AAPC members and AAPC staff. After finding out that some of our members were unable to get the help they needed from those organizations, the AAPC Chapter Association board decided to donate all Project AAPC money directly to chapter members in need. Project AAPC assists chapter members with money for food, lodging, and basic necessities when there is a proven need. Since its inception, Project AAPC has helped many chapter members subjected to a devastating event. For example: Members recently affected by the South Carolina flood; A member with a severe illness preventing her from working; and 12 Healthcare Business Monthly A member who couldn t afford a bus pass to get back and forth to work. Hardship Scholarship Fund The Hardship Scholarship Fund was established in 2012 to help chapter members who have fallen on difficult times due to loss of job or the inability to find a job. The financial help is used for members to keep their credentials, and can be applied to the cost of the ICD-10-CM proficiency exam, renewing national memberships, or purchasing coding books. The Hardship Scholarship Fund is not given for additional credentials or non-essential needs. It provides for AAPC educational services, books, etc., but it does not cover workshops through AAPC or other organizations. This fund s main purpose is to help struggling chapter members keep the original credential they worked so hard to obtain. Some things to keep in mind when applying for this fund: You must be an AAPC member in good standing. You must be active in your local chapter. Consider first reaching out to your local chapter for a scholarship. To date, the Hardship Scholarship Fund has helped over 336 members, at a cost of $55,333.85, and more than $103, has been contributed to the fund. How to Apply The application for the Hardship Scholarship Fund can be found on AAPC s official website at scholarship-application.aspx. Remember to be Project AAPC and the Hardship Scholarship Fund are here to help chapter members. specific in the application about what you are doing for yourself and why exactly you need help. There is always hope and support, so please reach out when it is needed by you or another chapter member. Pay It Forward The Scholarship Application Review Committee is made up of past AAPC Chapter Association board members serving in an anonymous and voluntary role. This ensures the process is fair to all. The funds are supported through donations made by members and local chapters. If funds run too low, the ability to grant scholarships will be put on hold until more funds become available. Talk to your chapter about budgeting for a gift to these funds, so we can keep helping our members who are in need. You can also make a personal donation. Personal donations should be in the form of a check, payable to the AAPCCA Hardship Scholarship Fund or Project AAPC, and mailed to: AAPCCA-Project AAPC/ AAPCCA-Hardship Scholarship Fund 2233 S. Presidents Drive Salt Lake City, UT 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 served on the AAPC Chapter Association board of director from , and is serving from 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.

13 Local Chapter News Houston s New Year Celebration Fosters Success The Houston, Texas, local chapter kicked off 2016 with a Happy New Year! theme chapter meeting. The entire chapter was very excited about the first meeting of 2016, which everyone agreed was a success. President Drieca D. Hopkins, CPC, CBCS, said, Our speaker for the evening, Steven Woods, SHR-CP, PHR, did an awesome presentation called Preparing Your Resume for the Job You Want, Not the Job You Had. According to Hopkins, It was beneficial for seasoned coders as well as newbies, giving us great tips on resume writing and what recruiters expect to see on resumes. Houston also had a recruiter from K-Force present and share career opportunities. Houston s Member Development Officer Carmen Chaisson-Hunt, CPC, was instrumental in sharing multiple job opportunities with the attendees, as well as creating the chapter s Facebook page. As a returning officer, Hopkins said she is excited for a complete new board for 2016 sharing new and bright ideas. The chapter made a toast to 2016 with a little bit of the bubbly (sparkling cider). It was a great time of mixing and mingling; it was informative, as well as fun, said Hopkins. Houston classes it up with fancy meeting flyers. Houston rings in the new year with Instagram selfies. We want our meetings to be informative, engaging, and fun! Our goal is to get more member involvement, educate more on ICD- 10, promote certification, and be a BIG help to our uncertified members, said Hopkins. That s the way they do things in Texas: BIG! Houston shows members that everything is bigger in Texas, even local chapter meetings. Crack specialty coding with the American Medical Association s 2016 CPT Coding Essentials series the perfect companion to your CPT Professional codebook This six-book series comes straight from the source of CPT code the AMA and exclusively provides the CPT Editorial Panel s Guidelines instructions on ICD-10-CM documentation and coding. To learn more, visit amastore.com or call (800) Series includes: Cardiology 2016 General Surgery & Gastroenterology 2016 Obstetrics and Gynecology 2016 Ophthalmology 2016 Orthopedics: Lower Extremities 2016 Orthopedics: Upper Extremities And Spine April

14 AAPC Ethics Committee By Michael D. Miscoe, JD, CPC, CASCC, CUC, CCPC, CPCO, CPMA A Question of What do you do when coding productivity is more important than ethics at your workplace? I have noticed AAPC has an abundance of information regarding coder ethics, but not very much information of how the ethical coder is to react in a not-so-ethical environment. Many of the coders I know are employed in an environment where ethics fall far below productivity on the scale of importance. How are we to stand up to this type of pressure? We are repeatedly beaten down for productivity numbers, and the terms quality, accuracy, and integrity are not even part of the vocabulary. It s all well and good to demand a level of ethics of your membership, but your membership has to be able to work under circumstances that are quite a different story. And the membership needs to work to pay your dues. Why do you constantly pander to the health systems and push the ethical agenda? The members are paying the dues, give us recourse to do what is ethical. Be ethical, be respectful, be responsible. But please, tell us how to deal with monopoly health systems who don t care about our ethics or if we are employed and able to pay our membership dues, but still expect us to be caring people, caring for people. Thank you for your question. You raise an excellent issue. There are often competing demands and your commitment to professional and ethical behavior will help you make correct choices. I would point out that the AAPC Code of Ethics addresses more than just the quality of your professional work. Although I understand that the demands of productivity can sometimes impact quality, the Code of Ethics is not designed to punish mistakes. And while you should strive to be both efficient and accurate, there is a breaking point. That s your employer s problem, not yours. When you re pushed to be more productive, it s likely that quality and accuracy will suffer. If that is the case, your obligation is merely to raise the issue with your employer. If they are willing to compromise quality for perceived productivity, so be it. You have met your obligation by raising the concern. Because your employer, as an entity, is not likely subject to the AAPC Code of Ethics, you can t make them do the right thing. That s the job of law enforcement and/or carrier special investigative units. The Ethics Committee would never waste time on a case where your coding was deemed inaccurate because you weren t given sufficient time to do your job properly, especially where you expressed the concern with your employer. The impact of those mistakes will fall where they belong, on the practice. The practice will be forced to refund overpayments or may suffer payment delays or denials because of those mistakes. Although the practice may seek to place the blame on you for the errors, the evidence of your previously-raised concerns would undermine such allegations. Relative to your work as a coder, the Code of Ethics would come into play only if you purposefully or negligently misrepresented services for the purpose of receiving some personal benefit. That doesn t seem to be the issue here. Productivity improvement and efficiency are not improper goals for any organization; they are key to profitability. There is a balance, however, that must be found. At some point, pure productivity based on how many claims you must code becomes counterproductive when you have insufficient time to ensure codes reported are justified or accurate. As to your question relative to the motive behind the Code of Ethics, it s in no way a form of pandering. AAPC members can be found working on behalf of providers, payers, and the government. Our ethical standards exist because we cannot call ourselves a professional organization without them. All professions impose and enforce ethical standards on their members. Our commitment to ethical conduct, as well as educational standards as measured through testing, is what separates us from others who have not had to demonstrate their competence in the areas of coding, billing, auditing, practice management, or compliance. For that reason, AAPC credentialed members have more value in the marketplace. Ultimately, you are the only person who can determine how you will act or react in a given circumstance. The Code of Ethics is a guide to help ensure you act or react in a professional manner. 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 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 and HIPAA OCR matters. Miscoe speaks on a national level, and is published nationally on a variety of coding, compliance, and health law topics. He is a member and past president of the Johnstown, Pa., local chapter. istock.com/travellinglight 14 Healthcare Business Monthly

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16 ADDED EDGE By Michelle A. Dick Search Online for Healthcare Business Monthly articles Looking for guidance on a particular topic you remember seeing in our magazine? Here s how to find it on the Web. Whether you re stuck on a particular code, modifier, or bundling rules, or have limited resources to find guidance unique to your specialty, chances are the answers you seek are somewhere in Healthcare Business Monthly s archives. AAPC makes it easy for you to find the article you re looking for online. It s at Your Fingertips Many times members contact us, asking: I remember reading an article in Healthcare Business Monthly magazine about a year ago with guidance on code Can you me the article? or Do you have information on interventional radiology? I think I saw guidance in a past issue, and I d like to use it for a presentation handout. In fact, all Healthcare Business Monthly articles are on the AAPC website in the News & Blog section, and you can search through them using keywords. For example, you remember recently seeing guidance on percutaneous vertebroplasty CPT code 22510, but can t remember what article or month it appeared in the magazine. Here s how to find the article: Log on to AAPC s website using your user name and password. Go to the News & Blog Web page at: On the right side of the Web page, under the blue tabs across the top, there s a search engine text box labeled Search Blog. Type in the Search Blog text box and then click on the magnifying glass search symbol next to it. Tip: Be sure not to type the code in the search box at the very top of the page. That box will search the entire AAPC website, not just the news and article feeds. Type in the box shown in above. All articles and news blogs that have the keyword in it will display, such as Vertebroplasty Quick Coding Guide, Solidify Your Vertebroplasty and Kyphoplasty Coding, CPT 2015: Sizable Changes for Drug Testing Codes and Others, and Vertebroplasty Is Not Vertebral Augmentation. Click on the link to read the article. Narrow Your Search To display only Healthcare Business Monthly articles, there is a pull-down menu on the page under the Search Blog text box labeled Other Categories. Hover your mouse over it and you ll see Healthcare Business Monthly Archive. Click on it and your search will be limited to only magazine articles. Under the Other Categories pull-down menu, you can also search by certain topics. For example, Coding Blog, Auditing Blog, Client Services, ICD-10, Home Health, CMS, Infographics, etc. Always Check Your Sources You should always verify all coding guidance found on AAPC.com and other coding websites with original sources (i.e., government regulations, payer guidance, CPT, ICD-10, HCPCS Level II, specialty societies, etc.) before taking the advice. We hope you enjoy using our site as a research tool for your next coding, auditing, or practice management challenge. Michelle A. Dick is executive editor at AAPC. Be sure to use the second search box, not the one at the very top of the Web page. 16 Healthcare Business Monthly

17 Access Your AAPC Passport Savings Today! It s as easy as 1 Register at aapc.com/passport 2 Download the Passport mobile app 3 Login and save! Visit aapc.com/passport to register for your Passport number. You ll need the unique AAPC code: ATBOHC15 to register. Your Passport number will be ed to you. Download the Passport mobile app by searching for Passport Mobile in your phone s marketplace. Enter your Passport number and start saving! In addition to the mobile app, you can view participating savings by visiting

18 CODING/BILLING By John Verhovshek, MA, CPC Examine Integumentary and Musculoskeletal Coding Changes Overlooking minor changes can be a costly mistake. Within the Surgery section of CPT, the new year brings just two new Integumentary codes, and deletes a single Musculoskeletal code. Minor changes such as these are easy to overlook, but costly to ignore. Integumentary Updates Fiducial markers serve as radiologic landmarks. Using imaging guidance, each marker is placed in or near a tumor and becomes the target to facilitate precise delivery of radiation treatments. CPT adds two codes to describe placement of these devices: Placement of soft tissue localization device(s) (eg, clip, metallic pellet, wire/needle, radioactive seeds), percutaneous, including imaging guidance; first lesion each additional lesion (List separately in addition to code for primary procedure) Report and per lesion, not per marker (several markers may be placed per lesion). Claim for placement of soft tissue markers at an initial lesion and for each additional lesion targeted beyond the first. The American Medical Association s (AMA) CPT Changes 2016: An Insider s View provides an example of proper application for 10035: istock.com/kot63 A 62-year-old female presents with previously biopsied left axillary lymph node metastases secondary to invasive ductal breast carcinoma. She is now referred for neoadjuvant chemotherapy. Marking of the positive lymph node is requested prior to the initiation of neoadjuvant chemotherapy. Note that CPT includes several codes that specifically describe placement of localization devices in the breast, either with ( ) or without ( ) biopsy. CPT Changes 2016 clarifies, and have been established to capture marker placements into areas such as the axilla and/or groin tissue. Do not report 10035/10036 if or better describe the location of the marker. Per CPT Assistant (May 2015): To report bilateral image-guided breast biopsies, report code 19081, 19083, or [depending on the type of imaging used; e.g., stereotactic, ultrasound, or MRI] for the initial biopsy. The contralateral image-guided breast 18 Healthcare Business Monthly Coding/Billing Auditing/Compliance Practice Management

19 To discuss this article or topic, go to Integumentary/Musculoskeletal biopsy and each additional image-guided breast biopsy are then reported with code 19082, 19084, or Similarly, to report bilateral marker placement, report code 19281, 19283, or [again, depending on the type of imaging used] for the initial marker placement. The contralateral and each additional breast image-guided marker placement are then reported with code 19282, 19284, or Marker placement includes imaging guidance. Do not separately report: istock.com//elnur Ultrasonic guidance for needle placement (eg, biopsy, aspiration, injection, localization device), imaging supervision and interpretation Code 21805, which previously described open treatment of rib fracture without fixation, is deleted for 2016 as an obsolete service. CODING/BILLING Fluoroscopic guidance for needle placement (eg, biopsy, aspiration, injection, localization device) Computed tomography guidance for needle placement (eg, biopsy, aspiration, injection, localization device), radiological supervision and interpretation Magnetic resonance guidance for needle placement (eg, for biopsy, needle aspiration, injection, or placement of localization device) radiological supervision and interpretation There are no guideline or parenthetical instruction revisions in the Integumentary chapter for Open Treatment of Rib Fracture Is No Longer Supported Code 21805, which previously described open treatment of rib fracture without fixation, is deleted for 2016 as an obsolete service. CPT Changes 2016 explains, In current practice, when an injured rib is treated in an open fashion, it is either resected or treated with some form of internal fixation. Because existing codes for open rib fixation and codes for rib excision (21600) may be used to identify open rib treatments, code has been deleted without replacement Instruction in the CPT codebook tells us to report Unlisted procedure, neck or thorax for external rib fixation. CPT further directs us to report an evaluation and management (E/M) service for closed treatment of an uncomplicated rib fracture (e.g., the fracture is reduced without surgical intervention). Turn to for open (surgical) treatment of rib fracture(s) with internal fixation (the use of plates, screws, nails, and wires to stabilize the rib fracture). There are no guideline or parenthetical instruction revisions in the Musculoskeletal chapter for John Verhovshek, MA, CPC, is managing editor at AAPC and a member of the Hendersonville-Asheville, N.C., local chapter. April

20 CODING/BILLING By Sheri Poe Bernard, CPC, COC, CPC-I, CCS-P Coder s Voice CMS EHR Toolkit Gives a Glimpse into Potential Compliance Issues istock.com/pandpstock The toolkit clarifies risks and provides guidance, but more can be done to address software and user pitfalls. 20 Healthcare Business Monthly Without any fanfare, the Centers for Medicare & Medicaid Services (CMS) last year published its Electronic Health Records Toolkit, offering coders, facilities, and providers a glimpse of the regulatory risks that CMS assigns to improper EHR use. Anyone with an EHR who hasn t reviewed the CMS documents should access the Toolkit and distribute all or parts of it to providers, coders, and legal counsel, as appropriate. Although the Toolkit falls short of answering many questions regarding documentation and coding compliance, it gives a glimpse into what CMS considers the important regulatory issues associated with electronic records, and provides some rudimentary guidance. Coding/Billing Auditing/Compliance Practice Management

21 CMS Toolkit For example, the Toolkit file, Ensuring Proper Use of Electronic Health Record Features and Capabilities: A Decision Table, states these best practices: providers must recognize each encounter as a stand-alone record, and ensure the documentation for that encounter reflects the level of service actually provided. It further recommends creation of an internal policy, in which: providers should weigh efficiency against the potential for inaccurate, fraudulent, or unmanageable documentation. Regarding authorship of an EHR entry, the Toolkit advises: Each entry not solely authored by the user must be validated in a manner similar to bibliographic notations and include the name, date, time, and source of the data. This can be satisfied by system software design that routinely provides validation. Documents in the CMS Electronic Health Records Toolkit include: Program Integrity Issues in Electronic Health Records: An Overview Resource Handout Resources for Program Integrity in Electronic Health Records Detecting and Responding to Fraud, Waste, and Abuse Associated With the Use of Electronic Health Records Booklist Preparing for and Responding to Audits of Electronic Health Records Checklist Detecting and Investigating Unauthorized Access to Electronic Health Records A Case Study Compliance Checklist for Electronic Health Records A Compliance Program for Electronic Health Records Fact Sheet Ensuring Proper Use of Electronic Health Record Features and Capabilities: A Decision Table Documentation Integrity in Electronic Health Records Conducting Internal Monitoring and Auditing Job Aid Manual Review of Electronic Health Records Job Aid Although CMS waited six years after HITECH to publish its first EHR guidance, the CMS Toolkit remains fuzzy in its vision regarding clinical documentation and coding issues relating to EHRs. CMS Hasn t Defined Clinical Documentation Expectations CMS became a key player in the EHR arena in 2009, when the federal government enacted the Health Information Technology for Economic and Clinical Health (HITECH) Act as part of the American Recovery and Reinvestment Act. HITECH was designed to stimulate adoption of EHRs capable of advancements in patient care quality, including e-prescribing and interoperability. Incentives of up to $44,000 per provider were offered for timely implementation of EHRs, along with a small penalty of approximately $500 per year for Medicare-participating providers who failed to implement compliant EHR systems within the CMS timeline. The Office of the National Coordinator for Health Information Technology (ONC) developed an EHR certification program to limit risks to providers and facilities shopping for EHRs, and to ensure providers receiving the incentive purchase legitimate EHRs. The ONC certification covers issues identified by the U.S. Department of Health and Human Services (HHS) as critical to national EHR success, mostly involving format structure that is easily transmitted and retrieved, but that is also secure and private and has meaningful use. These certification programs were in place when EHR purchases under HITECH began, but it s important to understand that the EHR certification criteria predominantly address administrative and information technology-related content. Some clinical issues were included when they satisfied HHS initiatives such as performance measures and e-prescribing; however, certification failed to CODING/BILLING April

22 CMS Toolkit Top EHR Misconceptions CODING/BILLING You can improve your income with electronic health records (EHRs). Vendors may promise EHRs provide an easy way to cut costs by reducing the number of employees needed in a practice, and increase income by improving provider productivity. Although the need for file clerks may be reduced with EHRs, the number of coders, schedulers, and other office personnel will likely remain steady, or grow. Increased productivity may come with time, but to date this either hasn t panned out in the short term for most practices, or has resulted from noncompliant up-coding. What EHRs should provide is enhanced levels of patient care, easier use of some mandated programs, increased efficiency in compliant documentation and coding practices, and safeguards for patient health. Automated E/M levelers in EHRs save time and ensure optimal coding levels. Some EHRs will automatically calculate the E/M level for an office visit, but because issues of medical necessity and failure to require qualitative features in the history of present illness; review of systems; past, family, and social history; physical exam; and clinical assessment, the EHR coding is unlikely to fare well in an audit. You re stuck with the features in an EHR. Many of the documentation features within an EHR can be edited by your information technology team or the vendor. If a feature is being misused or is simply one that you suspect may not be compliant, modify the system. EHRs are modifiable. Vendors may require a significant fee for modifications. All features within a government certified EHR are acceptable to all payers. Many EHR features raise compliance questions. The U.S. Department of Health and Human Services sent a letter to U.S. hospitals in September 2012 stating that the cut-andpaste feature of some EHRs risks medical errors as well as overpayments, and said, CMS has the authority to address inappropriate increases in coding intensity in its payment rules and CMS will consider future payment reductions as warranted We will continue to escalate our efforts to prevent fraud. Just because a feature is available in a certified EHR does not make it compliant with payer rules. Have your compliance department review the documentation and coding performed through your EHR. Many providers and coders today cite degradation of the clinical record as a result of templates, micros, macros, and copy/paste, and are looking for a fix. address non-compliant, day-to-day coding and clinical documentation features in EHRs, which focused on time-saving macros (often mislabeled as templates) and quick-pick lists of codes. Certification had little to do with clinical documentation excellence or coding accuracy and compliance; some clinical and coding advocates are hopeful that the Toolkit will fix some of that deficiency. Although CMS waited six years after HITECH to publish its first EHR guidance, the CMS Toolkit remains fuzzy in its vision regarding clinical documentation and coding issues relating to EHRs. For example, with the EHR feature called populating by default, a review of systems (ROS) or physical exam is already filled out for the provider for a new date of service. The form shows all systems are normal. The provider changes only the systems having abnormalities in the review or exam. The problem with populating by default is that it reports work the provider may not have performed because it assumes all body systems were reviewed and a complete physical exam was performed. This plays havoc with evaluation and management (E/M) leveling. Although stating that populating by default may result in the reporting of services that were not delivered, the Toolkit falls short of outlawing population by default; instead, saying the provider should verify the validity of auto-populated information. It offers no best practices solution for populating by default, although a simple best practice might be to turn off this function in the EHR. EHR Problem Areas to Watch In some instances, in Ensuring Proper Use of Electronic Health Record Features and Capabilities: A Decision Table, CMS states in the best practices field that there are none to report at this time. It s not known whether we can look to CMS for more detailed and helpful guidance in the future. Many providers and coders today cite degradation of the clinical record as a result of templates, micros, macros, and copy/paste, and are looking for a fix. The medical record is becoming so large and unwieldy as to be indecipherable, Steven J. Stack, MD, chair of the American Medical Association (AMA), said in an address to CMS in CMS should provide clear and direct guidance to physicians concerning the permissible use of EHR clinical documentation for the purposes of coding and billing. EHR improvement aligns with CMS goals, too. The Evaluation and Management Services Guide issued by CMS states: Clear and concise medical record documentation is critical to providing patients with quality care and is required in order for providers to receive accurate and timely payment for furnished services. Medical records 22 Healthcare Business Monthly

