HEALTHCARE. BUSINESS MONTHLY Coding Billing Auditing Compliance Practice Management. Let Blood Transfusion Payment Flow: 25

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1 HEALTHCARE BUSINESS MONTHLY Coding Billing Auditing Compliance Practice Management December Let Blood Transfusion Payment Flow: 25 Keep revenue roads clear of denial roadblocks Watch Out for Identity Thieves: 42 Protect patients from losing their medical identities Note Medical Scribes: 50 Qualified scribes can streamline processes

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3 Healthcare Business Monthly December 2015 COVER Coding/Billing 29 Sneak a Peek at 2016 CPT Changes G.J. Verhovshek, MA, CPC, and Raemarie Jimenez, CPC, CPB, CPMA, CPPM, CPC-I, CANPC, CRHC [contents] Coding/Billing Auditing/Compliance Practice Management 40 Make the Most of HCCs Colleen Gianatasio, CPC, CPC-P, CPMA, CPC-I 42 Nobody Is Immune to Medical Identity Theft Jonnie Massey, CPC, CPC-P, CPC-I, CPMA, AHFI 50 The Medical Scribe: A Hot Commodity Renee Dustman [continued on next page] December

4 Healthcare Business Monthly December 2015 contents Code of Ethics 10 Ethics Update Strengthens AAPC Membership AAPC Ethics Committee AAPC Chapter Association 12 Make Your Chapter a Success Faith C.M. McNicholas, RHIT, CPC, CPCD, PCS, CDC Added Edge 14 How a Credential Is Born Glenda Hamilton, CPC, COC, CPMA, CEMC, CPC-P Coding/Billing 16 Medicare Primary Care Center Exception Update Maryann C. Palmeter, CPC, CENTC, CPCO 20 Claim All Your Pennies for Discontinued Procedures Sarah W. Sebikari, MHA, CPC 22 Specimen Validity Testing Frank Mesaros, MPA, MT (ASCP), CPC 26 Coding that Brings You to Your Knees Ken Camilleis, CPC, CPC-I, COSC, CMRS, CCS-P Facility 25 Blood Transfusions: Document Properly for ICD-10-PCS Diana H. Williams, BS, CPC, CCS-P, CCS, CPMA Added Edge 36 Distance Learning: Choose Wisely Dawn Moreno, PhD, CPC, CBCS, CMAA, MTC, CPL, CLT Auditing/Compliance 44 Handling PHI Disclosure for Genealogists Joseph de Beauchamp, PhD Practice Management 47 Boost Your Immune System with Office Yoga Bridget Toomey, CPC, CPB, CRCR, RYT Onboarding Employees in a Small Office Ellen M. Wood, CPC, CMPE Member Feature 56 Military Members: Trained for Success Michelle A. Dick COMING UP: 2015 Salary Survey 2016 OPPS OIG Work Plan Pediatric Vaccination Venipuncture On the Cover: John Verhovshek, MA, CPC, and Raemarie Jimenez, CPC, CPB, CPMA, CPPM, CPC-I, CANPC, CRHC, give you a sneak peek into what changes are in store for CPT Cover design by Kamal Sarkar. DEPARTMENTS 7 Letter from CEO 8 Letters to the Editor 9 Healthcare Business News 10 Code of Ethics 66 I Am AAPC EDUCATION 60 Newly Credentialed Members Online Test Yourself Earn 1 CEU healthcare-business-monthly/archive.aspx 4 Healthcare Business Monthly

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6 Serving 153,000 Members Including You! vendor index 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! HealthcareBusinessOffice, LLC Optum360 TM A leading health services business Supercoder, LLC ZHealth Publishing, LLC 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 Designer Mahfooz Alam Kamal Sarkar Advertising Jon Valderama December 2015 Address all inquires, contributions, and change of address notices to: Healthcare Business Monthly PO Box Salt Lake City, UT (800) Healthcare Business Monthly. All rights reserved. Reproduction in whole or in part, in any form, without written permission from AAPC is prohibited. Contributions are welcome. Healthcare Business Monthly is a publication for members of AAPC. Statements of fact or opinion are the responsibility of the authors alone and do not represent an opinion of AAPC, or sponsoring organizations. CPT copyright 2015 American Medical Association. All rights reserved. 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. 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 2 Number 12 December 1, 2015 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 Work Worth Doing As I reflect on the past year, I am reminded of something Theodore Roosevelt said: Far and away the best prize that life has to offer is the chance to work hard at work worth doing. Events outside AAPC and your requests provided many challenges and opportunities we resolved to address. Our drive to serve members prompted several accomplishments this year, and I m grateful to be part of an organization that achieved the following: 150,000th Member We welcomed Elena Kuklina, PhD, as our 150,000th member this year. The Centers for Disease Control and Prevention (CDC) health scientist and Emory University adjunct professor joined AAPC to seek training and certifications that would help her in her obstetrics and gynecology research. ICD-10 Implementation AAPC members and staff were instrumental in making this year s long-awaited ICD-10 implementation go smoothly. AAPC members served as educators, coordinators, and leaders in the industry as the country transitioned from ICD- 9 to the new diagnosis code set. AAPC will continue to support you with advanced training opportunities, based on what you ve told us you want to learn about this new code set and its use. Code of Ethics The National Advisory Board s Ethics Committee released an updated Code of Ethics to better respond to members changing work environments. Simplified and meaningful, the Code of Ethics holds members to the highest standard. Adherence to these ethical standards instills public confidence in the integrity and professionalism of AAPC members. More Customer Service Staff To help serve you better and reduce wait times, we more than doubled AAPC s Service Center staff since the beginning of the year. We also added Online Chat as another way for you to reach an AAPC customer service professional. New Certifications and Products As part of AAPC s effort to support your requests and emerging opportunities, we developed the Certified Inpatient Coder (CIC ) and Certified Risk Coder (CRC ) credentials and curriculum. New online education modules help members of all disciplines. Look for more training and credential opportunities in 2016 to keep current with the business of healthcare. Improved, Less Expensive Codebooks AAPC responded quickly to member feedback surrounding our AAPC codebooks. We made a number of adjustments that will make the books easier to use as coding and education tools. The low priced books continue to help practicing coders and students. HEALTHCON We had record-breaking attendance at AAPC national conference this year. We hope you enjoyed all of the new tracks and sessions we added to better meet your needs. AAPC continues to augment its impact as we serve members through meaningful certification, education, and service. We have completed a great deal but have a lot more hard work worth doing. AAPC will continue to serve members through meaningful certification, education, and service. and that s our prize as we find ways to better serve you and the organizations for which you work. Here s to a successful 2016! Sincerely, Jason J. VandenAkker CEO AAPC members and staff were instrumental in making this year s long-awaited ICD-10 implementation go smoothly. December

8 Letters to the Editor Please send your letters to the editor to: HEALTHCARE BUSINESS MONTHLY Coding Billing Auditing Compliance Practice Management Take the Teaching Physician Quiz: 38 Get schooled in teaching hospitals physician guidelines Put a Cork in Revenue Leakage: 44 Get to the root cause by resolving communication issues Directors: Take Compliance Seriously: 56 Know what you re supposed to oversee September One Inhalation Treatment per Patient Encounter Don t Leave Money on the Nebulizer Table (September 2015, pages 24-27) indicated that payers may allow you to report multiple units of CPT Pressurized or nonpressurized inhalation treatment for acute airway obstruction or for sputum induction for diagnostic purposes (eg, with an aerosol generator, nebulizer, metered dose inhaler or intermittent positive pressure breathing [IPPB] device). Since January 2014, Medicare is not among these payers. The January 2014 National Correct Coding Initiative update, chapter XI, section J, states: CPT code should only be reported once during a single patient encounter regardless of the number of separate inhalation treatments that are administered. If CPT code is used for treatment of acute airway obstruction, spirometry measurements before and/or after the treatment(s) should not be reported separately. Ken Camilleis, CPC, CPC, CPC-I, COSC, CMRS, CCS-P, CCS-P 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. TCI-1 8 Healthcare Business Monthly

9 Healthcare Business News AMA Asks HHS to Make AAPC an ICD-10 Partner In a letter to U.S. Department of Health & Human Services (HHS) Secretary Sylvia Burwell, American Medical Association (AMA) Executive Vice President and CEO James L. Madara asked the agency to add AAPC as a Cooperating Party for the ICD-10 Coordination and Maintenance Committee. AAPC has the necessary expertise, experience and can serve as the voice of physicians lacking in today s Cooperating Parties. Parties making up the ICD-10 Coordination and Maintenance Committee include the Centers for Disease Control and Prevention s National Center for Health Statistics; the American Hospital Association (AHA); and the American Health Information Association (AHIMA). The parties are responsible for the development and maintenance of the International Classification of Diseases (ICD) code set mandated for use in the United States. AAPC s 141,000 [now 153,000] members represent the highest level of expertise in the industry in the areas of medical coding, medical billing, medical auditing, compliance, and practice management, Madara said in the letter. Being made a partner would help the committee, as well as AAPC members, Jaci Johnson Kipreos, CPC, COC, CPMA, CPC-I, CEMC, president of the organization s National Advisory Board, said. Representation at coordination and maintenance meetings will help coders better contribute to the development of the codes they use to establish medical necessity. This represents a huge success in the growth of AAPC as well as recognizes the importance and contribution of its members, she said. Rhonda Buckholtz, CPC, CPMA, CPC-I, CENTC, CGSC, COB- GC, CPEDC, vice president of strategic development for AAPC, said, With payment reforms and changes in the coding system, it is now vital for the cooperating parties to contain inclusion of physician coding representation, and AAPC is the best equipped to do that. Read the complete article on news.aapc.com. New Year Payment Releases The Centers for Medicare & Medicaid Services released final rules October 10, 2015, detailing how the agency will pay for physician services provided in 2016 to patients covered under Medicare. Among the key policies finalized in the 2016 payment rules are: Finalizing the Home Health Value-Based Purchasing model Finalizing updates to the Two-Midnight rule Finalizing the End-Stage Renal Disease Quality Incentive Program Beginning the new physician payment system post the Sustainable Growth Rate formula, and supporting patientand family-centered care Finalizing a provision to empower patients and their families regarding advance care planning Read all about it on the CMS website at: AAPC - Coder December

10 Code of Ethics By AAPC Ethics Committee Ethics Update Strengthens AAPC Membership Part 3: Foster the ethical principles of commitment and competence. There are six ethical principles of professional conduct: integrity, respect, commitment, competence, fairness, and responsibility. In previous issues, we ve discussed ethical responsibilities of AAPC members, the impact of negative conduct, and how to maintain integrity and respect. This month, we ll focus on being committed and competent. Commitment According to the Urban Dictionary s top definition, Commitment is what transforms the promise into reality. It is the words that speak boldly of your intentions. And the actions which speak louder than words. It is making the time when there is none. Coming through time after time after time, year after year after year. Commitment is the stuff character is made of; the power to change the face of things. It is the daily triumph of integrity over skepticism. Before you make a commitment, consider carefully the possible outcomes of your decision. A commitment obligates you to do something. Some commitments, like marriage, can be life altering. When you take a job, you re making a commitment to show up and do the job well whether it s a paid position and your employer has committed to compensate you, or it s a volunteer effort. Volunteering for your AAPC local chapter shows commitment to your professional growth and the development of chapter members. When we commit to AAPC membership, we commit to upholding a higher standard, which includes the responsibility to continually increase our level of professional competence. We commit to the AAPC Code of Ethics and the AAPC Chapter Association Code of Ethics, as well. Adherence to standards, like commitment, ensures public confidence in the integrity and service of medical coding, auditing, compliance, and practice management professionals who are AAPC members. AAPC Chapter Association board members work with local chapter officers and members, as do the local chapter representatives at AAPC headquarters in Salt Lake City, Utah. In doing image by istockphoto franckreporter 10 Healthcare Business Monthly

11 Code of Ethics so, we see commitment demonstrated consistently by local chapter officers and members, the people who volunteer their time and energy to strengthening local chapters. They are committed to the vision and mission of AAPC. They are committed to advancing the work of those who are involved in the business of healthcare by teaching, mentoring, proctoring, and supporting local chapter members. Similarly, AAPC advisory board members, such as the National Advisory Board, Ethics Committee, and Legal Advisory Board, make a commitment to serve AAPC members. Without these committed members and staff, AAPC could not function effectively. The commitment you express to yourself, AAPC, and employers includes an obligation to comply with standards that exist in every professional discipline. Without these standards, we cannot represent ourselves as a professional discipline. As you consider your commitment to professional conduct, think about your willingness to enhance and improve your professional image, and the image of healthcare professionals across the globe. Competence AAPC s commitment to core values includes competence, which adheres to: Developing and achieving a skill set that fosters high quality, effective work product and work process; Maintaining credentials and coding expertise through ongoing continuing education, networking, and professional development; and Maintaining a strong knowledgebase of key principles, including an awareness and understanding of applicable laws and regulations surrounding ethical and competent, professional coding. Competence, as defined by the Business Dictionary, is A cluster of related abilities, commitments, knowledge, and skills that enable a person (or an organization) to act effectively in a job or situation. In medical coding, competence requires more than memorizing codes or understanding physician office habits; it requires professional coders to describe the physician/patient encounter sufficiently to the payer for reimbursement on behalf of the provider. Coding is the last link in the chain of the physician/patient interaction. It tells the payer why the patient presented for care, what happened, and when. This step requires a high level of trust from the physician that the coder comprehends the note describing the patient s Competence, as defined by the Business Dictionary, is A cluster of related abilities, commitments, knowledge, and skills that enable a person (or an organization) to act effectively in a job or situation. problems and treatment, and from the payer that the codes submitted for payment correlate with the provider s documentation and the patient s condition. Competency cannot be emphasized enough. AAPC s Ethics Committee occasionally encounters disputes involving competency. Such issues rarely involve actual knowledge and skill, but instead involve member conduct, where a coder knew or should have known his or her actions deviated from generally accepted standards and practices. Taking shortcuts, not engaging in due diligence, failing to adhere to the rules of the road, and engaging in inappropriate behavior can lead to review before the AAPC Ethics Committee panel. For example, coders should question circumstances where the quantity of claims processed is more important than ensuring the codes on the claims are correct. If elected to represent a local chapter, it s necessary to become acquainted with AAPC s Local Chapter Handbook, which covers roles, expectations, and general guidance regarding chapter finances. If designated to proctor an AAPC certification exam, it s important to remember that AAPC credentials (your credentials) are highly regarded in the healthcare industry. They are earned based on merit. Test-takers must achieve credential(s) on their own, without the help of others. No one would seek care from a physician or advanced practice professional who cuts corners. Similarly, no one would want someone who is unprincipled to be responsible for coding their claims. The coding profession s role in healthcare is becoming more important with the transition to ICD-10 and the shift from fee-for-service to value-based compensation. Such importance is reflected by the increased discussion surrounding these transformative changes. AAPC seeks to ensure membership reflects the very best of competent and trustworthy professionals who are relied on to help physicians and other providers be properly compensated for their services. The AAPC Code of Ethics should serve as a road map to all who navigate the business of healthcare. AAPC Ethics Committee December

12 AAPC Chapter Association By Faith C.M. McNicholas, RHIT, CPC, CPCD, PCS, CDC Make Your Chapter a SUCCESS Tips to help officers advance the business side of healthcare. This is the season of giving, being thankful, and new beginnings. As I think of AAPC local chapters, I can t help but recognize how our local chapter officers are selfless individuals who give freely of their time, knowledge, and wisdom to help all AAPC members excel in their careers. We congratulate newly-elected officers and want you to know you are not alone. Officers rotating out have plenty of knowledge and experience to help you get a jumpstart on achieving a thriving chapter through the coming year. And you can always ask for assistance from your AAPC Chapter Association regional representative, too. Officers Promote Member Success As a chapter officer, you play an essential role in promoting AAPC s mission statement, Advancing the business side of healthcare. Part of your role is to provide an educational forum for AAPC members to: Receive low or no cost continuing education units (CEUs); image by istockphoto CamiloTorres Happy Holidays from the AAPC Chapter Association The AAPC Chapter Association board of directors encourages every officer and member to take time for family and friends during this holiday season. Stop, relax, and enjoy each other s company. We often are so involved with our daily activities that we forget to enjoy the time. Best wishes to all of you and your families this season, and in the coming new year. 12 Healthcare Business Monthly

13 AAPC Chapter Association Network and establishing an environment where less experienced members may interact, learn, and be mentored by those with more experience; and Make regular AAPC s certification examinations available throughout the country. Without your assistance, AAPC could not fully advance the business side of healthcare, and local chapters could not function effectively. Because your role is so important, AAPC offers several tools to support your leadership for a successful term. Everything you need to operate your local chapter is available at after you log into your AAPC membership account. Tips to Start the Year Right A few items you ll need to check off for a successful and exciting start are: 1. Download and review the 2016 AAPC Local Chapter Handbook Most of the answers to your questions have been addressed in the soon-to-be-released 2016 AAPC Local Chapter Handbook. Officers must abide by the guidelines and check for changes, effective October Attend the Local Chapter Officer Training Offered by AAPC Chapter Association and the AAPC Local Chapter Department, this is in-depth training to help you understand what it takes to operate a successful AAPC local chapter, as well as AAPC s expectations of all its officers. The training provides additional resources available on AAPC s website and how to find officer-related information. A leadership training session is available at AAPC HEALTHCON and additional sessions are offered around the country throughout the year. These officer training sessions are four hours, and well worth your time. 3. Abide by the following chapter officer expectations: Officer elections: Ensure the roles of president, vice president, secretary, and treasurer have been filled. àà Chapters with average attendance of fewer than 40 members at local chapter meetings can combine the positions of secretary and treasurer into one position. àà Chapters with an average attendance of 40 or more members at meetings are encouraged to elect an education and member development officer in addition to the four main positions above. Submit online election verification to AAPC, which includes the names of the newly elected officers, city, state, and contact information within 10 days of elections. àà All elected chapter officers must agree to the terms in the Chapter Officer Agreement, indicating their promise to serve as officers for one year; àà AAPC is allowed to post the officers names and contact information on the AAPC website for each chapter member s access; and àà All elected officers must maintain current AAPC membership. Meetings: Hold officers meetings routinely and distribute the minutes of these meetings to chapter officers and other meeting attendees in a timely manner by uploading a PDF copy to the chapter s online library. Hold at least six chapter meetings and four exams per year, in a friendly and professional manner. Chapter officers must share responsibility to proctor all chapter-sponsored exams. àà Encourage all officers to participate in the planning of events such as May MAYnia, chapter seminars/conferences, fundraisers, etc. àà Encourage and include chapter members to participate through committees. Finances: Retain all financial and non-financial chapter records and documents. Comply with all requirements related to the use of local chapter funds, including the submission of the monthly Profit and Loss Statement no later than the fifth of each month and for the end of the year by December 31. Ensure you have a minimum of two signatures on the local chapter checking account and are authorized to sign each check drawn from the local chapter bank account. Ensure appropriate use of chapter funds, as outlined in the Local Chapter Handbook. Submit all required paperwork and agreements. Above all, remember you serve voluntarily to represent your chapter members and AAPC, and are expected to act ethically and with integrity. Ensure you promote AAPC and its mission on a local level and communicate all local concerns to AAPC in a timely manner. Officers Stay Dedicated and True Blue The commitment of our volunteer officers is seen in all areas of our profession. I am impressed by the dedication of everyone involved in carrying out the AAPC mission statement, during challenging and rewarding times. Thank you for your service to our members. Your commitment moves us forward and demonstrates integrity, accountability, dignity, and respect. Faith C.M. McNicholas, RHIT, CPC, CPCD, PCS, CDC, specializes in dermatology coding. A national speaker on coding and regulatory issues, she presents at American Academy of Dermatology annual and summer meetings, AAPC regional conferences, and several other venues. Mc- Nicholas has a wide range of experience in various medical specialties and practice settings. She is also a certified and approved ICD-10-CM/PCS expert and trainer, a member of the AAPC Chapter Association, and has served office for the Des Plaines, Ill., local chapter. December

14 ADDED EDGE By Glenda Hamilton, CPC, COC, CPMA, CEMC, CPC-P How a Credential Is Born Understand the process of expanding specialty credential options. When I first became certified, AAPC offered only Certified Professional Coder (CPC ) and Certified Outpatient Coding (COC, formerly CPC-H) credentials. The Certified Professional Coder-Payer (CPC-P ) was added next. Soon after, a beta-test was offered to chapters for the Certified Evaluation and Management Coder (CEMC ) credential. These core credential certifications required equal continuing education units (CEUs). As AAPC grew, members requested a greater range of specialty credentials. Coders who worked in a single specialty found the CPC or COC credential difficult to earn because the exams tested on multiple specialties. AAPC decided to redesign the specialty exams to stand alone, so a core credential was no longer mandatory to sit for a specialty exam. If you have worked in a specialty practice for years and want to validate your expertise in that specialty, then acquiring a specialty certification is the way to go. The Birthing Process If you don t see a certification for your specialty on the AAPC website, you can request that it be added. Go to the Specialty Medical Coding Certification webpage at specialty-credentials.aspx, and click the link at the bottom right corner that says, Don t see your specialty? Tell us. When the survey pops up, select your specialty or, if it isn t listed, enter it. Then, click Done. Here begins the possibility of a new credential. But the process is complicated. If there is a large response requesting the same field of expertise, the process moves forward. Medical societies are contacted to make sure competing credentials with similar requirements are not being duplicated. It s also necessary to determine whether the credential is needed in the industry, and whether it will meet industry standards. When a credential is determined to be necessary, a test committee is formed. The committee is made up of five experts, with at least two years experience in the specialty. AAPC staff runs the committee. Work on the exam committee includes the following steps: Competencies needed to perform the job are determined. Competencies are vetted by employers. AAPC oversees the development, review, and vetting of all questions based on the determined competencies. The question bank includes questions used for the certification exam and test preparation materials (study guides and practice tests). Most coding exams include: Anatomy and physiology image by istockphoto shuttertop 14 Healthcare Business Monthly