23 CMS Toolkit Providers can save time and money using EHR coding pick lists or coding prompts. EHRs include current codes from the major code sets, and providers can use these lists to code encounters and either submit these codes directly or have them reviewed by coding/billing staff before submission. But nearly all systems lack code instructions, guidelines, and information from Coding Clinic or CPT Assistant. Most providers are not certified coders and do not have the breadth of understanding to select codes compliantly. Truncated code descriptions in some EHRs also contribute to coding errors. Certified coders should be excluded from EHR selection teams. Some vendors exclude coding staff from EHR selection, and suggest that certified coders are not qualified or interested. Neither is true. Coders can help providers and office managers understand the coding and compliance implications of EHR features. Their input is crucial to successful coding following implementation. EHR templates (i.e., macros) provide more detailed documentation. EHRs certainly provide more documentation, but not necessarily more detail. EHR templates catalog body systems and most allow the provider to select a button stating the system is normal or abnormal, or yes or no. Free text, where providers can enrich the record by describing qualitative details, is limited in most EHRs. Instead of stating yes to shortness of breath (SOB), free text allows the provider to state, SOB on exertion. Says he can no longer negotiate stairs at home, and became dyspneic in relating this to me. O2 on room air was 87. It is the qualitative information within the health record that provides the most information to clinicians and coders. Purchasing a federally certified EHR ensures it will be completely compliant. Certified EHRs are equipped with software that makes them compliant with portability, privacy, and security requirements, as well as some clinical tools including tracking preventive care and performance measures and the ability to detect and advise about prescriptions that could cause allergic or drug interactions. Certified EHRs are not equipped to contribute in any meaningful way to clinical documentation or coding compliance, and most do not follow the 1997 Documentation Guidelines for Evaluation and Management Services, the CMS policy on medical necessity as overarching criteria for E/M and payment, or avoidance of cloning practices and templates as outlined in documents published by CMS beginning in 1999 and continuing to CODING/BILLING chronologically report the care a patient received and are used to record pertinent facts, findings and observations about the patient s health history. Medical record documentation assists physicians and other health care professionals in evaluating and planning the patient s immediate treatment and monitoring the patient s health care over time. Stephen Levinson, MD, CHCA, author of AMA publications Practical E/M and Practical EHR, identifies five intrinsically flawed design and functionality features that are prevalent in most current EHRs. These flaws, according to Levinson, are capable of disrupting both compliance and physicians medical diagnostic process: 1. Failure to consider medical necessity (which Medicare defines as the overarching criterion for payment ) into guidance for appropriate levels of care, documentation, and code selection. According to the AMA s CPT guidelines for E/M, considering (and documenting) the nature of the presenting problem(s) provides confirmation and support for medical necessity. 2. Failure to guide and require documentation of the qualitative (i.e., individualized descriptive) aspects of care as defined in 1997 Documentation Guidelines. Required qualitative data includes, for: àà Chief compliant: stated in the patient s own words (rather than a forwarded copy of previously entered diagnosis); àà HPI: the chronological description of the course of the patient s illness; àà PFHS and ROS: supplementing with pertinent positive and negative responses to inquiries about details of the positive responses to questions in these history areas; àà PE: specific abnormal and relevant negative findings ; and àà Clinical assessment: patient-specific and visit-specific descriptions of diagnoses (e.g., location, severity, extent, and status relevant to previous encounters). 3. Non-compliant coding engines (based on the non-sanctioned, incomplete, and non-compliant scoring sheet introduced as a coding short cut in Use of data entry shortcuts that create non-compliant cloned pseudo documentation through automated function. 5. Use of data entry shortcuts that replace documentation of clinical assessment (i.e., impressions ) with ICD billing language and codes, a process that limits clinical descriptions and eliminates documentation of differential diagnoses. These EHR documentation problem areas should be identified and addressed because they are subject to the financial and emotional devastation of negative Medicare or Office of Inspector General (OIG) audits. Levinson also advises, It is important to distinguish between EHR utilization of (compliant) templates vs. (non-compliant) macros. Templates are pre-loaded frameworks that include history questions to be asked with individualized documentation of the responses or exam elements to be examined with individualized documentation of the findings. April

24 CMS Toolkit To discuss this article or topic, go to CODING/BILLING These EHR documentation problem areas should be identified and addressed because they are subject to the financial and emotional devastation of negative Medicare or Office of Inspector General (OIG) audits. Macros include the templated questions, plus pre-loaded generic negative history responses and normal exam findings As automatic or single-click tools, the macro loads a completed clinical document before the patient has even been evaluated, Levinson said. Levinson also emphasizes that coders and auditors require comprehensive and compliant tools that consider medical necessity when reviewing EHR documentation and coding. The commonly-employed, non-compliant scoring sheet not only offers inadequate and incorrect E/M coding in paper records, but it completely lacks tools to address the aforementioned five deficiencies of EHRs. Practical E/M s compliant audit forms for paper charts were published as part of a CD accompanying the second edition of Practical E/M in These forms were subsequently enhanced to consider all the above EHR danger areas; PDFs of these coding and audit charts were made available through AAPC in conjunction with Levinson s 2013 AAPC Workshop, Advanced E/M Coding for EHRs ( Sheri Poe Bernard, CPC, COC, CPC-I, CCS-P, is a coding education and risk adjustment consultant and author of the AMA publication, Netter s Atlas of Surgical Anatomy for CPT Coding. Her 20-year career in coding and reimbursement includes developing coding curriculum and references for AAPC, the AMA, DecisionHealth, Elsevier, Optum360, and Staywell. Bernard is a member of the Salt Lake City, Utah, local chapter. istock.com/mkurtbas Resources CMS, Electronic Health Records Toolkit, Program Integrity: Electronic Health Records files: Integrity-Education/electronic-health-records.html CMS, Ensuring Proper Use of Electronic Health Record Features and Capabilities: A Decision Table, Table 1: Prevention/Medicaid-Integrity-Education/Downloads/ehr-decision-table.pdf CMS, Medicare Learning Network, Evaluation and Management Services Guide: www. cms.gov/outreach-and-education/medicare-learning-network-mln/mlnproducts/ downloads/eval_mgmt_serv_guide-icn pdf 24 Healthcare Business Monthly

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26 CODING/BILLING By Judy A. Wilson, CPC, CPCO, CPPM, CPB, CPC-P, COC, CPC-I, CANPC Conquer Common BILLING ERRORS Avoid three frequent billing blunders to keep revenue streams flowing. Financial problems can be directly related to billing errors that could have been avoided simply by reviewing information. Errors can cause delayed payment, costly fines, and lost revenue if not caught. Let s take a look at a few of the top billing errors, and discuss how to prevent them. Verify Insurance The number one reason, by far, for denied claims is failure to verify insurance. Some of the common denials associated with not verifying insurance information are: 1. Subscriber is not eligible on the date of service. 2. Services are not covered or maximum benefits have been met. 3. Services were not authorized or authorization is required. When you see these denials, I am sure you ask, Why didn t someone take care of this before we filed the claim? With people changing jobs and moving more often, insurance information can change at any time. For this reason alone, your office should verify a patient s insurance eligibility at every visit. 26 Healthcare Business Monthly For example, you might establish parameters in your billing practice disallowing a claim that requires a pre-authorization to be filed without the authorization number. At the very least, a person should call carriers on every patient prior to a procedure to verify eligibility and the limits of the patient s benefits. It takes a little longer, but it s well worth the extra time on the front end. Remember: Each time you start over with a claim, you are losing money and filing inaccurate claims. Be Sure Your Information Is Complete Another common error is inaccurate or incomplete patient information. Even the smallest error in a patient s name can get a claim denied. This is why your front desk person is a valuable employee: He or she can help to reduce denials by checking to make sure the patient s name is spelled correctly and that you have the right date of birth and sex (for starters). The front desk person can also verify if the policy is valid and if you need a group number or authorization number prior to processing the claim. Coding/Billing Auditing/Compliance Practice Management istock.com/dina2001

27 Billing Errors Slow down and take extra time to verify and input patient information correctly, and check your procedure and diagnosis coding prior to billing. CODING/BILLING Be sure authorizations obtained are for procedures performed, and procedure codes and diagnostic codes reflect as much. This is another common billing error that is easily corrected by taking the time to look over the claim before processing. Always use the most current coding books. Some offices may think that it s too expensive to get new books every year, but claim denials can be much more costly. Criminal allegations may arise if you use procedure and diagnosis codes incorrectly. If the provider is still using handwritten charts and their writing is illegible, you cannot transcribe what you think the documentation says. If it s incorrect, you now have a false claim. This is where the electronic health record has helped to reduce billing errors. Avoid Duplicate Billing Lastly, let s look at duplicated billing, as this is a very common billing error, as well. Duplicate billing for the same procedure or treatments is considered fraud, and a practice can be fined for duplicate billing. If a claim is not paid within a timely matter, never just rebill the claim. Take the time to contact the insurance carrier to check on the status of the claim. Most carriers allow you to check claim status online, but the alternative is to call them. All systems now should have a way to check how long a claim has been outstanding. Your office insurance representative should follow up on all claims aged over 30 days. To reiterate: Never simply re-bill a claim that has not been paid. Rebilling can lead to another denial for duplicate billing, or worse duplicate payment, which may subject your practice to fraud. To avoid these common errors, take time to verify and input patient information correctly, and check your procedure and diagnosis coding prior to billing. These basic steps will keep your revenue flowing. Plus, it s always easier to do it right the first time. 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. April

28 CODING/BILLING By David Zielske, MD, CIRCC, CCVTC, COC, CCC, CCS, RCC CPT 2016: Percutaneous Biliary Interventional Coding Part 2: New codes change the way you should report these procedures. For 2016, the biggest CPT coding changes affecting interventional radiology occur within the subspecialties of urinary, biliary, and neurologic intervention. In March, we covered urinary intervention. This month, we ll discuss the major changes in percutaneous biliary interventional coding. Next month, we ll cover CPT updates for percutaneous neurologic intervention. Anatomically Speaking The biliary system is divided into right- and left-sided bile ducts; however, these ducts divide further into multiple smaller branches that may be individually accessed and drained, depending on the pathology treated (e.g., Klatskin tumor is a cholangiocarcinoma that has involved and caused bifurcation occlusions of the common bile duct. As Biliary obstruction at the distal common bile duct it grows further, it may compromise additional ducts requiring three or four catheters for successful drainage). Terminology for biliary procedures refers to either catheters (which are externally accessible, such as an internal/external biliary drainage catheter) or stents (which are not externally accessible, such as a metallic biliary stent). New Codes for 2016 There are 14 new biliary intervention codes for 2016 (see New Biliary Intervention Codes for 2016 on page 29 ). These codes include both the surgical and supervision and interpretation (S&I) components of the procedure. As well, all of the new codes bundle the use of imaging guidance, including fluoroscopy, ultrasound, computed tomography (CT), and magnetic resonance imaging (MRI). CPT guidelines instruct us to code separately for each catheter placement, replacement, conversion, or removal. Catheter procedure codes are based on each individual catheter via a separate access site. Here s a rundown of how to apply the new codes. Illustrations courtesy of ZHealth Publishing, LLC 28 Healthcare Business Monthly Cholangiography Cholangiography (47532 and 47531) is performed to evaluate the biliary system for patency, stones, strictures, malignancy, and leaks. These abnormalities can occur anywhere in the collecting system, but most often are between the ampullary sphincter of the distal common bile duct and the bifurcation of the more proximal common bile duct. The cholangiogram may be performed via a new access (placing a needle or catheter through the right side or anterior abdominal wall into the right or left bile ducts respectively) or via a pre-existing catheter, usually an existing biliary catheter. Contrast is injected and imaging is performed and interpreted. The procedure is reported with when performed via a new access, or with when performed via an existing access. Because imaging guidance is performed, be sure the ultrasound, CT, or MRI tech does not charge a guidance code when the access uses one of these imaging guidance modalities. Coding/Billing Auditing/Compliance Practice Management

29 Urinary New Biliary Intervention Codes for 2016 Diagnostic cholangiography Injection procedure for cholangiography, percutaneous, complete diagnostic procedure including imaging guidance (eg, ultrasound and/or fluoroscopy) and all associated radiological supervision and interpretation; existing access new access (eg, percutaneous transhepatic cholangiogram) Percutaneous biliary drainage catheters Placement of biliary drainage catheter, percutaneous, including diagnostic cholangiography when performed, imaging guidance (eg, ultrasound and/or fluoroscopy), and all associated radiological supervision and interpretation; external internal-external Conversion of external biliary drainage catheter to internal-external biliary drainage catheter, percutaneous, including diagnostic cholangiography when performed, imaging guidance (eg, fluoroscopy), and all associated radiological supervision and interpretation Exchange of biliary drainage catheter (eg, external, internal-external, or conversion of internal-external to external only), percutaneous, including diagnostic cholangiography when performed, imaging guidance (eg, fluoroscopy), and all associated radiological supervision and interpretation Removal of biliary drainage catheter, percutaneous, requiring fluoroscopic guidance (eg, with concurrent indwelling biliary stents), including diagnostic cholangiography when performed, imaging guidance (eg, fluoroscopy), and all associated radiological supervision and interpretation Percutaneous biliary stent placements Placement of stent(s) into a bile duct, percutaneous, including diagnostic cholangiography, imaging guidance (eg, fluoroscopy and/or ultrasound), balloon dilation, catheter exchange(s) and catheter removal(s) when performed, and all associated radiological supervision and interpretation, each stent; existing access new access, without placement of separate biliary drainage catheter new access, with placement of separate biliary drainage catheter (eg, external or internal-external) Three add-on procedures: cholangioplasty, biopsy, and stone extraction Balloon dilation of biliary duct(s) or of ampulla (sphincteroplasty), percutaneous, including imaging guidance (eg, fluoroscopy), and all associated radiological supervision and interpretation, each duct (List separately in addition to code for primary procedure) Endoluminal biopsy(ies) of biliary tree, percutaneous, any method(s) (eg, brush, forceps, and/or needle), including imaging guidance (eg, fluoroscopy), and all associated radiological supervision and interpretation, single or multiple (List separately in addition to code for primary procedure) Removal of calculi/debris from biliary duct(s) and/or gallbladder, percutaneous, including destruction of calculi by any method (eg, mechanical, electrohydraulic, lithotripsy) when performed, imaging guidance (eg, fluoroscopy), and all associated radiological supervision and interpretation (List separately in addition to code for primary procedure) Access placement to assist with endoscopic biliary procedure Placement of access through the biliary tree and into small bowel to assist with an endoscopic biliary procedure (eg, rendezvous procedure), percutaneous, including diagnostic cholangiography when performed, imaging guidance (eg, ultrasound and/or fluoroscopy), and all associated radiological supervision and interpretation, new access Cholangiography is bundled with the new external biliary catheter, internal/external catheter, and biliary stent placement codes. The cholangiogram codes may be used as a base code for , , and , but only if a catheter is not placed, replaced, or converted. Example: A patient has an existing external biliary drainage catheter. Diagnostic cholangiogram is performed (47531), demonstrating a distal common bile duct stenosis. Cholangioplasty is performed (+47542). No tubes are left in place at the end of the procedure. The following codes involve placement of an external or internal/external biliary drainage catheter: describes the initial placement of a percutaneous external biliary drainage catheter via a new access, and includes diagnostic imaging Submit once for each external biliary drainage catheter placed via a new access at the same session describes the initial placement of a percutaneous internal/external biliary drainage catheter via a new access, and includes diagnostic imaging Submit once for each internal/external biliary drainage catheter placed via a new access at the same session describes the conversion of an existing external biliary drainage catheter to an internal/external catheter (removal of the external catheter and placement of the internal/external catheter over a wire, which requires crossing of the distal common bile duct into the small intestine), and includes diagnostic imaging. Submit once for each biliary catheter conversion at the same session describes the exchange of an existing external biliary drainage catheter/external biliary drainage catheter or exchange of an existing internal/external catheter for a lesser external catheter, and includes diagnostic imaging. Submit for each catheter exchanged at the same session describes the removal of an existing external or internal/external biliary drainage catheter, and includes diagnostic imaging. Submit once for each catheter removed at the same session. Example: The patient recently underwent external biliary drainage catheter placement for biliary obstruction and in- CODING/BILLING April

30 Urinary CODING/BILLING External biliary drainage Illustrations courtesy of ZHealth Publishing, LLC Internal/External biliary drainage fection. Now that the infection has subsided, a diagnostic cholangiogram is performed, showing distal common bile stenosis. The external biliary catheter is removed over a wire and an internal/external catheter is advanced with the distal tip in the small intestine and secured in position (Add for the conversion of an external catheter to an internal/external catheter. Do not report 47531, as it s bundled with this conversion). Initial Biliary Stent Placements There are three new codes for initial biliary stent placements. The codes differentiate existing access from new access: describes the placement of a completely internal stent (metallic or plastic) via an existing access (prior external biliary catheter or internal/external biliary catheter access) and includes exchange of an existing externally draining biliary catheter (if done); down-conversion to an external catheter (when the original catheter is an internal/external catheter); or removal of a catheter at the end of the procedure. Do not submit or with this procedure describes the placement of a completely internal stent via a new access without leaving a biliary catheter at the end of the procedure describes the placement of a completely internal stent via a new access with separate placement of an external or internal/external biliary catheter. Do not submit or with this procedure. 30 Healthcare Business Monthly All three codes include an initial cholangiogram (47532, 47531) and all imaging guidance (e.g., fluoroscopy, ultrasound, CT, MRI). Two stent codes can be submitted when double-barrel, or side-by-side, stents are placed for the treatment of a single stenosis (usually in the common bile duct from two approaches), when two separate accesses are used to place two stents, and when two stents are placed into two bile ducts for treatment of two separate stenoses. The stent codes may be used more than two times in individuals requiring multiple stents to treat multiple stenoses in different ducts. If multiple overlapping stents are placed via a single access, only one stent procedure code is submitted. Cholangioplasty is bundled when performed at the same site as a biliary stent deployment. Deleted and Revised Biliary Codes Twelve biliary CPT codes were deleted for 2016 (47500, 47505, 47510, 47511, 47525, 47530, 47630, 74305, 74320, 74327, 75980, and 75982), and five previously recommended endoscopic codes (47552, 47553, 47554, 47555, and 47556) should no longer be used for percutaneous procedures because new codes more accurately describe these procedures. Example: A patient with an existing external biliary catheter presents for conversion to an internalized metallic biliary stent (47538). At the end of the procedure, a new external biliary drainage catheter is placed over the guidewire due to excessive bleeding during the procedure (This is bundled with internal biliary stent placement.). New Code for Rendezvous Procedure Code describes the creation of an access into the biliary system for subsequent use by an endoscopist. The radiologist will create a new access into a bile duct and advance a wire and small catheter across the biliary system and ampulla into the small intestine. The catheter and wire are secured in position and sent to endoscopy, where the gastroenterologist advances an endoscope into the duodenum, snares the wire, and uses this wire to advance a stent or bal-

31 To discuss this article or topic, go to Urinary loon to complete that portion of the procedure. A cholangioplasty or stent placement by the radiologist can be submitted separately. If the radiologist leaves in a drainage catheter, or should be submitted instead of Do not submit when a pre-existing catheter is accessed to perform the rendezvous procedure. When done via an existing access, submit a code describing a catheter exchange, removal, or conversion (e.g., ). New Add-on Codes Codes , , and require a base code, which can be any of the catheter placement, conversion, or exchange codes, as well as diagnostic cholangiogram codes and describes cholangioplasty (balloon dilation) of any bile duct for treatment of a stenosis or occlusion, and can also be used to report balloon dilation of the ampullary sphincter (sphincteroplasty) for subsequent stone extraction. Submit once per treatment site, for a maximum of two sites treated per session. If more than two separate sites are treated with balloon dilation, no additional codes are submitted for the additional cholangioplasties. This may limit the number of cholangioplasties submitted in patients with sclerosing cholangitis. This limitation does not apply to stent placements. Cholangioplasty at the site of a stent placement during the same session is bundled and not separately coded. Because of add-on code edits, it may not be possible to submit with a biliary stent code ( ), even when done in different ducts. Do not use this code when a balloon catheter is used for stone extraction describes an endoluminal biopsy (brush, needle, or alligator forceps) of the biliary ductal system (common bile duct, intrahepatic bile ducts). If multiple bile ducts are biopsied, do not report additional procedure codes because all ducts biopsied are described by using this single code. Submit only once per date of service describes percutaneous biliary stone extraction by any method, and includes removal of stone(s) with a basket and/or pushed through the ampulla with a balloon. Do not use this code for removal of debris or sludge, and do not use With the new codes added in 2016, a comprehensive set of biliary codes is now available to describe almost every procedure performed in the biliary system. it with an attempted procedure modifier if stone retrieval is attempted, but no stones are identified. Use this code only once per session. A catheter placement, replacement, conversion, or removal code can additionally be submitted if done. An imaging code (47531 or 47532) can be submitted instead if the above catheter codes are not performed. Code may be used for stone extraction from the gall bladder via a cholecystostomy tube. The three add-on procedure codes vary in the number of times each code can be submitted per day, and depend on access sites/approaches, location, and extent of the lesions treated and the specific limitations on the codes submitted. Example: The patient has an internal/external catheter in place via a left anterior duct approach. The patient has a known filling defect in the region of the distal common bile duct, and is here for biopsy. The catheter is removed over a guidewire and a sheath is placed up to the abnormality. A brush biopsy followed by alligator forceps biopsy are performed and sent for pathology (+47543). A new internal/external stent is placed over the wire (exchange of biliary drainage catheter, 47536). Same Old Code May Be Used with New Codes Percutaneous cholecystostomy, which includes placement of a drainage catheter into the gallbladder (47490 Cholecystostomy, percutaneous, complete procedure, including imaging guidance, catheter placement, cholecystogram when performed, and radiological supervision and interpretation), remains unchanged in This procedure may be reported with new codes for tube check (47531), tube change (47536), tube removal (47537), and stone extraction (47544). With the new codes added in 2016, a comprehensive set of biliary codes is now available to describe almost every procedure performed in the biliary system. The opportunity for coding specificity has never been better. David Zielske, MD, CIRCC, COC, CCVTC, CCC, CCS, RCC, or Dr. Z, is the founder and CEO of ZHealth, LLC, and ZHealth Publishing, LLC. He practiced as an interventional radiologist for 15 years and has 16 years of experience as a coding reviewer and educator. Dr. Z is Board Certified in Radiology with the Certification of Added Qualification (CAQ) in Interventional Radiology (ABR) (1995, 2005). He was on the AAPC National Advisory Board from , and is a member of the Nashville, Tenn., local chapter. CODING/BILLING April

32 CODING/BILLING By Leonta (Lee) Williams, RHIT, CPC, CPCO, CCS, CCDS MS-DRG May Spell TROUBLE for Mechanical Ventilation Billing CMS is looking for time to support billed services. Look at the Time For billing, compliance, and reimbursement purposes, document the procedure appropriately, with the dates and time (in hours) of when the mechanical ventilation began and when it concluded. To calculate the number of hours of continuous mechanical ventilation by ET intubation during a hospitalization, begin counting from the start of intubation; the clock stops after weaning, extubation, or patient discharge/transfer. When a patient presents to the hospital already intubated, counting begins when the patient is admitted. istock.com/paulvinten mechanical ventilator is a device used to perform artificial respiration on a patient whose natural ability to breathe is compro- A mised. Mechanical ventilation may be ordered for various reasons, but it is generally used to get air into lungs, expel carbon dioxide from lungs, or breathe for someone who can t do it on their own. Mechanical ventilation may also be used to help someone short of breath due to a chronic lung disease. Invasive mechanical ventilation usually accomplished by endotracheal (ET) intubation or an artificial airway, such as a tracheostomy may be reasonable and necessary when there are clinical indicators or lab values confirming the patient cannot maintain adequate ventilation. Remember these key points when reporting mechanical ventilation: Calculate the duration of time in hours, not days. Weaning time should be included in the calculation of total billable time. The billable time for patients arriving to the hospital on ventilation begins when the patient is admitted. Time stops once the patient is extubated or transferred/discharged. Ventilation support provided during a surgical procedure may be considered integral to the procedure and not separately coded. Ventilation support for an extended period following surgery may be coded if there is supporting provider documentation as to why the service is medically necessary. 32 Healthcare Business Monthly Documentation Must Support DRG Assignment The 2016 Office of Inspector General (OIG) Work Plan includes review of Medicare payments for inpatient claims where the use of a ventilator was billed. There is a difference in Medicare Severity-Diagnosis Related Group (MS-DRG) assignment and payment based on the procedure code billed. An OIG audit for , with a length of stay of four days or less, discovered an error rate of greater than 95 percent in mechanical ventilation billing to Medicare. A total of 377 claims were reviewed and 363 of those claims showed an overpayment. To prevent overpayments, hospitals should have an internal audit system to monitor this service and validate the MS-DRG assignment. In performing an internal audit, look for supporting documentation in the medical record such as physician orders, nursing notes, respiratory therapy notes, operative notes, and provider progress notes. In ICD-9-CM, the procedural codes identifying continuous invasive mechanical ventilation are Continuous Invasive Mechanical Ventilation of Unspecified Duration; Continuous Invasive Mechanical Ventilation for Less than 96 Consecutive Hours; and Continuous Invasive Mechanical Ventilation For 96 Consecutive Hours Or More. ICD-10-PCS requires you to be more specific: 5A1935Z 5A1945Z 5A1955Z Respiratory Ventilation, Less than 24 Consecutive Hours Respiratory Ventilation, Consecutive Hours Respiratory Ventilation, Greater than 96 Consecutive Hours Coding/Billing Auditing/Compliance Practice Management

33 To discuss this article or topic, go to MS-DRG The Centers for Medicare & Medicaid Services (CMS) revised the language for several MS-DRGs related to respiratory ventilation to reflect the title change of Greater than 96 Consecutive Hours. For example: MS-DRG 870 MS-DRG 871 Look for supporting documentation in the medical record such as physician orders, nursing notes, respiratory therapy notes, operative notes, and provider progress notes. Septicemia or Severe Sepsis with Mechanical Ventilation 96+ Hours Septicemia or Severe Sepsis without Mechanical Ventilation 96+ Hours with MCC MS-DRG 872 Septicemia or Severe Sepsis without Mechanical Ventilation 96+ Hours without MCC The message here is to make sure clinicians are documenting start and stop times, as well as supporting diagnoses. Resources Merck Manual, Overview of Mechanical Ventilation, Jesse B. Hall, MD, and Pamela J. McShane, MD 2016 OIG Work Plan: OIG, Medicare Payments for Inpatient Claims with Mechanical Ventilation (A ) AHA Coding Clinic Update on AHA Coding Clinic for ICD-10-CM and ICD-10-PCS Part I CMS, ICD-10-CM and ICD-10-PCS MS-DRG Definitions Manual: ICD10Manual/version33-fullcode-cms/fullcode_cms/P0001.html CODING/BILLING Lee Williams, RHIT, CPC, CPCO, CCS, CCDS, has over 13 years of health information management experience as a coding director, educator, trainer, and practice manager. She is the founder and past president of the Covington, Ga., local chapter and serves on AAPC s National Advisory Board, representing Region 4. Be with the family and earn CEUs! Need CEUs to renew your CPC? Stay in town. At home. Use our CD courses anywhere, any time, any place. You won t have to travel, and you can even work at home. Our coding courses with AAPC CEUs: The Where s and When s of ICD-10 (16 CEUs) Dive Into ICD-10 (18 CEUs) E/M from A to Z (18 CEUs) Primary Care Primer (18 CEUs) E/M Chart Auditing & Coding (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: 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 our newest course, The Where s and When s of ICD-10! Continuing education. Any time. Any place. April

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35 By Mary Pat Whaley, FACMPE, CPC CODING/BILLING Balance Billing: Is It Legal? Stay in line with private carrier rules and follow updated Medicare and Medicaid guidance. Balance billing is charging the patient for any balance on their account after insurance has paid its portion. The question on everyone s mind is: Does the patient truly owe the balance after insurance pays? The simple answer is, if there is a contract between the insurance plan and the physician practice, the practice may collect up front from the patient: Co-pays Co-insurance Deductibles Any amount due for services the plan does not cover If there is no contract between the insurance plan and the physician practice, the practice is not limited in what they may bill the patient. Of course, it isn t really that simple. Knowing when you can or can t balance bill takes a bit more explanation. Coding/Billing Auditing/Compliance Practice Management April

36 Balance Billing CODING/BILLING When to Balance Bill, and When Not To If a physician has a contract with an insurance plan and the contract states (hopefully, correctly) that the patient is not responsible for the deductible, co-pay, or co-insurance for a specific service, then billing the patient is illegal. Likewise, if a physician has a contract with an insurance plan and has permissibly collected the deductible, co-pay, or co-insurance, billing the patient for anything above the allowable rate is illegal. For Medicaid providers, balance billing is legal: If the physician does not have a contract with the insurance plan. If the services are non-covered services (think cosmetic surgery) by the insurance plan. If the patient chooses to opt-out of using their insurance and be a self-pay patient for any particular service. Here s the rub: Sometimes (actually, many times) the insurance company is not right. It fails to pay for things that should be paid, Balance Billing Terminology Contracted plan: An agreement between an insurer and a physician stating the physician agrees to accept a specific dollar amount for each service, regardless of what the physician actually charges for the service. Allowable: The contracted amount the physician has agreed to accept as complete payment for a service. The allowable is made up of the portion the insurance will pay and the portion the patient must pay. Write-off: The difference between the physician s charge and the allowable, which may not be collected from either the insurance plan or the patient. Accepting assignment: A physician who accepts assignment agrees to the insurance plan s allowable and write-off amounts. Some people equate accepting assignment with being a participating physician, but a physician can participate in Medicare and not accept assignment. In-network: This originally meant the physician was contracted with a preferred provider organization (PPO), but now often means a physician is contracted with any plan. This most often comes up when a patient is referred to an out-of-network provider for services, or when a patient undergoes a surgery or procedure in a hospital that is in-network, but the anesthesiologist, radiologist, pathologist, intensivist (critical care), hospitalist, emergency room doctor, or neonatologist is not. and informs the patient that they have no balance. That information may be confirmed by the insurance plan when the patient calls, simply because the company is referencing its own information. Some reasons why an insurer might process the services incorrectly are: There is a glitch in their system. They will not pay until the patient provides information to determine coordination of benefits. The patient s enrollment or COBRA information has not caught up in the system. They have incorrect information about the physician s participation in the network. Special Case: The Qualified Medicare Beneficiary Medicare recently updated information related to balance billing patients who are qualified Medicare beneficiaries (QMBs).The QMB Program helps Medicare beneficiaries of modest means pay all or some of Medicare s cost sharing amounts (i.e., premiums, deductibles, and co-payments). To qualify, patients must be eligible for Medicare and must meet certain income guidelines. The income guidelines change April 1 each year. The QMB program provides: Payment of Medicare Part A monthly premiums (when applicable); Payment of Medicare Part B monthly premiums and annual deductible; and Payment of co-insurance and deductible amounts for services covered under both Medicare Parts A and B. Note: Medigap premiums are not covered by the QMB. Eligibility criteria for this program require: The individual to be eligible for Medicare Part A insurance (even if not currently enrolled); and The monthly income to be at or below 100 percent of the annual federal poverty level, which is issued annually by the U.S. Department of Health and Human Services. Note: Individuals who are eligible for Medicare Part A, but not enrolled, may conditionally enroll in Medicare Part A at any time 36 Healthcare Business Monthly

37 To discuss this article or topic, go to Balance Billing If a physician has a contract with an insurance plan and has collected the deductible, co-pay, or co-insurance, billing the patient for anything above the allowable rate is illegal. during the year, after which they may apply for QMB to cover the cost of the Medicare Part A premium. If a patient is eligible for the QMB program, purchasing additional Medigap coverage for Medicare premiums, deductibles, and/or co-payments may be unnecessary. Review the benefits covered by the Medigap policy to see if the plan covers services other than the Medicare cost-sharing that may be useful to the patient. QMB Provider Certification for Title 19 The QMB program pays the 20 percent Medicare Part B co-insurance if the service provider is certified as a Medicaid provider. Note, however, a provider may choose to treat only QMB patients and not all Medicaid recipients. The provider may also limit the QMB patients he or she sees. Providers have no obligation to treat Medicaid patients, or anyone in particular (I m asked this question a lot!). Medicare Update on Balance Billing According to MLN Matters SE1128 Revised, February 1, 2016: Federal law bars Medicare providers from balance billing a QMB beneficiary under any circumstances QMB is a Medicaid program for Medicare beneficiaries that exempts them from liability for Medicare cost sharing. State Medicaid programs may pay providers for Medicare deductibles, coinsurance and copayments. However, as permitted by federal law, states can limit provider reimbursement for Medicare cost sharing under certain circumstances. Medicare providers must accept the Medicare payment and Medicaid payment (if any) as payment in full for services rendered to a QMB beneficiary. Medicare providers who violate these billing prohibitions are violating their Medicare Provider Agreement and may be subject to sanctions. Despite federal law, erroneous balance billing of QMB individuals persists. Many QMBs are unaware of the balance billing guidelines (or concerned about undermining provider relationships) and want to pay the cost-sharing amounts. How to Ensure Compliance with QMB Providers who participate in original Medicare and Medicare Advantage Replacement Plans not just Medicaid participants must follow balance-billing prohibitions. QMBs retain balance billing protection when they receive care in other states. QMBs cannot waive their QMB status and pay Medicare cost-sharing. Find out how to file for monies that Medicaid pays for QMBs. Understand the processes you need to follow to request reimbursement for Medicare cost-sharing amounts if they are owed by your state. To bill your state, you may need to complete a state provider registration process and be entered into the state payment system. Here s how to identify QMB patients in your patient population: Learn what your state s QMB card looks like. Find out if your state system can be queried to identify QMBs. Contact the commercial Medicare plans you accept to learn what their QMB card looks like. Make sure your billing staff exempt QMB individuals from Medicare cost-sharing billing and related collection efforts. Resources Mary Pat Whaley, FACMPE, CPC, has more than 30 years experience managing physician practices of all sizes and specialties in the private and public sectors. She is board certified in Medical Practice Management. Whaley draws 30K+ visitors to her website (managemypractice.com) monthly, and is a Healthcare LinkedIn Thought Leader with 275,000+ followers. She is the originator of Credit Card on File for medical practices. Whaley s mission is to create sustainable financial viability for small independent physician practices. She is a member of the Durham, N.C., local chapter. Shots Health News, NPR, States Make Laws to Protect Patients from Hidden Medical Bills, Michelle Andrews, July 15, 2015: states-make-laws-to-protect-patients-from-hidden-medical-bills MLN Matters SE1128 Revised, February 1, 2016: Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/se1128.pdf CODING/BILLING April

38 CODING/BILLING By Heather Greene, MBA, RHIA, CPC, CPMA The Ins and Outs of Inpatient Psychiatric Facility Perspective Payment System Account for DRG and comorbidity adjustments and ensure all active medical treatments and diagnoses are documented. Part of our responsibility as healthcare business professionals is to understand the financial realities of healthcare delivery and reimbursement. For those of us working in mental health, this means learning the ins and outs of the Inpatient Psychiatric Facility Perspective Payment System (IPF PPS). IPF PPS Background In section 124 of the Balanced Budget Refinement Act (BBRA) mandated the secretary of the U.S. Department of Health & Human Services (HHS) to develop a per diem PPS for inpatient hospital services furnished in psychiatric hospitals and psychiatric units. The PPS had to: Include an adequate patient classification system to reflect the differences in patient resource use and costs among psychiatric hospitals and psychiatric units; Maintain budget neutrality; and Permit the HHS secretary to require psychiatric hospitals and psychiatric units to submit information necessary for developing the PPS. The HHS secretary was required to report to congress describing the development of the PPS. The new system applies to Medicare patients, and the Centers for Medicare & Medicaid Services (CMS) decided to use the current PPS for consistency; however, instead of using a diagnosis related group (DRG) payment, the facilities would be paid per diem, using adjustments to a federal per diem base amount. The adjustments were derived using regression analysis to determine relevant factors to predict patient resources. The payment adjustors include both facility-specific and patient-specific adjustments. The final IPF PPS was developed using regression analysis data obtained from the 2002 cost report file and 2002 Medicare Provider Analysis and Review (MEDPAR) data for IPF stays. The effective date for implementing IPF PPS was for cost reporting periods beginning on or after January 1, The PPS was based on the final federal per diem rate for Medicare patients and is updated yearly. Formulating Base and Adjustment Rates Each year, the base rate is set and then adjusted using several factors to formulate the calculated base rate for an individual facility. For 2016, the federal per diem rate is $ Providers who fail to report quality data for fiscal year (FY) 2016 will receive a proposed FY 2016 per diem rate of $ (a 2 percent reduction). istock.com/hoodesigns 38 Healthcare Business Monthly Coding/Billing Auditing/Compliance Practice Management

39 IPF PPS Abbreviations & Definitions Adjustment factor (ADJ) Payment for an individual patient is adjusted, due to certain factors. Inlier A time covered by the Medicare Severity-Diagnosis Related Group (MS-DRG) payment period of a claim that includes fully paid days, coinsurance days, or days after benefits have exhausted. Outlier An additional payment made by Medicare for high-dollar claims, intended to protect hospitals from large financial losses due to unusually expensive cases. Comorbidity The presence of one or more additional disorders (or diseases) cooccurring with a primary disease or disorder, or the effect of such additional disorders or diseases. The additional disorder may also be a behavioral or mental disorder. Comorbidity ADJ Adjustment factor reimbursement based on a comorbidity category. In Alaska and Hawaii, there are varying cost of living adjustment factors. Alaska ranges from 1.23 to 1.25 percentage points, and Hawaii ranges from to 1.25 percentage points. Another adjustment of 1.31 for first day is given if the facility has a qualified emergency room (ER). To qualify, the ER department must be licensed, advertised, and staffed, and 33 percent of patients sought urgent treatment for ER conditions. Finally, if the patient receives an ECT, there is an adjustment of $ There are also patient-specific adjustment factors. Patients under 45 years of age receive an adjustment factor of This increases by 0.01 every five years after age 45, until age 64. For ages 65-69, the adjustment factor is 1.10; for ages 70-74, the adjustment is 1.13; for ages 75-79, the adjustment is 1.15; and for those who are 80 years old or older, the adjustment factor is There are 17 Medicare severity-diagnosis related group (MS-DRG) categories that receive adjustment factors. For example, DRG 885 receives an adjustment factor of 1.00 and DRG 881 receives 0.99, as shown in Table A on the preceding page. CODING/BILLING The IPF PPS is based on a federal per diem base rate that includes both inpatient operating and capitalrelated costs (including routine and ancillary services), and excludes certain pass-through costs (i.e., bad debt and direct medical education). The base rate also provides patient-level and facility-level adjustments including wage index, teaching adjustments, and an add-on for rural facilities. The payment for an individual patient is further adjusted for factors such as the DRG classification, age, length of stay, and the presence of specified comorbidities. Additional payments are provided for cost outlier cases, and qualifying emergency department (ED) electroconvulsive therapy (ECT) treatments. The IPFs affected by the PPS are freestanding psychiatric facilities, distinct part psychiatric units of acute care hospitals, and distinct part units of critical access hospitals Several factors may adjust the payment: The federal wage index adjustment, which is applied to the labor portion of the service, an add-on of 17 percent for facilities in rural areas, and an adjustment made for qualified teaching facilities of percent. Table A: There are 17 MS-DRG categories that receive adjustment factors. Name of Specific DRG DRG Adjust Degenerative nervous system disorders with MCC Degenerative nervous system disorders without MCC Nontraumatic stupor and coma with MCC Nontraumatic stupor and coma without MCC Operating room procedure with principal diagnoses of mental illness Acute adjustment reaction and psychosocial dysfunction Depressive neuroses Neuroses except depressive Disorders of personality and impulse control Organic disturbances and mental retardation Psychoses Behavioral and developmental disorders Other mental disorder diagnoses Alcohol/Drug abuse or dependence, left against medical advice Alcohol/Drug abuse or dependence with rehabilitation therapy Alcohol/Drug abuse or dependence without rehabilitation therapy with MCC Alcohol/Drug abuse or dependence without rehabilitation therapy without MCC April

40 IPF PPS CODING/BILLING How CCs and MCCs Change Payment Many patients have comorbidities. For psychiatric facilities, some of these will add an adjustment factor, as shown in Table B. This is different from the Medicare hospital inpatient prospective payment system, where a complication or comorbidity (CC) or major complication or comorbidity (MCC) would change the DRG, thus changing the payment; rather, comorbid conditions that fall into a comorbidity category add another adjustment factor. The IPF PPS has 17 comorbidity categories, each containing codes of comorbid conditions. Each comorbidity grouping will receive a grouping-specific adjustment. The facility can receive a single comorbidity adjustment per comorbidity category; however, it can also receive an adjustment for more than one comorbidity category per encounter. Comorbidities are specific patient conditions that are secondary to the patient s principal diagnosis and that require treatment during the stay. The diagnoses that relate to an earlier episode of care and have no bearing on the current hospital stay are excluded and must not be reported on the facility s claim. According to the 2015 IPF PPS final rule, comorbid conditions must exist at the time of admission or develop subsequently, and must affect the treatment received, length of stay, or both. The physician of record must connect any conditions the patient may have with the treatment during the encounter. These conditions, if treated, must be well documented throughout the chart. It s not enough simply to list the name of a condition; there must be documentation to support the condition s treatment or how the condition is affecting the mental condition s therapeutic treatment. Resources Table B: The IPF PPS has 17 comorbidity categories, each with an adjustment factor. Description of comorbidity Adjustment factor Developmental disabilities 1.04 Coagulation factor deficits 1.13 Tracheostomy 1.06 Renal failure, acute 1.11 Renal failure, chronic 1.11 Oncology treatment 1.07 Uncontrolled diabetes-mellitus with or without complications 1.05 Severe protein calorie malnutrition 1.13 Eating and conduct disorders 1.12 Infectious disease 1.07 Drug and/or alcohol induced mental disorders 1.03 Cardiac conditions 1.11 Gangrene 1.10 Chronic obstructive pulmonary disease 1.12 Artificial openings digestive and urinary 1.08 Severe musculoskeletal and connective tissue diseases 1.09 Poisoning 1.11 Comorbidity Adjustments Another patient-specific adjustment factor relates to the length of stay. A variable per diem adjustment factor depends on several things. For example, day one depends on if your facility has a qualified ER. If it does, the adjustment factor is 1.31; if not, the adjustment factor is 1.19, as shown in Table C on the next page. The adjustments recognize the higher cost incurred in the early days of a stay. CMS.gov Inpatient Psychiatric Facility PPS: Service-Payment/InpatientPsychFacilPPS/index.html Tools and Worksheets: InpatientPsychFacilPPS/tools.html IPF PPS Regulations and Notices: Payment/InpatientPsychFacilPPS/IPF-PPS-Regulations-and-Notices.html The Medicare Claims Processing Manual, chapter 3 - Inpatient Hospital Billing, section Application of Code First: Guidance/Manuals/downloads/clm104c03.pdf 40 Healthcare Business Monthly

41 To discuss this article or topic, go to IPF PPS Table C: Other adjustment factors include length of stay. Variable Per Diem Adjustments Day 1 Facility without a qualifying emergency department Day 1 Facility with a qualifying emergency department Day Day Day Day Day Day Day Day Day Day Day Day Day Day Day Day Day Day Day Day Day After Day Code First Rules A significant concern arises when we have to follow the Code First rule. The Medicare Claims Processing Manual, chapter 3 - Inpatient Hospital Billing, section : Application of Code First (last updated October 30, 2015) has been pivotal in explaining the Code First rule. The manual explains how CMS handles this rule, and how to calculate your DRG adjustment factor when the patient s condition results in a principal diagnosis that is the etiology of the manifestation treated in the facility. Diagnosis code F02.81 Dementia in other diseases classified elsewhere with behavioral disturbance is designated as NOT ALLOWED AS PRINCIPAL DX code. The three-digit code F02 Dementia in other diseases classified elsewhere is designated a Code First diagnosis, indicating that all diagnosis codes that fall under the F02 category (codes F02.80 Dementia in other diseases classified elsewhere without behavioral disturbance and F02.81) must follow the Code First rule. The code F02 appears in the ICD-10-CM, as follows: It s not enough simply to list the name of a condition; there must be documentation to support the condition s treatment or how the condition is affecting the mental condition s therapeutic treatment. Code first the underlying physiological condition, such as: F02.80 Dementia in other diseases classified elsewhere without behavioral disturbance NOT ALLOWED AS PRINCIPAL DX F02.81 Dementia in other diseases classified elsewhere with behavioral disturbance NOT ALLOWED AS PRINCIPAL DX According to Code First requirements, the provider would code the appropriate physical condition first: for example, G20 Parkinson s disease as the principal diagnosis code and F02.81 as a secondary diagnosis or comorbidity code on the patient claim. The purpose of this example is to demonstrate proper coding for a Code First situation. In this case, the principal diagnosis groups to one of the 15 DRGs, or 17 MS-DRGs, for which CMS pays an adjustment. Had the diagnosis code grouped to a non-psychiatric DRG/MS-DRG, the Pricer would search the first of the other diagnosis codes for a psychiatric code listed in the Code First list to assign a DRG adjustment. Final note: All diagnostic and non-diagnostic outpatient services (excluding ambulance) provided one day immediately preceding the date of the admission are considered to be inpatient services and are included on the inpatient claim, unless the patient does not have Medicare. Documentation Is Key As health information management or coding professionals, you should work to educate practitioners and clinicians on required documentation, so you can fully and accurately account for a patient s DRG and comorbidity adjustments. You should ensure all active medical treatment and diagnoses are captured in the medical record documentation, and remind practitioners to connect clinical dots to substantiate treatment patients receive. Heather Greene, MBA, RHIA, CPC, CPMA, is assistant vice president of compliance and process improvement for Haven Behavioral Healthcare, Inc. She has approximately 20 years of experience in a variety of health information management roles. Greene performs coding and documentation audits, physician education, and process improvement for the Haven Behavioral Health, Inc. psychiatric facilities. She is a member of the Florence, Ky., local chapter. CODING/BILLING April

42 AUDITING/COMPLIANCE By Sue Miller The Latest on HIPAA: The Gun Check Rule If you provide care for patients with mental illness, understand the nuances of this final rule. As of January 6, there s a new HIPAA final rule. Formally known as the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule and the National Instant Criminal Background Check System (NICS) final rule, it s been nicknamed the gun check rule. Effective February 5, 2016 this rule requires an FBI check to determine whether an individual who wants to purchase a firearm from a federally licensed vendor is diagnosed with mental illness. Note: Parts of this article appeared in Litmos, an online blog: If your organization is a covered entity that cares for people with mental illness, you need to understand the nuances of the new rule, and be ready to report to the NICS when necessary. The HIPAA Privacy Rule has been added on to at Section 512 Uses and disclosures for which an authorization or opportunity to agree or object is not required (k) Standard: Uses and disclosures for specialized government functions, (7) National Instant Criminal Background Check System. Per the revised rule: If a covered entity orders involuntary commitments or makes other adjudications regarding an individual s mental health, or that serve as repositories of the relevant data, they are permitted to use or disclose the information needed for NICS reporting of such individuals either directly to the NICS or to a state repository of NICS data. If a covered healthcare entity also has a role in the relevant mental health adjudications or serves as a state data repository, it now may disclose the relevant information for NICS reporting purposes under this new permission, even if it s not designated as a HIPAA hybrid entity or required by state law to report it. It does not create an express permission for covered entities to disclose to NICS for reporting purposes the protected health information of individuals who are subject to state-only mental health prohibitors. If you are a covered entity that must report to the NICS, the preamble states that you must report the data elements the NICS needs to create a record, plus there is more that you re permitted to share with NICS. The elements needed to create the NICS record are: The individual s name The individual s sex The individual s date of birth The Federal Mental Health Prohibitor The federal mental health prohibitor makes individuals ineligible to purchase a firearm because they have been committed to a mental institution or adjudicated as a mental defective. Department of Justice regulations define these categories to include persons: Who have been involuntarily committed to a mental institution for reasons such as mental illness or drug use; Have been found incompetent to stand trial or not guilty by reason of insanity; or Otherwise have been determined by a court, board, commission, or other lawful authority to be a danger to themselves or others or unable to manage their own affairs as a result of marked subnormal intelligence or mental illness, incompetency, condition, or disease. The record documenting the involuntary commitment or adjudication The entity from which the record initiated (your business name) Additional data you may send include the individual s: Social Security number State of residence Height Weight Place of birth Eye color Hair color Race These additional elements will help authorities weed out false positives. The new section in the HIPAA Privacy Rule does not name any data elements outlined above. This gives the covered entity the flexibility to report the data required and requested by the federal government and any state requirements your state may have for your area. Sue Miller has a 10-page memorandum explaining the new HIPAA final rule in depth. You may contact her at tmsam@aol.com or (978) istock.com/skapl 42 Healthcare Business Monthly Coding/Billing Auditing/Compliance Practice Management