15 Credential If you don t see your specialty certification on the AAPC website, you can request it to be added. Medical terminology Coding concepts for the specialty Medical record abstraction of office notes and procedures, if applicable Evaluation and management (1995 and 1997 Documentation Guidelines for Evaluation and Management Services) Compliance Payment methodologies Beta Testing Ensures a Thorough Exam A question bank for the certification exam is developed next. Questions are pulled for a beta exam, which is used to gather statistics for question performance. Expert coders in the field are evaluated on performance for each question. These statistics are used to vet the accuracy of each test question. Beta testers also complete a survey to determine whether all competencies were covered, the difficulty level of the exam was appropriate, and the proper amount of time was allotted. Only after all of the steps and statistics in the process are complete is a decision made whether to offer the certification exam. Then, just maybe, we witness the birth of a credential! Glenda L. Hamilton, CPC, COC, CPMA, CEMC, CPC-P, brings over 25 years of experience to practice management, coding, reimbursement, education, and consulting as a business owner. She joined Cooper University Hospital in 2005 as clinical documentation educator. Hamilton is now senior compliance auditor at Cooper. She has held many officer positions over the past 10 years at the Cherry Hill, N.J., local chapter. Hamilton started multiple charitable projects in the chapter and believes in paying it forward. ADDED EDGE Need an official answer? Ask an AAPC Expert Visit aapc.com/ask-an-expert to get expert answers to your healthcare questions. Whether you are settling a coding dispute or need a response from a reputable source, AAPC Ask an Expert provides the answers you need. Post a coding, billing, auditing, practice management or compliance question and receive a response from an AAPC Expert within one business day. The AAPC Expert team includes professionals from all facets of the business of healthcare. Get answers to tough questions from a source you can trust. December

16 CODING/BILLING By Maryann C. Palmeter, CPC, CENTC, CPCO Medicare Primary Care Center Exception Update Clarify the rules, and understand documentation requirements and limitations when reporting services. image by istockphoto ivanastar 16 Healthcare Business Monthly Coding/Billing Auditing/Compliance Practice Management

17 Primary Care The primary care center exception is not limited to primary care or family practice residency programs. The final rule for teaching physician presence and documentation requirements under Medicare Part B has been in effect since July 1, Over the years, the Centers for Medicare & Medicaid Services (CMS) has revised and clarified the rule. Let s assess the current regulations to see how they affect coding and billing in your medical practice. CODING/BILLING Billing Guidelines Generally, to bill Medicare Part B for services involving residents, the teaching physician must personally perform the service, or at least be physically present during the critical or key portions of the service. Only specified services performed by residents under a primary care exception (within an approved Graduate Medical Education Program) may be billed to Medicare Part B under the teaching physician s provider number without the teaching physician there to perform the service. The primary care center exception is not limited to primary care or family practice residency programs. Per CMS, the exception could apply to any residency program with requirements that are incompatible with the teaching physician physical presence requirement. Residency programs most likely to qualify for the exception include family practice, general internal medicine, geriatrics, pediatrics, and obstetrics/gynecology. Attest in Writing For the exception to apply, the center must attest in writing to the Medicare administrative contractor (MAC) that the following conditions have been met: 1. The services are performed in a center located in an outpatient department of a hospital or another ambulatory care entity in which the time spent by the residents in patient care activities is included in determining Medicare Part A payments to the hospital. 2. The residents involved have completed more than six months of a residency program. 3. The teaching physician directs the care of no more than four residents at a time, and directs the care from such proximity as to constitute immediate availability. December

18 Primary Care CODING/BILLING Under the exception, residents may provide reasonable and necessary, low- to mid-level evaluation and management (E/M) services, and other specified services, without the presence of a teaching physician. Specific procedure codes that may be billed under the exception include: CPT Codes New patient office or other outpatient visit: 99201, 99202, and Established patient office or other outpatient visit: 99211, 99212, and HCPCS Level II Codes G0402 Initial preventive physical examination; face-to-face visit, services limited to new beneficiary during the first 12 months of Medicare enrollment image by istockphoto sshepard G0438 Annual wellness visit, includes a personalized prevention plan of service (PPPS), first visit 4. The teaching physician has no other responsibilities at the time (including the supervision of other personnel) and manages responsibility for those patients seen by the residents. 5. The patients seen are an identifiable group who consider the center to be the continuing source of their healthcare, and are cognizant that residents under the medical direction of teaching physicians furnish services. The residents follow the same group of patients throughout the course of their residency program. Centers exercising the exception do not need to obtain prior approval, but they must maintain records demonstrating that they qualify for the exception. Services Included Under the Exception The range of services residents may furnish under the exception includes: Acute care for undifferentiated problems or chronic care for ongoing conditions, including chronic mental illness Coordination of care furnished by other physicians and providers Comprehensive care not limited by organ system or diagnosis G0439 Annual wellness visit, includes a personalized prevention plan of service (PPPS), subsequent visit For services other than those listed above, the general teaching physician policy applies. Append Modifiers Properly Modifier GE This service has been performed by a resident without the presence of a teaching physician under the primary care exception must be appended to services billed under the exception. Services that do not meet the requirements for an exception revert to the general teaching physician guidelines, and claims must include modifier GC This service has been performed in part by a resident under the direction of a teaching physician. Follow 4-to-1 Ratio Rules A teaching physician may not supervise more than four residents at any given time, and only residents who have completed more than six months of an approved GME program may furnish billable patient care without the teaching physician s physical presence. Although residents with less than six months in an approved GME program do not qualify for the exception, they are counted among the four residents under supervision of the teaching physician. See the following chart for scenarios of how the 4:1 ratio affects billing. 18 Healthcare Business Monthly

19 To discuss this article or topic, go to Primary Care Sample Scenarios with 4-to-1 Ratio Resident with six months or less in residency program. New resident A Resident with more than six months in residency program. Old resident B Resident with more than six months in residency program. Old resident C Resident with more than six months in residency program. Old resident D Exception applies to old residents B, C, and D, but not to new resident A. Follow general teaching physician rules for new resident A. Apply modifier GC to charge for new resident A. Apply modifier GE to charges for residents B, C, and D. CODING/BILLING Resident with six months or less in residency program. New resident A Resident with more than six months in residency program. Old resident B Resident with more than six months in residency program. Old resident C Resident with more than six months in residency program. Old resident D Resident with more than six months in residency program. Old resident E Exception does not apply to ANY residents because the 4-to-1 ratio is exceeded. Follow general teaching physician rules for ALL residents. Apply modifier GC to charges for ALL residents. Resident with six months or less in residency program. New resident A Resident with six months or less in residency program. New resident B Resident with more than six months in residency program. Old resident C Resident with more than six months in residency program. Old resident D Exception applies to old residents C and D, but not to new residents A and B. Follow general teaching physician rules for new residents A and B. Apply modifier GC to charges for new residents A and B. Apply modifier GE to charges for old residents C and D. Documentation Requirements To qualify for the exception, the teaching physician must document the extent of his or her participation in the review and direction of the services furnished to each patient. Good Teaching Physician Note Example I have reviewed with the resident Jane Doe s medical history, physical examination, diagnosis, and results of tests and treatments and agree with the patient s care as documented in the resident s note. This is a good teaching physician note because it specifies that the teaching physician reviewed and discussed the history, physical examination, assessment, and plan provided by the resident, and it supports the teaching physician s agreement with the plan of care for the patient. Poor Teaching Physician Note Example I have discussed the case with the resident. This note is poor because it does not specify what was discussed with the resident, nor does it support the teaching physician s direction of the services furnished to the patient. Resources Guidelines for Teaching Physicians, Interns, and Residents, and-education/medicare-learning-network-mln/mlnproducts/downloads/teaching- Physicians-Fact-Sheet-ICN pdf Medicare Claims Processing Manual, Pub , chapter 12, Guidance/Guidance/Manuals/Downloads/clm104c12.pdf Maryann C. Palmeter, CPC, CENTC, CPCO, is director of physician billing compliance with the University of Florida Jacksonville Healthcare, Inc., where she provides professional direction and oversight to the billing compliance program of the University of Florida College of Medicine-Jacksonville. Her extensive experience in federal and state government payer billing and compliance regulations has been gained through executive level positions on both the physician billing and government contractor sides of the healthcare industry. Palmeter served as a National Advisory Board member from and as secretary from She was named AAPC s 2010 Member of the Year and is a member of the Jacksonville, Fla., local chapter. December

20 CODING/BILLING By Sarah W. Sebikari, MHA, CPC Claim All Your Pennies for Discontinued Procedures When a procedure is cut short due to complications or risks, be sure to meet payer reporting criteria. it may be necessary to indicate that a surgical or diagnostic procedure was started but discontinued. This circumstance may be reported by adding modifier 53 to the code reported by the individual for the discontinued procedure. The American Medical Association (AMA) created modifier 53 in 1997 to distinguish between services discontinued at the provider s discretion, and those discontinued as a result of extenuating circumstances that cause a risk to the patient. image by istockphoto Chris_Elwell discontinued procedure is one that is halted prior to completion A but after anesthesia has been induced, usually because the patient s health is at risk. Modifier 53 Discontinued procedure is appended to the procedure code to indicate such an occurrence. Used improperly, modifier 53 can get you in hot water. Let s consider the proper use of this modifier in a physician setting. Modifier 53 Defined Modifier 53 is used to denote a discontinued surgical or diagnostic procedure, and indicates that the provider aborted the procedure as a result of an unexpected event or a complication that put the patient s welfare at risk. Per CPT instruction: Under certain circumstances the physician or other qualified health care professional may elect to terminate a surgical or diagnostic procedure. Due to extenuating circumstances, or those that threaten the well-being of the patient, Supporting Documentation Requirements To append modifier 53, certain documentation criteria must be met, and that documentation must be available for payer review. Documentation must substantiate the discontinued procedure and support medical necessity. Specifically: The operative report must indicate anesthesia was induced and the procedure started. Anesthesia may include local, regional block, moderate/conscious sedation, deep sedation, or general anesthesia. If a scope was used, documentation must support that a scope was introduced prior to termination of the procedure. Documentation must indicate in detail the reason the procedure was discontinued. The more detail, the easier it is for the payer to manually adjust the claim, rather than hold it for further review (held claims delay reimbursement and subsequently affect operations). Examples of documentation that would warrant use of modifier 53 include: The patient encountered difficulty breathing during the procedure; therefore, the procedure was terminated. As a result of extensive hemorrhaging, the procedure was discontinued. The patient suffered continued arrhythmia, so the procedure had to be aborted. An adverse reaction to anesthesia caused the patient to convulse, prompting a discontinuation of the procedure. 20 Healthcare Business Monthly Coding/Billing Auditing/Compliance Practice Management

21 Discontinued Procedures The patient was unable to tolerate the procedure as a result of morbid obesity. In addition to operative notes, the Center for Medicare & Medicaid Services (CMS) requires documentation stating the percentage of the procedure performed; however, most commercial payers will determine the percentage of the procedure completed based on documentation in the operative report. To append modifier 53, certain documentation criteria must be met, and it must be available for payer review. sterile fashion, general anesthesia is administered, and a flexible bronchoscopy under fluoroscopic guidance is inserted through the oropharynx to the trachea. On visualization, a lung mass is noted. Biopsy forceps are inserted to obtain a biopsy and the patient starts to bleed uncontrollably. At this point, Dr. Bronco decides to terminate the procedure after controlling the bleeding, as this caused evident risk to the patient s life. CODING/BILLING Reimbursement Reimbursement for procedures billed with modifier 53 is based on how much of the procedure was performed, as documented in the operative report. This shows the significance of clear and concise documentation detailing the extent of the procedure. The CMS Physician Fee Schedule Relative Value Files list a separate Relative Value Unit (RVU) for some codes based on modifier 53. For example, CPT Colonoscopy, flexible, proximal to splenic flexure; diagnostic, with or without collection of specimen(s) by brushing or washing, with or without colon decompression (separate procedure) has already been reduced on the fee schedule. Typically, however, payers manually price procedures billed with modifier 53. Tips: Send an operative report with the claim so the payer will determine reimbursement. Expect a reduced reimbursement rate, so do not reduce your fee in advance. Do not report elective cancellation of a procedure prior to anesthesia with modifier 53. Do not report evaluation and management or time-based services with modifier 53. Only append modifier 53 to physician services. Do not append modifier 53 to laparoscopic or endoscopic procedures converted to an open procedure, or when a procedure is converted to a more extensive procedure. Example 1 A patient with pneumonia of an unspecified nature was scheduled by Dr. Bronco s office for a surgical bronchoscopy with biopsy. On checking in at the endoscopy suite, the patient signs an informed consent. The patient is prepped and draped in normal The appropriate procedure code Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with transbronchial lung biopsy(s), single lobe is billed with modifier 53 appended to signify the procedure was started and discontinued by the physician, since the risks of continuing the procedure would be high. Example 2 A patient who has been experiencing severe headaches for the past two month is scheduled for a spinal tap. On arrival, the patient is prepped and sedated. While performing the spinal tap, Dr. Tap realizes the patient is experiencing difficulty breathing and is moving and twisting in pain. Dr. Tap notes that the patient s well-being is at risk, and decides to immediately halt the procedure. Code Spinal puncture, lumbar, diagnostic is billed with modifier 53 appended to alert the payer that the procedure was discontinued. By appending modifier 53 in this instance, you also potentially avoid a denial for duplicate billing if the procedure is completed successfully in the future. Risk Management Reminder When a discontinued procedure is aborted as the result of potential risk to a patient s life, risk management must be notified. Resources: AMA, 2015 CPT Professional Edition CMS Medicare Claims Processing Manual, chapter 4, section Sarah W. Sebikari, MHA, CPC, is employed by Summit Health Management a Physician Practice Management Organization in New Jersey as a coding compliance education lead for their Coding Compliance department. She has been in the healthcare field for over 12 years, with experience spanning from multiple-specialty physician to outpatient coding and reimbursement. December

22 CODING/BILLING By Frank Mesaros, MPA, MT (ASCP), CPC Specimen Validity Testing Determine coverage and be sure to maintain documentation. image by istockphoto nikesidoroff You may know it as adulteration, specimen validity, or specimen integrity testing; regardless of terminology, Medicare does not cover it, but other insurance plans do. The key to reimbursement is to understand the tests, determine if they are medically necessary, review payer policies for coverage parameters, and be sure your physician s documentation is supportive. Urine Evaluation and Report Understanding how to evaluate urine drug screens for adulterations, substitutions, and potential false results is complex, but vital to interpreting their results. A detailed medication history including prescription, nonprescription and herbal medications and proper knowledge of medications that cross-react with urine drug screens are essential for assessing cross reactivity that may affect results. (Moeller 2008) Urine tests can appear in a report as adulterated, substituted, or dilute. An adulterated urine specimen contains a substance that is not 22 Healthcare Business Monthly normally found in urine, or that normally is found, but is in abnormal concentrations. Adulterants work by interfering with immunoassay and/or confirmatory assay function, or they convert the target drug into compounds not detected by the test. Synthetic urine products can be submitted when urine specimen collection is not observed; however, more commonly, water or saline solution is substituted. Diluting the urine sample to the point where the targeted drug is below the cutoff concentration is a way to get a negative result. (Substance Abuse and Mental Health Services Administration) The National Correct Coding Initiative (NCCI) manual (chapter 10, section E) says: Providers performing validity testing on urine specimens utilized for drug testing should not separately bill the validity testing. For example, if a laboratory performs a urinary ph, specific gravity, creatinine, nitrates, oxidants, or oth- Coding/Billing Auditing/Compliance Practice Management

23 Validity Test Specimen validity testing is typically ordered by treating clinicians who use the results to make therapeutic decisions regarding specific medical problems of their patient, including those related to medication and illicit drug use. er tests to confirm that a urine specimen is not adulterated, this testing is not separately billed. [a] laboratory test is a covered benefit only if the test result is utilized for management of the beneficiary s specific medical problem. Testing to confirm that a urine specimen is unadulterated is an internal control process that is not separately reportable. Medical Necessity Treating physicians typically order specimen validity testing to make patient-specific therapeutic decisions, including those related to medication compliance and illicit drug use. In the absence of this validity testing, a patient may succeed in deceiving a physician through the submission of an adulterated urine specimen. This may have the unintentional effect of masking the presence of some underlying medical conditions by providing misleading urine drug test results. (Kirsh 2015) Concerns of drug abuse and noncompliance are considerations pain management physicians routinely assess. Specimen validity testing provides evidence that, when taken into consideration with other indicators (e.g., incorrect pill counts, suspicious behaviors, clinical symptoms), may assist the medical management of the patient, including the initiation of a conversation regarding potential drug abuse, mismanagement of medications, or diversion of prescribed drugs. (Ko 2013) Coverage Varies, but Is a No for Medicare Palmetto Government Benefits Administrator states their position in policy M00024, consistent with the NCCI manual: a diagnostic laboratory test must be ordered by the treating physician and the test results must be used in the management of the beneficiary s specific medical problem. Although some laboratory requisitions allow the ordering physician to designate specimen validity testing (e.g., creatinine, oxidant, ph, specific gravity) to ensure that a patient specimen has not been adulterated, the results of this testing are not used in the management of the beneficiary s medical problem. Therefore, Palmetto GBA has determined that specimen validity testing is a statutorily excluded service. Similarly, Florida Medicare administrative contractor First Coast Service Options does not cover specimen validity testing including, but not limited to ph, specific gravity, oxidants, and creatinine. (First Coast Service Options, Inc., 2014) Cigna coverage policy 0512 regarding drug testing indicates routine tests to confirm specimen integrity are not covered because they are not considered medically necessary. (Cigna 2015) Because the phrase routine tests is used, you can argue that although routine integrity testing is not covered, integrity testing when specifically requested may be covered. A federal employee health benefit plan for mail handlers (Mail Handlers Benefit Plan) on urine drug testing specifically indicates CPT codes Urinalysis, by dip stick or tablet reagent for bilirubin, glucose, hemoglobin, ketones, leukocytes, nitrite, ph, protein, specific gravity, urobilinogen, any number of these constituents; non-automated, without microscopy; Urinalysis, by dip stick or tablet reagent for bilirubin, glucose, hemoglobin, ketones, leukocytes, nitrite, ph, protein, specific gravity, urobilinogen, any number of these constituents; automated, without microscopy; and Creatinine; other source as additional tests that may be appropriate to verify a urine sample was not adulterated when specifically ordered by the authorized requesting provider. Coventry Health Care, an Aetna company, has a urine drug testing policy with the same coverage wording. In a document published on the Anthem Blue Cross Blue Shield website titled Urine Drug Screening A Practical Guide for Clinicians, laboratory tests are specifically specified, indicating contamination should be considered if test results for ph, specific gravity, urine creatinine, or urine nitrite levels are outside predetermined levels. (CARES Alliance 2010) Specimen validity testing is mandatory for the Department of Transportation workplace drug and alcohol testing programs. (Section 40.89(b) 2008) The U.S. Department of Health & Human Services drug testing standards were first published in In 2004, significant revisions requiring specimen validity testing on federal employee donor urine specimens were included. (Bush 2008) Although specimen validity testing is arguably medically necessary, routine use fits into Medicare s definition. This does not, however, take into account conditions where there may be medical value in the tests. Check the relevant coverage policies to determine whether this testing is covered and what documentation to maintain. CODING/BILLING December