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44 AUDITING/COMPLIANCE By Michael D. Miscoe, JD, CPC, CASCC, CUC, CCPC, CPCO, CPMA 2016 OIG Work Plan: Part B Risk Areas Put these OIG compliance efforts on a high priority focus list for your provider. The Office of Inspector General s (OIG) annual work plan for 2016 outlines significant new areas, as well as ongoing target areas, on which the federal agency will focus its reviews and audits of U.S. Department of Health and Human Services (HHS) programs and operations this year. Let s take a look at what s on the OIG s radar for Medicare Part B providers. Similar to the approach we took with Part A, published in Healthcare Business Monthly last month, we ll review the new and revised focus areas only. Medical Equipment and Supplies Policies and Practices For medical equipment and supplies, the OIG is honing in on the policies and practices of: Power mobility devices lump-sum purchase versus rental Competitive bidding for medical equipment items and services mandatory post-award audit OIG will determine the reasonableness of the Medicare fee schedule by comparing Medicare payments made for orthotic braces to the amounts paid by non-medicare payers, such as private insurance companies, to identify potentially wasteful spending. NEW! Osteogenesis stimulators OIG will look at lumpsum purchase versus rental. They will determine whether potential savings can be achieved by Medicare and its beneficiaries if osteogenesis stimulators are rented over a 13-month period, rather than acquired through a lumpsum purchase. Medical Equipment and Supplies Billing and Payments Regarding billing and payments of medical equipment and supplies, the OIG is focusing on: Power mobility devices supplier compliance with payment requirements Nebulizer machines and related drugs supplier compliance with payment requirements Effectiveness of system edits for diabetes testing supplies to prevent inappropriate payments for blood glucose test strips and lancets to multiple suppliers NEW! Orthotic braces OIG will review Medicare Part B payments for orthotic braces to determine whether durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) suppliers claims were medically necessary and were supported in accordance with Medicare requirements. OIG makes clear that compliance with documentation requirements and utilization guidance outlined in the local coverage determinations (LCDs) issued by the DMEPOS Medicare administrative contractor will be the focus of its analysis. DME suppliers should review published Medicare guidance to ensure compliance. NEW! Increased billing for ventilators OIG has noticed a significant increase in billing for ventilators (specifically, HCPCS istock.com/macgyverhh 44 Healthcare Business Monthly Coding/Billing Auditing/Compliance Practice Management

45 Work Plan Level II code E0464 Pressure support ventilator with volume control mode, may include pressure control mode, used with non-invasive interface (e.g., mask). From 2013 to 2014, OIG reports a 127 percent increase in allowed amounts for E0464. OIG believes that suppliers may be inappropriately providing/billing for ventilators for patients with non-life-threatening conditions, and not meeting the medical necessity criteria for ventilators. The Medicare National Coverage Determinations Manual, Section 280.1, stipulates that ventilators are covered for the treatment of severe conditions associated with neuromuscular diseases, thoracic restrictive diseases, and chronic respiratory failure consequent to chronic obstructive pulmonary disease. Ventilators are not considered reasonable and necessary when the patient has a condition for which the relevant LCD indicates a continuous positive airway pressure or respiratory assist devices is appropriate. DME suppliers should review published LCD guidance to ensure compliance. Medical Equipment and Supplies Quality of Care and Safety OIG is reviewing quality of care and safety measures for DME in regards to: Access to DME in competitive bidding areas Other Providers Policies and Practices For other providers policies and practices, the OIG is focusing on: Ambulatory surgical centers (ASCs) payment system End-stage renal disease facilities payment system for renal dialysis services and drugs NEW! ASC quality oversight OIG will review Medicare s quality oversight of ASCs. Previous OIG work found problems with Medicare s oversight system, including finding spans of five or more years between certification surveys for some ASCs, poor Centers for Medicare & Medicaid Services (CMS) oversight of state survey agencies and ASC accreditors, and little public information on the quality of ASCs. CMS requires that ASCs become Medicare certified by a state survey and certification agency or privately accredited to show they meet the conditions. Because certification is a condition of payment, payments to ASCs without Because this is a mere summary of the Part B provider portion of the 2016 OIG Work Plan, you are encouraged to review it in its entirety to ensure applicable risk areas are well understood. proper or current certification are deemed as overpayments. For this reason, ASCs should verify compliance with state accreditation requirements. Other Providers Billing and Payments For other provider billing and payments, the OIG is targeting: Ambulance services questionable billing, medical necessity, and level of transport ASC anesthesia services; payments for personally performed services Chiropractic services Part B payments for non-covered services Chiropractic services portfolio report on Medicare Part B payments Imaging services payments for practice expenses Selected independent clinical laboratory billing requirements Annual analysis of Medicare clinical laboratory payments Physical therapists high use of outpatient physical therapy services by independent therapists Portable X-ray equipment supplier compliance with transportation and set-up fee requirements Sleep disorder clinics high use of sleep-testing procedures (CPT Polysomnography; age 6 years or older, sleep staging with 4 or more additional parameters of sleep, attended by a technologist and Polysomnography; age 6 years or older, sleep staging with 4 or more additional parameters of sleep, with initiation of continuous positive airway pressure therapy or bilevel ventilation, attended by a technologist) Inpatient rehabilitation facility payment system requirements ASC versus hospital outpatient payments NEW! Physicians referring/ordering Medicare services and supplies OIG will review select Medicare services, supplies, and DME referred/ordered by physicians and non-physician practitioners (NPPs) to determine whether the ordering provider was a Medicare-enrolled physician or NPP. If the referring/ordering AUDITING/COMPLIANCE April

46 Work Plan To discuss this article or topic, go to AUDITING/COMPLIANCE physician or NPP is not eligible to order or refer, then the claims are not compensable. You should internally validate that the ordering provider of services, supplies, and DME is currently enrolled. A review of past claims is also recommended. If the ordering provider is not an eligible (Medicare enrolled) provider, the payments associated with claims made pursuant to any order from such a provider should be disclosed and refunded. NEW! Anesthesia services non-covered services. OIG will review Medicare Part B claims for anesthesia services to determine whether the patient had a related and covered Medicare service. Medicare will not pay for items or services that are not reasonable and necessary. Specifically, where the anesthesia procedure was related to the performance of a non-covered procedure, the anesthesia is non-covered, as well. Anesthesia providers should review past claims for compliance, and voluntarily disclose and refund any inappropriate payments. Make necessary modification to policies and procedures to ensure compliance. NEW! Physician home visits reasonableness of services. OIG will determine whether Medicare payments to physicians for evaluation and management (E/M) services performed in the home were reasonable and made in accordance with Medicare requirements. Since January 2013, Medicare made $559 million in payments for physician home visits. Physicians are required to document the medical necessity of a home visit in lieu of an office or outpatient visit. Providers should review past claims for compliance and voluntarily disclose and refund any inappropriate payments. Make necessary modification to policies and procedures to ensure compliance. NEW! Prolonged services reasonableness of services. OIG will determine whether Medicare payments to physicians for prolonged E/M services were reasonable and made in accordance with Medicare requirements. The necessity of prolonged services is considered by CMS to be rare and unusual. The Medicare Claims Processing Manual, publication , chapter 12, section , includes requirements that must be met to bill a prolonged E/M service. Providers should review past claims for noncompliance and voluntarily disclose and refund any inappropriate payments. NEW! Histocompatibility laboratories supplier compliance with payment requirements. OIG will determine whether payments to histocompatibility laboratories were made in accordance with Medicare requirements. From March 31, 2013, through September 30, 2014, histocompatibility laboratories reported $131 million in reimbursable costs. Histocompatibility laboratories are reimbursed based on reasonable costs, which must be related to the care of patients, as well as reasonable, necessary, and proper. Histocompatibility laboratories should review past claims and cost reports for noncompliance and voluntarily disclose and refund any inappropriate payments. Histocompatibility laboratories should make necessary modification to policies and procedures to ensure compliance. Get to Know the OIG Work Plan Because this is a mere summary of the Part B provider portion of the 2016 OIG Work Plan, you are encouraged to review it in its entirety to ensure applicable risk areas are well understood. For each focus area affecting your provider, be certain to review appropriate CMS interpretive guidance, LCDs, and any referenced regulatory provisions cited in the OIG Work Plan to ensure you completely understand and comply with CMS expectations, particularly with respect to documentation content and coverage limitations. 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 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 and HIPAA OCR matters. Miscoe speaks on a national level, and is published nationally on a variety of coding, compliance, and health law topics. He is a member and past president of the Johnstown, Pa., local chapter. Resources For details pertaining to ongoing reviews, which are listed in this article only by name, or for details regarding risk areas associated with Part C, Part D, and Medicaid programs, please refer to the 2016 OIG Work Plan: archives/workplan/2016/oig-work-plan-2016.pdf. Medicare National Coverage Determinations Manual, 280.1: Regulations-and-Guidance/Guidance/Manuals/downloads/ncd103c1_part4.pdf Medicare Claims Processing Manual, publication , chapter 12, : www. cms.gov/regulations-and-guidance/guidance/manuals/downloads/clm104c12.pdf For details regarding coverage requirements for histocompatibility laboratories, see 42 CFR 413.9(a), (b), and (c)(3): Payment/ClinicalLabFeeSched/downloads/413_9.pdf For requirements pertaining to cost reporting, see 42 CFR (a), (c): gov/fdsys/pkg/cfr-2011-title42-vol2/pdf/cfr-2011-title42-vol2-sec pdf 46 Healthcare Business Monthly

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48 AUDITING/COMPLIANCE By Lisa Jensen, MHBL, FACMPE, CPC Rock the Mock Audit Know how your practice would fare in a government audit. Does the thought of an external audit keep you up at night? Well, fear no more! By conducting mock or self audits, you can uncover potential issues before a regulator or payer does. During such an audit, an outside consultant or staff within your company assumes the role of enforcement officials and conducts the level of investigation that is anticipated from the regulator. Mock audits prepare your practice or facility for an official audit by walking you through the process of documentation requests, which involves identifying the information you will be asked to disclose and designating personnel responsible for gathering, preparing, and presenting that information. With this knowledge in hand, you can focus on resolving issues uncovered during the mock audit. How to Get Started First, determine how many resources and how much time you can expend on an audit. For example: Is there someone who will be in charge and who is able to keep the focus and energy moving towards the end goal? Do you have access to the reports you need to identify your audit target areas? Are the providers on board with this idea? And will they be open to the feedback, corrective actions, and results you will find? Asking yourself these questions will help you to anticipate and address obstacles you may encounter during the mock audit. You also must know what you agreed to with your payers. Review the websites and contracts of top payers to learn what each health plan requires as part of its integrity program or claims review process. Take note of the time periods for records review, whether an auditor is allowed to visit the practice site, and the frequency with which auditing can occur for each plan. istock.com/pbophotographer 48 Healthcare Business Monthly Identify Risk Areas With limited resources and dollars, you ll need to define the scope of the mock audit to your highest risk areas. Start by determining if past risk areas have been resolved. If no issues rise to the top, use resources such as benchmarking data and common error reports to assess risk. Good resources are the Centers for Medicare & Medicaid Services (CMS), the Office of Inspector General (OIG), Comprehensive Error Rate Testing, Medical Group Management Association (MGMA) survey data, specialty society member Web tools, etc. The OIG s top hits for auditing can be found in the OIG Work Plan. Common targets of the OIG are: Improper application of modifier 25 Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service and modifier 59 Distinct procedural service; Coding/Billing Auditing/Compliance Practice Management

49 Mock Audit Up-coding (especially relative to evaluation and management (E/M) services); Unbundling of global surgery; and Overuse of diagnostics without supporting medical necessity. Compare your CPT and HCPCS Level II utilization data with CMS data available on the Medicare Utilization for Part B web page ( For example, open the 2014 Medicare Part B Physician/Supplier National Data - Calendar Year Evaluation and Management Codes by Specialty file. To use this data file, copy the Internal Medicine utilization under Allowed Services for each E/M code you are interested in reviewing onto a spreadsheet, as shown in Chart A. Chart A: CMS Internal Medicine 2014 CPT Frequency Percentage ,184 1% ,835 5% ,415 30% ,102 47% ,662 17% Total 1,660,198 Next, calculate a percentage for each code. For example, divide the frequency number that internal medicine physicians coded (8,184) by the total of new patient codes reported (1,660,198). The result tells us that internal medicine physicians coded approximately 1 percent of the time when billing Medicare for a lowlevel, new patient office visit in AUDITING/COMPLIANCE Chart B Internal Medicine Bell Curve 47% 30% 17% 1% 5% April

50 Mock Audit AUDITING/COMPLIANCE Generate a similar billing utilization report from your practice management system. Follow the same procedure to calculate the frequency use of each code in your practice. These percentages can then be used to create a bell curve (as shown in Chart B). Although coding above, below, or at the national bell curve for your specialty does not necessarily mean you re coding accurately (or not), knowing how your personal bell curve stacks up offers a clue to areas your coding may deserve a closer look. To simplify this process, AAPC offers the E/M Utilization Benchmarking Tool ( This tool compares a physician s, or an entire practice s, evaluation and management (E/M) CPT code utilization to peers in the same specialty. The distribution of utilization by code within each E/M subcategory is benchmarked to the distribution of paid Medicare claims for physicians in the same specialty, nationally. Time to Audit After you identify the areas, providers, and codes that should be targeted, it s time to conduct the audit. Pulling a sample of, for instance, 10 charts per provider or 10 percent of total targeted charts may be a good way to start, and keep the workload manageable. External consultants may have other recommendations based on the total volume of your practice and the types of services you bill. The coding should be consistent with the auditing tools provided by your Medicare carrier, private payers, and standard coding auditing guidance, including those found in the CPT and ICD codebooks. Tip: AAPC s Healthicity medical auditing software provides two viable solutions for internal auditing: Audit Manager is an all-in-one audit management solution that simplifies the audit workflow and takes the guesswork out of the audit process; Audit Services enables you to pool from our nationwide network of credentialed auditors to conduct medical chart reviews, medical record and documentation review, and audit validation. For more information, visit: For information on this year s OIG Work Plan, check out 2016 OIG Work Plan: Part B Risk Areas on pages of this issue of Healthcare Business Monthly and 2016 OIG Work Plan: Part A Risk Areas on pages of March s Healthcare Business Monthly. Share the Results Shortly after the review session, be sure each provider receives a report (in table format) summarizing your overall findings. For example, the report might show there were three instances in which a service was billed as Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A problem focused history; A problem focused examination; Straightforward medical decision making, but documentation would have supported Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: An expanded problem focused history; An expanded problem focused examination; Medical decision making of low complexity. You should also provide each physician with a copy of his or her charts with the reviewers comments. If you re concerned that some providers may disregard the feedback, you can place a redacted summary for all providers to see. In this summary, let each provider know which data represents their results, but block out the others. They can see how they did in comparison with their peers. Many find this sort of competition very motivating. Make a Positive Change Be sure you do something about the errors, inconsistencies, and other issues you find. For example: Do policies and procedures need to be updated or corrected? Are there areas where additional education may be needed? Does your electronic health record template require some refining or a complete overhaul? The same people who conduct the audit should notify management of the actions needed to address areas of weakness. Management should determine procedures for correcting these errors. These procedures may vary from payer to payer. Overpayments may need to be refunded or corrected bills resubmitted. Although this may amount to waving a red flag in front of the insurer, it s usually better to come forward than to play the game of wait and see. For significant errors, consult your healthcare attorney before acting on your findings. Like preventive medicine, proactive internal reviews allow you to correct over-coding before it causes overpayment, and to correct under-coding before it turns into under-billing. 50 Healthcare Business Monthly

51 To discuss this article or topic, go to Mock Audit To gain support you might create T-shirts, candy bar wrappers, and notes with sayings such as, I Rock the Mock, Be Audit You Can Be! Keep Calm and Audit On, or Don t make me use my audit voice. Overcome Obstacles If a physician refuses to adapt his or her coding and documentation patterns to ensure compliance with applicable regulations, disciplinary action may be warranted. A very real danger is that you will conduct the audit and identify errors, but will have no support to correct them. Knowing there is an issue that your practice has done nothing to correct can create a huge liability risk. To gain support, make the process as fun as possible. For example, you might create T-shirts, candy bar wrappers, and notes with sayings such as, I Rock the Mock, Be Audit You Can Be! Keep Calm and Audit On, or Don t Make Me Use My Audit Voice. Lastly, remember that rules change and people change, so periodic internal audits are necessary. Keep the audit process fresh and relevant, and do your best to identify risk areas before they become real problems. Lisa Jensen, MHBL, FACMPE, CPC, is the senior manager of external audit at Providence Health Plans in Beaverton, Ore. She has a master s degree in Healthcare Business Leadership. Jensen has been a Certified Professional Coder (CPC ) since 1996 and a Fellow in the American College of Medical Practice Executives (FACMPE) since She is a member of the Portland Columbia River, Ore., local chapter. AUDITING/COMPLIANCE AAPC VIRTUAL WORKSHOPS NOW AVAILABLE! Find a virtual workshop near you: AAPC's virtual workshops gives you more of what you need: Up to 6 CEUs 4 hours of virtual presentation Authored and presented by leading experts In-depth information on critical topics Workshop Features: Interactive and hands-on exercises with case studies 4-hours includes presentation and skill-building practice Access on-demand recording aapc.com/workshops April

52 PRACTICE MANAGEMENT By Lori A. Cox, MBA, CPC, CPMA, CPC-I, CEMC The Doctor Said What When medical situations get serious, sometimes the medical record becomes humorous. About a year ago, a group of my coding friends and I started an string we called, A Little Humor. We would like to share some of our discoveries (taken from redacted provider documentation) with you, along with our comments. To that end I recommend to the daughter that they proceed rectally to the emergency room. Make sure to back in to the ER. Hand pain she is to keep her abdomen with orthopedics. Her hand can go home with her, however. She was milking a car at work. Is that 2 percent or low-gas milk? Blood pressure 135/75 is the gold. What s the silver and bronze blood pressure (BP), I wonder? Mother presents to ER with her 6-year-old for redness and facial swelling. The child appeared normal, so the doctor asked, In what context does he have these symptoms (e.g., what is the child doing when symptoms appear). The mother answered, When he s blowing up a balloon. No comment needed. Patient was placed on the operating tablet. I guess you can use tablets for more than just getting on Facebook. Hypertension with diabetes. Her blood pressure is cold. Wonder what warm BP would be? She is stressed because he has invited another woman into their home to help get her on her feet. This woman is sharing the bed with them. I would be stressed, too! Patient states that she will lose weight one day, when her family stops cooking so much. If only it were that easy. Her biggest complaint [is] she would like to have bacon in her diet. You can t live without Bacon. 8 year old white male was at work around 9:30 a.m. when a heavy metal piston device smashed his finger. I guess they start working em early in some places. Humor is mankind s greatest blessing. Mark Twain He went outside to attempt the fetus chickens. Feed. Feed the chickens. A teenage driver lost control throwing a banana out the window. That s what you get for littering, kids. Pt s trial of a small amount of alcohol each afternoon may not be working well, according to her daughter. Maybe the dose needs to be adjusted? Male with an ax in his head. He states his wife did it because he asked her if it was that time of the month. And yes, he lived. Many thanks to the team who shared their hillarious notes: Karen Lavigne, CPC, CPMA, CRC; Marcelle Viator, CPC, CRC; Kristie Fissler, CPC, CPMA, COC, COSC; Brenda Stevens, CPC, CPMA, CRC; Jen Bueddeman, CPC, CRC; Kelley Sorenson, CPC; Dawn Catanese, CPC, COC, CRC; and Colette Bohon, CPC, CRC. Send in Your Funny Doctors Notes We d like to hear your funny stories. Submit your laughs to lori.cox@ aapcnab.com for possible inclusion in future editions of Healthcare Business Monthly. Lori A. Cox, MBA, CPC, CPMA, CPC-I, CEMC, is the coding team leader at MedKoder, and has over 17 years experience in multiple areas of healthcare. She has been certified since 2002 and is the Region 5 Representative for the AAPC NAB. Cox is the treasurer for the Quincy, Ill./Hannibal, Mo., local chapter. istock.com/igor Zakowski 52 Healthcare Business Monthly Coding/Billing Auditing/Compliance Practice Management

53 Crack specialty coding with the American Medical Association s 2016 CPT Coding Essentials series the perfect companion to your CPT Professional codebook Strengthen your knowledge and simplify your research with the new 2016 CPT Coding Essentials series. This six-book series includes illustrations and plain English descriptions for code selection in a CPR code-driven format. Each book focuses on CSM reimbursement and medical necessity information. This is the only specialty series that comes straight from the source of CPT code the AMA and exclusively provides the CPT Editorial Panel s Guidelines instructions on ICD-10-CM documentation and coding. AMA Each CPT Coding Essentials title includes CPT code for surgeries, medicine and ancillary services, paired with: Illustrations and plain English descriptions of the service represented by the code Official, code-specific instructions and parenthetical information from the AMA s CPT Professional codebook ICD-10-CM codes mapped by coding experts RVUs, global periods and modifier payment rules References to CMS s Pub 100 and the AMA s CPT Assistant newsletter To learn more, visit amastore.com or call (800) Series includes: CPT Coding Essentials for Cardiology 2016 CPT Coding Essentials for General Surgery & Gastroenterology 2016 CPT Coding Essentials for Obstetrics and Gynecology 2016 CPT Coding Essentials for Ophthalmology 2016 CPT Coding Essentials for Orthopedics: Lower Extremities 2016 CPT Coding Essentials for Orthopedics: Upper Extremities And Spine 2016

54 PRACTICE MANAGEMENT By Ken Camilleis, CPC, CPC-I, COSC, CMRS, CCS-P The Nine Cs of Clinical Documentation Improvement Work together to ensure CDI is maximized in all practitioner documentation. 54 Healthcare Business Monthly Clinical documentation affects the entire revenue cycle. If a medical note is not properly documented, a domino effect leads to inaccurate coding, which affects billing and financial management of the practice. Poor documentation may also affect quality of patient care because all elements aren t captured accurately or considered based on a practitioner s findings. Because of this, clinical documentation improvement (CDI) plays a key role across the spectrum of healthcare business management. Coding/Billing Auditing/Compliance Practice Management shutterstock.com