24 Validity Test To discuss this article or topic, go to CODING/BILLING Resources Bush, Donna M., The U.S. Mandatory Guidelines for Federal Workplace Drug Testing Programs: Current status and future considerations, Forensic Science International 174 (2-3): , CARES Alliance, Urine Drug Screening - A Practical Guide for Clinicians, 2010: Center for Substance Abuse Treatment, Medication-Assisted Treatment for Opioid Addiction in Opioid Treatment Programs, Treatment Improvement Protocol (TIP) Series 43 (Substance Abuse and Mental Health Services Administration): Cigna, Cigna Medical Coverage Policy - Drug Testing, October 15, 2015: coveragepositioncriteria_drug_test.pdf. The Centers for Medicare & Medicaid Services (CMS), NCCI Policy Manual for Medicare Services, chapter 10, section E. Coventry Health Care, Urine Drug Testing Coverage, American Foreign Service Protective Association: First Coast Service Options, Inc., Controlled Substance Monitoring and Drugs of Abuse Testing, First Coast Service Options. November 15, 2014: K.E. Moeller, Lee, K.C., and Kissack, J.C., Urine Drug Screening: Practical Guide for Clinicians. Mayo Clinic Proceedings 83 (1): Kenneth L. Kirsh, Christo, P.J., Heit, H., Steffel, K., and Passik, S.D., Specimen validity testing in urine drug monitoring of medications and illicit drugs: Clinical implications, Journal of Opioid Management, 11 (1): Mail Handlers Benefit Plan, FEHBP Urine Drug Testing. public/@cvty_mailhandlers_mhbp/documents/document/c pdf Mancia Ko, Merritt, P., and Dawson, E., Specimen Validity Testing - Focus on Screens looks at interpreting urine drug assay results. Practical Pain Management. June 1, 2013: Palmetto GBA, Specimen Validity Testing (M00024), MolDX. September 4, Section 40.89(b), 49 CFR, June 25, Substance Abuse and Mental Health Services Administration, Clinical Drug Testing in Primary Care (TAP 32), chapter 4, page 43. Substance Abuse and Mental Health Services Administration, Clinical Drug Testing in Primary Care (Technical Assistance Publication Series - TAP 32), chapter 5, pages Tellioglu, Tahir, The Use of Urine Drug Testing To Monitor Patients Receiving Chronic Opioid Therapy for Persistent Pain Conditions, Medicine and Health Rhode Island 91 (9), pages , 282. Frank Mesaros, MPA, MT(ASCP), CPC, is CEO of Trusent Solutions, LLC, a management consulting firm specializing in the laboratory industry. Trusent provides revenue stream integrity services to regional laboratories, hospital based laboratories, and physician office based laboratories. He is a member of the Harrisburg, Pa., local chapter. EARLY BIRD REGISTRATION SAVE $100 HEALTHCON.com Healthcare Business Monthly

25 By Diana H. Williams, BS, CPC, CCS-P, CCS, CPMA FACILITY TRANSFUSIONS Document Properly for ICD-10-PCS Assign correct characters and keep the revenue road clear of denial roadblocks. Timely documentation reviews can help you to find problematic coding. With ICD-10 implementation, blood transfusion facility coding is one area you may want to check for medical record deficiencies. The first step to ensuring your physician documentation is sufficient is knowing what you must look for. Assign the Right Characters Blood transfusions can be found in the Administration section of ICD-10-PCS with the first character 3, meaning procedures to put in or on a therapeutic, prophylactic, protective, diagnostic, nutritional, or physiologic substance. The second character for a blood transfusion is a 0 Circulatory (system), and the third character is 2 Transfusion (putting in blood or blood products). This brings you to the ICD- 10-PCS table that begins with 302. See the following excerpt from Table 302 for reference: Section - 3 Administration Operation - 2 Transfusion: Putting in blood or blood products Body System - 0 Circulatory Body System/Region Approach Substance Qualifier 3 Peripheral Vein 4 Central Vein 5 Peripheral Artery 6 Central Artery 0 Open 3 Percutaneous G Bone Marrow H Whole Blood J Serum Albumin K Frozen Plasma L Fresh Plasma M Plasma Cryoprecipitate N Red Blood Cells P Frozen Red Cells Q White Cells R Platelets S Globulin T Fibrinogen V Antihemophilic Factors W Factor IX X Stem Cells, Cord Blood Y Stem Cells, Hematopoietic 0 Autologous 1 Nonautologous Character 4 specifies the body system/region and identifies the site where the substance is administered not the site where the substance administered takes effect. The body systems/regions for arteries and veins are peripheral artery, central artery, peripheral vein and central vein. Locate where this is documented in the medical record and, specifically, if an artery or vein was accessed for the transfusion. Most of the time this is a peripheral vein, but it should be documented as such. You don t want your documentation to fall short for coding purposes. Conducting a review can be very helpful here. Character 4 of the seven character code for the transfusion must be: 3 Peripheral Vein; 4 Central Vein; 5 Peripheral Artery; or 6 Central Artery. For the 5th character, Approach, you must select either 0 Open or 3 Percutaneous. Check your documentation and, if necessary, reach out to your providers to ensure this information is captured and present in the medical record. The final two characters necessary to complete the code are character 6 Substance, and character 7 Qualifier. There are many choices for character 6, and some pertinent are: H Whole Blood, K Frozen Plasma, L Fresh Plasma, N Red Blood Cells, P Frozen Red Cells, Q White Cells, and R Platelets. Character 7 Qualifier has two options: 0 Autologous and 1 Nonautologous. Following these steps, for example, the correct code in ICD-10-PCS for a red blood cell transfusion accessing a percutaneous peripheral vein using nonautologous cells is 3023N1. Documentation Is Key Find out how many of these procedures are performed a day in your facility. Be sure you can locate proper documentation in each patient s medical record. When you find the documentation, ensure it holds up for coding and possible review. Timely reviews can assist you and your organization to answer these important questions. Ensure that you can document and code blood transfusions correctly, and keep the revenue road clear of preventable roadblocks. Resources ICD-10-PCS Introduction, Administration Section Diana H. Williams, BS, CPC, CCS-P, CCS, CPMA, has over 30 years of experience in healthcare as a consultant, coder, educator, auditor, manager, and medical insurance professional. She is a multi-specialty surgical coder, specializes in evaluation and management audits and works in clinical documentation improvement. You can reach Williams at Diana.Williams@FTIConsulting.com. She is a member of the Pensacola, Fla., local chapter. Coding/Billing Auditing/Compliance Practice Management December

26 CODING/BILLING By Ken Camilleis, CPC, CPC-I, COSC, CMRS, CCS-P Coding that Brings You to Your Knees Part 2: Open surgical procedures and non-operative procedures Manipulation of the knee joint Manipulation of knee joint under general anesthesia (includes application of traction or other fixation devices) usually is bundled into a surgical procedure, and is rarely paid unless it s done alone. Because of the anticipated recovery time of a few days, total knee arthroplasty (TKA), Arthroplasty, knee, condyle and plateau; medial AND lateral compartments with or without patella resurfacing (total knee arthroplasty) is an inpatient procedure (POS 21). The most common diagnosis to justify a TKA is severe osteoarthritis (ICD-10 M17.- or ICD /715.36). Know the Lingo To verify TKA procedural notes, watch for words such as medial, lateral, patellofemoral, and tibial. Progress notes should confirm the osteoarthritis is so severe there is bone-on-bone encroachment. (Payers may want to see a copy of the dictated notes.) For a TKA revision (27486 Revision of total knee arthroplasty, with or without allograft; 1 component and Revision of total knee arthroplasty, with or without allograft; femoral and entire tibial component), watch for key words such as removal and replacement of polyetheline liner or poly exchange, and determine whether both the femoral and tibial components were removed. If only the liner was removed and replaced, report with modifier 52 Reduced services. image by istockphoto Maridav Last month, we discussed coding arthroscopic knee procedures. Now, let s address coding open knee procedures, as well as nonoperative services, including injections and fracture care. Open Procedures There is a wide range of CPT codes ( ) that covers the gamut of open knee services, such as incision, excision, repair/revision/reconstruction, fracture/dislocation treatment, etc. 26 Healthcare Business Monthly Don t Get Tripped Up By Common Errors A common error is failing to document or code a tendon transfer, which can be reported separately with Transplant or transfer (with muscle redirection or rerouting), thigh (eg, extensor to flexor); single tendon. The tendon repair codes also can easily be confused with Arthroplasty, patella; without prosthesis, which refers to a bone/joint repair rather than a tendon repair. This is a classic example of how important it is to read the entire report and to understand exactly what type of tissue is being repaired, as well as to account for all procedures performed during the operative session (some of which may not be included in a primary procedure and would not trigger National Correct Coding Initiative edits). More Tricks of the Trade Fracture/dislocation care coding ( ) depends on the specific anatomic site, type of fracture, and approach (closed, open, percutaneous). Report a bone graft (e.g., Bone graft, any donor area; major or large) if the graft is harvested from a non-adjacent site (i.e., through a separate incision), and when the graft is not included in the CPT descriptor for the surgery. You might be able to report multiple units of Arthrotomy with meniscus repair, knee (possibly with modifier 59 Distinct procedural service/xs Separate structure) if the Coding/Billing Auditing/Compliance Practice Management

27 To discuss this article or topic, go to Open Knee open meniscus repair is done on both the medial and lateral compartments. Check your specific payer s guidelines, and be sure there is adequate supporting documentation in the operative note. Coding for patella surgeries can be tricky. A relatively common procedure is a patellar tendon repair, coded as Suture of infrapatellar tendon; primary or Suture of infrapatellar tendon; secondary reconstruction, including fascial or tendon graft. The latter includes obtaining and using a fascia or tendon graft. Non-operative Knee Treatments Services to treat early osteoarthritis and other chronic or acute knee conditions include steroid or nonsteroidal anti-inflammatory drug (NSAID) injections, and various non-operative fracture treatments. These are just temporary alternatives to surgery. If the provider performs an appropriately documented and medically necessary exam prior to injection, you may report the supported evaluation and management (E/M) service with 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 appended, as well as Arthrocentesis, aspiration and/or injection, major joint or bursa (eg, shoulder, hip, knee, subacromial bursa); without ultrasound guidance or Arthrocentesis, aspiration and/or injection, major joint or bursa (eg, shoulder, hip, knee, subacromial bursa); with ultrasound guidance, with permanent recording and reporting. Sometimes, depending on the recommended medication, an injection regime is planned to cover more than one session. In such a case, there is no separately identifiable E/M service after the initial session. You may also report the HCPCS Level II code for any medication injected in the doctor s office (e.g., Euflexxa J7323 Hyaluronan or derivative, euflexxa, for intra-articular injection, per dose or Synvisc J7325 Hyaluronan or derivative, synvisc or synvisc-one, for intra-articular injection, 1 mg); however, it s important to read the patient s chart notes and to understand contractual arrangements with local payers. If the medication is supplied by pharmacy script (as is often the case), reporting the supply is double-dipping. Another type of nonsurgical knee treatment consists of fitting the patient to an orthosis, such as a splint or cast in the event of a fracture. Such a service is reported as closed treatment without manipulation and any of the following might apply: Closed treatment of femoral fracture, distal end, medial or lateral condyle, without manipulation Closed treatment of distal femoral epiphyseal separation; without manipulation Closed treatment of patellar fracture, without manipulation Closed treatment of tibial fracture, proximal (plateau); without manipulation Closed treatment of intercondylar spine(s) and/or tuberosity fracture(s) of knee, with or without manipulation Femur Prosthesis Condyle component Femur Patella Tibia Needle access into fluid filled knee joint Patella (kneecap) Fluid-filled joint capsule Tibia Knee replacement Plateau component Patellar aspiration in the treatment. These visits are reported using Postoperative follow-up visit, normally included in the surgical package, to indicate that an evaluation and management service was performed during a postoperative period for a reason(s) related to the original procedure, which is a zero-charge postoperative visit. If the physician determines at such an encounter that the patient failed non-operative treatment (e.g., still experiencing pain caused by the fracture) and decides to perform surgery within 48 hours, you may report an E/M code with modifier 57 Decision for surgery appended. If a new problem (including the same condition on the contralateral knee) is discovered during this 90-day period, you may report the appropriate E/M code with modifier 24 Unrelated evaluation and management service by the same physician or other qualified health care professional during a postoperative period appended. Ken Camilleis, CPC, CPC-I, COSC, CMRS, CCS-P, is an educational consultant and PMCC instructor. He is also a professional coder for Signature Healthcare, a health system covering much of southeastern Massachusetts. Camilleis primary coding specialty is orthopedics. He is a member of the Hyannis, Mass., Cape Coders local chapter. Illustration 2015 Optum360 Illustration 2015 Optum360 CODING/BILLING Although nonsurgical, these treatments have a 90-day global period; therefore, any related office visits during this time are included December

28 Wanting to Advance Your Career? CIC COC CRCTM TM AAPC s CIC, COC, and CRC certifications are the ONLY specialized inpatient, outpatient, and risk adjustment credentials offered in the business of healthcare. Professionals with one of these three specialized credentials can earn up to 61%* more than non-certified professionals. Advance your career today! Visit aapc.com/compare to learn more about AAPC's three newest credentials and how they can elevate your career and increase your earning potential. *Percentages based on 2014 Salary Survey 28 Healthcare Business Monthly Visit aapc.com/compare and discover which credential is right for you.

29 By John Verhovshek, MA, CPC, and Raemarie Jimenez, CPC, CPB, CPMA, CPPM, CPC-I, CANPC, CRHC CODING/BILLING image by istockphoto PeopleImages Sneak a Peek at CPT 2016 Changes See what procedural coding changes will affect you most. The release of the 2016 CPT codebook brings us approximately 350 new, revised, or deleted codes, as well as many new guidelines, coding tips, and parenthetical instructions. Here are some highlights. What s New for Prolonged Clinical Staff Services New for 2016 are two, time-based, add-on evaluation and management (E/M) codes to describe prolonged clinical staff services provided with direct patient contact: Prolonged clinical staff service (the service beyond the typical service time) during an evaluation and management service in the office or outpatient setting, direct patient contact with physician supervision; first hour (List separately in addition to code for outpatient Evaluation and Management service) each additional 30 minutes (List separately in addition to code for prolonged service) Services must be directly supervised by the physician or qualified healthcare professional. As defined at 42 CFR , direct supervision means that the physician or nonphysician practitioner must be present on the same campus where the services are being furnished. Coding/Billing Auditing/Compliance Practice Management Time counted toward and does not have to be continuous; however, time spent by clinical staff performing other, separately reported services does not count toward prolonged services time. Note that facilities may not report and No News Is Good News? There are no changes to CPT modifiers this year. Anesthesia coders can rest easy, as well: There are no CPT code changes for anesthesia services in Endobronchial Ultrasound Gains Codes Endobronchial ultrasound (EBUS) combines ultrasound with bronchoscope to visualize the airway wall and adjacent structures. The technique allows surgeons to obtain sample tissue from the lungs and nearby lymph nodes; for example, to diagnose and stage lung cancer, detect infections, and identify other lung conditions. December

30 CPT 2016 CODING/BILLING Over the past several years, radiological supervision and interpretation (S&I) increasingly has become an included component of many procedures. The trend continues in Code (which previously reported EBUS) is deleted and replaced by three new codes: Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with endobronchial ultrasound (EBUS) guided transtracheal and/or transbronchial sampling (eg, aspiration[s]/biopsy[ies]), one or two mediastinal and/or hilar lymph node stations or structures with endobronchial ultrasound (EBUS) guided transtracheal and/or transbronchial sampling (eg, aspiration[s]/biopsy[ies]), 3 or more mediastinal and/or hilar lymph node stations or structures with transendoscopic endobronchial ultrasound (EBUS) during bronchoscopic diagnostic or therapeutic intervention(s) for peripheral lesion(s) (List separately in addition to code for primary procedure[s]) Intravascular Ultrasound Now Includes Radiological S&I Over the past several years, radiological supervision and interpretation (S&I) increasingly has become an included component of many procedures. The trend continues in For example, non-coronary intravascular ultrasound codes and (which did NOT include radiological S&I) are deleted, to be replaced by two new add-on codes that describe identical procedures, but now include radiological S&I. The codes are: New Urinary Imaging Procedures CPT 2016 introduces and for antegrade nephrostogram and ureterogram (imaging procedures for diagnostic assessment of the urinary system), and designates revised and replacement codes for urinary catheter procedures. For example, Placement of nephroureteral catheter, percutaneous, including diagnostic nephrostogram and/or ureterogram when performed, imaging guidance (eg, ultrasound and/or fluoroscopy) and all associated radiological supervision and interpretation, new access describes percutaneous nephrostomy to place a nephroureteral catheter that drains internally and/or externally (via new access). Report a single unit of for each renal collecting system/ureter accessed (e.g., x 2, if both renal collecting systems/ureters are accessed.). The procedure includes diagnostic nephrostogram and/ or ureterogram (when performed), as well as imaging guidance and all associated radiological S&I. Additional codes are added to describe percutaneous conversion of a nephrostomy catheter to nephroureteral catheter (50434), Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; initial noncoronary vessel (List separately in addition to code for primary procedure) each additional noncoronary vessel (List separately in addition to code for primary procedure) Cholangiography-related Codes Get an Overhaul Cholangiography is visualization of the bile ducts using an injected contrast medium to locate obstruction(s). Cholangiography codes are deleted and replaced by a new set of codes describing injection of the contrast medium (47531, existing access and 47532, new access), placement/revision/removal of biliary drainage catheter ( ), stent placement ( ), access for rendezvous procedure (47541), removal of stones from the biliary ducts (+47544), and more. image by istockphoto decade3d 30 Healthcare Business Monthly

31 CPT 2016 image by istockphoto budgetstockphoto and removal and replacement of an existing nephrostomy catheter (50435). Intracranial Thrombolysis Gains a Code Thrombolysis is the breakdown of blood clots. For 2016, you ll report this service with CPT Percutaneous arterial transluminal mechanical thrombectomy and/or infusion for thrombolysis, intracranial, any method, including diagnostic angiography, fluoroscopic guidance, catheter placement, and intraprocedural pharmacological thrombolytic injection(s) for thrombolysis for intracranial arteries using mechanical thrombectomy (clot removal) or infusion. Diagnostic angiography, fluoroscopic guidance, selective catheterization and thrombolytic injection(s) are included, although you may separately report diagnostic angiography of a non-treated vascular territory. Also included are neurologic and hemodynamic monitoring of the patient, and closure by manual pressure, arterial closure device, or suture. You may report once per intracranial territory treated. The intracranial territories include right carotid circulation, left carotid circulation, and vertebro-basilar circulation. There are also new codes for prolonged administration of pharmacologic agent(s) in any intracranial artery, for any reason other than thrombolysis: Endovascular intracranial prolonged administration of pharmacologic agent(s) other than for thrombolysis, arterial, including catheter placement, diagnostic angiography, and imaging guidance; initial vascular territory each additional vascular territory (List separately in addition to code for primary procedure). Three New Codes for Paravertebral Block A paraspinous block completely desensitizes the affected spinal segment (generally for pain relief). CPT 2016 adds three codes to report thoracic paravertebral block (PVB) by injection (single and additional) or continuous infusion: Paravertebral block (PVB) (paraspinous block), thoracic; single injection site (includes imaging guidance, when performed) second and any additional injection site(s) (includes imaging guidance, when performed) (List separately in addition to code for primary procedure) continuous infusion by catheter (includes imaging guidance, when performed) Radiologic Exam Codes Get More Precise New codes describing radiologic exam of the spine now provide greater specificity as to the number of views. For example: Radiologic examination, spine, entire thoracic and lumbar, including skull, cervical and sacral spine if performed (eg, scoliosis evaluation); one view or 3 views or 5 views minimum of 6 views Earwax Removal by Lavage Now a Distinct Service Impacted cerumen (ear wax) can cause symptoms including pain, dizziness, and loss of hearing. In years past, removal of impacted cerumen not requiring instrumentation has been reported using an appropriate evaluation and management (E/M) code. The American Medical Association (AMA) added a parenthetical note to CPT 2014 instructing, For cerumen removal that is not impacted [see above] or does not require instrumentation, eg, by irrigation only, see E/M service code, which may include new or established patient office or other outpatient services. The AMA also revised the CPT descriptor for to specify requiring instrumentation. For 2016, the rules have changed. You may still report Removal impacted cerumen requiring instrumentation, unilateral for removal of cerumen requiring instrumentation; however, removal by lavage now has its own code, Removal impacted cerumen using irrigation/ lavage, unilateral, and no longer is reported as an E/M service. CPT 2016 now instructs, for cerumen removal that is not impacted, see E/M service code. Note that both and are unilateral procedures; for removal of impacted cerumen from both ears, append modifier 50 Bilateral procedure to the appropriate code. CODING/BILLING December

32 CPT 2016 CODING/BILLING The new codes replace several now-deleted codes, such as and Similar changes affect codes describing radiologic exam of the hip(s) and pelvis. Two examples include: Radiologic examination, hip, unilateral, with pelvis when performed; 2-3 views Radiologic examination, hips, bilateral, with pelvis when performed; minimum of 5 views Clinical Brachytherapy Revised Many codes describing services related to clinical brachytherapy are deleted and replaced, while several other codes are revised. For example, deleted codes and are replaced by the following: Remote afterloading high dose rate radionuclide interstitial or intracavitary brachytherapy, includes basic dosimetry, when performed; 1 channel channels over 12 channels Also added are new codes for skin surface brachytherapy, Pathology and Laboratory: Refining Test Methods and More There have been many changes to the Pathology and Laboratory chapter for 2016, most of which are based on methods used to perform various tests. For example, a new code was created to report an obstetric panel with HIV testing: Obstetric panel (including HIV testing). Ten new codes are added to the Multianalyte Assays with Algorithmic Analyses (MAAA) section to report risk scores for rheumatoid arthritis, coronary artery disease, heart transplant rejection, and oncology (including colon, colorectal, gynecologic, lung, and thyroid). Cleaning Up the Vaccine Codes There are over 60 revisions to vaccine codes for 2016, almost all of which are minor housekeeping changes. Many obsolete vaccines are deleted (for example, and 90646); and many vaccine descriptors are revised to provide greater clarity, with no affect on code application. For example, the abbreviation HepA is added after the name of the vaccine in the descriptor for Hepatitis A vaccine (HepA), pediatric/adolescent dosage-3 dose schedule, for intramuscular use, but code use does not change. In a few cases, revisions are more substantial. For example, the descriptor for Haemophilus influenzae type B vaccine (Hib), PRP-OMP conjugate, 3 dose schedule, for intramuscular use is revised to delete 3-dose schedule, and to change the vaccine to Haemophilus influenzae type B. Also added is Cholera vaccine, live, adult dosage, 1 dose schedule, for oral use and two codes for meningococcal recombinant protein and outer membrane vesicle vaccine (90620, 90621). Special Otorhinolaryngologic Services Caloric vestibular testing is used to evaluate the vestibular nerve. For 2016, the former code for caloric vestibular testing (92543) is deleted and replaced by two new codes: Caloric vestibular test with recording, bilateral; bithermal (ie, one warm and one cool irrigation in each ear for a total of four irrigations) monothermal (ie, one irrigation in each ear for a total of two irrigations), which more precisely define the test protocol. image by istockphoto mediaphotos 32 Healthcare Business Monthly