55 CDI The fundamental basis for CDI is to improve the clinical note, which contains information about the encounter such as the patient s symptoms (i.e., the reason for the visit) and history of present illness, data measured and recorded, examination observations, an assessment, a definitive diagnosis, and a care management plan. A clinical note may reflect a variety of services and formats, such as a progress note compiled by a doctor or staff nurse during an encounter with a patient in the office or outpatient setting, a summary of laboratory findings and recommendations, a radiological interpretation or report, and an operative note. A clinical note is a like a snapshot. Physicians may see dozens of patients a day, and if the information isn t recorded in the progress note or operative report, it s probably lost for good. Will a physician really remember how many minutes he spent counseling a patient on smoking cessation or what the specific dimensions of a skin wound repair were if this information is not documented at the time of the encounter? This accentuates one of the assertions of the coders creed: If it s not documented, it didn t happen. To assess the quality of your providers clinical documentation, you may want to refer to what I call the Nine Cs of CDI. 1. Clarity The doctor may be able to read his own handwriting, but if you can t make it out, the documentation is worthless. It shouldn t be your responsibility to decipher something illegible or ambiguous, and risk miscoding based on that interpretation. Providers who are still using pen and ink need to be enlightened to the 21st century, where we have sophisticated electronic health record (EHR) templates. Shockingly, some practitioners with EHRs are still in the habit of preparing their notes manually and relying on a scanner to transmit them; this should be discouraged while using technological resources should be encouraged. 3. Completeness As we strive to capture the entire clinical picture of the patient, it s important for the physician to document all information pertinent to the patient s diagnosis, such as any current and recently discontinued medications and changes in condition status. For example: If a patient is diagnosed with septic arthritis or bursitis, the organism causing the sepsis should be documented. If a patient returns with lower sugar readings a week after diabetes was assessed as out of control, controlled diabetes (reflected by the lower readings) should be documented for the current encounter. Hypoxia caused by respiratory failure should be documented for accuracy of coding, as well as clarity of the illness severity. If a lysis of adhesions was performed, what organs or structures were released? If an acquired absence of an organ is relevant to a physician s finding, it should be documented and picked up by you. It may not be sufficient to simply document status post surgery because you may need to know whether a complication was actually post-procedural or caused by the surgery. Be sure to list any potentially related comorbid conditions. Key elements missing from the clinical note disservice the coders and billers, as well as quality of care. 4. Cohesion There are many different styles of clinical notes, but whether the practitioner uses a SOAP, CHEDDAR*, or narrative format, the underlying document should outline the patient s chief complaint and other related subjective data, as well as objective data, and smoothly segue into the assessment of the patient s condition and the course of action the provider will pursue. PRACTICE MANAGEMENT 2. Consistency Medical notes must not contain any words or sentences that could be interpreted as inconsistent with the diagnosis assessed or the procedure performed. Consistency of documentation is important not only for coding accuracy, but also for compliance. It s easy to slip up on this if close attention is not paid to the chronology of the patient s present illness and treatment. In the event of an external audit or a payer request for supporting documentation, the documenter must be able to back up a claim of medical necessity. Inconsistencies in the encounter note diminish the preparer s credibility. *SOAP stands for subjective, objective, assessment plan and CHEDDAR stands for chief complaint, history of presenting illness, examination, details, drugs and dosages, assessment, return visit information or referral. 5. Coder Friendliness Physicians sometimes document in terms only they understand. You may need to learn quickly about what is documented; Internet researching often helps, but it s not a cure-all. You and your physicians should educate each other. April

56 CDI PRACTICE MANAGEMENT For example, if an orthopedic surgeon treats an open fracture, he can simply add the word open to his diagnosis, or at least document that a skin wound was caused by the fracture. If the treatment was performed on the proximal humerus, the specific location (surgical neck, greater tuberosity, etc.) will help you to code more precisely, instead of selecting an unspecified code within this anatomic site. Physicians should also try to minimize the amount of unfamiliar abbreviations they enter into clinical notes. 8. Cleanliness A clinical note riddled with grammatical and typographical errors lacks professionalism and can create repercussions down the revenue cycle, including the possibility of a payer audit. Language barriers can sometimes cause transcription of incorrect information, such as 50 mg instead of 15 mg. With medical terms, you have to be especially careful with spelling and pronunciation because words may look and sound similar (e.g., hypertension vs. hypotension). It s important for all clinical staff, including medical assistants who act as data processors and transcriptionists, to be properly trained in CDI. This may require someone validating their work before it gets submitted. 6. Concision Ideal documentation stays on point with the patient s current problem and the reason for seeking medical care. It s not necessary to enumerate (or copy and paste) the patient s entire medical history or medication regimen, or make statements in the note that have no bearing on treatment of the condition being managed or a related procedure being performed. Despite extreme severity of certain comorbid illnesses that must remain a part of the patient s record of active problems, a specialist does not need to reiterate conditions if they are not relevant to the encounter. Concise documentation speeds up the coding process because you aren t bogged down reading superfluous text. 7. Compartmentalization Sometimes physicians will document everything they are supposed to, but in no particular order or pattern. This may cause you to overlook information germane to accurate coding. Most EHR packages provide medical practice staff with the capability to design sophisticated templates from which they can fill in the details of their progress note in a timely, cost-effective manner. In the EHR, the most valuable feature of the compartmentalization process is the ability to standardize the location of any key element within the note. This greatly eases validating a charge or coding the note from scratch, saves time, and creates a much less error-prone workflow. For instance, if a patient is given an inhalation treatment or a vaccination, the details of this procedure (drug dosage, constituents, etc.) can be entered into a field called Orders, and you will always know to look there for this piece of data. 9. Credibility Credibility is one of the most important facets of CDI. When coding for professional services, medical staff including on-site and off-site coders cannot use working diagnoses to code actual findings. Words such as question of, probable, or likely preceding a clinical diagnostic term negate that term because no actual diagnosis has been established. If the physician has determined the actual diagnosis, he or she should not add words in the documentation that cast doubt on the finding. During the dictation and transcription process, you must be careful with cloned documentation, which is boilerplate text lifted (i.e., copied and pasted) from one patient visit to the next (or even from one patient to another). Such habits are fraught with peril, especially if cloned text hasn t been proofread for parameters that can vary from encounter to encounter or patient to patient. As deemed necessary, subordinate data entry should be qualitycontrolled at a checkpoint before a claim is submitted. This checkpoint should primarily be the responsibility of the clinical staff because the workflow may completely bypass you if no major edits are caught between the EHR and the billing pipeline. Will a physician really remember how many minutes he spent counseling a patient on smoking cessation or what the specific dimensions of a skin wound repair were if this information is not documented at the time of the encounter? 56 Healthcare Business Monthly

57 To discuss this article or topic, go to CDI CDI Is More Important than Ever The clinical note is a legal document. Physicians, coders, billers (and anyone else involved in healthcare) are touched by the clinical note. It s the source from which you abstract information to select optimal codes for reporting to payers. We all must work as a team to ensure we are maximizing the CDI factor in all practitioner documentation. With ICD-10 now a reality, specificity of documentation is more important than ever, and more stringent governmental and payer regulations reflecting CDI are in our future. Coders and clinical staff should convene periodically or as needed to address CDI, reviewing general issues discussed here, as well as those that are specialty-specific. PRACTICE MANAGEMENT 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. CDI Checklist for Clinicians 1. Make sure someone other than the documentor can read every element in the note. 2. Avoid any inconsistencies in a clinical note. 3. Capture all clinical information that may affect patient care. 4. Use clear paragraph structure, where sentences adhere together, so as not to break the reader s train of thought. 5. Strive to document in a coder-friendly manner to the extent possible. 6. Cut to the chase. Don t document what isn t relevant to the encounter. 7. Ease the validation process by standardizing location of common key elements. 8. Perform quality assurance checks to find obvious errors and questionable transcriptions in clinical notes. 9. Make sure the note is credible in all respects. April

58 PRACTICE MANAGEMENT By John Verhovshek, MA, CPC What (Not) to Wear While Job Hunting To play the role of a successful employee, you have to look the part. Looking for work is hard enough: Don t hurt your chances with a wardrobe that fails to make a good impression. Here are a few insights from individuals on the front lines, with the responsibility to fill open positions within their organizations. The consensus: Be neat, polished, professional, and not too flashy. And remember: You re never fully dressed without a smile. Geanetta Agbona, CPC, CPC-I Educator, CGS Medical Billing Service, Charlotte, N.C. On any interview, strive to appear polished, accomplished, skilled, and competent. Your attire should impel me to belive you are an expert in your field. Pam Brooks, MHA, CPC, COC, PCS Coding manager, Wentworth-Douglass Hospital, N.H. I always recommend a prospective employee check out the dress code of the organization prior to any interviews. What s deemed appropriate attire in some parts of the country may not be so appropriate in others never assume. Aside from that, I recommend business attire: For women: a dark skirt or dress trousers, light-colored blouse, and jacket or cardigan. For men: shirt and tie, jacket optional. No, to the golf shirt. Being overdressed is better than being inappropriately dressed. Never wear jeans, sneakers, sweatshirts, t-shirts, or anything too short, tight, or revealing. Women should wear stockings and low heels. Keep jewelry simple. You want the interviewer to see you, and not be distracted by your outfit. Most hospitals have rules about multiple tattoos, multiple piercings, unnatural colored hair, and overwhelming cologne. I once had an asthma attack and had to usher a job candidate out of my office because she had marinated herself in cologne earlier that day. Rhonda Buckholtz, CPC, CPC-I, CPMA, CENTC, CGSC, CPEDC, COBGC, CRC, CHPSE Vice president strategic development, AAPC Research the organization at which you are applying to learn their standards. You don t want to out-dress the CEO, but you also want 58 Healthcare Business Monthly Coding/Billing Auditing/Compliance Practice Management

59 To discuss this article or topic, go to Job Hunting to appear polished and professional. Your appearance weighs heavily on first impressions. Clean, well-pressed clothes are a must. Don t wear heavy scents or heavy makeup that will distract interviewers. The best thing you can wear is your smile; show them that you want to be there. MariaRita Genovese, CPC, PCS Administrator, oncology revenue cycle, Thomas Jefferson University, Philadelphia, Pa. What to wear to an interview: Clean, well-fit clothing nothing tight or clingy Ladies: Wear a dress/skirt with a jacket or cardigan sweater, or a pantsuit Men: Wear a suit and tie. A cardigan sweater in place of a jacket is acceptable. Appropriate footwear: no sneakers, platform heels, or flip-flops Stockings for ladies Moderate makeup Moderate jewelry nothing that jangles No colognes or other fragrant products someone at the office may be allergic A smile The best thing you can wear is your smile; show them that you want to be there. PRACTICE MANAGEMENT istock.com/michalel Jung Ellen Maura Wood, CPC, CMPE Practice manager, Seacoast General Surgery, Dover, N.H. No matter if you re dropping off your resume cold or going to an interview, dress professionally. That means business attire. For a man: blazer, tie, and pressed pants. For a woman: stockings (no open toe shoes or flip flops), pressed pants or dress/skirt. Dresses and skirts shouldn t be much above the knee. I look at fingernails, too. We work in the medical field, so cleanliness is important. When I went to business school over 30 years ago, I learned something that always stuck with me: Clean and polish your nails before an interview. I ve done it before every interview I ve ever gone to. I used to tell my daughters, even if they were just getting after-school jobs, dress like you want the job! John Verhovshek, MA, CPC, is managing editor at AAPC and a member of the Hendersonville-Asheville, N.C., local chapter. April

60 NEWLY CREDENTIALED MEMBERS Magna Cum Laude Ajomol Atlin, COC-A Alecia Cartwright, CPC, CRC Azaruddin Mahammad, CIC Baswaraj Banjanagari, CIC Jennifer Borsody, CPC-A Jessa May Taniñas, CPC-A Joan Opleda Salvatus, CPC-A Joseph Paul, CIC Julia Haun, CPC Jyothirmayee Gaddamedi, CPC-A, CIC Lalitha devi Veeramsetti, CIC Leigh Ann Mahjoobi, COC-A Linabelle De Venecia, CPC-A Lindsey Wheeler, CPC-A Maria Orta, CPC-A Mary Gannon-McMurry, CPC-A Padmavathy Narayanan, CIC Pradeep Kumar Gattlola, CIC Pradeep Pagidimarri, CIC Raja Shekar Devanaboina, CPC-A, CIC Rajesh Kumar Natchimuthu, CPC, CIC Rakesh Gaddam, CIC Santhosh Reddy Mandadi, COC-A, CIC Shiela Marie Ong, CPC-A Sona Thirumoorthy, CIC Suganya Subramanian, CIC Swapna Marepally, CIC Swathi Gaddam, CIC Vikram Reddy, CIC Vinay Kumar Daram, CIC CPC Aarti B Menghrajani, CPC Abraham Grimas, CPC Adam Walker, CPC Africa Ware, CPC Agnieszka Popowski, CPC Aimee Haydel, CPC Alex Gonzalez, CPC Alfredo Nasiff Hadad, CPC Alisa R Hillock, CPC Alisha Eifert, CPC Altrese Jacob, CPC Alyson Merrill, CPC Amber Meade, CPC Amell M Solano, CPC Ana Cruz, CPC Anays Fundora, CPC Andrea Checovich, CPC Andrea Hochstatter, COC, CPC, CEDC Anessa Marie Uberroth, CPC Angela Barber, CPC Angela Jean Hall, CPC Angelique Rodriguez, CPC Anna Melendez, CPC Anuradha Lakshminarayanan, COC, CPC Aramis Paz, CPC Arathy Radhakrishnan, CPC Arlene Padron Alfonso, CPC Ashley Creel, CPC Ashley Meyers, CPC Ashok Reddy Marella, COC Athena Parscal, CPC Autumn Cope, CPC Awilda Agosto, CPC Barbara Helen Sweeney, CPC Becky Quarry, CPC Belinda Phelps, CPC Belkis Diaz, CPC Bernadine Bell, CPC Birgit Otto, CPC, CPMA Biswajita Lenka, CPC Bree Safranski, CPC Brenda Honeycutt, CPC Brenda Keller, CPC Brenda Nielsen, CPC Brianna Guinn, CPC Brittany Etheredge, CPC Brooke Swindal, CPC Carlos Trujillo, CPC Carmen G Perez Fundora, CPC Carolyn Booker-Cruz, CPC Carrie M Hook, CPC Cassandra J. Whitehead, CPC Cassie Ihrke, CPC Catherine Lynn Chidzik, CPC Cecilia Harris, CPC Cecilia Sosa, CPC Celeste Sowder, CPC Chaine Socorro, CPC Chandrani Roy, CPC Chanthini Kothakulamparambil Venugopalan, CPC Chinh Nguyen, CPC Christine M Leite, CPC Christine Nguyen, CPC Ciara Quarles, CPC Cindy Carpenter, CPC Constance Holte, CPC Cornelia Wallace, CPC Courtney Long, CPC Cristina Garcia, CPC Crystal Callahan, CPC Crystal Ramos, CPC Cynthia Berry, CPC Cynthia R Brannock, CPC Daidy Guanche, CPC Dana Birt, CPC Danielle Wilkinson, CPC Davina Manson, CPC Dawn Shaw, CPC Dawn Zellner, CPC Dayci Torres, CPC Deanna Clunie, CPC Deborah Barker, CPC Dede Kelly, CPC Denise Ehrensberger, CPC Denise Gardenia Cruz, CPC Diana Hang, CPC Diana Mahalbasic, COC Diana R Seymour, CPC Diana Roque-Gamez, CPC Donna Spurlock, CPC Donna Tabernacki, CPC Dustin Berg, CPC Dwaain Straker, CPC Ebony Fair, CPC Ebony Jones, CPC Elizabeth Alfaro, CPC Elizeth Milagros Garcia, CPC Emily Dillow, CPC Emily Narvais, CPC Erin Brockmeier, CPC Erin Kay Cox, CPC Erin Puett, CPC Erin Reed, CPC Euna Ball, CPC Felicia Burton, CPC Felicia M Cephus-Williams, COC, CPC, CPC-I, CEMC, CGSC Ginger Whitley, CPC Hannah Gross, CPC Harish T, CPC Heather Boothe, CPC Iliana Rojas, CPC Jackie Anne Zupon, CPC Jayanna Coleman, CPC Jeanetta Hambrick, CPC Jennifer Guffey, CPC Jennifer Jarrard, COC, CPC Jennifer Robbins, CPC Jennifer Rose Huffman, CPC Jessica Brown, CPC Jessica Francis, CPC Jody Tenold, CPC Johna Popovich, CPC Josephinemary Samuelasirvatham, COC, CPC Julia Nicole Duran, CPC Julie Ann Bradley, CPC Karen L Becraft, CPC Karen Lynn Edgar, CPC Karen Megge, CPC Karen Ranero, CPC Katherine Mallette, CPC Kathleen Lyman, CPC Kathryn Walter, CPC Kathy Bates, CPC Katie Campbell, CPC Katrina Rieta, CPC Keesha L Coram, COC, CPC, CRC Keisha Martinez, CPC Kelli Bearden, CPC Kelli Kienker, CPC Kelly Bronnenberg, CPC Kelly Thrower, CPC Kemi J Hubbard, CPC Khristina Valdez, CPC Kimberley Ramsey, CPC, CPB Kimberly Mahany Dixon, CPC Kimberly Porter, CPC Kimberly Williams, CPC Kristen Dennis, CPC Kristin Birmingham, CPC Kristina Marthaler, CPC Kristina Martinez, CPC Kristy Nickson, CPC Labiba Alam, CPC Lameka Michael, CPC Lana Jean Groth, CPC Latoya Calloway, CPC Laura Cirilli, CPC Laurie Robertson, CPC Laxmibhavani Dharavathu, CPC Leanna Manley, CPC Lena Rae Ragland, CPC Leslie Koehn-Fertel, CPC Leticia L Gonzalez, CPC Lina E Rivero, CPC Linda Grimes, CPC, CPC-P, CPMA Lisa Alonso, COC, CPC Lisa G Palmer, CPC Lisa K Wilson, CPC Lisa Lash, CPC Lisa M Cona, CPC Lorenza Ortiz, CPC Loretta Lee, COC Lori Cronise, CPC Lori Hillman, CPC Lori Taggart, CPC Lori Warren, CPC Lorie Ann Fitzer, CPC Lorretta Maria Dixon, CPC Lucy Mitha, COC, CPC Luz M Paras, CPC Lynette Lara, CPC Mandy Norris, CPC Marcella Soto, CPC Marcia Hernandez, CPC Margaret Ann Wilson, CPC Maria De Luna, CPC Maria Eugenia Trujillo, CPC Maria Lorena Angel, CPC Maria Saura, CPC Marianela Delgado Medina, CPC Marielena Urquiola, CPC Marla Vance, CPC Marvette Sherell Smith, CPC Mary Ashley Adkins, CPC Mary Duke, CPC Mary V Balentine, CPC Masheena Larkin, CPC Mayda Rodriguez, CPC Mayon Marie Tahal, CPC Meagan Peluso, CPC Melisa Falcon Garcia, CPC Melissa Leeds, CPC Melissa A Cruz, CPC Melissa F Young, CPC Melissa Schave, CPC Melodie Ortiz, CPC Meredith Ray, CPC Michelle Brewer, COC, CPC Michelle Pena, CPC Michelle Trotter, CPC Mila Nazarenko, CPC Mirtza Pi, CPC Mohamed Fayiz Nalakath Kuttikattil, CPC Monica D Henderson, CPC Monica Trumpler, CPC Nahed Ibrahim, CPC Nanette Turner, CPC Natasha Brown, CPC Nora Nervar Balabarcon, CPC Norma Francisco Bonus, CPC Osleidys Perez, CPC Patricia Clarke, CPC PushpaLatha Subbiah, COC Rachel Stone, COC, CPC Rajat Kumar Yadav, CPC Rajesh Nakka, COC Randi Butcher, CPC Ranney Romero, CPC Rasathithecla Lucas, COC, CPC Rashana I Smith, CPC Regina Hollins, CPC Renee Garrison, CPC Rizelle Mauleon, CPC Robert Warburton, CPC Ronda Eden, COC, CPC Roxana Perez, CPC Ruthie joy Punay, CPC Safal Chariyampadath, CPC, CPC-P Samantha L Popella, CPC Samantha Carlton, CPC Samantha Ruiz, CPC Santina Mayo, CPC Santor LaRay Wayans, CPC Sarah Leggitt Sones, CPC Saranya Ganesan, COC, CPC Shahid Mahmood, CPC Shameka Houston, CPC Shanmuga Nagarajan Chickannan, COC Shannon McNamee, CPC Sharon Winters, COC, CPC Shashikumar Natarajan, COC, CPC Sherry Ann Coates, CPC Sheyla Reyes, CPC ShiCoah Yarbrough, CPC Shimeka Johnson, CPCO, CPC-P, CPB, CPMA, CPPM Sima Kaufman, CPC Sindhuja Chalamalasetty, CPC Sonja Winstead, CPC Sonya Gee, CPC Sravana Jyothi Vedurupaka, CPC Srinivasan Arumugam, CPC Stacie Watie, CPC Stephanie Anderson, CPC Stephanie Durboraw, CPC Stephanie T Baumert, COC, CPC Steve John Meyer, CPC Subhashini Manohar, CPC Suneethi Venkatesh, COC, CPC Sureshgujjanapudi Gujjanapudi, CPC, CPC-P Susan Anding, CPC Susan Smith, CPC Susanne J Tuck, COC, CPC Susanne Rancourt, COC, CPC Sushma Bellaby, CPC, CPB Susithra Somasundaram, COC, CPC Suzanne Murphy, CPC Tammy Ragsdale, CPC Tammy Schmarkey, CPC Tara Hamilton, CPC Tasha Turner, CPC Teneka Taylor, CPC Teresa M Stenquist, CPC Teresa Mercer, CPC Teresa Soffa, CPC Teri L Roath-Baum, CPC Thiencuong Nguyen, CPC Tiffany Asher, CPC Tina Knospe, CPC Tonya L Johnson, CPC Tonya Millsap, COC Tracy Y Riedl, CPC Tramaine Lewis, CPC Tsion Tesfaye, CPC Uyen Hodgdon, CPC Vicky Marie Bowen, CPC Vudari Kalpana, CPC Wanda J Russell, CPC Wendy Bahaw, CPC Yajaira D Vazquez, CPC Yaneris Lopez, CPC Yaney Curbelo, CPC Yara Romain, CPC Zia Ahmed, COC Apprentice Aalapati Anusha, COC-A Abhilash S, CPC-A Abhisha Surabhi, COC-A Abigail Rich, CPC-A Ablessin Johnson, CPC-A Ache. Shravan, CPC-A Ada Chin, CPC-A Adam Gold, CPC-A Adapa Deepak Kumar, CPC-A Adele Ciruti, CPC-A Adrianna Brinker, CPC-A Adrianne Hughes, CPC-A Adrienne Lozano, CPC-A 60 Healthcare Business Monthly