33 To discuss this article or topic, go to CPT 2016 There have been many changes to the Pathology and Laboratory chapter for 2016, most of which are based on methods used to perform various tests. CODING/BILLING No Time for Electronic Analysis of Neurostimulator Pulse Generator System In prior years, electronic analysis of implanted neurostimulator pulse generator system was a timebased service. For 2016, that s no longer the case. Code Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude, pulse duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); complex spinal cord, or peripheral (ie, peripheral nerve, sacral nerve, neuromuscular) (except cranial nerve) neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming has been revised to eliminate the time element up to one hour, while (previously used to report each additional 30 minutes beyond the first hour) has been deleted. Special Dermatological Procedures A new series of codes ( ) now describes reflectance confocal microscopy for cellular and sub-cellular imaging of skin. The technique allows for imaging of skin lesions in vivo (no biopsy is necessary). More information is available in AAPC s December workshop, New Year, New Updates, in several cities December Check out the Education section on AAPC s website for more information. John Verhovshek, MA, CPC, is managing editor at AAPC and a member of the Hendersonville-Asheville, N.C., local chapter. Raemarie Jimenez, CPC, CPB, CPMA, CPPM, CPC-I, CANPC, CRHC, is vice president, Member and Certification Development and a member of the Weston, Fla., local chapter. December

34 ICD-10 is Here! Advance Your Skills Now. ICD-10-CM General Code Set Training Updated training methods for ICD-10 ilable September 2012 Features: Now the most comprehensive and affordable methods to prepare for ICD-10 will also allow coders to demonstrate their proficiency at their own pace and with unlimited attempts. AAPC - Rhonda Buckholtz, CPC, CPMA, CPC-I, CGSC, CPEDC, CENTC ICD-10 AAPC Vice President, ICD-10 Training and Education ICD-10 format and structure Complete, in-depth ICD-10 guidelines Nuances of the new coding system Hands-on ICD-10 coding exercises Course manual for ICD-10-CM Code Set At-Your-Own-Pace Proficiency Assessment (included or optional) Choose from the five four options 34 Healthcare Business Monthly

35 Includes ICD-10-CMCM Proficiency Assessment Online $395 Online training at your own pace. 16 CEUs Boot Camps $695 2-day, live training and interactive group environment in a city near you. 16 CEUs These training options include access to AAPC s Online ICD-10-CM Proficiency Assessment Course. Successful completion of the hands-on exercises and questions found at the end of the course will satisfy AAPC s certification maintenance requirements for ICD-10-CM. Advanced Code Set Training AAPC ICD-10 Online $195 Online training at your own pace. Boot Camps $295 1-day, live training at select locations. 8 CEUs 8 CEUs These training options take your ICD-10-CM coding skills to a higher level, raising productivity and refreshing skills. Understanding the clinical concepts of commonly treated conditions will help you more readily assign the correct codes and effectively work with clinicians. Add either training to a General Code Set Boot Camp and save $95! For more information, call or visit: aapc.com/icd10 December

36 ADDED EDGE By Dawn Moreno, PhD, CPC, CBCS, CMAA, MTC, CPL, CLT Selecting a comprehensive coding and billing curriculum will help you to land your first industry job. 36 Healthcare Business Monthly

37 Distance Learning Advanced curriculum and training is necessary to a medical coder s or biller s success. Not all online programs are equal, however. The reality is that there are subpar schools on the Internet. You must do your homework before you buy in. Detect Subpar Schooling There are a few ways to spot a subpar school or curriculum right away: The school offers only its own, proprietary reference materials. Schools that do not use the gold-standard textbooks in teaching medical coding/billing may create their own texts to reduce supply costs. Proprietary training is OK, with professional textbook backup. Course hours are skimpy compared to schools and curriculums that offer comprehensive training programs. Subpar training covers only the basics; the credit or course hours are low and the foundational knowledge is brief. Medical coding requires a skill that is developed over time, requiring much practice, working closely with a qualified, certified instructor to hone your skill set to an employable level. Lack of one-on-one assistance. Very large schools that do not have enough instructors will resort to tactics such as telling students to contact the instructor only via . The student may wait a week or more for exam results or to have a simple question answered. A good school will require instructors to answer student questions within 24 hours and to have exams graded and back to students within 48 hours. Anything else is shortchanging the student. They usually cost the same or more than quality education programs. This is because profit is the first priority. A good school balances the desire to make a fair profit with the desire for an excellent reputation in the industry, gained by helping students. They try to enroll you without making sure it is a good career fit for you. A good school will enroll students that it feels are apt to be successful. If a prospective student says she dislikes working on the computer all day, it s obvious that she will not enjoy coding or billing. When you talk to potential schools, be sure you (and not just your tuition money) are important to them. New graduates with subpar training may miss out on job opportunities because they can t pass an employer s test, or because they simply do not have the skills to perform the job. Their money has been spent, and they are often left high and dry, without any support. A scaled down education doesn t generally offer monetary savings subpar schools often charge nearly the same as the really good schools and may end up costing you more in lost opportunities. If you scale down your education, you are also scaling down your potential success in the industry. Curriculum Aimed at Success A comprehensive and advanced curriculum is necessary to your success as a new medical coder/biller. Regardless of what anyone tells you, medical coding is not easy to learn. It takes a lot of practice to build your skill set to an employable level. A comprehensive program includes, at least: Professionally written textbooks by credible sources. Access to a qualified and certified instructor. A good instructor will answer questions within 24 hours and grade exams within 48 hours throughout your training. ADDED EDGE December

38 Distance Learning ADDED EDGE Your future success starts with choosing a program that is advanced in nature, that has many hours of practice, and that offers career guidance. A minimum of 800-1,000 hours of coursework to give the student enough knowledge and practice to excel in the workplace. ICD-10-CM training in addition to CPT and HCPCS Level II. Medical coders and billers use all three codes sets and must understand them, thoroughly. Comprehensive foundational training in medical terminology, anatomy, physiology, and in the anatomy and terminology of each medical specialty. If a student does not have this detailed training, there is no way he or she will pass the AAPC s Certified Professional Coder (CPC ) examination. Plenty of hands-on practice, rather than just reading a computer screen and taking online quizzes. There should be textbooks and coding/billing scenarios with which to practice. Excellent post-graduate support to assist students with resumes and guide them on where and how to land a job. Good schools teach and encourage members to join the industry s professional association, AAPC. They also encourage students to test for AAPC s CPC(R) credential after graduation, and provide guidance and assitance. They provide externships so students get hands on experience in the industry and to remove apprentice status from their credentials. Similarly, new medical billers should obtain AAPC s Certified Professional Biller (CPB ) credential to prove expertise in medical billing. Certification and AAPC membership promotes professionalism, documents proven skills to an employer, and allows the new graduate to shine above others who are not certified. In the job market, new graduates are competing against older, more experienced coders and billers; new medical coders and billers must possess a stellar skill set to compete. They must score well on employment tests and interviews. They must have comprehensive knowledge of all medical specialties, terminology, and anatomy to earn AAPC s Certified Professional Coder - Apprentice (CPC-A ) entry-level status. Having this credential assists new coders in getting his or her foot in the door, and opens up industry networking opportunities. Face the Truth and Shop Around Your future success starts with choosing a program that is advanced in nature, has many hours of practice, and offers career guidance. Here s a list of questions you should ask any school before you enroll: Can I contact my instructor by phone and ? Is there a time frame in which he or she is supposed to respond? What textbooks do you use? Do you discuss the software used for medical coding/billing in the industry? Are your materials proprietary, or do you use professionally written and widely accepted textbooks in your program? How many credit or course hours is your program? Do you assist with my resume and give me guidance on how to land my first job? May I speak to one or two graduates of your program? How long have you been in business? Are you a member of the Better Business Bureau (BBB)? (Check the BBB website to see if there are multiple complaints against the school.) How much hands-on practice do I get in your program? Are there any other possible fees I may incur after enrolling? (Hidden fees are common among subpar schools.) When you talk to potential schools, be sure you (and not just your tuition money) are important to them. Are they asking the right questions to determine whether you are a good fit for medical cod- 38 Healthcare Business Monthly

39 Distance Learning ing/billing? Are they trying to rush you off the phone after five minutes, or trying to get you to sign an enrollment agreement before you feel comfortable? Medical coding/billing is a great career choice being part of the medical field can be interesting, rewarding, and financially lucrative but becoming a medical coder or biller is not easy. The training time usually takes six months, or more (although a very motivated student working through a course full-time can finish faster). Finishing quickly is not the priority. Learning the material of an advanced, detailed, in-depth curriculum is your goal. ADDED EDGE Dawn Moreno, PhD, CPC, CBCS, CMAA, MTC, CPL, CLT, is the admissions manager of Medical-Technical-Administrative Career Center (MTACC) and has worked in the online adult education industry as a content writer, instructor, and director in medical coding, medical billing, medical office management, and medical transcription. She has written for national industry publications such as Healthcare Business Monthly, NCRAs Journal of Court Reporting, BC Advantage magazine, and industry blogs and publications. Moreno s passion is in helping adults learn new career skills to change their lives for the better, and her motto is that one is never too old to learn something new. She is a member of the Albuquerque, N.M., local chapter. Our coding courses with AAPC 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) The Where s and When s of ICD-10 HealthcareBusinessOffice LLC: Toll free info@healthcarebusinessoffice.com Web site: 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. HBO 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 our website for our newest course, The Where s and When s of ICD-10! Continuing education. Any time. Any place. December

40 CODING/BILLING By Colleen Gianatasio, CPC, CPC-P, CPMA, CPC-I Make the Most of HCCs Part 1: Bolster documentation for commonly under-coded conditions. Accuracy and specificity in diagnosis coding and medical documentation are critical in risk adjustment payment models. Over the next few months, we ll look at several commonly under-coded conditions in the Medicare hierarchical condition category (HCC) model diagnosis code categories and discuss strategies for improving documentation. COPD HCC 111 in Medicare 2014* CMS HCC Model Category The category of chronic obstructive pulmonary disease (COPD) includes many different respiratory conditions. The word chronic provides very important information in this category. If the provider is defaulting to an unspecified asthma or bronchitis code, the patient will not be considered in this measure. The documentation should specify the condition (e.g., chronic obstructive asthma, emphysema, or chronic obstructive bronchitis): for example, Chronic bronchitis with cough, patient advised to quit smoking. There are several pulmonary conditions associated with this HCC. In patients with pulmonary disease, it s also important to document and code, when present, hypoxemia and or acute/chronic respiratory failure. If your patient is oxygen dependent, the doctor must document the reason for the oxygen. You cannot assume the relationship. *HCC risk coding is retrospective. The 2014 model is the most recent one being used. CHF HCC 85 in Medicare 2014 CMS HCC Model Category Chronic heart failure (CHF) is one of multiple cardiovascular conditions associated with this HCC. Multiple codes specify heart failure by type and acuity. The HCC also includes cardiomyopathies and pulmonary hypertension, which should be specified by type. Remember: You cannot assign a diagnosis from findings on a chest X-ray, echocardiogram, electrocardiogram, etc. The provider must interpret and document his findings. 40 Healthcare Business Monthly Coding/Billing Auditing/Compliance Practice Management

41 To discuss this article or topic, go to HCCs Diabetes is one of the most frequently under-coded conditions in risk adjustment. image by istockphoto greenwatermelon Many patients with these conditions are stable on medication. In this case, it s very important for the provider to link the medication use to the disease it s used to treat (e.g., chronic diastolic CHF, stable on Lasix ). Angina Pectoris HCC 88 in Medicare 2014 CMS HCC Model Category Chest pain and angina are not interchangeable for coding. Chest pain is not a risk adjusted diagnosis because chest pain can be caused by many non-cardiac conditions. The provider should specify the type of angina, when known. Angina that is controlled on medication should be documented and coded (e.g., Angina stable on Isordil ). Diabetes with Complications HCC 18 in Medicare 2014 CMS HCC Model Category Diabetes is one of the most frequently under-coded conditions in risk adjustment. Many providers default to diabetes without complications due to habit or because of how their electronic health record is set up. Correct coding requires the type and method of control to be documented. The provider needs to establish a direct correlation when a patient with diabetes has a complication or manifestation. Documenting statements such as due to, caused by, or secondary to are sufficient to make the link between the diabetes and the documented complication (e.g., stage IV chronic kidney disease due to diabetes - GFR 20; considering dialysis ). The Big Picture These are just a few of the categories in the Medicare HCC model. There is great opportunity for outpatient coders to have a very positive affect in their practice, as well as in our industry. Focusing on a few, simple documentation improvement strategies at a time will help to illustrate patients true severity of illness. Correctly documenting and coding diagnoses will ensure better patient care, as patients are more easily identified for care management by Medicare and other health plans. This data ultimately serves to provide the industry with financial forecasting and planning, which drives the cost of care. Colleen Gianatasio, CPC, CPC-P, CPMA, CPC-I, is a risk coding and education specialist for Capital District Physician s Health Plan. She enjoys teaching PMCC, auditing, and ICD-10 classes. Gianatasio is president of the Albany, N.Y., local chapter and a member of the National Advisory Board. Risk-adjusted Payment: What s at Stake? As healthcare moves from fee-for-service to focusing on risk adjustment, you must pay close attention to providers documentation. In a risk-adjusted payment model, the more severe or complex a diagnosis, the higher the risk value assigned to it. A risk adjustment value is assigned to each diagnosis code that falls into the payment model. Codes are then grouped into a hierarchical condition category (HCC). Hospital and physician claims are the main sources of data that drive the risk adjustment model. Providers in the outpatient setting have been paid on a fee-for-service model for so long, many neglect their diagnosis code documentation and reporting. If medical documentation lacks the accuracy and specificity needed to assign the most appropriate diagnosis code, providers face the possibility of reduced payment in a performance-based payment model. CODING/BILLING December

42 AUDITING/COMPLIANCE By Jonnie Massey, CPC, CPC-P, CPC-I, CPMA, AHFI image by istockphoto duckycards Nobody Is Immune to Medical Identity Theft Take steps to protect your practice and its patients from being victimized. 42 Healthcare Business Monthly Many forms of identity theft may stem from a medical record breach. Thieves may use someone else s identity to seek medical care, open new utility accounts, receive credit cards, conduct online transactions, apply for home loans, buy cars, get a job, commit crimes, or file for fraudulent government benefits. Medical records contain a plethora of information all in one place. This is a jackpot for thieves. Medical identity theft poses a risk even greater than financial breaches. Consider someone claiming to be you and seeking medical care. Perhaps he or she has a serious medical condition that you do not have. Now this condition is on your permanent record. What if the thief is a drug addict, has a terminal illness, or a different blood type? Now, the thief s medical profile is part of yours. Often, thieves will visit emergency rooms and leave the balance of the medical bill to the real person to pay. Unpaid bills go to collection agencies and affect credit ratings. The provider, also a victim, is left with unpaid services. The Devastation of Medical Identity Theft Consider the true case of the drug-addicted, pregnant woman who delivered a baby using a stolen health insurance card. The baby was born addicted to drugs and with other serious health concerns. The mother abandoned the baby the next day. The real insurance cardholder was visited by authorities and had her children taken into protective custody. She was a suburban housewife with no history of drug use. Fortunately, she was able to get her kids back later the same day, but she had to prove she had not delivered a drug-addicted baby the day before. Coding/Billing Auditing/Compliance Practice Management

43 Identity Theft Consumers expect healthcare providers to be proactive in preventing and detecting medical identity theft. In another case, a college student signed up to donate blood, but was told she could not donate because she was HIV positive. It was many years and thousands of dollars later before she was able to correct her medical record and reclaim her identity. The ramifications of a medical identity theft don t end there. A false medical profile can be devastating emotionally and financially: Victims may be denied life insurance, fired from their job, or even receive death threats. Medical Devices Other medical identity theft risks include medical alert devices, implanted defibrillators, continuous positive airway pressure machines, and insulin pumps. These devices connect to networks. Sophisticated hackers can intercept the data and access these devices and the personal information associated with them. If a device has a signal that can be hacked, the user is at risk. Consumers can contact the device manufacturer to determine how the data is protected and how the company responds to data breaches. Takeaways Consumers expect healthcare providers to be proactive in preventing and detecting medical identity theft. According to a recent Poneman study, 48 percent of respondents surveyed said they would consider changing healthcare providers if their medical records were lost or stolen. If a breach occurs, 40 percent expect prompt notification to come from the responsible organization. Everyone who touches a medical record must be hyper vigilant. The U.S. Federal Trade Commission s Red Flags Rule requires businesses and organizations to develop and implement procedures to detect suspicious activities or patterns of behavior that suggest identity theft. Some of the measures are as simple as asking for photo identification. Providers should ask for photo ID (government issued is preferred) and maintain a photo in the chart. Patients should protect their information, including their health insurance ID card. Identity Theft: A Serious Problem According to the Ponemon Institute, 2.3 million Americans were victims of medical identity theft in Victims will tell you, medical identity theft is one of the most expensive and time-consuming types of identity theft to resolve. Protected health information (PHI) breaches affect not just patients, but also providers and health plans. In 2010, Ponemon Institute conducted a survey that concluded the average cost incurred to resolve a medical data breach is more than $20,000, or $211 per record. More than 50 percent of victims are not aware their identity has been stolen for a year, or more. Victims may become aware of a breach when they are turned down for credit. Often, collection agency letters and phone calls are the first indication identity has been stolen or breached. Medical identity theft victims might also suffer embarrassment from disclosure of sensitive personal health conditions. File a complaint with the FTC at or by phone at ID-THEFT ( ); TTY: ; and see info at File a report with local police, and send copies of the report to their health plan s investigations or privacy department, their healthcare provider(s), and the three nationwide credit reporting companies: Equifax, Experian, and TransUnion. Information on how to file a police report and reach the credit reporting companies is at Look for signs of other misuses of personal information by reviewing credit reports. The law requires each of three major nationwide credit-reporting companies to give people a free copy of their credit report each year if they ask for it, at or Inaccurate or fraudulent information can be reported at You can also learn how to get inaccurate information corrected or removed. Medical identity theft is serious business, and should be acted on immediately to help mitigate risk. Many employers and insurance companies offer credit protection and monitoring services. Some companies also offer medical identity fraud alert systems. Everyone should look at options and take necessary precautions. Sources: Ponemon Institute Research Report, Fifth Annual Study on Medical Identity Theft, February 2015: Experian, Combating the Rising Tide of Medical Identity Theft : AUDITING/COMPLIANCE Tips and Resources Victims can take advantage of their rights under the HIPAA Privacy Rule. To learn more about medical identity theft and how to protect yourself, check out these tips and resources: Jonnie Massey, CPC, CPC-P, CPC-I, CPMA, AHFI, is director of the Blue Shield of California, Special Investigations Unit. Her specialties include healthcare fraud investigation, prevention, and resolution. Massey has extensive experience in health insurance plans and management and trains on healthcare fraud, coding, and ICD-10. She is on AAPC s National Advisory Board, and also served from Massey is a member of the Sacramento, Calif., local chapter. December

44 AUDITING/COMPLIANCE By Joseph de Beauchamp, PhD Handling PHI Disclosure for Genealogists image by istockphoto johnwoodcock Awareness of your responsibility for protecting client and family medical information is essential. Heritage societies and genealogists often request access to personal health information (PHI) of patients and the deceased and are, therefore, subject to HIPAA privacy and security rules. To prevent a HIPAA compliance breach that could lead to possible jail time and a lofty fine, it s important to know what heritage society researchers and genealogists do, how they handle PHI, and your role in disclosure of information for their research. Experience Speaks Volumes When I was young, I was an idealist. I thought, What you don t know, won t hurt you. Now that I have grown up and have over 40 years of career experience under my belt, I know ignorance can indeed hurt you. It s no excuse in the eyes of the law, and you can go 44 Healthcare Business Monthly to jail for it. When you understand the ramifications of the HIPAA security and privacy rules and PHI breaches, you can avoid breaches and the consequences that come with them. Ensure Clients Identity and Intentions The first critical point of engagement should be for the researcher to identify the client and his or her intentions. Proper client identification is important because certain documents might be discovered to which the purposed client is not entitled, such as in the case of heritage or estate matters. Heritage societies use a notary to detect false identification. Notaries are critical in the discovery process for heritage matters because they are licensed to investigate the identities and to check for false Coding/Billing Auditing/Compliance Practice Management