61 NEWLY CREDENTIALED MEMBERS Adunola Ademiluyi, CPC-A Afrah Abdulkareem, CPC-A Afshan Shamim, CPC-A Ahmed Al Saedi, CPC-A Ahmed Unnisha Shaik, COC-A Ahuva Sclair, COC-A Aide Romero, CPC-A Aiza Uy, CPC-A Ajesh Jose, COC-A Akash Jain, CPC-A Akhila Addhu, COC-A Akkamolla Santhosh Reddy, COC-A Akshaya Ashok Kumar, CPC-A Akshaya Penkar, CPC-A Alan Willoughby, CPC-A Alberto Alfonso, CPC-A Alegria Edono Mallorca, CPC-A Alejandra McClain, CPC-A Alejandra Torres, CPC-A Alessandra Bentley, CPC-A Alex Walker, CPC-A Alex Hoover, CPC-A Alexa Banegas, CPC-A Alexandra Mickiewicz, CPC-A Alfie Acabo, CPC-A Alfred Blas, CPC-A Alice Li, CPC-A Alice Mierzwa, CPC-A Alicia Edwards, CPC-A Alicia Gray, CPC-A Alicia Scrip, CPC-A Alicia Shevokas, CPC-A Alisa Kolomenskaya, CPC-A Alison Bryan, CPC-A Alison McKinney, CPC-A Alissa Rosario, CPC-A Allyson Schulte, CPC-A Alma VanWinkle, CPC-A Alwen Alilaen Elevado II, CPC-A Alyssa Woodward, COC-A Alyxandria Guzman, CPC-A Amali Auxilia, CPC-A Amanda Casner, CPC-A Amanda Conklin, CPC-A Amanda Gutzmann, CPC-A Amanda Loy, CPC-A Amanda Lupfer, CPC-A Amanda Raemhild, CPC-A Amanda Smith, COC-A Amarendra Nath Bai, COC-A Amarjeet Singh, CPC-A Amber Perez, CPC-A Amber Todi, CPC-A Amber Underwood, CPC-A Amir Khan, CPC-A Amit Kumar Shrivasta, CPC-A Amy J Hull, CPC-A Amy Keeney, COC-A Amy Messacar, CPC-A Amy Phillips, CPC-A Amy Simon, CPC-A Amy Speidel, CPC-A Amy Trujillo, CPC-A Anagha Bhusari, CPC-A Andrea Boger, CPC-A Andrea Dixon, CPC-A Andrea Johnson, CPC-A Andrew Bulgin, CPC-A Anesha Spencer, CPC-A Angela Banks, CPC-A Angela Kaatz, CPC-A Angela Zito, CPC-A Angelica Macalalag, CPC-A Angelina Mullins, CPC-A Angelo Alpuerto Hernandez, CPC-A Angie Sanders, CPC-A Anil Kumar Boorgula, COC-A, CPC-A Anil Kumar Boorgula, COC-A, CPC-A Anil Shreedhar Shet, CPC-A Anil Singh, CPC-A Anita Anderson, CPC-A Anitha H.K, CPC-A Anjana K R, CPC-A Anjana Seena, COC-A Anna Barrios, CPC-A Anna Lachance, CPC-A Anna Shvedchenko, CPC-A Anthony Campbell, CPC-A Anthony Shepps, CPC-A Anuja Lad, CPC-A Anuradha Singh, COC-A Anurag Anant Jadhav, CPC-A Anurag Malik, CPC-A Anurag Sharma, COC-A Aparnanagaveni Vennapusapalli, CPC-A Apoorva Srivastava, CPC-A April Rojas, CPC-A April Zabele, CPC-A Archana Poola, CPC-A Archival Sotto Nadal Jr, CPC-A Ardith Charles-Harris, CPC-A, CGSC Arelia Huff, CPC-A Arjun Kumar, CPC-A Arlene Santos, CPC-A Arlhyn Aguirre, CPC-A Arsha George, COC-A Arti Singh, CPC-A Arun Raju, COC-A Arun T Raj, COC-A Aruna Selvaraju, CPC-A Ashita Patel, CPC-A Ashlee Anderson, CPC-A Ashlee Harover, CPC-A Ashley Ischar, CPC-A Ashley Marie Ambeau, CPC-A Ashley Mekmorakoth, CPC-A Ashley Michelle Culbreth, CPC-A Ashley Nicole Riley, CPC-A Ashley Pineda, CPC-A Ashlyn Breanna Tanner, CPC-A Astha Bhatnagar, CPC-A Aswinkumar Swarnaraj, CPC-A Athira Chelladwora Raj, CPC-A Athira G, COC-A Audra Clarke, CPC-A Audrey Precious Raquinio, CPC-A Austin Wentworth, CPC-A Auyna Bethancourt, CPC-A Azeemuddin Mohammed, CPC-A Azharuddin Mohammed, COC-A Balabhadra Misra, COC-A Balaji Kathirvel, COC-A Bandaru Chaithanya, COC-A Banupriya Mohanam, CPC-A Barb Dufresne, CPC-A Barbara Blood, CPC-A Barbara Young, CPC-A Baskar Balaji, COC-A Baskaran R, COC-A Beeram Sampath Kiran, CPC-A Belinda Mabry, CPC-A Bellamkonda Naresh, CPC-A Bency Mol, CPC-A Beth Shaddock, CPC-A Beverly Benito, CPC-A Bhagirath Reddy Palla, COC-A Bhagwant Singh, CPC-A Bharath Devendhiran, CPC-A Bhaskar Reddy M, COC-A Bhavya Suren, COC-A Bhoopal Reddy Katipally, COC-A Bhulaxmi Garikapati, COC-A Billie Persons, CPC-A Bindhu Sundaram, CPC-A Blanca Patricia Baker, CPC-A Blerina Ducellari, CPC-A Bobbili Sunil, CPC-A Bonnie Wallace, CPC-A Bonnie Yoder, CPC-A Brandy Marten, CPC-A Brandy Mills, CPC-A Briana Gilbert, CPC-A Bridget Ferland, CPC-A Bridget Hrycek, CPC-A Bridget Miller, CPC-A Brie Patterson, CPC-A Brighty Devakirubai, CPC-A Brittany Howell-Blaszczyk, CPC-A Brittany Wassell, CPC-A Brittney Miller, CPC-A Brittney Pritchett, CPC-A Bryan Pfeiffer, CPC-A Candi A. Anderson, CPC-A Carine Kimon, CPC-A Carla Martinez, CPC-A Carlee Lugo, CPC-A Carlie Scholer, COC-A Carly Batzel, CPC-A Carol Bagal, CPC-A Carol Berry, CPC-A Carol L Keyes, CPC-A Carole Flagler, CPC-A Casey Thavy, CPC-A Cassandra Forsman, CPC-A Cassey Hattaway, CPC-A Cassie Anderson, CPC-A Catherine Foster, CPC-A Catherine Renteria, CPC-A Cathy Halstensgaard, CPC-A Celia Mendez, CPC-A Chaitali Ambekar, CPC-A Chandralekha Chinnakannu, COC-A ChandraSekhar Raju, CPC-A Chandrasekhar Singh, CPC-A Charizze Anne Sauro, CPC-A Charles Allender, CPC-A Chelsea Thomas, CPC-A Chenchaiah Ramisetti, COC-A Cherish Scott, CPC-A Cheryl Rockwell, CPC-A Cheryl Tinsley Hayes, CPC-A Chethana Gobbali Kumara, CPC-A Cheyenne Jorgensen, CPC-A Christina Coleman, CPC-A Christina Fuller, CPC-A Christina O Marrah, CPC-A Christine Stello, CPC-A Christopher Dukart, CPC-A Cielo Marcelino Hipolito, CPC-A Cindy Brister, CPC-A Cindy Howard, CPC-A Cindy McNamara, CPC-A Clarence Alindogan Nicolas, CPC-A Claudia Nogueira, CPC-A Claudia Salcedo, CPC-A Colby Ware, CPC-A Colleen Blevins, CPC-A Connie Jones, CPC-A Connie-Diane Whalen, CPC-A Courtney Dumais-Myers, CPC-A Courtney Johnson, CPC-A Crystal Marie Akins, CPC-A Cynthia Ballard, CPC-P-A Cynthia Cates, CPC-A Cynthia Dawkins, CPC-A Cynthia Rodriguez, CPC-A Cynthia Schmied, CPC-A D.Mukesh Kumar, CPC-A Daisy Santiago, CPC-A Damon W Cohoon, CPC-A Danaize Garcia, CPC-A Danavian Sims, CPC-A Danelle Davis, CPC-A Daniel Hunt, CPC-A Daniel Salazar, CPC-A Danielle Freeman, CPC-A Danielle Stokman, CPC-A Danyel Speaks, CPC-A Dara Crookshank, CPC-A Darlene A Delibro, CPC-A Darshana Nagwenkar, CPC-A David Hufham, CPC-A David Jaime, CPC-A David Jr Ruiz, CPC-A Dawn Gabree, COC-A Dawn Hubbard, CPC-A Dawn Lynn Klyczek, CPC-A Dawn Potter, CPC-A Dayami Estrabao, CPC-A Deanna Elizabeth Perry, CPC-A Deanna K Iwen, CPC-A DeAnna Lerschen, CPC-A Deanna Marie Duquesne, CPC-A Debbie Peck, CPC-A Debbie Schreppel, CPC-A Debi Metevia, CPC-A Deborah Hanner, CPC-A Debra Downham, CPC-A Debra Grabowski, CPC-A Debra McMahon, CPC-A Debra Sargent, CPC-A Debra Whittum, COC-A Dee Hart, CPC-A Deepa Narayanagowda, CPC-A Deepak Saxena, CPC-A Deepti Katyal, CPC-A DeLisa Smith, CPC-A Detra Parker, CPC-A Dharmateja Pennada, COC-A Diana Kim Hager, CPC-A Diana Nicholson, CPC-A Dianne Henson, CPC-A Dianne Potochniak, CPC-A Dilip Chaudhari, CPC-A Dinah St. Victor, CPC-A Divya Chollati, CPC-A Divya Francis, CPC-A Divya Manisi, CPC-A Divya N, CPC-A Divyabharathi Selvaraj, CPC-A Dizon Winnifred, CPC-A Dolly Flowers, CPC-A Dongababu Bandaru, CPC-A Donn Polson, CPC-A Dr Poornima, COC-A Durgadevi Ramalingam, CPC-A Eddagotla Himan Kumar, CPC-A Edna Louise Compton, CPC-A Edward Masong Tenorio, CPC-A Efstratia Eleftheriou, CPC-A Einat Berkman, CPC-A Elias Abelardo Bequer, CPC-A Elizabeth Allison, CPC-A Elizabeth Beardsley, CPC-A Elizabeth Green, COC-A, CIRCC Elizabeth Molina, CPC-A Elizabeth Nash, CPC-A Ellen R Beason, CPC-A Ellyssa Norkin, CPC-A Elvira E Lara, CPC-A Emily Dunbar, CPC-A Emily Robinson, CPC-A Emily Russo, CPC-A Eric Flores, CPC-A Erika Joy Arrieta, CPC-A Erika Lemieux, CPC-A Erika Parsons, CPC-A Erika Ravenscraft, CPC-A Erin Coleman, CPC-A Estrella Tapec, CPC-A Eva Silegy, CPC-A Evelina Krivtsova, CPC-A Ezhildevi Mohanmari, CPC-A Faith Yonzon Secula, CPC-A Frennylyn Gambayan, CPC-A G Shiva Shankari, CPC-A Gabriell Johnson, CPC-A Gail Gaul, CPC-A Gary Neu, CPC-A Gayathri Arya. K, COC-A Gayatri Atikela, COC-A Geetha K, COC-A Genine Santiago Neo, CPC-A Gentry Jackson, CPC-A Gerardo Labra, CPC-A Ghouse Mohammad, COC-A Gilberto Alcocer III, CPC-A Glenn Mark Najorra, CPC-A Gleybis Martinez, CPC-A Gouthami Rakasi, CPC-A Govil Packia Muthu Pounraj, CPC-A Gowtham Kumar Inaganti, COC-A Gowthaman Inbaraj, CPC-A Grace Lebeda, CPC-A Graciela Flynn, CPC-A Gretchen Stenson, CPC-A Guohong Li Watkins, CPC-A Hammurabi Kabbabe, CPC-A Harendra Rai, COC-A Harika Kotha, COC-A Hayley Simmons, CPC-A Heather Kocourek, CPC-A Heather Sinkevitch, CPC-A Heather Sweat, CPC-A Hector Brea Jr., CPC-A Heidi Nystrom, CPC-A Heidi Ricks, CPC-A Helyn Adams, CPC-A Hemalatha Kovoori, COC-A Hemalatha Lakkala, CPC-A Hemlata Sharma, CPC-A Heng Saely, CPC-A Hepsibha Sanamula, CPC-A Hilda Griffin, CPC-A Holly P Nelson, CPC-A Holly Rietscha, CPC-A Hudson R Harris, CPC-A Husnaara Shaikh, CPC-A Ian, CPC-A Imran Ahmed Khan, CPC-A Imran Mohammed Shaik, COC-A Inga Chandler, CPC-A Ivette Cano, CPC-A Ivy Grace Silvestre, CPC-A Jacci AR, CPC-A April

62 NEWLY CREDENTIALED MEMBERS Jacintha Clara Pinto, CPC-A Jacob Camandona, CPC-A Jacqueline Ang - Bigtas, CPC-A Jaggarao Jalumuru, CPC-A Jagruti Vyas, CPC-A Jaime Lomax, CPC-A Jakkena Purushottam, COC-A Jalyn Ashley Branscum, CPC-A Jama Dunn, CPC-A Jamie Carney, CPC-A Jamie Donnelly, CPC-A Jamie Short, CPC-A Jan Michael Saludar Barroga, CPC-A Jana Aplin, CPC-A Jane Gabriel, CPC-A Jane Marie Tyler, CPC-A Janet Hosterman, CPC-A Janet Kemp, CPC-A Janet Scheltema, CPC-A Janet Steed, CPC-A Janice Diesta Go, CPC-A Janice Gentile, CPC-A Janice Wong, CPC-A Jankee Patel, CPC-A Jansi Venkatesan, COC-A Jason Carden, CPC-A Jason Maddox, CPC-A Jason Smith, CPC-A Javaji Kartheek, CPC-A Jayanthi Balumurali, CPC-A Jayanthi Narasiman, CPC-A Jayanti Kushwaha, CPC-A Jazil VP, CPC-A Jean Ruby, CPC-A Jeff Schultz, CPC-A Jennifer Holmes, CPC-A Jennifer Huskey, CPC-A Jennifer Lynn Prohoroff, CPC-A Jennifer Miller, CPC-A Jennifer Miskowsky, CPC-A Jennifer Paige Golden, CPC-A Jennifer Prince, CPC-A Jennifer Rickards, CPC-A Jennifer Sandau, CPC-A Jennifer Slagle, CPC-A Jennifer Ziesemer, CPC-A Jenny Parkin, CPC-A Jenny Wilson, CPC-A Jerika Celine Matias, CPC-A Jerin John, CPC-A Jess Ayers, CPC-A Jessica Gomez, CPC-A Jessica Hamilton, CPC-A Jessica Hernandez, CPC-A Jessica Johnson, CPC-A Jessica Nicole Litton, CPC-A Jessica Reilly, CPC-A Jessica Rentz, CPC-A Jessica Schroeder, CPC-A Jessica Short, CPC-A Jessica Smith, CPC-A Jessica Wilson, CPC-A Jessy Ancy Varghese, CPC-A Jestine Bugner, CPC-A Jewel Abraham, CPC-A Jiji Joboy, COC-A Jill Keetch, CPC-A Jill Kepner, CPC-A Jill Maruska, CPC-A Jincy George, CPC-A Jitender Rawat, CPC-A J Lyn Carruth, CPC-A Jo Nell Grover, COC-A Joanna Chowaniec, CPC-A Joanna Michell Alcasid, CPC-A Joanna Ordonez, CPC-A Jodi Bonham, CPC-A Jodi Cihal, CPC-A Joel Arun Kumar Rajarathinam, CPC-A Joemar Maglalang, CPC-A Johanna Luber, CPC-A John Ivan Reyes Torres, CPC-A Joseph DeLoreto, CPC-A Joseph Garrett, CPC-A Joseph Linson, CPC-A Joseph Luigi Torres, CPC-A Josie Fonua, CPC-A Joy Wilson, CPC-A Joyce Bowden, CPC-A Joyce Piper, CPC-A Juan Montanez, CPC-A Judy Lyn McCue, CPC-A Judy Zamora, CPC-A Julia Keiser, CPC-A Julia Keiser, CPC-A Julia Stephenson, CPC-A, CPPM Julie Ahrendt, CPC-A Julie Dillon, CPC-A Julie Hoffman, CPC-A Julie Wieneke, CPC-A Julie Wysner, CPC-A Julissa Tuya, CPC-A Jullianne Tanya Regencia, CPC-A Justin Dipiazza, CPC-A Justine Malecki, CPC-A Jyothisree Vadlakonda, CPC-A Jyoti Anand, CPC-A Kabde Ankita, COC-A Kaeylor Joseph, CPC-A Kakarla Venkata Hemanth, COC-A Kalpana Janagam, COC-A Kalpana Kannan, CPC-A Kamala Shaddock, CPC-A Kara Flaugher, CPC-A Karan Shinde, CPC-A Karen Shewmaker, CPC-A Karen Wisby, CPC-A Kari A. Willingham, CPC-P-A Karthik Katakam, COC-A Karthik Nalla, COC-A Karthik Raman, COC-A Kassia Lynn Olszewski, CPC-A Katherine Kreamer, CPC-A Katherine Licerio, CPC-A Kathleen Casey, CPC-A Kathleen Murphy, CPC-A Kathryn Arena, CPC-A Kathy Hansen, CPC-A Katie Hoffer, CPC-A Katie Rebeca Sousan, CPC-A Katrina Medina, CPC-A Kavya Allam, CPC-A Kay Johnson, CPC-A Kayla DeMott, CPC-A Kayla Herrera, CPC-A Kayla Kerns, CPC-A Kayla Rice, CPC-A Kayla Sauls, CPC-A Kayti Shipley, CPC-A Kela Hamilton, CPC-A Kelli Quilici, CPC-A Kellie Wilson Phillips, COC-A Kelly Benoit, CPC-A Kelly Black, CPC-A Kelly Buchanan, CPC-A Kelly Heeg, CPC-A Kelsi Mikel Brown, CPC-A Kendra Quach, CPC-A Keneath Anne Villarin, CPC-A Kenneth Gary, CPC-A Kenneth Jay Cabrito, CPC-A Kerri Miller, CPC-A Ketananandrao Jadhav, CPC-A Kevin McFadden, CPC-A Kevin Raj, CPC-A Khadija Bowen, CPC-A Khaleelur Rahman, CPC-A Kim Johnson, CPC-A Kim Lecus, CPC-A Kim Piotrowicz, CPC-A Kimberly Myers, CPC-A Kimberly Aguirre, CPC-A, CPB Kimberly Cooper, CPC-A Kimberly Cotter, CPC-A Kimberly Erickson, CPC-A Kimberly Jones, CPC-A Kimberly M Hamilton, CPC-A Kimberly McLain, CPC-A Kimberly Pence, CPC-A Kimberly Wilson, CPC-A Kira Hamill, CPC-A Kirk Neal, CPC-A Kolla Ravindar Reddy, CPC-A Kompally Kiran, COC-A Korina Solis, CPC-A Kosgi Chandana, CPC-A Kothanda Raman P B, COC-A Krishnateja Kolusu, CPC-A Krista De Kerillis, CPC-A Kristalyn Thompson, CPC-A Kristen Machen, CPC-A Kristen ONeill, CPC-A Kristen Orange, CPC-A Kristina Louise Crowner, CPC-A Kristina Richwine, CPC-A Kristine Joyce Acosta, CPC-A Kruti Dineshbhai Patel, CPC-A Krystal L Libertucci, CPC-A Kuldeep Singh, CPC-A Kuppuswamy K, CPC-A Kuril Rahul, COC-A Kyla Keith, CPC-A Kyle Deters, CPC-A Laarnie Mallari, CPC-A Lakshmanudu Bommana Boina, COC-A, CPC-A Lakshmisri Mariappan, CPC-A Larry Walton, CPC-A Laura Egloff-Slater, CPC-A Laura Parrish, CPC-A Laura Sinitsky, CPC-A Lauren Bilbrey, CPC-A Lauren Elizabeth Sherman, CPC-A Laurice Joy Micmic, CPC-A Laurie Bouzarelos, CPC-A Laurie Burrell, CPC-A Laurie Crawford, CPC-A Lavanya Reddy Kandadi, COC-A Laverne Howard, CPC-A Laymar Lopez, CPC-A Leah Dormitorio Peregrino, CPC-A Leeah Harris, CPC-A Leena Gogada, COC-A Leenus Patrick Obed, CPC-A Leiann Kinder, CPC-A Leighanne Smith, CPC-A Leonard Melgarejo, CPC-A Leslee Colbert, CPC-A Leslie A Knueppel, CPC-A Leslie Alexander, CPC-A Leslie Boyd, CPC-A Leteia Ann Holt, CPC-A Leydis Perez, CPC-A Li Shao, CPC-A Lillian Thayer, CPC-A Lily Thakur, CPC-A Limaris Perez, CPC-A Lindleigh Wirth, CPC-A Lindsey Adkins, CPC-A Lindsey McKane, CPC-A Lisa Arbeene, CPC-A Lisa Duncan, CPC-A Lisa Marie Wilson, CPC-A Lisa Miller, CPC-A Lisa Molnar, CPC-A Lisa Pedicini, CPC-A Lisa Tibbs, CPC-A Liz Crociani, CPC-A Liza Peñaflorida, CPC-A Lizeth M Cruz, CPC-A Lori A Kahler, CPC-A Lori Azzouz, CPC-A Lori Pendleton, CPC-A Loribeth Carbonell, CPC-A Lorie Bryant, CPC-A Louie Allam, CPC-A Loukya Boppana, COC-A Lovakumar Korumilli, COC-A Love Brunson, CPC-A Lucnol Jean-Pierre, CPC-A Lynda Ross, CPC-A Lynette Singh, CPC-A Lynne Lanneau, CPC-A Lynzee Ringeisen, CPC-A M. Naga Saikiran, CPC-A Ma. Ailyn Benz Nicolas, CPC-A Ma. Dianne Zafe Reso, CPC-A Ma. Lourdes Loyola Maglalang, CPC-A Ma. Virginia Quinan, CPC-A Machangar Akshitha, CPC-A Macy Loden, CPC-A Madelyn Aldridge, CPC-A Madhu Keerthi Dhanalakota, COC-A Madhura Walke, COC-A Madhusmita Bhaisora, CPC-A Magdalena Sandu, CPC-A Magnolia T. Reyes, CPC-A Mahendar Reddy G R, COC-A Mahender Reddy Mechala, COC-A Mahesh Boora, COC-A Mahesh Jaya Poojari, COC-A Mahesh Vavilala, COC-A Majlinda Laska, COC-A Maj-Maj Melendres, CPC-A Malathi Durairaj, CPC-A Malia Dyck, CPC-A Malini Rishikesh, CPC-A Mallorie Oneal, CPC-A Mallory Pemberton, CPC-A Mamatha Kalyani Yellagandula, COC-A Mamatha Pulyala, COC-A Manasa Devi Kancharla, CPC-A Mangali Laxmaiah, COC-A Manikanta Tirumala, COC-A Manisha Pasupuleti, CPC-A Marcela Marie Johnson, CPC-A Marcy Smith, CPC-A Margiemel Castro Adviento, CPC-A Maria DiFiore, CPC-A Maria Elishah Ruth Corpuz, CPC-A Maria Martens, CPC-A Mariam Thomas, CPC-A Maridol Nina Mutia Taladua, CPC-A Marie C Lillie, CPC-A Mariela Manzanares, CPC-A Marielle Lopez, CPC-A Marion Isaiah Dimapilis Garcia, CPC-A Marissa Lesky, CPC-A Maritzabel Garcia, COC-A, CPC-A, CRC Markondaiah Anthati, COC-A Marlene Rogers, CPC-A Marren Gilchrist, CPC-A Mary Ann Jones, CPC-A Mary Ann Kompinski, CPC-A Mary Boyer, CPC-A Mary C. Ward, CPC-A Mary Catherine Keiper, CPC-A Mary Davenport, CPC-A Marye Minor, CPC-A Matin Raje, CPC-A Matta Sanjay Kumar, CPC-A Matthew Garis, CPC-A Maximilian Golec, CPC-A Meenaben Mahida, CPC-A Megan Fry, CPC-A Megan Herrick, CPC-A Megan Walter, CPC-A Meghan Morris, CPC-A Melissa Beller, CPC-A Melissa Hottinger, CPC-A Melissa Mackler, CPC-A Melissa Neuharth, CPC-A Melody Dawson, CPC-A Melody Karamba, CPC-A Meridith Roe Hall, CPC-A Merrisa Hall, CPC-A Michael Dexter Sy, CPC-A Michele Calvin, CPC-A Michele Payne, CPC-A Michele Reinert, CPC-A Michelle Chu, CPC-A Michelle Dallaire, CPC-A Michelle Norat, CPC-A Michelle Sartelle, CPC-A Michelle Zuniga, CPC-A Mickey (Warren) McCandless, CPC-A Misty Yandell, CPC-A Moganapriya Prakash, CPC-A Mohammad Imran Baig, CPC-A Mohammed Chand Basha, COC-A Mohan, CPC-A Mohana Rajendran, CPC-A Mohsina Hassan, COC-A Mona Bedros, CPC-A Monica Smith, CPC-A Monika Shivaji Mane, CPC-A Monisha Chand, CPC-A Morgan Dodson, CPC-A Moyah Hardin, CPC-A Mrignalini Ranjan, CPC-A Muppirisetty Balaji, CPC-A Muthumari Durga Nachiyappan, CPC-A Muthuselvi Gurusamy, COC-A Mylinda Hawks, CPC-A N. Madhury, CPC-A N.B. Lakshmi Priya, CPC-A Nadya Soho, CPC-A Naga Jyothi Swarna, CPC-A Nagalakshmi Yandamuri, CPC-A Nagaraju Arroju, COC-A Nagaraju Mamidi, COC-A Nagarjun V, COC-A Nagavel Suresh, CPC-A Nakicia Turner, CPC-A Nakisha Murry Gordon, CPC-A 62 Healthcare Business Monthly