45 PHI Disclosure identification proofs, such as government photo identification and Social Security cards. The use of a false Social Security card, birth certificate, or drivers licenses is punishable up to 15 years in jail, with no statute of limitations. (Justice, August 30, 2012) A genealogist or historian must identify the applicant or client before engagement; not knowing your applicant or client is not a legitimate excuse that will keep you out of jail if a HIPAA breach occurs. Not properly checking the identification of the person can lead to her or him fraudulently obtaining health records and other financial information. There are cases where people are serving 45 years in jail, and have received fines as much as $158 million for such offenses. How Medical Records for Research Affect You When a heritage society is asked to obtain records for a person, it might include health records such as birth certificates, death certificates, and even DNA results. These records fall under HIPAA, and should never be copied, scanned, or sent over the Internet via . Genealogists also should never hold these records in their care because the risk is too high. Violations of healthcare records carry penalties of 20 years imprisonment and million dollar fines. (American Medical Association, February 17, 2009) If you mail medical record documents to a heritage society, you must be clear in your disclosures that these places of business are beyond your control. If you don t know what a genealogist or heritage society is doing with the documents, make sure this is disclosed to the client. The information discovered may affect estate or title of property documents. They might also assist in property settlements with divorce or annulment. To leverage risk, make sure: The client is entitled to see the documents. Disclose in all cases to every client what and how you will retain the files. You have permission for sending or copying documents. You know where you are sending documents. Over 83 percent of medical facilities and financial institutions holding files of persons are breached. You know to whom you are sending documents and what they are doing with those documents. You bear the full responsibility of the law for sending and storage of information belonging to the client. You safeguard this information for five years. The Office of When a heritage society is asked to obtain records for a person, it might include health records such as birth certificates, death certificates, and even DNA results. Inspector General and the Department of Justice have the right to check your safeguards at any time during this period. Occupational Safety and Health Administration also has the right to investigate and arrest you for any reason stated or not stated at any time. Remember Who You Are You are a member of a professional organization, and know what your code of ethics dictates you to do. If you volunteer for a nonprofit organization, such as a heritage group or first response organization, never avoid the duties and responsibilities of protecting client information. Recently there has been a wave of interest in DNA tracking and publishing of this information; avoid retaining and accepting this information. When handling PHI, please advise your clients to carefully review the disclosures with their attorneys before they undergo any DNA testing. You have a responsibility to your clients/patients to make them aware of the possible consequences. If you send any documents, disclose this to your client, even if you are volunteering without pay. Helping people to discover their roots is very rewarding, but it comes with much responsibility. Pay attention to those around you and their intentions. Knowing the heritage society, genealogist, and customer, and what you can legally do to help them, is a critical part of your responsibility. What you don t know can hurt you. Resources American Medical Association, HIPAA Violations and Enforcement, AMA and 42 USC 132o-5, 1-3; February 17, Dictionary, B. L., Ignorantia juris non excusat, St. Paul: Black s Law Dictionary, Justice, 9. C.-A, False Identification, 18 USC 1028 (a) (7), Department of Justice, August 30, 2012). AMA, HIPAA Violations and Enforcement, 42 USC , 1-3; February 17, Justice, O., Office of Public Affairs; Harris County, Texas: Justice News, September 15, George J. Annas, J. M., The New England Journal of Medicine, HIPAA Regulations - A New Era of Medical Records Privacy? 5120 et, seq., April 10, Joseph de Beauchamp, PhD, carries Doctorates of Philosophy in Theology, Finance, and Psychology. He runs a Medical Level I secured facility enforced under HIPAA, works as a recovery agent for government payers, and serves hospice patients in heritage and genealogical societies as both a chaplain and advisor. He has helped over 70,000 families and patients in a career spanning over 40 years. De Beauchamp is a member of the Las Vegas, Nev., local chapter. AUDITING/COMPLIANCE December

46 Healthicity Smart Design. Intelligent Auditing. We streamlined the way you manage audits by merging audit workflow, management, and reporting capabilities into one easy-to-use, web-based solution. HEALTHICITY.COM/AUDITING 46 Healthcare Business Monthly

47 By Bridget Toomey, CPC, CPB, CRCR, RYT-200 PRACTICE MANAGEMENT Photo by Stephanie Knutson Photography. Stay healthy at your desk by using postures that stimulate immunity. As the winter months begin, so does the cold and flu season. When a staff member is sick, the germs spread quickly and before you know it the absence list is a mile long. We can all take precautions to help stay healthy this winter. Being bound to a desk or office space is no longer an excuse not to move your body throughout the day. Here are some office yoga postures that specifically work to boost your immune system. Coding/Billing Auditing/Compliance Practice Management December

48 Office Wellness PRACTICE MANAGEMENT Photos by Stephanie Knutson Photography. Back Posture: Sit comfortably at the front of the chair. Keep your feet flat on the floor, about hip distance apart. Technique: Place your hands on your thighs. Inhale, expand the chest forward, driving the rib cage out and up by pushing back the shoulders. Exhale, bring the shoulders in front and retract the chest in. Keep the chin level with the floor during all movements. Continue for 10 repetitions. Benefits: Helps to break up knots in the shoulder blades. Encourages blood flow to the upper torso. Arms Posture: Sit comfortably with a straight spine, either at the front of the chair or all the way to the back. Keep your feet flat on the floor, about hip distance apart. Technique: Bring your hands to chest level, interlock your fingers, and turn your palms outward. Inhale, stretch both arms forward. Exhale, raise both arms over your head with the palms up towards the ceiling. Inhale, bring the arms back down out in front of the body with the palms out. Exhale, bring the hands back to the center of the chest. Repeat 10 times. Benefits: Improves blood circulation in the arms. Expands lung capacity. Being bound to a desk or office space is no longer an excuse not to move your body throughout the day. 48 Healthcare Business Monthly

49 To discuss this article or topic, go to Office Wellness Chest Posture: Sit comfortably with a straight spine, either at the front of the chair or all the way to the back. Keep your feet flat on the floor, about hip distance apart. Technique: Grip the fingertips of both hands together and bring them to chest level with the forearms parallel to the ground. Inhale. Suspend the breath and, without separating the hands, try and pull the hands apart. Exhale. Inhale and pull again. Repeat 10 times. Benefits: Opens up the heart center and chest. Stimulates the thymus gland. PRACTICE MANAGEMENT Shoulders Posture: Sit comfortably with a straight spine, either at the front of the chair or all the way to the back. Keep your feet flat on the floor, about hip distance apart. Technique: Interlock the fingers and bring the arms up over the head. Bend the head, arms, and torso to the left, stretching the right side of the body. Hold this posture with long deep breathing for 10 seconds. Then bend the head, arms, and torso to the right and feel the stretch on the left side of the body. Hold with long deep breathing for 10 seconds. Repeat 10 times. Benefits: Opens up the lungs and enhances breathing. Helps to circulate clean air throughout the body, keeping the body energized. References: Akhar, Shameem. Yoga in the Workplace, Chenni: Westland Ltd, Bhajan, Yogi. The Aquarian Teacher, Santa Cruz: The Teachings of Yogi Bhajan, Thakur, Bharat. Desktop Yoga, New Delhi: Wisdom Tree, Bridget Toomey, CPC, CPB, CRCR, RYT-200, teaches Kundalini yoga at Heartland Yoga in Iowa City, Iowa. She is certified by the Kundalini Research Institute as a Kundalini yoga teacher and is a member of the International Kundalini Yoga Teachers Association. Toomey works for the University of Iowa Hospitals and Clinics in Patient Financial Services as a revenue cycle coordinator, where she supervises staff on the physician Iowa Medicaid team. She is a member of the Iowa City, Iowa, local chapter. December

50 PRACTICE MANAGEMENT By Renee Dustman THE MEDICAL SCRIBE: A Hot Commodity image by istockphoto shironosov They streamline the documentation process so physicians can concentrate on healing patients. HIPAA regulations, ICD-10 documentation requirements, electronic health records (EHRs), and quality initiatives, among other things, have put a lot of demands on physicians time. To regain focus on healing people, many physicians and hospitals are hiring medical scribes to delegate administrative tasks. The Role of the Medical Scribe For centuries, scribes have been documenting important events for recordkeeping. It s been a natural progression for scribes to enter the healthcare industry. Their usefulness for capturing accurate and detailed documentation (handwritten, electronic, or otherwise) of the physician/patient encounter is undeniable. Although there are no prevailing federal regulations concerning the use of scribes in the healthcare setting, there are plenty of opinions for what a scribe may do. The Joint Commission takes the stand that a scribe does not and may not act independently but can document the physician s or practitioner s dictation and/or activities. The healthcare certifying organization goes further to say that scribes may assist practitioners in navigating EHRs and in locating information such as test results and lab results. Medicare administrative contractors (MACs) also may have something to say on the matter. Cahaba GBA, for example, published guidance in the form of a local coverage article (A52695), in which 50 Healthcare Business Monthly Coding/Billing Practice Management Auditing/Compliance

51 Scribes A scribe s responsibilities are ultimately controlled by the regulatory requirements and policies established by the provider, and the level of risk an employer is willing to accept. it reiterates The Joint Commission s opinion and adds, The physician who receives the payment for the services is expected to be the person delivering the services and creating the record, which is simply scribed by another person. The Jurisdiction J MAC further states that when a scribe independently records the past, family and social history and the review of systems (ROS) for an evaluation and management (E/M) service in as far as the scribe is simply documenting the physician s words and activities during the visit the physician may count that work toward the final level of service billed. Examples of information entered by a scribe into the EHR or chart may include: History of the patient s present illness ROS and physical examination Vital signs and lab values Results of imaging studies Progress notes Continued care plan and medication lists Scribes are generally not credentialed medical personnel and, therefore, rarely qualify to enter computerized physician order entry (CPOE) in the EHR to meet meaningful use requirements. The Centers for Medicare & Medicaid Services (CMS) realizes there are exceptions: If a staff member of the eligible provider is appropriately credentialed and performs similar assistive services as a medical assistant but carries a more specific title due to either specialization of their duties or to the specialty of the medical professional they assist, he or she can use the CPOE function of CEHRT [certified EHR technology] and have it count towards the measure. This determination must be made by the eligible provider based on individual workflow and the duties performed by the staff member in question. A scribe might also be responsible for expediting patient flow through surgery under direction of the medical doctor or other qualified healthcare provider, and facilitating patient flow by assisting the provider in navigating through electronic documentation including entering orders, reviewing lab/test results, post-op notes, medication reconciliation, and discharge summaries. A scribe s responsibilities are ultimately controlled by the regulatory requirements and policies established by the provider, and the level of risk an employer is willing to accept. Legal Ramifications As with any employee or contractor who has access to patient records, a scribe must abide by HIPAA and HITECH regulations. Compliance with the Record of Care and Provision of Care standards also apply. It is important to be certain that the scribe s services are used and documented appropriately, and that the documentation is present in the medical record to support that the physician actually performed the service. For example: The scribe must sign (name and title), date, and time stamp all entries into the medical record electronic or manual. The role and signature of the scribe must be clearly identifiable and distinguishable from that of the physician or licensed independent practitioner or other staff. The scribe cannot enter the date and time for the physician or practitioner. Although allowed in other situations, a physician or practitioner signature stamp is not permitted for use in the authentication of scribed entries; the physician or practitioner must actually sign or authenticate through the clinical information system, and do so before the physician or practitioner and scribe leave the patient care area. The provider s note should indicate: Affirmation of the provider s presence during the time the encounter was recorded Verification that the provider reviewed the information Verification of information accuracy Any additional information needed Authentication, including date and time It s The Joint Commission s stand that scribes may not make independent decisions or translations while capturing or entering information into the health record beyond what is directed by the provider; nor does the agency support scribes entering orders for physicians or practitioners. As the use of scribes becomes more prevalent, the potential for expanded legal guidance and direction grows. Physicians using scribes PRACTICE MANAGEMENT December

52 Scribes To discuss this article or topic, go to PRACTICE MANAGEMENT must monitor federal and state regulatory changes to ensure their practices consistently meet compliance standards. Certified scribes will become in high demand, as their credentials will negate much of that liability. Becoming a Medical Scribe Working as a medical scribe requires more than just good penmanship and computer skills. A qualified, employable scribe comes equipped with a broad range of skills, such as: Knowledge of medical terminology and technical spelling Basic anatomy Familiarization with HIPAA Privacy and Security Rules Medico-legal risk mitigation An understanding of the essential elements of documenting a physician-patient encounter and E/M levels Knowledge of federal initiative requirements General knowledge of the roles and responsibilities of medical personnel and billing practices Strong interpersonal and communication skills You will also need at least a high school diploma and at least one year of experience in the healthcare field. As a scribe, you may find employment or contract work in various settings, including physician practices, hospitals, emergency departments, long-term care facilities, long-term acute care hospitals, public health clinics, and ambulatory surgery centers. Resources =426&ProgramId= Medical Scribes Improve Productivity ProScribe, a medical scribe employment service, collected and compared data from a five-hospital system over a three-year period to demonstrate the impact of scribe services on physician productivity, throughput metrics, and patient satisfaction. The results are impressive. ProScribe was also able to demonstrate a 20 percent increase in provider productivity after one year of scribe services. The five-hospital system saw an increase of 40,000 patients from year 1 to year 3. In ProScribe s case study, there were demonstrated improvements in door-to-provider times and door-to-discharge times, as well as a significant decrease in the number of patients who left without being seen. Source: image by istockphoto mkurtbas Renee Dustman is an executive editor at AAPC. 52 Healthcare Business Monthly

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54 PRACTICE MANAGEMENT By Ellen M. Wood, CPC, CMPE Onboarding Employees in a Small Office Invest in new employees and focus on the benefits small practices offer. image by istockphoto DMEPhotography Bringing new employees up to speed requires a significant investment, which may be especially challenging in smaller offices lacking a formal training program or other dedicated resources. For practice managers in small and growing offices (two to 10 practitioners), there are several ways to ease the process. First, Find a Match Successfully integrating a new employee into your office depends on finding the right person for the job. When writing a help wanted ad and when conducting interviews name the exact qualities you are seeking in an employee and the requirements of the job. Rather than saying, must be motivated and willing to multi-task, list the typical duties the job entails, and stress the specific skills an applicant must have. For example, important qualities for front desk staff are the ability to stay positive even if a patient is being unpleasant, and not to take patients negative comments personally. The interview process lasts a long time, and involves several steps. When resources are tight, you can t afford to hire the wrong person. During an initial interview, try to gauge the individual s level of professionalism and seriousness about the job. You may want to test the applicant s skill or knowledge. When interviewing someone for a coding/billing position, for example, you might ask the applicant how he or she would handle a few real-life scenarios you ve had in your office (such as complaints about a wrong billing code). If you are impressed with a candidate after an initial interview, invite the person back to spend an hour observing the job he or she would be doing (have the individual sign a confidentiality agreement first). Do this on a busy day, so he or she can see what is expect- 54 Healthcare Business Monthly Coding/Billing Practice Management Auditing/Compliance

55 Onboarding ed. Some candidates may find they are not interested after they see what really goes on. The smaller an office, the more everyone must work together and contribute to a positive environment. You may want to bring your top two or three candidates back for a group interview with existing staff. This gives staff a stake in the future employee s success, and allows them to share the credit for new hires. Review staff questions for the candidate ahead of time to be sure they are appropriate. Quality healthcare is a mission, not a job, and it takes a certain kind of person to work in our industry. Throughout the interview process, consider how an applicant s personality will help (or hinder) his or her success. Employees must be resilient and even-tempered. The busy, messy, day-to-day realities of a healthcare office may disappoint idealists or the faint of heart. For example, general surgeons deal with life and death daily. They often treat trauma victims in the hospital, and occasionally must be the bearers of bad news. Patients are likely to be physically stressed and generally worried. Emotions run high and frustrations build. Even the nicest people can snap when things aren t going well. In addition to professional competence, healthcare workers must have thick skin, humility, and patience. Training Tips to Boost Competency When training new employees, get creative. For example, HIPAA and Occupational Safety & Health Administration (OSHA) training videos (often with accompanying exams to test employee comprehension) are widely available simply by searching online. Check with your professional colleagues (for example, at your next AAPC chapter meeting) and ask if they have effective resources they d recommend or share. You might also look to your vendors to provide low- or no-cost training. For instance, the service that collects used sharps must offer OSHA training to its employees. As part of your contract with the company, ask that they share training materials (such as binders or an instructional DVD) with your staff. If your internal systems include a training component, take advantage of them. For example, some electronic health records (EHRs) include webinars to teach employees how to use the system. Have employees view the webinars throughout their initial 90 days, and beyond, so they learn to become efficient in the system with less trial and error. For each position, ask an experienced employee to make a check-off list of daily, weekly, and monthly responsibilities. The new-hire can The smaller an office, the more everyone must work together and contribute to a positive environment. check off items on the list as he or she is trained on each area. The list can also double as a reminder of regular tasks to be completed. You may want to ask experienced employees to create a three-ring binder for each position that describes what needs to be done and how to do it. For example, a binder might include instructions on how to order scans for each payer. Keep Tabs, Get Feedback, and Improve Assessments are useful to provide feedback to employees, but also to ask for feedback. Conduct 90-day self-assessments of your newhires to help answer these questions: What tasks are you most comfortable doing? In what areas are you least comfortable? What parts of your job do you like and not like? How can the practice help to make your job easier? Never punish an employee for his or her opinion; use the responses as feedback to improve the overall practice. For example, a fresh set of eyes may recognize a more efficient way to complete a task, or may notice a weakness in training. One of the main advantages of a smaller practice is that you can adopt new processes fairly quickly, with a minimum of red tape. Self-assessments also help pinpoint and curtail employee problems before they escalate. You are better off hearing about and responding to a complaint before a disgruntled employee poisons the well and turns other employees negative. For example, an employee who is unhappy with your earned time off policy may be willing to talk through the issue, so he or she no longer needs to complain to other employees. Above all, at every step along the way, it s important to have transparency and to clearly define employee expectations. This contributes to everyone s peace of mind and satisfaction, which will improve employee morale. Ellen Wood, CPC, CMPE, has worked in the medical field for over 20 years and has been a certified coder for over 13 years. She is the practice manager for Seacoast General Surgery and an adjunct professor at a local community college. Wood s experience includes employee mentoring and oversight of meaningful use policies and objectives, PQRS, and eprescribing programs. She helped to start the first New Hampshire local chapter, Seacoast-Dover, and served on its board. PRACTICE MANAGEMENT December

56 MEMBER FEATURE By Michelle A. Dick MILITARY MEMBERS Trained for Success You may remember military slogans such as Be all you can be, (Army), It s not just a job; it s an adventure, (Navy), Aim high (Air Force), and The few, the proud, the Marines. They were concise, tough slogans that prompted pride and excitement for our country. Although powerful slogans, they don t capture the true emotion of serving in the military and the discipline, unbreakable bonds, and life-long friendships soldiers experience. Our military personnel are a rare and beautiful breed that only a service member can truly understand, and we are honored to have them as AAPC members. The training and experience the military creates produces excellence in the workplace and in life. Let s meet just a handful of AAPC s military members: Caren J. Swartz, CPC-I, CPMA, COC, CRC, CPB - served ( active duty, active reservist). Rank: petty officer 3rd class, Sub base Groton, Connecticut; operating room technician (scrub) active reservist at Willow Gove, Pennsylvania, naval air station, then Bethesda Naval, Bethesda, Maryland; hospital Corps school in Great Lakes, Illinois, then operating room (OR) school in Portsmouth, Virginia. Rob J. Pachciarz, CPC, COC, CIRCC, CASCC - served from as a communications/computer systems operator at Eaker Air Force Base (AFB) in Blytheville, Arkansas. Jeanne Yoder, RHIA, CPC, CPC-I, CCS-P - 27 years as a hospital administrator. Rank: 2nd lieutenant through lieutenant colonel. She spent 17 years as a medical logistics officer at Hill Air Force Base, Utah; Kadena Air Base, Okinawa, Japan; Altus AFB, Oklahoma; Brooks AFB, Texas; Philadelphia at Defense Personal Support Center; medical records at Sheppard AFB, Texas; billing for TRI- CARE Management Activity in Falls Church, Virginia; and data analysis at Bolling AFB in Washington, D.C. Sherry Blackwell, CPC - served in the Air Force Reserves from , retired with the rank of Master Sergeant (E-7). She was deployed in countries such as Germany, Spain, Egypt, Italy, and Panama. She served active duty for two years in 2003, Baghdad, Iraq, and then was deployed to Ali Al Salem Air Base, Kuwait in 2006 and Her last deployment was in 2012 to Manas Transit Center in Bishkek, Kyrgyzstan. Michael D. Miscoe, JD, CPC, CASCC, CUC, CCPC, CPCO, CPMA - served from From , Pennsylvania Army National Guard, 1/103rd Armor Basic Non-Commis- We are honored to have the crème de la crème bettering our organization. Caren J. Swartz (left) Jeanne Yoder Michael D. Miscoe Rob J. Pachciarz Sherry Blackwell 56 Healthcare Business Monthly

57 Military Members MEMBER FEATURE image by istockphoto Niyazz December

58 Military Members MEMBER FEATURE The opportunities offered to me would have never been offered as a civilian. sioned Officers Course (Distinguished Graduate), rank: Specialist-4. From , United States Military Academy, West Point, New York, graduated with bachelor s degree in Electrical Engineering, rank: Cadet - Commissioned 2nd Lieutenant, Branch, Aviation. From , Fort Rucker, Alabama, Aviation Officer Basic Course (Distinguished Graduate), Air Assault School, Airborne School (Fort Benning, Georgia), Rotary Wing Aviator Course (Distinguished Graduate), Attack Helicopter Qualification Course, rank: 1st Lieutenant. From , 5/9 Air Cavalry, 25th Infantry Division, Schofield Barracks, Hawaii. Current status: service disabled veteran. Why Did They Choose Medical Coding? Swartz s military OR experience led her to coding; she became increasingly interested in the billing/practice management side of medicine. She said, It was important to me to learn what drove payment and why, since this was not something that was ever spoken about on active duty. The more Swartz learned, the more she wanted to educate herself to ensure the best pay for physicians. I needed to educate them based on payer policy as well as coding rules, she said. Blackwell started her coding career while working in the business office of a county hospital as a cashier. She said, My interest was sparked from working side by side with the ER coders and listening to them discuss cases when extracting codes. Blackwell applied for and accepted a Department of Radiology coding position. She has been a coder since 1985 and is supervisor of anesthesia and surgical services coding for Medical University of South Carolina Physicians. Miscoe went into coding as a result of developing a medical billing program. He said, Curiosity led me to study coding, documentation, and billing rules, and I noted how they varied from payer to payer. This led Miscoe to steady progression of consulting and shortly thereafter, working as a forensic coding expert, and then to health law and law school. Now he is AAPC s National Advisory Board president-elect, Legal Advisory Board member, and Ethics Committee chair, a compliance and health law expert, and legal consultant. Spreading Smiles During War Sherry Blackwell, CPC, served 33 years in the Air Force Reserves and retired with the rank of Master Sergeant. During her service she enjoyed her deployments the most. She traveled to many countries such as Germany, Spain, Egypt, Italy, and Panama. After 911, she was called to active duty in 2003 for 2 years, and was deployed to Baghdad, Iraq. Blackwell s greatest joy during this time was trying to bring smiles to war zones. She recalls the experience: While deployed I worked in a support function in which we worked with the troops that were in-transit to Afghanistan, Iraq, and other countries within the Theater of Operations. Our job was to make sure the arrival to their deployment destination was as smooth as possible. This was a difficult job because most of the time I was looking into the eyes of a scared 19-year-old who was heading into a war zone, not knowing what to expect. If I could make them smile by greeting them with a smile, a pre-paid card to call home, or even a candy bar and soda, I felt like I had made his or her day a little better. That is what made me love my job! Yoder became a coder because she had a degree in biology and needed a job. She said, A member of the northern Illinois fencing club, where I fenced, recommended I get into the Medical Record Administration program at the University of Illinois Medical Center. She did, and the rest is coding history. Pachciarz chose coding simply to be of better service to the physician practices [he] served by helping them with denials and other coding needs. Applying Military Skills to Coding Work Yoder has applied to her coding career what she learned in the U.S. Air Force as a medical logistics officer, TRICARE management, and a data analyst. She said to run a practice well, you need good data that tells you who your patients are, the conditions they have, the level of health they want, and how much they are willing to do to have that level of health. You also need to know what can be done to help them, what you actually provide, and the resources involved. Yoder says coding tells the story, which she learned throughout her coding career. Standard code sets (e.g., ICD, CPT /HCPCS Level II, NDC) need to be maintained. 58 Healthcare Business Monthly

59 Military Members Why Did You Join the Military? Some of our military members served to follow in family member s footsteps. For others, it was American pride and giving themselves to our country. Here is why these members served this great nation: I always wanted to do something that contributed to society, and I felt there was no better way than defending the country I loved. - Sherry Blackwell, CPC I actually never thought about not joining the military. Everyone in my family served. - Michael D. Miscoe, JD, CPC, CASCC, CUC, CCPC, CPCO, CPMA My father served as an MP in the Air Force, my brother a crew chief in the Marine Corps. I knew I would get excellent training and really wanted to serve my country in some way. - Caren J. Swartz, CPC-I, CPMA, COC, CRC, CPB I love my country and many in my family served, as well. - Rob J. Pachciarz, CPC, COC, CIRCC, CASCC After backpacking around Europe during college, and seeing a variety of governments in action, I decided that although there may be problems in the USA, it was the best country around. - Jeanne Yoder, RHIA, CPC, CPC-I, CCS-P I ve found that corrupting a code set to collect something for which it was not intended is usually a mistake, she said. Code sets need to be easily collectable, well defined, and worth more than the resources to collect. Miscoe said skills he brought from the military to his current work include leadership fundamentals, problem-solving skills, confrontational tolerance, and knowledge that with effort, I can succeed at any task. Pachciarz said what he carried to his coding career from his military experience is a discipline to get where I need to be on time; respect for a chain of command; importance of functioning as a team; and attention to detail. Blackwell agrees with Pachciarz about discipline being a skill she brings to her career. She also brings a deep respect for her fellow airmen that she said has been a great attribute in her civilian career. As for Swartz, everything she does today stems from her military training. She said, All the anatomy and terminology in every note I was happy to pay back some small part of what this country provides. I read as a coder, I learned from this training. She constantly questioned the physicians, asked about disease, anatomy, and the procedures that took care of health issues, and she learned about different specialties and procedures. Swartz said, The opportunities offered to me would have never been offered as a civilian. Favorite Military Experiences Reflecting on his experiences, Pachciarz said that working and living alongside others with the same common goal of loving and protecting our great country was his favorite part of serving in the military. Swartz cherishes the life-long friendships she has made. She said, It s a feeling that people in the civilian community cannot appreciate bonds between people who have served. They understand what that truly means. Miscoe s fondest memories were of flying attack helicopters, and he loved the Cavalry mission. He said, Beyond that, my favorite part about serving was that it gave me the opportunity to earn the freedoms that I enjoy, as well as the incredible opportunities that this country provides to those willing to work and take advantage of them. Miscoe recognizes the incredible investment that the country made in his schooling and additional training. Service to our country provided a way to balance the ledger, he said. Yoder added to Miscoe s assessment of military favorites and concluded, I was happy to pay back some small part of what this country provides. Thank you for your service military members. AAPC honors and salutes you. Michelle A. Dick is executive editor at AAPC. MEMBER FEATURE December

60 NEWLY CREDENTIALED MEMBERS Magna Cum Laude Amande Lee, CPC-A Amruta Paranjape, CPC, CPMA, CEMC Anna Odor, CPC-A Ashley Generallo, CPC Barbara Michelle Bess, CPC Christine Vienneau, CPC, CIRCC Christine Yost, CASCC Dawn James, CPC Donna Malone, CPC, CRC Ellen Bryant, CPMA, CRC Isabella Demedici, CPC-A Jennifer Wood, CPC-A Julia Santiago, CPC, CRC Kathleen McKula, CPC, CPMA, CEMC Kelli Rain, CPC, CPMA Kelly Lauer, COC-A, CPC-A Kristen Driver, CPC Kristin Colbert, CPC-A Laura E Sheriff, CPC, CRC Madhura Malvankar, CPC-A Mahathi Chadalavada, CPC-A Marla S Miller, COC, CPC Mary C Grove, CPC, CIRCC Mary Peabody, CPC, CPMA Nicholas Massa, CPC Nicki Bress, CPC-A Nicole Clevenger, CPC-A Pam Wayman, CPC, CCC Prema Karthick, CPC-A Ryan John Roberts, CPC, CIRCC, CANPC Sarah Collinson, CPC, CPMA, CPCD Sean Su, CRC Smitha Rachel John, CPC-A Stacie Buck, CIRCC Steven Charles Dina, CPC Susan A Carbone, CPC, CPMA, CPC-I Tonya Morgan, CPC-A CPC Abitha Venkatesan, CPC-P Adina Lopez, CPC Aimee Kruger, CPC Akobundu Amuta, CPC Alice Anne Smith, CPC Alicia Arruda, CPC Alicia Evawn Robertson, CPC Alicia Roberts, CPC Allie Venhuizen, CPC Allison Colwell, COC Alma Morales, CPC Alvina Robinson, CPC Amanda Peryea, COC, CPC Amanda Ploeger, CPC Amey Johnson, CPC Amy Burg, CPC Amy Kalieta, CPC, CPC-P Amy Large, CPC Amy Tarr, CPC Andrea Lloyd, CPC Angel Hill, CPC Angel Romo-Rubalcaba, CPC Angela Flory, CPC Angela Tuck, CPC, CPPM Angela Ward, CPC Angelena Burks, CPC Anna Lorey, CPC-P Annabel Luna Ruiz, CPC Armishia Handberry, CPC Ashley A Titus, COC, CPC Ashley Sewald, CPC Audrey Lynne Schaffran, CPC Autumn Poland, CPC Barbara Redman, COC Bonnie Smith, CPC Brad Smedley, CPC Brenda Winkler, CPC Brenda Cox, CPC Brianne Stephens, CPC Bridget Haught, CPC Bridgot Peters, CPC Britanny Davila, CPC, CGSC Brittany Frye, COC, CPC Brittany Goldstein, CPC Bryce Jardine, CPC Candace Dos Santos, CPC Candace Mary Jordan, COC Cara Cross, CPC, CPMA Carol Bradley, CPC Carol Prince Penninger, COC, CPC Carolyn Bartholomew, CPC Caryn Kropf, CPC Catina Ann Tomlin, COC, CPC Cesarina Stagno, CPC Charity Robinson, CPC Chaunda Capers, CPC Cherilyn Phillips, CPC Cherita Turner, CPC Chindanee Mam, CPC Christa Hendricks, CPC Christi Timbs, CPC Christine Fisk, CPC Christine Page, COC, CPC Cindy Pennycuff, CPC Crystal A Torres, CPC Crystal Gardner, CPC Cynthia Cochran, CPC Cynthia Hogue, CPC Dana Brett, CPC Dana M Dunn, COC, CPC Dani Compston, COC Daniel Cormier, CPC Darcy Petersen, CPC Deborah Kracl, COC, CPC Debra Knight, COC, CPC De Lyne Willis, CPC Dena Childress, CPC Diana Brown, CPC Dianne Lolley, CPC-P Dolores Morris, CPC Donna M Gawel, COC Doris S. Salazar Sawyer, CPC Dynanna N Bryant, CPC Ebonie Griffin, CPC Elizabeth Thornton, CPC Faith Finley, CPC Falecia Randolph, CPC Felicia Gilliland, CPC Forrest Bleau, CPC Frances Benson, CPC Francisca Longoria, CPC Frunscean Chisholm- West, CPC G Gail Stephenson, CPC, CPC-P Giovanni Flores, CPC Girija Reddy, COC, CPC, CIRCC Greta Bach, CPC Gwendolyn Kay Miller, CPC Hafidh Shihabuddin, CPC Heather Crosby, CPC Heather Lamberg, CPC Heather Matthias, CPC Heather Sorenson, CPC Heidi Whitesides, CPC Holly Christiansen, CPC Inay Iriban, CPC Jackie Wabaunsee, CPC Jade Nichole Peterson, COC, CPC Jamie Ashby, CPC Jamie Reidhead, CPC Jan McReynolds, CPC Jane Gray, COC, CPC, CPC-P Jane M Rapes, CPC Janie Loftis, CPC Jean Marie Figlioti, COC, CPC Jenna Lee Rice, COC Jennifer Buzzelli, CPC Jennifer Hendrix, CPC Jennifer LaPiana, CPC Jennifer Latva, COC, CPC Jennifer Lynn Schneider-Lueken, CPC Jennifer Moeller, CPC Jennifer Nordlund, CPC Jennifer Stamey Hannah, CPC Jennifer Stamey Hannah, CPC Jeremy Cox, CPC Jeremy Cox, CPC Jessica Hurless, CPC Jill Jennings, COC, CPC Jill Jorgensen, CPC Joan Clyne, CPC, CRC Joanna Welch, CPC Jodi Johnson, CPC Joett Nicholson, CPC John Christopher Horst, CPC Jose Ramon Rodriguez, CPC Jose Raul Belen, CPC Joyce L Sole Reeves, CPC Julie Blanchfield, CPC, CPB Julie-Marie Ewell, CPC Kaitlyn Leavens, CPC Kalpita Masani, COC, CPC Kandis Chestnut, COC Kara Markle, COC Karen A Jones, CPC Karen C Kostecki, COC, CPC Karen Girard, CPC Karen McLaughlin, COC, CPC Karen Trammell, CPC Karen Wiedau, COC, CPC-P Karissa Shirts, CPC Katherine Comerford, CPC Kathleen Alvarez, CPC Kathleen Ann O Hara, COC, CPC Kathryn Crossman, CPC Kathy Kirkendall, CPC Katie Cosby, CPC Katie Troup, CPC Keila Orozco, CPC Kelli Anderson, CPC Kelli J Squire, CPC Kelli Timmons, CPC Kelly Marie Kuehn, COC, CPC Kelly McFadden, CPC Kelly Sullivan, CPC Kenrick Mui, COC, CPC Kerry Hooley, CPC Kevin Mansfield, CPC Kim Godwin, CPC Kim Norris, CPC Kirk Grantham, CPC, CPMA Kristen Hansmann, CPC Kristen Ohm, CPC Kristi Mathews, CPC, CGIC Kristie McDuffie, CPC Kristin Layne, CPC Kristyn Billings, CPC Ladina Jones, CPC Lakshmi Ramakrishnan, CPC Laureen Marie Conrad, CPC Leah Elise Matthew, CPC Leah Johnston, CPC Leann Lawson, CPC LeAnne Mace, COC Lena Nicole Clark, CPC Lenora Williams, CPC Leona Lutsch, CPC Lessa Kimbrell, CPC Linda Lester, COC, CPC Liri Sheshi, COC Lisa Mahlum, CPC Liudmyla Musiienko, CPC Lori A Overton, CPC Lori Guaraglia, CPC Lori Neyens, CPC Louise J Hayes, COC, CPC Lucretia Price, CPC Madea DeHaven, CPC Madelaine M Luces, CPC Margarite Scott, CPC Maria Dolores Casas, CPC Maria Grace Morabe, COC Maria Manolov, CPC Maria Robles, CPC Maribeth Durbin, CPC Marina Gonzalez, CPC Marjorie Bedsole, CPC Marlena Daughenbaugh, CPC Mary Alexander, CPC Mary Anderson, CPC Mary Brasfield, CPC-P Mary Cortez, CPC Mary Duke, CPC Mary Wackerle, CPC Marybeth K McCall, COC, CPC Maureen Frederick, CPC Maureen Landry, CPC Mayra A Tapia, CPC Megan Gilliam, COC Megan Pfingsten, CPC Melanie Etter, CPC Melanie Prosser, COC Melissa Clements, CPC Melissa Colombo, CPC Melissa James, CPC Melissa Roaten, COC Melissa Thompson, CPC Michele Dawn Christopher, CPC Michelle Lopez, CPC Michelle Mckay, CPC Michelle Newsome, CPC Monita Phillips, COC Mui Ngov, CPC Mykeela L Hackett, CPC Nancy Choi, CPC Nancy Garcia, CPC Nancy Louise Lucas, CPC Nannette Mayo, CPC Natalie Arnold, CPC Natasha D Barrett, CPC Nicole Calcanes, COC, CPC Nicole Frantz, CPC Nicole Moulden, CPC Nora Hunter, COC, CPC Pamela Lynn Graham, CPC Pamela Medina, CPC Pamela Schulman, CPC Pat Hance LPN, CPC Patricia Brayton-Winter, CPC Patricia Nichting, COC, CPC Patti Kelley, CPC Paula Giovanetti, CPC Phyllis Baker, CPC Phyllis Pratt, CPC Prasanna Mary, CPC Precy Lim, CPC Rachel Ann Cristobal, COC, CPC Ramona Lazenby, CPC Raul Reyes, CPC Rebecca K Nelson, CPC Rebecca Nieman, CPC Rebecca Rios, CPC Regina Taylor, CPC Renae Wilson, COC Reva Harris, CPC Rhonda G Crouch, CPC, CHONC Rhonda Rappe, CPC Roberta Burkhart, CPC Robin Griffin, COC Rohan Sasmal, CPC Ronna Foster, CPC Rose M Garcia, COC Rustie Elkins, CPC Ruth Anderson, CPC Ruth Hancock, CPC Sabrina McDowell, CPC, CPC-P Sabrina Smith, CPC Samantha D. Ulery, COC Sandi Miller, CPC Sandra R Talada, CPC Sandra Thompson, CPC Sandy Mclynch, CPC Sarah Burnham, CPC Sarah Lindahl, CPC Shannon M Schwartz, COC Shannon Ramirez, CPC Shannon Smith, CPC Shareef Sabree, COC, CPC Sharon Babin, CPC Sharon Britian, CPC Sharon Juguilon, CPC Shayla D. Gowers, CPC Sheetal Bhutani, CPC Sheila Ayers, CPC Sheila Cornwell, CPC Shellee Barbour, CPC Shelley Hutchinson, CPC Sherry Sroka, COC, CPC Shervonne L Walker, CPC Shoshana Espin, CPC Sommer Williams, CPC Sonia M Magliocchetti, COC, CPC, CPMA, CEMC Stacey Lynn Rudd, CPC Stacy Stasiewicz, CPC Stephanie Love Jones, COC, CPC Stephanie Michaelson, CPC Stephen Swisher, COC, CPC Sule Mohammed, COC, CPC Summer Burns, CPC Susan Beeman, CPC Sushma M S, CPC Suzzeatte Wisdom, CPC Tammy Comfort, CPC Tammy J Arlt, CPC Tammy Story, CPC Tara Megee, CPC Taylor Thompson, CPC Teresa Striley, CPC Terry Goodman, CPC Tetyana Shlyakhova, CPC Theresa Johnson, CPC Tina Grech, CPC Tina Reiter, CPC Tonya A Miller, CPC Tonya Vike, CPC Tracey Morehart, COC, CPC Traci Chrisman, CPC Tracie Van Wyngarden, CPC Tracy Fillies, CPC Trisha Mullins, CPC Tyna Miller, CPC Valerie Alvarado, CPC Vicki Vargas, CPC Victoria Basile, CPC Victoria Hubbard, COC, CPC Virginia Anderson, CPC Virginia Banatt, CPC Wayne Greenwood, CPC Wendy R Lawrence, CPC Wendy S Rowe, COC, CPC, CPMA 60 Healthcare Business Monthly