63 NEWLY CREDENTIALED MEMBERS Nallavelly Smitha Varma, COC-A Nancy G Fernandez, CPC-A Nancy Ma, CPC-A Nancy Prabha, COC-A Nancy Ryan, CPC-A Nandhakumar P, COC-A Naresh Krishna Pattapu, COC-A Naresh Kumar, CPC-A Naresh Nukala, COC-A Natalia Jessica Javier, CPC-A Natalie Anderson, CPC-A Natalie Savage, CPC-A Natalie Toth, CPC-A Nataraj M, CPC-A Naveen Chinnam, COC-A Naveen kumar Manchala, COC-A Naveen Manga, COC-A Naveen Mokide, CPC-A Naveena Josephin, COC-A Nazima Anwar Khan, CPC-A Neha Parte, CPC-A Neil Radovan, CPC-A Nelaine Grace Tan, CPC-A Nelissa Anne Flojo, CPC-A Ness-Lee Guerrero, CPC-A Nethula Sravani, CPC-A Nick Fenn, CPC-A Nicole Fuller, CPC-A Nicole M Fuentes, CPC-A Nicole Parrish, CPC-A Nicole R Nichols, CPC-A Nicole Robinson, CPC-A Nicole Williams, CPC-A Nigam Gupta, COC-A Nikhil Prabhakar Patil, CPC-A Nikitagangaram Palkar, CPC-A Nila Sankar, CPC-A Nilam Mandave, CPC-A Nina Kristine Sabio, CPC-A Niquela Cole, CPC-A Nirmala Boyapati, COC-A Nisha Darling, COC-A Nithiya K, COC-A Nitin Kumar Jaiswal, CPC-A Nitin Makkar, COC-A Nitin Verma, CPC-A Nydia Altamirano, CPC-A Olanike Dada, CPC-A Olivia Malardo, CPC-A Omkaram Venkata Ramesh Babu, CPC-A Oummaly Barrie, CPC-A Padma Sree Donthula, CPC-A Padmanav Dash, COC-A Paige Evans, CPC-A Pambala Rohini Priyanka, CPC-A Pamela Coats, CPC-A Parimala Nelaturi, COC-A Parminder Kaur, CPC-A Parveen Banu, CPC-A Patil Vaidhyanath Reddy, CPC-A Patrice Feddes, CPC-A Patricia Blosser, CPC-A Patricia Camille Jomento, CPC-A Patricia Campos Hernandez Franco, CPC-A Patricia Depew, CPC-A Patricia Flynn, CPC-A Patricia Grabill, CPC-A Patricia M Gibson, CPC-A Patrick John Martinez Roca, CPC-A Paul A Spaziante, CPC-A Paul Ryan Tolentino Valencia, CPC-A Paula Perry, CPC-A Paula Richards Broek, CPC-A Payton Pelto, CPC-A Peddinidinesh Nageshwarrao, CPC-A Peereddy Amani, CPC-A Peggy Ann Hefner, CPC-A Penny Hand, CPC-A Philip Don Nelo Deus, CPC-A Phillip Brizendine, CPC-A Pinky Yadav, CPC-A Polukonda Nalini, CPC-A Poonam Jawala, COC-A Poonam Kasawlekar, CPC-A Potineni Seshendra, CPC-A Pradeep Reddy Thada, COC-A Prajakta Digambar Bagde, CPC-A Pratik Parab, CPC-A Princess Joy Tumambing, CPC-A Priscilla Brzezinski, COC-A Priscilla Pereira, CPC-A Priya Ravikumar, CPC-A Priya Venuganandam, CPC-A Priyanka Kumari, COC-A Priyanka Rajendran, CPC-A Puli Manga, COC-A Puneet Gunjikar, CPC-A Pushpa Suralkar, CPC-A Pushpalatha Dhadal, CPC-A Pushpalatha Sivalingam, COC-A Qerimane Kelmendi, CPC-A R. Radha Krishna, CPC-A Rachael Mahan, CPC-A Racheal Ann Hill, CPC-A Rachel Best, CPC-A Rachel Hofmeister, CPC-A Rachel Reyes, CPC-A Raghava Rahul Ravutu, COC-A Raghavender Dhanwada, COC-A Rajalakshmi Saminathan, COC-A Rajesh Puthiyedath, CPC-A Rakesh Bashabattini, COC-A Rakesh Rao, COC-A Rakesh Varma Baindla, COC-A Ramakrishna Gadasu, COC-A Ramesh Cherukupally, COC-A Ramesh Subramanian, COC-A Ramya Srikumari Vikraman, CPC-A Ramya Subramanian, CPC-A Ramya Vadiraj, CPC-A Randa Dissing, CPC-A Randi Anderson, CPC-A Rani Ghogare, CPC-A Rani Joseph, CPC-A Ranil Kalarikkal Ravi, COC-A Raquel Perez, CPC-A Rasika Narayan Bagade, CPC-A Ratheesh Nair, CPC-A Ravali Doddi, COC-A Ravi Kumar Kasanagottu, CPC-A Ravi Prema, CPC-A Ravikiran Yengali, CPC-A Ravindra Kunwar, COC-A Raviteja Anumolu, COC-A Rebecca J Oliver, CPC-A Rebecca Polyniak, CPC-A Rebecca Schilling, CPC-A Rebecca Wells, CPC-A Regina Mary, CPC-A Rekha Patel, COC-A Remi Rangasamy, COC-A Remya G Kurup, COC-A Renee M LaRocque, CPC-A Renee Fox, CPC-A Renju Raju, COC-A Renu Jayavel, CPC-A Renuka Ellappareddy, CPC-A Renuka Modugu, CPC-A Reshma Rajan, CPC-A Reshmi Venugopala Prabhu, CPC-A Revathi Chitharanjan, CPC-A Rex Salvado, CPC-A Reynaldo Llana, CPC-A Rhonda Riffe, CPC-A Richard Tamunday, CPC-A Richelle Bedoya, CPC-A Rinolucy Menguito Cantong, CPC-A RiswanaParveen Iqbal, CPC-A Ritesh Ranjan, CPC-A Riyaz Khan, COC-A Robert Huffman II, CPC-A Robin Bonner, COC-A, CPC-A Robin Newsome, CPC-A Robin Schermerhorn, CPC-A Robyn Hunter, CPC-A Rohit Anand, CPC-A Rohit Kumar. S, CPC-A Roland Hernandez Jr, CPC-A Romir Aglugub, CPC-A Rona Gigante De Asis, CPC-A Roni Berlin, CPC-A, CPB Rosalie Tabios, CPC-A Rosalyn Balmes, CPC-A Rosalyn Jamison-Charles, CPC-A Rose Deleta McLean, CPC-A Rosie Guerrero, CPC-A Rowell Ramon Zaragoza, CPC-A Roxana Q Mendoza, CPC-A Roxane Chinoy, CPC-A Rubeshkumar Gopal, CPC-A Ruby Ann Moreno Non, CPC-A Ruby Cabe, CPC-A Ruby grace Edward, CPC-A Rupali Raghunath Rokade, CPC-A Ruthika Sundaragiri, CPC-A Ryan Johns, COC-A S Shabana Begum, CPC-A Sabnapriya Somasundaram, CPC-A Sabrina Bostian, CPC-A Sabrina Crawford, CPC-A Sabrina Romero, CPC-A Sabrina Torres, CPC-A Sahana K, CPC-A Sai Reddy Samala, COC-A Sai Srinivas, COC-A Sai Susmitha Daggubati, CPC-A Samantha Litmer, CPC-A Samantha Maguire, CPC-A Sampath M, CPC-A Samrat Penjarla, COC-A Samrin Fathima Imtiaz Hussain, CPC-A Sana Mirasahab Shaikh, CPC-A Sandeep Sikar, COC-A Sandhya Pandiri, CPC-A Sandip Wagh, CPC-A Sandra Bales, CPC-A Sandra Kimura, CPC-A Sandy Guthrie, CPC-A Sanitha Narayanan, CPC-A Sanjay Patil, CPC-A Sanjaykumar Bhupathi, COC-A Sankararao Gullipalli, COC-A Santhi Bandaru, CPC-A Santhi Muttha, CPC-A Sarah Dobrovolny, CPC-A Sarah Perkins, CPC-A Sarath Chandran Chandran, CPC-A Saravani Thiyagarajan, CPC-A Sarina Alexis Fullmer, CPC-A Saritha Reddy G, CPC-A Sasidhar Aradyula, CPC-A Satartia Christine Collins, CPC-A Sateesh Gummadi, CPC-A Sathishkumar Munuswamy, COC-A Sathya Priya Kittusami, CPC-A Schani Marie O Brien, CPC-A Schmeca Lawrence, CPC-A Sebi Pappachan, COC-A Seema Atul Paradkar, CPC-A Seema Kumar, CPC-A Seetha Arumugam, CPC-A Selena Cameron, CPC-A Selvarani Suresh, CPC-A Senthil Venkatesan, CPC-A Shabbir Hussain K Mohammed, CPC-A Shaira Myn Herrera, CPC-A Shalini Dillibabu, CPC-A Shanice Johnson, CPC-A Shankar Chandragiri, CPC-A Shannon Saunders, CPC-A Shanthi Priya, CPC-A Shara Elaine Klem, CPC-A Sharada Kalakota, CPC-A Sharat Kumar, CPC-A Sharon Erickson, CPC-A Shashi Kant, CPC-A, CIC Shashi Kiran, COC-A Shawn Gantz, CPC-A Shawna Wallace, CPC-A Shay Peterson, CPC-A Sheeba Inasu, CPC-A Sheeooli Nag, CPC-A Sheetal Vasoya, CPC-A Sheila Lund, CPC-A Shelley Shafer, COC-A Sherbanu Ahmed Sayyed, CPC-A Sheri Vickery, CPC-A Sherita Mitchell, CPC-A Sherri Pearce, COC-A Sherri Shink, CPC-A Sherry Bounds, CPC-A Sherry De Castro Balbuena, CPC-A Sherry Deig, CPC-A Sheryl Denny, CPC-A Shibashish Mohanta, COC-A Shifa Mahzabin, CPC-A Shikha Pathak, COC-A Shirley Belken, COC-A Shoban Raj A V, CPC-A Shobhit Kumar, CPC-A Shridhar Ekanekar, COC-A Shrutidhar Kanhaiya, CPC-A Shrutiyogesh Kini, CPC-A Shumaila Ansari, CPC-A Shwetha Ayathan, COC-A Sibbie Pauline Frazier, CPC-A Siddhanta Mishra, CPC-A Siddhartha Madala, COC-A Silpa C, CPC-A Silvia C Quant, CPC-A Simeon Sampathkumar, COC-A Simone Thompson, CPC-A Simple Patel, CPC-A Sneha Dhake, CPC-A Snehajagannath Patil, CPC-A Sonakshi Singh, CPC-A Sonia DaSilva, CPC-A Sonia Luke, CPC-A Sonia Rawat, CPC-A Soniya T Joseph, CPC-A Sophia Bell, CPC-A Soumyashree Choudhury, CPC-A Sowmya Pappu, CPC-A Sowmya Rangan, CPC-A Sravani Goli, CPC-A Sravanthi Gorusu, COC-A Sreerag Vageeswari, COC-A Sridhar Rao Muthineni, COC-A Sriharsha Bugude, COC-A, CPC-A Srilekha Baskar, CPC-A Srinivas Kanthala, CPC-A Srinivas Reddy Narahari, COC-A Srinivas Thatipamula, COC-A Srinivas Vadde, COC-A Srinivasan Govardhanan, CPC-A Srinuvali Shaik, COC-A Sruthi Reddy G, CPC-A Sruthy Hari, COC-A Stacey A Sam, CPC-A Stacy Ann Johnson, CPC-A Starla Ehrisman, CPC-A Steffi Shae Uy, CPC-A StellaMary Arokiasamy, CPC-A Stephanie Clarke-Mahoney, CPC-A Stephanie Marie Reed, CPC-A Stephanie Miranda Shore, CPC-A Stephanie Ristau, CPC-A Stephanie Wright, CPC-A Stephen Dong, CPC-A Stephen Ledford, CPC-A Subbaravamma Kommareddy, CPC-A Sucheta Sarkar, CPC-A Suchita Gawand, CPC-A Sudha Paramasivam, COC-A Sudhir Kumar, CPC-A Sudhir Mohan, CPC-A Sujith kumar Telly, COC-A Sujiva Kumari Anton, CPC-A Suman Kalaidoss, COC-A Suman Shreyaah, CPC-A Sumanreddy Samala, COC-A Sumit Kumar, CPC-A Sumitnagsen Shishupal, CPC-A Sundaravani Elangovan, CPC-A Suneel Kumar, COC-A Sunil Kumar Metta, COC-A Sunny Puri, CPC-A Surekha Banda, COC-A Suresh Bellam, CPC-A Surja Sikha De Roy, CPC-A Susan Gonzalez, CPC-A Susan Marini, CPC-A Susan Scott, CPC-A Susan Smith, CPC-A Susan Valadas, CPC-A Sushil Kumar, CPC-A Sushma Chintha, CPC-A Sushma Kamuni, COC-A Suzanne Carino, CPC-A Swathi Kethireddy, CPC-A Swathi Mangelipelly, CPC-A Swathi Shyamsunder, CPC-A Swathisaranya Chitikila, CPC-A Sweety Pavithran, CPC-A Syamala Chityal, CPC-A Syed Shakeer Ali, CPC-A Sylvia Emmanuelle Krieg, CPC-A Tadi Sivaparvathi Reddy, CPC-A Talluri Kranthi Kumar, COC-A Tamara Detillo, COC-A, CPC-A Tamara Ingram, CPC-A Tamara Yamin, CPC-A Tammy Alexander, CPC-A Tammy Derk, CPC-A April