61 NEWLY CREDENTIALED MEMBERS Wendy Sowa-Maldarelli, CPC Wendy W Knight, CPC Whitney Loss, CPC Yasmin Mejia, CPC Yolonda Ray, CPC Apprentice A. Deepthi, CPC-A Aaron Collard, CPC-A Aarti Singh, CPC-A Abbey Morin, CPC-A Abdul Hafeez Salam, COC-A Abinaya Vidyashankar, CPC-A Africa Bulbula, CPC-A Agnieszka Piqueras, CPC-A Aileen Boucher, CPC-A Akash Chauda Gupta, COC-A Alayna Reagor, CPC-A Alejandra C Martinez, CPC-A Alejandra Troconis, CPC-A Alekhya Bollina, COC-A Alexander Pait, CPC-A Alexandra Fancher, CPC-A Alicia J Olmeda, CPC-A Alicia Aamoth, CPC-A Alicia Bellante, CPC-A Alicia Clardy, CPC-A Alicia Pride, CPC-A Alicia Ripa, COC-A, CPC-A Alison Hatt, CPC-A Alison Simmons, CPC-A Alissa Bradburn, CPC-A Allison Blair, CPC-A Allison Davis, CPC-A Allison Klosky, CPC-A Allison Troxell, CPC-A Allu Naresh Kumar, CPC-A Allyson Hafner, CPC-A Althea Mathews, CPC-A Alwyn Fong, CPC-A Alyssa Ditzler Ethridge, CPC-P-A Alyssa Norton, CPC-A Amanda R Brown, CPC-A Amanda Boronda, CPC-A Amanda Bullis, CPC-A Amanda Costabile, CPC-A Amanda Figel, CPC-A Amanda Frazier, CPC-A Amanda Harvey, CPC-A Amanda Perkins, CPC-A Amanda Sauls, CPC-A Amanda Swords, CPC-A Amarnath Arjunan, COC-A, CPC-A Amber DeAtley, CPC-A Amber Gay, CPC-A Amber Green, CPC-A Amber Kashyap, CPC-A Amber Kean, CPC-A Amber Mayhew, CPC-A Amber Mitchell-Gamber, CPC-A Amber O Daniel, CPC-A Amber Orchowski, CPC-A Amber Ramsey, CPC-A Amber Schmidt, CPC-A Amber Thornton, CPC-A Amelia Rogers, CPC-A Amudhavalli D, CPC-A Amy Bunyard, CPC-A Amy Coyle, CPC-A Amy L Ramadhan, COC-A, CPC-A Amy Plante, CPC-A Ana Bernal-Martinez, CPC-A Ana Katherine James, CPC-A Ancy Kurumkulam Peter, CPC-A Andrea Dow, COC-A Andrea Howard, CPC-A Andrea Ketelhut, COC-A Andrea Koberlein, CPC-A Andrea Leann Strauch, COC-A Andrea Pearson, CPC-A Andrew Cobbs, COC-A, CPC-A Andrew David Martin, CPC-A Andrew Yurkosky, CPC-A Andria Riley, CPC-A Angel M Dauzat, CPC-A Angel Musgrave, COC-A, CPC-A Angela Allen, CPC-A Angela Blythe, CPC-A Angela Gieling, CPC-A Angela Tunstall, CPC-A Angela Wilson, CPC-A Angelia Brown, CPC-A Angie C Flaherty, CPC-A Anil Pandey, CPC-A Anila Lakshmanan, CPC-A Anish Thomas, CPC-A Anita Hahner, CPC-A Anitha Kanagarajan, CPC-A Anju Suresh, COC-A Ann Mia Haning, CPC-A Anna Miller, CPC-A Annamarie Forcella, CPC-A Anne Ardath Stakkeland, CPC-A Anne Winchell, CPC-A Annette Cleveland, CPC-A Annie Fettig, CPC-A Annie Houser, CPC-A AnnMarie O Neill, COC-A Anns Jacob, CPC-A Annu Agrawal, CPC-A Annu Kumari, COC-A Antomary Bincy.J, CPC-A Anu Varghese, CPC-A Anumol Krishnankutty, CPC-A Aparna Gopireddy, CPC-A Aparna Piraji Jadhav, CPC-A April Bouchie, CPC-A April Euteneuer, CPC-A April Evans, CPC-A April King, CPC-A April Morin, CPC-A April Sayers, CPC-A Aprille Ruiz, CPC-A Archana Hole, COC-A Archana KishorKumar, CPC-A Archana Srinivasan, CPC-A Ardenia Lowry, CPC-A Arlene Edwards, CPC-A Arshkara Khan, COC-A Arunkumar Jagadesan, CPC-A Arvind Singh Kaira, CPC-A Aseem Arora, CPC-A Asha Irine Monis, CPC-A Ashanti Hadley, CPC-A Ashley Care, CPC-A Ashley Dixon, CPC-A Ashley Hall, CPC-A Ashley Hillestad, CPC-A Ashley Mayers, CPC-A Ashley Porter, CPC-A Ashley Wollaber, CPC-A Ashok Gundabathina, COC-A Ashwini Dhopte, COC-A Ashwini Raja, COC-A Aswathy Madathil Rajappan Nair, CPC-A Azarudheen Tajudheen, CPC-A B.K. Jayalakshmi, CPC-A Bahoran Singh, CPC-A Bala Murali, CPC-A Bandi Shankar, COC-A Bandi Shilpa, CPC-A Bangaru Pavani Teja, CPC-A Bao Vang, CPC-A Barbara Clavier, CPC-A Barbara McCray, COC-A Barbara O Neil, CPC-P-A, CPB Barbara Pascarella, CPC-A Barbara Robson, CPC-A Beatrice A Santos, CPC-A Belinda Interior Gonzalvo, CPC-A Benjamin Whitt, CPC-A Benzy Ann Mathew, CPC-A Bestha Chandra Sekhar, COC-A Beth King, CPC-A Beth Shelton, CPC-A Betsy Johnson, CPC-A Betty Duncan, CPC-A Beverly Gagnon Miller, CPC-A, CPB Bhavya Ravikumar, CPC-A Bhimrao Chandrakant Gawade, CPC-A Bhumika Patel, CPC-A Bhuvaneshwari Rajan, CPC-A Bhuvaneshwari Thirumoorthy, CPC-A Bhuvaneswari M Sivakumar, CPC-A Billie Jo Robbins, CPC-A Binoy Thomas, CPC-A Birgit Williams, CPC-A Bisher Changaranchola, CPC-A Blessy Nishanthi, CPC-A Bobbi Such, CPC-A, CPB Bobby Lowe, CPC-A Bojarajan Kumarasamy, COC-A Bonita Garshnick, CPC-A Bonthala Ramesh, CPC-A Brad Schwarck, CPC-A Brandi Brown, CPC-A Brandy Zurcher, CPC-A Breanna Salamone, CPC-A Brenda Johnson, CPC-A Brenda Jones, CPC-A Brenda L Lass, CPC-A Brenda Marcum, CPC-A Brennan Mainers, CPC-A Brittany Adams, CPC-A Brittney McClafferty, CPC-A Broncy Rose Joseph, CPC-A Bryan Jefferson Icban, CPC-A Camille Sewell, CPC-A Candace Jolene Harmer, CPC-A Candace Sizemore, CPC-A Candice Waples, CPC-A Carie McCormick, CPC-A Carla Rose, CPC-A Carly Ziev, CPC-A Carmela Mendoza-Baltazar, CPC-A Carmen Garcia, CPC-A Carol Swedensky, CPC-A Carolyn Carr, CPC-A Carolyn Michele Shaw, CPC-A Carrie Flood, CPC-A Carrie Scholl, CPC-A Carrie Stubbs, CPC-A Cassandra Rogers, CPC-A Cassie A Burkholder, CPC-A Cassie Parker, COC-A, CPC-A Cassie Rainwater, CPC-A Catherine Santiago, CPC-A Cathy Maniatakos, CPC-A Celeste Misbah, CPC-A Ch. Amrutha, CPC-A Challa Sindhu, CPC-A Chandra Weekley, CPC-A Chandrashekhar Puyed, CPC-A Channon Stout, CPC-A Charles Grant, CPC-A Charlie Flores, CPC-A Charlotte Dunkle, COC-A, CPC-A Charlotte Jean, CPC-A Chelsea Moody, CPC-A Chelsea Pederson, CPC-A Cherie Ann Nickles, CPC-A Cheryl Moser, CPC-A Cheyanne Andersen, CPC-A Chiluveru Manogna, COC-A Chindam Rajesh, CPC-A Chitipothu Shruthi, CPC-A Chitra Nellaiappan, CPC-A Chitra Sekar, COC-A Chris Faber, CPC-A Chris Voutas, CPC-A Christa Clagon, CPC-A Christina Franks, CPC-A Christopher Boc, CPC-A Christopher Nicolaison, CPC-A Christopher Steven Hayes, CPC-A Cindy Jackson, CPC-A Cindy Sue Arnold, COC-A, CPC-A Claire Meehan, CPC-A Clifford Chen, CPC-A Colleen Kobe, COC-A Connie Mucci, CPC-A Connie Ward, CPC-A Constance Duff, CPC-A Corina Diaz, CPC-A Corinne Weckherlin, CPC-A Corissa Mclean, CPC-A Corrie Nave, CPC-A Courtney Crookshanks, CPC-A Cristina Hebert, CPC-A Crystal Gonzales, CPC-A Crystal Thompson, CPC-A Crystal Thompson, CPC-A Crystal Watkins, CPC-A Cymantha Martinez, CPC-A Cynthia Cox, CPC-A Cynthia Howell, CPC-A Dale Spencer, CPC-A Dan Hughes, CPC-A Dandu Swathi, CPC-A Daniel Criswell, CPC-A Daniel Toledo, CPC-A Danielle Arcadi, CPC-A Danielle Emerson, CPC-A Danielle Garvey, CPC-A Danielle Papa, CPC-A Danielle Scholten, CPC-A Davette Malufka, CPC-A David Hurst, CPC-A David McElfresh, CPC-A Dawn Elford, CPC-A Dawn Loser, CPC-A Dawna Alphonse, CPC-A Deann Reed, CPC-A Debby Waddle, CPC-A Deborah Brookover, CPC-A Deborah Cramer, CPC-A Deborah McGhee, CPC-A Deborah Wodhanil, CPC-A Debra Granger, CPC-A Deena Barton, CPC-A Deepa Muthusamy, CPC-A Deepthi Ghanta, CPC-A Dellareese M Lowe, CPC-A Delphin Joseph, COC-A Denise Inman, CPC-A Denise Bostic, CPC-A Denise Faulkner, CPC-A Denise Kline, COC-A Denise M Kelley, CPC-A Denise M Kelley, CPC-A Dephanie Hogan Begay, CPC-A DeShara Shells, CPC-A Desiree Elekwa-Izuakor, CPC-A Desiree Schwartz, CPC-A Dhivya Prabha Palanisamy, CPC-A Diamela Valdes, CPC-A Diana Neatrour, CPC-A Diane Carpenter, CPC-A Diguvapati Naga Lingeswara Reddy, CPC-A Dina O Reilly, CPC-A Dinesh Chauhan, CPC-A Divya Gurusekaran, CPC-A Divya Palanisamy, CPC-A Divyaa Doguparthi, COC-A Dolmaya Thogra, COC-A Dolores Ratay, CPC-A Dominic Bethel II, CPC-A Doneice Honeycutt, CPC-A Donica Marie Collier, CPC-A Donna Bougher, CPC-A Donna Corbani, CPC-A Donna Houghton, CPC-A Donna Moore, CPC-A Donna Sestito, CPC-A Doreen Melear, CPC-A Dorene Thorgesen, CPC-A Dottie Sue Davis, CPC-A Dwight Jackson, CPC-A Earl T. Burris III, CPC-A Eden Cabalu, CPC-A Edmee Vale, CPC-A Eileen Maca, CPC-A Elena Long, CPC-A Elisha Somers, CPC-A Elizabeth Ann White, CPC-A Elizabeth Boden, CPC-A Elizabeth Cardenas, CPC-A Elizabeth Parsons, CPC-A Elizabeth Tressler, CPC-A Elizabeth Watts, CPC-A Ella Uma Devi, CPC-A Ellenmarie Caisse, CPC-A Emily Bernhardt, CPC-A Emily Jones, CPC-A Emily Long, CPC-A Emily Lovelace, CPC-A Enosh Saka, COC-A Erica Griffin, CPC-A Erica Ramirez, CPC-A Erik Geissal, CPC-A Erin Ash, CPC-A Erin Aune, CPC-A Erin Becker, CPC-A Erin Lynn Jehle, CPC-A Erin Thunder, CPC-A Errer Dena Jackson, CPC-A Esther Leal, CPC-A Etta Smalley, CPC-A Eva Janice Gauthier, CPC-A Evelyn Aguirre, COC-A Evelyn Harr, CPC-A Fahida Moinudheen, CPC-A Falon Stone, COC-A Fawn L Lueck, CPC-A Faye Halbur, COC-A Frances Ellaine Roc, CPC-A Frances Michelle Strickland, CPC-A Gade Mallikarjuna Rao, COC-A Gail Clizbe, CPC-A Gail Quinn, CPC-A Gayathri Pugalanthi, CPC-A Gayle Farha, CPC-A Gelisa Stafford, CPC-A Genevieve Kellogg, CPC-A George Esguerra, COC-A, CPC-A, CPB Gerardo Vela, CPC-A Geri Smith, CPC-A Gia Jacquet, CPC-A Ginger Persinger, CPC-A Ginger Walsh, CPC-A Giuliano Edmund Fabian, CPC-A Givenchy Costar, CPC-A December

62 NEWLY CREDENTIALED MEMBERS Glenda Werkmeister, CPC-A Gloria Beverly, CPC-A Gloria D Durham, CPC-A Gloria Myllykangas, CPC-A Gomathi Palanisamy, CPC-A Gouse Mohiddin Sayyad, CPC-A Grace Anne Tudan, CPC-A Greg Killian, CPC-A Gregory Thompson, COC-A, CPC-A Gretchen Bender, CPC-A Gricel Rivera, CPC-A Guinevere Shapiola, CPC-A Gunasekar Ramaiah, COC-A Gurpreet Matharu, CPC-A Gurrapu Naveen, CPC-A Hanna Marie Langley, CPC-A Hari Priya Balasubramaniam, CPC-A Haris Rahman, CPC-A Harold Moran, COC-A Heather Harvey, CPC-A Heather Nelson, CPC-A Heather Orza, CPC-A Heather Perry, CPC-A Heidi Hughes, CPC-A Heidi Marie Whiteman, CPC-A Heidi Smith, CPC-A Henry Algarin, CPC-A Hillary True, CPC-A Himabindu Yampati, COC-A Holli Peifer, CPC-A Holly Brock, CPC-A Holly Gillingham, CPC-A Humaira Shah, CPC-A Inbaraj Chandran, COC-A Iracema Hernandez, CPC-A Israr Saifi, CPC-A Jackannette Drisko, CPC-A Jackie LeClair, CPC-A Jacob Robinson, CPC-A Jacqueline Krueger, CPC-A Jacqueline Skahan, CPC-A Jaime Moore, CPC-A Jalpa Parmar, CPC-A Jamell Richmond, CPC-A Jamie Lee Geronimo Staples, CPC-A Jamie Petricich, CPC-A Jamie Tauferner, CPC-A Jan Edward Julian, CPC-A Jan Ingram, CPC-A Jana Martin, CPC-A Jana Sanderson, CPC-A Jane Mattison, CPC-A Jane McKenzie, CPC-A Janelle Crahan, CPC-A Janet Egessah, CPC-A Janet Varathan, CPC-A Janice Newman, CPC-A Janice Wilson, CPC-A Janine Mills, CPC-A Janine Skwarczynski, CPC-A Jaqueline Da Silva, CPC-A Jaro Mayda, CPC-A Jasmil Fabiano, CPC-A Javier Cavazos, CPC-A Jayalakshmi Y, CPC-A Jayalakshmi Yadav Guthi, CPC-A Jayme Uhrig, CPC-A Jayme Yoshida, CPC-P-A Jé DeVance, CPC-A Jean Stackpoole, CPC-A Jean Szurgot, CPC-A Jeanette Bueno Bautista, CPC-A Jeanette Springer, COC-A Jeanie Ogle, COC-A Jeannie Scott, CPC-A Jeni Danielak, CPC-A Jenifer Tobin, CPC-A Jenna Brown, CPC-A Jennetta R Parker, CPC-A Jennie Alvarado, CPC-A Jennie Rowland, CPC-A Jennifer Birkbeck, CPC-A Jennifer Bodie, CPC-A Jennifer Braunschweig, CPC-A Jennifer Burris, CPC-A Jennifer Chaffin, CPC-A Jennifer Fenger, CPC-A Jennifer Gray, CPC-A Jennifer Knolton, CPC-A Jennifer Kunz, CPC-A Jennifer Maciej, CPC-A Jennifer Manella, CPC-A Jennifer Painter, CPC-A Jennifer Reddick, CPC-A Jennifer Schmid, CPC-A Jennifer Torres, CPC-A Jenny Noel, CPC-A Jessica Giffin, CPC-A Jessica Bowen, CPC-A, CPB Jessica Erin Harris, COC-A, CPC-A Jessica Gonzalez, CPC-A Jessica Gonzalez, CPC-A Jessica Helfrich, CPC-A Jessica Kerbs, CPC-A Jessica L McKenzie, CPC-A Jessica Lynn Bixby, CPC-A Jessica Swenson Nelson, CPC-A Jessica Thomas, CPC-A Jessica Williams, CPC-P-A Jeydaliz Ruiz, CPC-A Jho Mhar De Chavez Malinao, CPC-A Jijitha Hareendran, CPC-A Jill Benson, CPC-A Jill Dunton, CPC-A Jill Headley, CPC-A Jill Huston, CPC-A Jill Manca, CPC-A Jill Miyagawa, CPC-A Jillian Kelly, CPC-A Jim Dimartino, CPC-A Jim Kim, CPC-A Jinoy Mathew, CPC-A JoAnn Reed, CPC-A Joanne Anheuser, CPC-A Joanne Ching, CPC-A Joanne Graham, CPC-A Joanne McGraw, COC-A Jodi Atwood, CPC-A Jody A Hubbard, CPC-A Joey Sandoval, CPC-A John Henry Caranto, CPC-A John Paquette, CPC-A Jolene Riesselman, COC-A Jolynn Ortiz, CPC-A Jonathan Haney, CPC-A Jonathan Torres, CPC-A Jonida Murati, CPC-A Jordan Stacey, COC-A Josephine Mcgonagle, CPC-A Joshua Martin, CPC-A Joy Meharg, CPC-A Joy Stearns, CPC-A Joyce Esther Rani, CPC-A Joyce Weis, CPC-A Joyce Willettte, CPC-A Julia Donohue, CPC-A Julia Mink, CPC-A Julie Worch, CPC-A June Martin, CPC-A Juney Jose, CPC-A Justine Gaumond, CPC-A Jyotir Kulmacz, CPC-A K. Madhavi, CPC-A K. Vinutna, CPC-A Kacey Dodenhoff, CPC-A Kaitlin Tatro, CPC-A Kaitlin Wilhalme, CPC-A Kalika Colquhoun, CPC-A Kalpana Nagar, CPC-A Kalpana Premkumar, CPC-A Kalpana Ragala, CPC-A Kalyana Sundaram Nataraj, CPC-A Kamal Saini, CPC-A Kanaka Spandan, COC-A Kandula Lakshmi Chandana, CPC-A Kandy Olsen, CPC-A Kannan S, COC-A Kannan Thonthi, COC-A Kara Masters, CPC-A Kara McConniel, CPC-A Kara Shaver, CPC-A Karen Brautigam, CPC-A Karen Case, CPC-A Karen Garofano, COC-A Karen King, COC-A, CPC-A Karen M Hanson, COC-A Karen Mandt, CPC-A Karen Marosz, CPC-A Karen McCulloch, COC-A Karen McEuen, COC-A Karen Mohler, CPC-A Karen Phipps, CPC-A Karen Richter, CPC-A Karen Sutley, CPC-A Karen Thomas, CPC-A Kari Christopherson, CPC-A Kari Jackson, CPC-A Kari Johnson, CPC-A Kari Stordahl, CPC-A Karl Olson, CPC-A Karolina Majerczak, CPC-A Karra Cubellis, CPC-A Karri Kavitha, CPC-A Karthikeyan Duraisamy, COC-A Karyn Sweeney, CPC-A Kasey Boehmann, CPC-A Katelyn Delorm, CPC-A Katherine Ingram, CPC-A Kathleen Carroll, CPC-A Kathleen Gione, COC-A Kathleen Lazar, CPC-A Kathleen Loera, CPC-A Kathryn C Smith, CPC-A Kathryn Klingenberg, CPC-A Kathy Ude, CPC-A Katrina Boldt, CPC-A Kavitha Aarthiga Kalyana Sundaram, CPC-A Kavitha Prakash, CPC-A Kavitha Subbiah, CPC-A Kayalvizhi P, CPC-A Kayla M Beachler, CPC-A Kayla Miller, CPC-A Kayla Rivera, CPC-A Kay-lee Alaspa, CPC-A Kayleigh Frazier, CPC-A Keely Geffre, CPC-A Kelli Beck, COC-A Kellie Koop, CPC-A Kelly Brogan, CPC-A Kelly Conner, CPC-A Kelly L Carter, CPC-A Kelly Moody, CPC-A Kelly Sarratt, CPC-A Kelsey Apodaca, CPC-A Kelsey Ellis, CPC-A Kelsey Ellis, CPC-A Kelsi Noteboom, CPC-A Kenzi Brooks, COC-A, CPC-A Kevin Sherar, CPC-A Kiarra Harris, CPC-A Kim Ford, CPC-A Kim Iles, CPC-A Kimberley Stoner, CPC-A Kimberly Ehlert, CPC-A Kimberly Noble, CPC-A Kiruthika Mohan, CPC-A Klnrr Deepika, CPC-A Kolla Jaipal Reddy, CPC-A Komal Bhumkar, COC-A Konda Sravanthi, CPC-A Kori E Frank, CPC-A Kourtney Wright, CPC-A Krishan Gopal, CPC-A Krishnaveni PV, CPC-A Kristen Driver, CPC-A Kristi Truscott, CPC-A Kristin Fessick, CPC-A Kristina Dawson, COC-A Kristy Parker, CPC-A Kshama Nagaraj, COC-A, CPC-A, CPB L. Rakesh Reddy, CPC-A Lacey Nally, CPC-A Lacey Rosson, CPC-A Lakmini Prematillake, CPC-A Lana Lamas-Nicholson, CPC-A Lane Mayhew, CPC-A Laneta Kay Watts, CPC-A Lanka Ravi Kiran, CPC-A Larissa Amundson-Keller, CPC-A LaShanda Wilks, CPC-A Laura Davy, CPC-A Laura Lacy, CPC-A Laura Liu, CPC-A Laura Route, CPC-A Laurel Frudd, CPC-A Lauren Ariane McCloskey, CPC-A Lauren Calhoun, CPC-A Lauren Creager, COC-A Lauren Davis, CPC-A Lauren Hartigan, CPC-A Laurena Laughlin, CPC-A Laurie Schrader, CPC-A Laurilee Eades, CPC-A Lavina Edward Joseph, COC-A Layla Abdirahman, CPC-A Leah Corbett, CPC-A Leeann OByrne, CPC-A Leigh Harold, CPC-A Leighanne Truelove, CPC-A Lendi Kinsaul Watkins, CPC-A Leslie Eysler, CPC-A Leticia Bellantoni, CPC-A Lija George, CPC-A Lilli Thorsell, CPC-A Lily Pennell, CPC-A Linda Bugdanowitz, CPC-A Linda Luxo, COC-A Linda Morse, CPC-A Lindsay Carlson, CPC-A Lindsay Sobczak, CPC-A Lindsey Cleek, CPC-A Lindsey Smith, CPC-A, CPB Lindsey Voorhies, CPC-A Lindy Aven, CPC-A Lisa Baker, CPC-A Lisa Clugston, CPC-A Lisa Colbert, CPC-A Lisa Creech, CPC-A Lisa Davis, CPC-A Lisa Harvey, COC-A Lisa Hembree, CPC-A Lisa Jones, CPC-A Lisa Ketsenburg, CPC-A Lisa Kindig, CPC-A Lisa Lange, CPC-A Lisa McLeod, CPC-A Lisa Melanson, CPC-A Lisa Mills, CPC-A Lisa Spohn, CPC-A Lisa Walsh, CPC-A Lisdey Silverio Castillo, CPC-A Loogeswary Thiruvengadam, COC-A Loretha Davis, CPC-A Lori Bloom, CPC-A Lori Gomez, CPC-A Lori Krueger, PharmD, CPC-A Lori L Mauel, CPC-A Lori Scarafile, CPC-A Lorraine Marshall, CPC-A Louise Kauppinen, CPC-A Luida Rieche, CPC-A Lukaiah Guduri, COC-A LydiaRathna Sugunaraj, CPC-A Lynda Beamish, CPC-A Lynsey Hersley, CPC-A M Swapna Latha, CPC-A M. Shekar goud, CPC-A Mackenzie Pennington, CPC-A Madison Kelly, CPC-A Makesha Lynn Pettit, CPC-A Malisa Jokbengboon, CPC-A Mallory Reefer, CPC-A Mamta Kapoor, CPC-A Manasi Maji, CPC-A Mandati Shanthi Sree, CPC-A Manikandan Sekar, COC-A Manoj S, COC-A Marci Dusseault, CPC-A Marcia Cornele, COC-A Mareena Susan Roy, CPC-A Margaret Rogers, CPC-A Margorie Bartley, CPC-A Maria A Hershberger, CPC-A Maria Bilbao, CPC-A Maria Rosetto, CPC-A Maria Teresa Gonzalez, CPC-A Mariah Mikula, CPC-A Maricel Borges, CPC-A Marie Agnes Holliday, CPC-A Marie Johnson, CPC-P-A Marilyn Jaskowiak, CPC-A Marilyn Wheat, CPC-A Marissa Macri, CPC-A Martin Richards, CPC-A Mary Dominique G Deato, CPC-A Mary Grace Reyes, CPC-A Mary Hogan, CPC-A Mary Kay Bross, CPC-A Mary Nancy Gnanasekaran, CPC-A Mary Pavithra, CPC-A Mary Quinn, CPC-A Mary Roland, COC-A Mary Surber, COC-A Mary Wilson, CPC-P-A Maurice Mankowski, CPC-A Mazen Zakeria, CPC-A Meagan Taylor, CPC-A Megan Allen, COC-A, CPC-A Megan Barnes, CPC-A Megan Drake, CPC-A Megan Guymon, CPC-A Megan Heusinkveld, CPC-A Megan Kincade, CPC-A Megan Potter, CPC-A Megan Stafford, CPC-A Megha Dhanesh, CPC-A Melanie Brame, CPC-A Melanie Brown, CPC-A Melanie Javier, CPC-A Melanie Mathis, CPC-A Melannie Phillips, CPC-A Melinda DeVries, CPC-A Melissa Archie, CPC-A Melissa Ballester, CPC-A Melissa Cox, CPC-A 62 Healthcare Business Monthly