64 NEWLY CREDENTIALED MEMBERS Tanya Reppert, CPC-A Tapaswi More, CPC-A Tasha Tribune, CPC-A Taylor Brnik, CPC-A Taylor Thompson, CPC-A Tehzibali Saiyad, CPC-A Teja Babu Addanki, COC-A Tejpattie Lachman, CPC-A Teonna Benning, CPC-A Teresa Bezek, CPC-A Teresa Klein, CPC-A Teresa Luciana Anderson, CPC-A Terra Clarke, CPC-A Terrence Gaylon, CPC-A Terri-Karlene Peart, CPC-A Thelma Josephs, CPC-A Theresa Milligan, CPC-A Thota Venkatesh, COC-A Thumma Thomas Reddy, COC-A Tiana Broadhead, CPC-A Tiff Weilbacher, CPC-A Tiffany Buckmiller, CPC-A Tiffany Gandy, CPC-A Tiffini Hunter, CPC-A Tracey Bonner, CPC-A Tracey Henderson, CPC-A Tracy Doyle, CPC-A Tracy Holcombe, CPC-A Tracy Lynn Ellis, CPC-A Tracy Marshall, CPC-A Tricia M Brown, CPC-A Ty Moltmann, CPC-A Tylar S Melton, CPC-A Uday Banu Brundam, COC-A Uma Devi Nagappan, CPC-A Uma Maheswari, CPC-A Umesh D, CPC-A Upinder Walia, CPC-A Urszula Ochman, CPC-A Usharani Rajaraman, CPC-A V N S Manikanta Perumalla, COC-A V Chaitanya Prasad, CPC-A V Gangadhar Reddy, CPC-A V Prema Latha, CPC-A Vaishnavi Deenadayalan, COC-A Valerie Gillen, CPC-A Valerie Morris, CPC-A Vandana Teckchandani, COC-A Vandana Vanam, CPC-A Vanessa Blacano, CPC-A Vanessa Carter Ray, CPC-A Vani Kammari, CPC-A Varshil Patel, CPC-A Vasanthi Paulraj, CPC-A Vasanthi Ramineni, CPC-A Veena Raju, COC-A Veeralakshmi Nallaiah, CPC-A Vemulapalli Namrata, CPC-A Venkata Apparao Yandrapu, COC-A Venkatachalapathy Thoppayan, COC-A Venkateswara Raju Bollepally, CPC-A Venu Gopal, COC-A Vernetta Dunbar, CPC-A Veronica Bentley, CPC-A Veronica Lynn Hurley, CPC-A Vevie Gilliam, CPC-A Vicki Halverson, CPC-A Vicki Hersey, CPC-A Victor Changanaqui, CPC-A Vida Carmen Del Rio, CPC-A Vidhi Shrimali, CPC-A Vidhyalakshmi Ranganathan, CPC-A Vidya Marudhavanan, COC-A Vijay Kumar Dunka, CPC-A Vijaya Thatha, CPC-A Vijayakumar Manickam Pillai, COC-A Vikki N Perry, CPC-A Vincent Legaria, CPC-A Vineet Chauhan, CPC-A Vinni Narayanasamy, CPC-A, CRC Vinothkumar Vijayarangan, COC-A Virendra Kumar Singh, CPC-A Virginia O Brien, CPC-A VML Eswararao Gummadi, COC-A Vonda Mendez, CPC-A Wanda Williamson, CPC-A Wendy Hoachlander, CPC-A Wendy Silver, CPC-A Wesley Woodard, CPC-A Willard Perry, CPC-A Willy Ferrer Pagarigan, COC-A Xay Chao, CPC-A Yacquelyn Sosa, COC-A Yaima Ramos, CPC-A Yamily Simon, CPC-A Yarabolu Sahithi, CPC-A Yasmin Shaik, COC-A Yilian Lopez, CPC-A Yn Shivakumari, COC-A Yoga Priya N Narayanan, CPC-A Yurisay Vergara, CPC-A Yuvaraj Venkatesan, CPC-A Yvonne Ogden, CPC-A Zacarias Cometa, CPC-A Zaria Morales, CPC-A Zayd Hamza, CPC-A Zoila de La Cruz, CPC-A Zullyn Ball, CPC-A, CPMA Specialties Abhinav Kumar Maurya, CPC-A, CIC Afiya Richards, CPC, CPMA Aileen Panganiban, CIC Ajudia Rupal Damjibhai, CIC Alexandra Garkey, CPB Alexis Perez, CPB Alfredo Ramones, CIC Alisa Hermansen, CPC, CPC-I, CRC Alva Elano, CRC Alvin Cyrel Albino, CIC Amaechi Lawrence Ofunne, CPC, CPMA, CEMC, CGSC, CPRC Amanda Castro, CPB Amanda Proctor, CPC, CRC Amit Dhingra, CIC Amy Fields, CPC, CRC Amy M Decker, CPC, CRC Amy Powell Gross, CPB, COBGC Amy Shilliam, CPC, CPCO Amy Walker, COC, CPC, CPB, CPMA, CEDC, CRC Anand Babu Ponnusamy, COC, CPC, CIC Ananda Kumar, CPC, CRC Anandhan Sivagnanam, CPC, CPMA Andrea Crowe, CPB, COBGC Andrea Mitchell, CPC, CRC Angela D Brown, CPC, COSC Angela Larsen, CPC, CRC Angela S Romero, CPC, CEMC Angela Swartz, CPC, CPB Angelica Gatchalian, CIC Angelique Wilson, CPC, CRC Anirudh Ekbote, CPC, CIC Ann Wurtinger, CPC, CIC Anne Brown, CPC, CPB, CPMA, CIMC Anne C Strout, COC, CPC, CRC Anne Turla Solomon, CIC Antoinette Hill, CRC Anuradha Sankarraj, CIC Anusha Bonasu, CIC Aparna Ravinuthala, CRC April Christine Adams, CPC, CRC Araceli Linn, CPC, COBGC Arejay Tabaquero, CRC Arisa Lynn Widrick, CPC, CPMA Arlene E Wilkins, CPC, CRC Asaithambi Dhanapal, COC, CPC, CIC Ashfaq Mohammad, CIC Ashlea Kerley, CPCO Ashvini Arun Jagtap, CPC-A, CIC Asokar Arasu, CPC, CPMA, CANPC Audrey Bergstrom, CPB Avinash Daripally, CIC Barbara A Williams, CPC, CRC Barbara Gonzalez, COC, CPC, CPMA, CRC Barbara Reyes, CPC, CPMA Bart Stein, CPC, CPCO, CEMC Becky Bertrand, CPC, CEMC Becky Dunn, CPCO Belissa Cipreni Thompson, CRC Beth Ann Buchanan, CPC, CANPC Beth Anne Hickey, CPC, CFPC Bhaskar Kolli, CIC Bhuvaneshwari Palanisamy, CIC Bianca Otto, CPMA Birgit Otto, CPC, CPMA Blummenroth Otto, CPMA Brenda Brock, CPC-A, CPB Bridget Jones, CPC, CRC Bridget Nutter, CPC, CPB Bronwyn Hadlock, CPCO C Juliette Morell, CPC, CPMA Camille VanDerSteen, CPC, CIRCC, CCC Candice Dyxse Czelusniak, CPC, CRC Cara Erlenwein, CPC-A, CHONC Caren Joy Mesias, CIC Carey Ketelsen, CRC Carla B Williams, CPC, CEMC, CGSC Carletta Ellen Vasknetz, CPC, CPMA Carol Sager, CPCO Caroline Faulkner, CIC Caroline R Epperly, CPC, COSC Carrie E Caldewey, CPC, CPMA Catherine A Phipps, CPC, CPMA, COBGC, CRC Cathy L Smith, CPB Chad Benjamin Peterson, CPC, CEMC Chad Tubbs, CIRCC Chaitanya Pamba, CIC Chandra Lynn Stephenson, COC, CPC, CPCO, CPB, CPMA, CPC-I, CANPC, CCC, CEMC, CFPC, CGSC, CIC, CIMC, COSC, CRC Chandrashekar Reddy Muttannagari, CIC Chaniece Evans, CPC-A, CPMA Charles Solomon Raja, CPC, CPMA, CGSC Charles Zulauf, CPC, CIC Cheryl Bendana, CIC Cheryl Ben-David, CPC, CRC Cheryl R Berzat, CPC, CPMA, CIMC Cheryl Reynolds, CPC, CRC Christine Coppola, CPC, CRC Christine Peterson, CPC, CEMC Christine Smith, CPC, CRC Christy Szolis, COC, CPC, CRC Cindy Nixon Hall, CPC, CGSC Cindy Y Lopez, CPC, CPMA Clemente Guido, CPB Courtney Jones, CPC, CPCO Crystal Romat, COC, CPC, CRC Cynthia Leslie, CPC, COBGC Cynthia Lynn Hubbard, CPC, CGIC Dana Radack, CPC, CRC Daniel Richard Francis, COC, CPC, CIC Daniel Rowden, COC, CPC, CPCO, CPMA, CIC Daniela Simoski, CPC-A, CPB Danielle Ann Misin, CPC, CPMA Danielle Shanklin, CEDC Darby Amezcua, CPPM Darwin Roque Santos, CIC Dawn Lambert, COC, CPPM Dawn M Fenwick, CPC, CPB Deanna Householder, CPB Deborah Lloyd, CPC-A, CRC Debra Ann Keyes, CPC, CCC Debra Johnson-Phythian, CPMA, CRC Delia Delatorre, CRC Denise Majoris, CPC, CRC Diane Gotkin, CPC, CRC Diane Herbeck, CPC, CPB Diane Walczak, CPC, CPMA, CUC Divya G Gopinathan, CRC Divya Jyothi Gadapa, CIC Donita Mallak, CPC, CPB, CGSC Donna Barrameda Cabugos, CRC Donna Lynn Barker, CPC, CPCO, CPMA, CPC-I Donna Stefonetti, CRC Doris V Branker, CPC, CIRCC, CPC-I, CANPC, CEMC Durga Devi, CIC Dwijesh Udvij, COC, CPC, CIC Edward Bosita Ringor, CPC, CRC Eileen Pinares, CPC, CPMA, CPC-I, CRC Elaine Fischer, CPC, CRC Elan Neuman, CPPM Elizabeth A Williams, CPC, CPB Elsa Brinkman, CPC, CGIC Enriqueta Almeida, CPC, CPMA, CPPM Eric Stephens, CPPM Erina Master, CPPM Erlinda S Balaan, CPC, CPEDC, CRC Erra Samatha, CIC Erwin Salud, CIC Esther Walker, CPB Evelynn McCulloch-Owens, CCS, CPC-A, CRC Fallon Charisse Brown, CPC, CPMA Fasiya Ahamed, CPC, CPMA Fathima Begum Jaffer ali, CRC Frances Easter, CRC Gaddala Jhansirani, CIC Gadeela Narender Reddy, CIC Gail A Volpi, COC, CPC, CIC, CRC Gail Bricker, CPC, CPB Ganesh Bhoje, CPC, CIC Golla Pavani, CIC Gowsalya M Murugesan, CRC Graciela Alvarez, CPC, CPMA Guia Zhao, CPC, CIC Gurram Sudhaveeru, CIC Hanna Roman, CRC Hannah Howald, CPC, CPMA, CPPM Harika Sambu, CIC Harikrishna Soorishetty, CIC Harriet Thomas-Fryer, COC, CPC-P, CPMA, CRC Heather McCallum, CPC, CCC Helen Kirkland, CPB Hilda Garcia, CPC, CPMA Hillary Julien, CPCO Himanshu Sharma, CPC-A, CIC Hollie Lindley, CPB Imamsaheb Shaik, CIC Inay Iriban, CPC, CPMA Indhira Kalaiparthiban Rajendran, CIC Ines Agnes Morales, CIC Izel Silva, CPC, CPMA, CRC Jade Ariel Reeves, CPC, COBGC Jagjeet Singh, CIC Jamie Addler, COC, CPB, CPMA Jamie Jo Pool, CPC, CPB Jamie Taylor, CPB Jan Lambert, CRC Jan Marie Flanders, COC, CPC, CASCC Jana Gustafson, COC, CPC, CPCO, CPMA, CRC Jana Morgan, CPB Janice Douglas, CPC, CPMA, CEMC Janice Raffa, CPC-A, CRC Janis Stelzner, CPC, CRC Jason Knowles, CPCO Javeed Mohamed Kalil, CPC, CIC Jayalakshmi Kulanthaimani, CRC Jayesh Ramteke, CPC, CRC Jefferson Esperida, CRC Jelene Roxas, CPB Jennie E Moody, COC, CPC, CRC Jennifer Kniffen, CPC, CGSC Jennifer L Deal, CPC, CPMA, CEMC Jenny Harvey, CPC, CPMA Jerame Capacia-Castro, CRC Jessica Fenolio, COC, CPB, CASCC Jhan Jester Solmoro, CPC-A, CIC Joan Aileen Del Mundo, CIC Joan M Bartholomew, COC, CPC, CRC Joan Marie Dion, CPC, CRC Jodi Long, CPB Jody Hart, CPC, CRC Jody Mortensen, CPC, CEMC John Philip Martinez, CIC John Ray Elders, COC, CRC John Sauder, CPC, CPPM Jonel Gomez, CPCO Joseph Hughes, CPPM Joy Anne Monteverde, CRC Joyce Daquipil, CIC Judith Andrea Facey, CPC-P, CRC Judith Carol Quesnel, COBGC Judybeth Fernandez, CPC, CPC-P, CRC Julia Brauer, CPB Julianne Thomas, CPC, CRC Justine Basa Asilo-Daelo, CPC, CPMA Kamaal Ahmed, CIC Karen Fan, COC, CPC, CRC Karen Summers Clinard, CPC-P-A, CRC Karen Tinoco, CPC, CPMA, CRC Karen Webb, CPC, CANPC, CIC, CPCD Karen Worrell, CPB Karen Y Manigault, CPC, CPMA, CEDC, CEMC Kari Leigh Giles, CPC, CRC Karthick Jayaraj, CPC, CEDC Karthikeyan Thandapani, CIC Kasinath Thalikota, CIC Kathleen Guzzi, CPC, CIC Kathleen M Skolnick, COC, CPC, CPCO, CPB, CPMA, CPPM, CPC-I, CEMC, CRC Kathryn Jones, CPC, CRC 64 Healthcare Business Monthly

65 NEWLY CREDENTIALED MEMBERS Kathryn Joyce Phillis, CPC, CPB, CPC-I Kathryn R. Melton, CPC, CRC Kathy LaPierre, CPC, CPMA, CEDC, CEMC Katie Lee Cheong, CPC, CENTC Katrina Woodring, CPC, CPC-P, CPC-I, CRC Kawana N Scott, CPC, CPMA, CEDC Kayla Williams, CPC, CEDC Kellie Louise Zimmerman, CPC, CRC Kelly Moritz, CIC Kelly Johnson, CPC, CPC-P, CENTC, CFPC Kelly McCormick, CPC, CPC-P, CRC Kelsey Storey, CPC, COBGC Kendra Hamiel, CPB Kilona Kara, CPC-A, CRC Kim F Turner, CPC, COSC Kim Fields, CPC, CRC Kim Montenegro, CPC, CPMA, CPC-I, COSC, CSFAC Kim Morvant, CPC, CRC Kimberly J Fields, CPC-A, CPMA Kimberly Salazar, CRC Kimberly T Dues, CPC, CRC Kimothy Williams, CPC, CPB Kristina Bolio, CRC Kristina Marie Metrejean, CPC, CPB Kristine Diana West, CPC, CPMA Kurt Alyn Kaskie, CPC, CRC Kushali Cherukumalli, CIC Kynet Watkins, CPCO LaBrena Settles, CPCO Lanileen Caisip, CIC Larry Roberson, CPC, CPMA, CRC Laura Duffy, CPC, CPMA Laurie Elliott, CPB Leann Haven, CPPM Lenette Russell, CPB Leyiset Crespo, CPC, CRC Liana Urdanivia, CPC, CPMA Libest J Larez, CPC-A, CPB, CPMA Lilian Russo, CPC, CPMA, CUC Lina Liza Arcilla Alcances, CPC, CPC-I, CIC Linda D Hall, CPC, COSC Linda Manuli Huckin, CPC, CIC Linda Marshburn, CPPM Linda R Farrington, CPC, CPMA, CPC-I, CRC Linda Thomas, CPC, CRC Lisa Maria McIlquham, CPB Lisa Bradshaw, COC, CPC, CHONC Lisa Griswold, CPC, COSC Lisa Janell Fouts, CPC, CPMA Lisa L Rogers, CPC, CRC Lisa M. Noles, CPC, CPCO, CPC-I Lisa Magnotti, CPC, CRC Lisa Purnell, CPC, CPCO, CPMA, CRC Lisa Sandusky, CPC, CPMA, CANPC Lisa Swanson, COC-A, CPC-A, CPC-P-A, CPB Lokesh Gupta, CPC, CRC Lori Lingo, CPC, CRC Lourdes Suarez, CPC, CPMA Lourdes Valbuena, CPC, CPMA, CEMC Lynda Knighton, CPMA Machaelle M Diaz, CPC, CPMA, CRC Majas Fayaz, CRC Malakondaiah Gotha, CPC-A, CIC Malana Skolnick, COC, CPC, CPCO, CPMA, CPPM, CEMC, CRC Malissa Amend, CPC, CPMA Manjunath Ballappa, CIC Manuel De Jesus Grullon, CPC, CPMA, CRC Maram Harish, CRC Marbella Patino, CPC, CPMA Marcie Small, CCS, CPC-A, CRC Marcy Short, CPPM Maria A Joseph, CPC, CPCO, CPMA, CEDC, CEMC Maria Boyd, COC, CPC, CPC-P, CEMC Marie Bergin, CPC, CCVTC Mark Anthony Marlangawe, CIC Marnetia Spratley-Pruden, CPC, CPMA, CANPC, CRC Marsha Sporhase, CPC, CPMA, CRC Martha L Gaviria, CPC, CPMA, CRC Martha Tokos, CPC, CPMA, CPC-I, CRC Mary Elizabeth Grimmett, CPC, CRC Mary Jane Dickey, CPC, CPB Mary M Murphy, CPC, CRC Mary Rountree, COC, CIC Mary-Jo Griffith, CPC, CPC-I, CEMC, CGIC, CGSC, COSC Maryline Medina, CPC, CRC Mathanagopal Pandiarajan, CRC Matilde Perez Chon, CPC-A, CRC Maya Mohan, CIC McKenzie Harrison, CPMA Melanie Rae Edwards, CPC, CPCO, CPMA Melissa Brownlow, CPC, CPMA Melissa Burke, CPC-A, CRC Melissa Troiano, CPMA, CPPM Michele Brassell, CPC, CRC Michele Gibbs, CPPM Michele R Hayes, CPC, CPMA, CPC-I, CEMC, CGIC, CRC Michelle D Reese, CPC, CRC Michelle Hartley, COC, CPC, CRC Michelle Lopez, CPC, COBGC Michelle M Mesley-Netoskie, CPC, CPPM Michelle R Davis, CPC, CPB, COBGC Michelle Santos, CIC Mikel Miller-Edwards, CPC, CPMA Mildred I Hanna, CPC, CPCO Mohammed Mazheruddin, CIC Monica Marie Diaz, CPC, CRC Muthaiya Murugappan, CIC Nadia Campbell-Johnson, CPMA Nafeeza Abzal, CPC, CGSC Nagaraj Varadharaju, CRC Najuma Syeduebrahim, CIC Nancy Martin, CPC, CPPM Nancy Zizelman, CPC, CPB, CRC Nandhakumar Deenadhayalan, CPC, CIC Nanette Driscoll, CPC, CPMA, CPPM Narda J Mattos, CPC, CPMA Narendathu Cherla, COC-A, CIC Nasir Mire, COC-A, CPMA Nathan L Kennedy, Jr, CPC, CPB, CPPM, CPC-I Naveen Kumar Nanamala, CIC Naveen Kumar Ch, CIC Naveena E Dineshkumar, CIC Neelima Akula, CRC Neelima Haneesha Dara, CIC Nicole K Worobel, CPC, CPMA, CGSC Nieve Garcia, CPC, CGIC Nilesh Tukaram Lad, CPC, CIC Palani Balasubramaniam, CPC, CPMA, CEMC Pam Wayman, CPC, CCC, CCVTC Pamela Joan Bess, CPB Pamela Trisler, CPC, CRC Patrice Zezza, CPC, CRC Patricia A Smith RHIT, CPC, CPMA, CEMC Paula J Dubel, COC, CPC, CPC-I, CIC Pauline Hernandez, CPB Pedro Camejo, CRC Peter Wamen Lau, CPB Phoebe L Moore, COC, CPC, CRC Phyllis Ingram, CPB Pichi Reddy Boggula, CRC Pradeep Kalmat, CPB Pragati Yadav, COC-A, CIC Prithviraj Reddy Patlolla, CIC Priyanka Bharathi, CIC Pulla Rao Rao Penke, CIC Racheal Hernandez, CPB Rachel A Hively, CPC, CPMA Rachelle Rea, CPC, CRC Rahul Ghanshyam Thorave, CIC Rahul Sukhdev Talekar, CIC Rajasekharnaik G, CIC Rajat Puri, CPC-A, CIC Rajesh Mannam, CIC Rajesh Singam, CPC-A, CIC Rajeswari Muthaiah, CPC, CPMA Rajkumar Santhanam, CIC Rajmohan Alagarsamy, CPC-A, CIC Raju Shivanathri, CIC Rakesh Kumar, CIC Rakesh Yemineni, CPC-A, CIC Ramasubbu Subburayalu, COC, CPC, CPCO, CPC-P, CIRCC, CPB, CPMA, CPPM, CANPC, CASCC, CCC, CCVTC, CEDC, CEMC, CENTC, CFPC, CGIC, CGSC, CHONC, CIC, CIMC, COBGC, COSC, CPCD, CPEDC, CPRC, CRC, CRHC, CSFAC, CUC Ramon Lucero Radoc, CPC, CRC Ranjani Venkat, CIC Ranjith Telu, CIC Ravi Mannela, CIC RaviKumar Alluri, CIC Ravikumar Dobbala, CIC Reather M Westbrook, CPC, CRC Rebecca Erickson, CPB Rebecca Lynn Hanif, CPC, CPCO, CPMA Renee Connor, COC, CPC, CPC-I, CANPC, CEDC, CEMC, CRC Rhazel Adoyo, CRC Richard Carreon, CIC Rita D Bobbitt, CPC, CRC Robin Doerfler, CPC-A, CRC Robin Henry, CPC, CPPM Rochelle G Johnson, CFPC Roni Berlin, CPC-A, CPB Roshan Lal, CPC-A, CIC Ruby Catherine O Brochta-Woodward, CPC, CPB, CPMA, COSC, CSFAC Ruchira Narayanan, CPC, CRC Ruth Spinelli, CPC, CPMA, CIC Sahera Banu, CIC Saisree Ravindranath, CPC, CPMA Sambaiah Deshini, CIC Samira Khalaf, CPCO Sandra Chamberlin, CPC, CPC-I, CRC Sangareddy Paidi, CIC Sanoop George, COC-A, CPMA Sarah E Pross, CPC, CPB, CFPC Sarah E Pross, CPC, CPB, CFPC Sarah Malin, CPC-A, CPB Sarah Marcelle, CPC, CRC Sarah Spivey, CPC, CRC Saravanan Thangarasu, CPC-A, CIC Saravanan Thulasingam, COC, CPC, CPMA, CEMC Sateesh Rayapati, CPC-A, CIC Sateesh Reddy Malle, COC-A, CIC Savita Kumari, CPC-A, CIC Scott Smith, CPC-A, CPMA Shadrach Viswanth Chembeti, CIC Shaik Ahmed Sharief, CIC Shakeda Jenrette, CPEDC Shalini Nanjappan, COC, CPMA Sharon M Casto, CPC, CEDC, COSC Shashi Kant, CPC-A, CIC Shashikala Elumalai Mrs, COC-A, CIC Sheryl T Witter, COC, CPC, CPC-I, CRC Shivashankar Sadila, CIC Shravya Vaddiraju, CIC Shu Zhen Liu, CPC, CIRCC, CCC, CCVTC Shuvendu Kumar Sahoo, CIC Shyam sunder goud Panjala, CIC Siddharthi Nagaraj, CRC Silvia Lassales, COC, CPC-P, CPMA, CRC Sindhuja Gothandaraman, CIC Smita Suresh Bandre, CPC, CEMC Sobih Abdurahman, CPPM Sonia Devereaux, CPB Sophia Scott, CPC, CRC Sreedhar Kondapalli, CPMA Sridhar Chitla, CIC Srujana Jagati, CIC Stacey Howe, CPMA Stephanie Johnson, CEDC Stephanie Darlington, COC, CPC, CIC Stephanie Garst, COC, CPC, CPMA Stephanie Reynolds Garrick, CPC, CPMA Subodh Awana, CPC-A, CIC Sudheer Kumar Bachu, CIC Sue E Davis, CPC, CRC Sukendhar Reddy Malipatlolla, CIC Sukumar Vankavarasa, CIC Summer Johnson, CPB Sunday A Adesina, CPCO Sunil Raj Natarajan Krishnamma, COC, CIC Sunny Samrat Meka, CIC Suresh Jumple, CPC-A, CIC Suriya Gunasekaran, CIC Surya Prakash Kakumanu, CIC Susan Jantz, CRC Susan Mecodangelo, COC, CPC, CRC Suyin Cecilia Borrero, CPC, CPMA Suzanne Maureen Santellanes RN, CPC, CPMA, CRC Swetha Jagari, CIC Sydra Wynette Paige, CPC, CIRCC Sylvia Ramones, CIC Tabitha Sauls, CRC Takeda McTear, CPC, CPMA Tammy Darlene Harris, CPC, CRC Tammy G Phillips, CPC, CPMA Tammy Marie Anderson, CPMA, CEMC Tanya E Perales, CPC, CCC Tawana Johnson McIver, COC, CPC, CPC- P, CPC-I, CIC Teena Long, CPC-A, CPMA Teresa Suzanne Bartrom, CPC, CPB Teri Mauro, CPB Terri A King, CPC, CRC Thelma Stewart, CPC, CPMA Theresa Thompson, CPC, CCC, CCVTC Theresa W Burnett, CPC, CRC Thirukumaran Jayasankar, CPC-A, CIC Thirumozhi Mgk, CPC, CIC Thirupathi Puppala, CIC Thomasina L Young, CPC, CPCO, CPMA, CRC Tichelle Lyons, CPB Tiffiney R McDaniel, CPC, CIRCC Tina Jonas, CPC, CPMA Tonya Berndt, CPB Tracy Bowers, CPC, CPB, CPPM Tracy Rink, CPC, CEDC, CEMC Trina Empey, CPC, CRC Tyling M Batista, CPC, CPMA, CEMC Uma Maheswari, CPC, CIC Usha Pandiyan, CPC-A, CIC Vaitheeswaran Purusothaman, CPC, CPMA Vamshi Krishna Aluvala, CIC Vanitha Mourthy, CIC Varalakshmi Joseph, CIC Venkata Krishna Suresh Pendyala, CPMA Venkatesh Kanuri, CIC Vickie Hicks, CPC, COBGC, CRC Victoria Angela Holmes, CPC, CIRCC Victoria Russell, CPB Vidyasagar Godishala, COC-A, CIC Vijay Pralhad Tiwari, CPC, CIC Vijay Sundarraj, CPPM Vijaya Kumar Bhathula, CPC-A, CIC Vijayakrishna Soorishetty, CIC Vijaykumar Tammali, CIC Vinni Narayanasamy, CPC-A, CRC Virginia N Hylton, CPC, CRC Vishal Balasaheb Gaikwad, CIC Vishnu Pavani Kakumanu, CIC Viswa Manoj Pikkili, CIC Vivian Washington, COC, CPC, CPMA, CPC-I Wendy Ann Higham, CPC, CPB Wendy Droppleman, CPC, CPMA Yanira Zeigler, CPC, CPMA Yesenia Hernandez, CPC, CRC Yiliana Pena, CPC, CPMA, CRC Yogesh Pal, CPC-A, CIC Yolanda Michelle Stewart, CPC-A, CIC Yolanda Thomas, CPC, CIRCC Ysabel Lopez, CPC-A, CPCO, CPMA Zahoor Thekkidi Chalil, CIC Zaida Cabrejos, CEDC April

66 Minute with a Member Jeremy Padgett, CPC-A Student, DeLand, Florida Going back to college and getting my certification for billing and coding was the best decision I ever made. Tell us a little bit about how you got into coding, what you ve done during your coding career, and where you work now. I became a healthcare business professional because I wanted to make a better life for myself and I was tired of dead-end jobs. I knew that healthcare was the right choice for me I had previous experience working as a care provider for my aunt, and then for an autistic child. I never thought about medical billing and coding, however, until a relative suggested it. Going back to college and getting my certification for billing and coding was the best decision I ever made. I really enjoy it. My plans are to obtain a master s degree in billing and coding and to open my own medical billing and coding office. What is your involvement with your local AAPC chapter? I am a member, and I am open to helping any way I can with my local chapter. What AAPC benefits do you like the most? I like the help I receive from the organization when looking for a job. Also, the help they gave me in my preparation for the Certified Professional Coder (CPC ) test, mainly from Professor Ramsey at Florida Tech, who helped me a lot. How has your certification helped you? My certification has opened many doors for me that I did not know were there. I also enjoy the fact that, as a certified coder, I am able to meet many interesting people in my field. Do you have any advice for those new to coding and/or those looking for jobs in the field? Stay at it. It s not an easy field, but if you have the proper training, you can do it. Never give up. What has been your biggest challenge as a coder? I think by biggest challenge was learning CPT coding. If you could do any other job, what would it be? Medical billing and coding is the job for me. How do you spend your spare time? Tell us about your hobbies, family, etc. I spend my spare time watching pro wrestling and going to pro wrestling events. I am also a big fan of the Florida State Seminoles and the Green Bay Packers. 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. 66 Healthcare Business Monthly

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