63 NEWLY CREDENTIALED MEMBERS Melissa Daniels, CPC-A Melissa Douglas, CPC-A Melissa Edwards, CPC-A Melissa Fischer, CPC-A Melissa Grainger-Harry, CPC-A Melissa Hollar, CPC-A Melissa Rhodes, CPC-A Melissa S Bundren, CPC-A Menaka Baskaran, CPC-A Michael Chastain, CPC-A Michele dejong, CPC-A Michele Krieg, CPC-A Michele Weir, CPC-A Michele Yanes, CPC-A Michelle Gregorius, CPC-A Michelle Hastedt, CPC-A Michelle Hutton, CPC-A Michelle Marie Pajimula, CPC-A Michelle Othot, CPC-A Michelle Spivey, COC-A Michelle Wolfe, CPC-A Mindy Gislason, CPC-A Miranda Morgan, CPC-A Miri Hayner, CPC-A Miriam Priscilla Morales, CPC-A Miriam Semendy, CPC-A Misti Spiering, CPC-A Mithlesh Verma, CPC-A Mohammed Shafeeque, COC-A Mohd Anees Mohd Haneef, CPC-A Monika Balan, CPC-A Mousamy T.M, CPC-A Mukesh Jha, CPC-A Munmi Saikia Matlotia, COC-A Muralimohan Reddy, COC-A Mustafa Shariff, CPC-A Mylene Almoite, CPC-A Myvizhi Deenadhayalan, CPC-A N. Lokesh, CPC-A Nadezhda Shotropa, CPC-A Naeem Parveen, CPC-A Nagadurgaprasad Bodapati, COC-A Nakia Young, CPC-A Namdev Kadam, CPC-A Nancy A Galvin, CPC-A Nancy Anderson, CPC-A Nancy Dougherty, CPC-A Nancy Gulley, CPC-A Nancy Hochu-Oliveira, CPC-A Nandhini Madheswaran, CPC-A Nandini Sekar, CPC-A Natalie Anderson, COC-A, CPC-A Natalie Jury, CPC-A Natalie Norris, CPC-A Natalie Russell, CPC-A NaTasha Ross, CPC-A Nate Evans, CPC-A Nathan Bushlow, CPC-A Natraj Adla, COC-A Naveen Kumar, CPC-A Neelam Malumphy, COC-A Nereida Bruno, CPC-A Nezyl Mante, CPC-A Nichol Wilson, CPC-A Nicole Bokanoski, CPC-A Nicole Litterio, CPC-A Nicole M Ball, CPC-A Nicole Shafer, CPC-A Nicole Ward, CPC-A Niharika Dhusia, CPC-A Nikki Wanger, CPC-A Nikki Trahan, CPC-A Nikkie Suveerachaimontian Phukunhaphan, CPC-A Nilofar Hakim, CPC-A Nina Newman, CPC-A Nina Sonin, CPC-A Nirmala Devi Rodda, CPC-A Nirmala Dharmalingam, CPC-A Nishanth Purushothaman, COC-A Nivas Raj Ganesan, CPC-A Nkiru Ogbogu, CPC-A Nnaemeka Morah, CPC-A Noor Aaysha Nasrin Mohamed Sadiq, CPC-A Norazimah Sabree, CPC-A Nuseba Abdul Khader, CPC-A Nydia Davila, CPC-A Odapally Srinivas, CPC-A Odette Alonso, COC-A Olive Carlos, CPC-A Olivia Wiltse, CPC-A Olivia Wong, CPC-A Olyvia Freeman, CPC-A Omar Emil Monet, COC-A P. Swetha, CPC-A Padma Vaddi, CPC-A Padmalatha Pilli, CPC-A Paige Haase, CPC-A Pam Chitwood, CPC-A Pamela J Branch, CPC-A Pamela Jean Brandt, CPC-A Pamela Reaser, CPC-A Pamela Sanford, CPC-A Pamela Stark, CPC-A Parimala Mamillapalli, CPC-A Parisa Coffman, CPC-A Pathula Sravani, CPC-A Patrice Simpkins, CPC-A Patrice Vary, CPC-A Patricia A Ward, CPC-A Patricia Curtis, CPC-A Patricia Easley, CPC-A Patricia Fowler, CPC-A Patricia Gutierrez, CPC-A Patricia Mathison, CPC-A Patricia Possenriede, CPC-A Paula-Kay Magda, CPC-A Paulette Palmer, CPC-A Paulette Viney, CPC-A Pawan Sharma, COC-A Peggy Klocke, COC-A Peggy Trujillo, CPC-A Penumaka BabyRajitha, CPC-A Phyllis Ann Zyglewyz, CPC-A Pillalamarri Kalyani, CPC-A Polinaidu Bonu, COC-A Pooja Pandey, CPC-A Poonam Nigam, CPC-A Poonam Vilas Wankhade, COC-A Prachi Dhobale, CPC-A Pramit Kumar, CPC-A Prasad K, CPC-A Prashanth Kukkala, CPC-A Prashanthi Dharmaraj, CPC-A Prathima Badrinarayanan, COC-A Priya B, CPC-A Priya Krishnan, CPC-A Priyanka Mekala, COC-A Priyanka Patil, COC-A Prudhvi Vani Yerram Setti, CPC-A Pugazholi Parthiban, CPC-A Quiana Petteway, CPC-A R. Sirisha Reddy, CPC-A Rachael Hoyez, CPC-A Rachel Bannick, CPC-A Rachel Kile, CPC-A Rachell Nye, CPC-A Raghunandhan Awari, COC-A Rajesh Sampath, COC-A Rajeswari Nagarajan, CPC-A Rajitha Mudike, COC-A Rajkamal Jagadeesan, COC-A Rajshekhar S Kabanuri, CPC-A Raju Aloopady Padmanabhan, CPC-A Ramprasad Dussa, COC-A Ramya Parthasarathy, CPC-A, CPB Ramya Devi, COC-A Randi Hillebrandt, CPC-A Raquel Kenley, CPC-A Raquel Rodriguez, CPC-A Rashedha Banu Mohammed Abubackar, CPC-A Ravi Kishore Yadav Romala, COC-A Ravi Tripathi, CPC-A Ravindar Reddy D, CPC-A Rebecca Broome, CPC-A Rebecca Jasse, CPC-A Rebecca Kraynak, CPC-A Rebecca Mullins, CPC-A Rebecca Snowberger, CPC-A Rebecca Young, CPC-A Reeja Mary Raju, CPC-A Regina Balch, CPC-A Regina Driscoll, COC-A Regupriya Madhavan, CPC-A Rejithamol Anjilithottathil Manoharan, CPC-A Reka Jayakumar, CPC-A Rekha Agarwal, CPC-A Renata Rambo, CPC-A Renee Knutsen Phay, CPC-A Renee Wilkins, COC-A Reshma Garule, CPC-A Resmy George, CPC-A Revathi Sekar, CPC-A Rhonda M Mowry, COC-A, CEDC Rhonda Olt, CPC-A Rhonda Pepper, CPC-A Richard Shorter, CPC-A Risvana Jaibunisha, CPC-A Riyas Mohamed Saleem.I, CPC-A Robert Palmer, CPC-A Roberta Phillips, CPC-A Robin B Stewart, CPC-A Robin Clark, CPC-A Robin Cox, CPC-A Robyn Roche, CPC-A Robynn Denise Cochran, CPC-A Rohan Brizan, CPC-A Rohan Pardeshi, CPC-A Rohini Patil, COC-A Ronda Lister, CPC-A Roni Lynch, CPC-A Rosa Lee Trompeter, CPC-A Rosaelia Samaniego, CPC-A Rose Wakefield, CPC-A RoselinJannet AbrahamMani, CPC-A Rosely Arugolanu, CPC-A Roshni Rai, CPC-A Roslyn Bouchikas, COC-A Rozalia Arguello, CPC-A Rupali Gupta, COC-A, CPC-A Ruth Zinken, CPC-A Ryan Boyle, CPC-A Ryan S Dischner, CPC-A Ryan Williams, CPC-A S. Arun Kumar, CPC-A Sabitha Kethineedi, COC-A Sabrenia Johnson, CPC-A Sachin Kumar, CPC-A Sachin Sharma, CPC-A Sadananda Behera, CPC-A Sailendra Koka, CPC-A Sajana K Badusha, CPC-A Salla Shiva Krishna Reddy, CPC-A Samantha Blair, CPC-A Samantha Danielle Hursey, CPC-A Samar S Shaqqoura, CPC-A Sameena Ishrath, CPC-A Sameer Abhiman Aher, COC-A, CPC-P-A Sami Staley, CPC-A Samudrala Naresh, COC-A Samuel Richardson, CPC-A Sandhya Dumpa, COC-A Sandhya Lahu Dhuri, COC-A Sandra Garrett, CPC-A Sandra Zanos, CPC-A Sangeetha Chinnarasu, COC-A, CPC-A Sara Acevedo, CPC-A Sara Burnette, CPC-A Sara Jordan, CPC-A Sara Shader, CPC-A Sarah Bridgeman, CPC-A Sarah Buonano, CPC-A Sarah Cole, COC-A, CPC-A Sarah Malin, CPC-A Sarah Mcclellan, CPC-A Sarah McQueen, CPC-A Sarah Rios, CPC-A Sarah Watt, CPC-A Saraswathy Harichandran, CPC-A Saritha Veerasamy, CPC-A Satish Kumar Ponna, CPC-A Satyanarayana Kalavala, COC-A Satyawathi Anantha Karedla, CPC-A Sayeeda Begum, CPC-A Serphina Nez, CPC-A Shahanaz Fathima Akbar Basha, CPC-A Shaik Khadar Vali, CPC-A Shail Bala Anne, CPC-A Shalan Beasley, CPC-A Shalimar Patricia Clayton, COC-A Shanika McDaniel, CPC-A Shanila PS, COC-A Shankar Bobbili, CPC-A Shanmuga Bharathi Kesava Moorthi, CPC-A Shannon Nielsen, CPC-A Shannon Saunders, CPC-A Shannon Strickland, CPC-A Shannon Suezann Cobb, CPC-A Shari Floyd, CPC-A Sharon Jackson, CPC-A Sharon Maike, CPC-A Shashi Kant Patel, COC-A Shauna Lemay, COC-A Shawn Weaver, CPC-A Sheba Sushma, CPC-A Sheilene Simon, CPC-A Shelby Matsuoka, CPC-A Shelley Bojalad, CPC-A Shemia Joseph, CPC-A Sheneika Green, CPC-A Sheri Davis, CPC-A Sherri Barnes, CPC-A Sherry Mitchell, CPC-A Sheryl Houser, CPC-A Shirish Shrikrishna Patil, CPC-A Shivalore Swarna latha, CPC-A Shraddha Singh, CPC-A Sierra Bunting, CPC-A Silpa V E, CPC-A Silva Sarian, CPC-A Siranjeevi Chandran, CPC-A Sivapriya Sugumar, CPC-A Soibam Sotindro Singh, CPC-A Somesh Bhatt, CPC-A Sompalli Seshadri, CPC-A Sonja Maria Powell, CPC-A Sony Yellapu, CPC-A Soujanya Rupner, CPC-A Soumya Mohanan Nair, CPC-A Soumya Vasam, COC-A Sowmya Kandula, COC-A Sreejith C, CPC-A SreenivasaReddy ChinnaMuntala, CPC-A Srinivas Chowdary Bandla, CPC-A Srinivas Reddy Pulugu, COC-A Stacey Amick, CPC-A Stacey Benson, CPC-A Stacey Brewer, COC-A Staci Ertzberger, CPC-A Staci Wortzman, CPC-A Stacie Ann Parker, CPC-A Stacy Cable, CPC-A Stacy Escobedo, CPC-A Stacy Fitzgerald, CPC-A Stacy Norton, CPC-A Stacy Webb, CPC-A Starlet Verhovec, CPC-A Stephanie Allen, CPC-A Stephanie Anderson, CPC-A Stephanie Davis, CPC-A Stephanie Fox, CPC-A Stephanie Grice, COC-A Stephanie Guynn, CPC-A Stephanie Hespe, CPC-A Stephanie Shelp, CPC-A Stephanie Steig, CPC-A Stephanie Thorsell, CPC-A Stephany LaRue, CPC-A Steven R Brennan, CPC-A Subi Anil, CPC-A Sudhir Babaji Gunjal, CPC-A Sujitha Mathew, CPC-A Sundae Richason, CPC-A Sunil Kumar Santha, CPC-A Sunilkumar Thurram, COC-A Sunitha Bolabanda, CPC-A Suraj Anand, CPC-A Sure Laxmi Sirisha, CPC-A Surekha Degala, CPC-A Suresh Babu Banda, COC-A Susan Aszmann, CPC-A Susan Balcom, CPC-A Susan Bunch, CPC-A Susan Ferrara, CPC-A Susan Langley, COC-A Susan Shuman, CPC-A Susan Vanessa Titus-Davies, CPC-A Susan Whitehall, CPC-A Sushma Somisetty, CPC-A Suvarna Salunke, CPC-A Suvidha Sangaraju, CPC-A Suvila Samuvel, CPC-A Suzanne Hernandez, CPC-A Suzanne Paglino, CPC-A Swarnalatha R, COC-A Sydney Perez-Means, CPC-A Sydney Salazar, CPC-A Tabitha Williams, CPC-A Tacheima Bien-Aime, COC-A, CPC-A Taelor Wright, CPC-A Tami Randall, CPC-A Tami Wilson, CPC-A Tamila Emerick, CPC-A Tammi Seger, CPC-A Tammy Dreves, CPC-A Tammy Warren, CPC-A Tangala Malone, CPC-A Taniqua M. Alexander, CPC-A Tanura Marcheline Moss, COC-A Tanya Philip, CPC-A Tara Goedken, CPC-A Tara R Lyons, CPC-A Tara Rocklin, CPC-A Tara Spence, CPC-A Tara Williams, CPC-A Tarisa DeSalvo, CPC-A Tawna Johnson, CPC-A Teresa Cochran, CPC-A Terri McKernon, CPC-A Tetyana Doolittle, CPC-A Thangaraj Jayabalan, COC-A Thea Sierra, CPC-A December

64 NEWLY CREDENTIALED MEMBERS Theresa Brown, CPC-A Theresa Couture, CPC-A Theresa Insinga, CPC-A Tiana Stewart, CPC-A Tierra Cummings, CPC-A Tiffany Padilla, COC-A Tiffany Plumber, CPC-A Timothy Wise, CPC-A T Kara Jones, CPC-A Tom Sweeney, COC-A Tonya Scott, CPC-A Torri Clark, CPC-A Tracy Marinaro, CPC-A Tracy Norman, CPC-A Tracy Peters, CPC-A Tracy Port, CPC-A Tracy Wells, CPC-A Trisha Moore, CPC-A Tuesday McCauley, CPC-A Umamageswari Prithiviraj, CPC-A Upasana Rangrez, CPC-A Urmi Saha, CPC-A V N Bhushanam Tallapudi, CPC-A Vaishali Chauhan, CPC-A Vaishnavi Krishnamurthy, CPC-A Valeria E Williams, CPC-A Valeria Smith, CPC-A Valerie James, CPC-A Valerie Mirabella, CPC-A Valorae Stressman, CPC-A Vanaja Bathini, CPC-A Vanessa Lopez, CPC-A Vantessa Morgan, CPC-A Vanya Maury, CPC-A Varun Sulodia, CPC-A Veena Pulakanti, CPC-A Veronica Herrera, CPC-A Veronica Kapp, CPC-A Vicki L Rohrer, CPC-A Vicki Summerlin, CPC-A Vicky Anderson, CPC-A Vicky Huyhnh, CPC-A Vicky Taylor, CPC-A Vidhya Sivasubramanian, CPC-A Vidya Kunreddy, CPC-A Vignesh Muruganandham, CPC-A Vijay Jawahar Londhe, CPC-A Vijaya Dharshini Dharmarajan, CPC-A Vijaya Priya Bakthavachalu, CPC-A Vikash Prakash, CPC-A Vimalsundar Marimuthu, COC-A Vinayan Ponnully Kizhakethil, CPC-A Vinessa Tafoya, CPC-A Vinodhini Gandhi, CPC-A Vinoth Kumar Lawrence, COC-A Virginia Hawley, CPC-A Virginia Prevost, COC-A Visalakshi Dhevarajan, CPC-A Vishnu Balachander, CPC-A Vita Jaunmaize, CPC-A Will Sailors, CPC-A Winsome Boykin, CPC-A Y. Ganga Parvathi, CPC-A Yakasiri Ramesh, CPC-A Yanet Triana Moya, CPC-A Yarrabothu Parameshwari, CPC-A Yazmin Rodriguez De Welsh, CPC-A Yemme Sreekanth Reddy, COC-A Yerenso Martinez, CPC-A Yerrabadu Ummar Basha, COC-A Ymelda Lewis, CPC-A Yolanda Rivera, CPC-A Yuvaraj Sanjeevi, CPC-A Zina Pape, COC-A, CPC-A Zuleyma Garrido, CPC-A Zulma Quinones, CPC-A Specialties Abigail Erlandson, CPC, CEMC, COBGC Abigail Pipkin, CPC, CENTC Abirami Mayandi, CPC, CPMA Adianet Rivero, CPC, CPMA Adriana Carrillo, CPC-A, COSC Adriana Lara, CPC, CGSC, CIMC, CPEDC Adriana Lara, CPC, CGSC, CIMC, CPEDC Aida Fadhil Ali, CPMA Aimie Ellen Maston, CPC-A, CEMC Ajovin Vijay, CIC Alejandro Gerardo Suarez Fernandez, CPC, CPMA Alexandra Chrisler, COC, CPMA, CRC Alicia Renae Waddell, CPC, CRC Alma Acosta, CPC, CRC Alres Dinnall, RN, M.Ed., CPC, CRC Amanda Armstrong, COC-A, CPC-A, CRC Amanda B Feaser, CPC, CRC Amanda Brooks, CPC, CPMA Amanda Donoho, CPC, CRC Amanda Harvey, CPPM Amanda J Andrews, CPC, CEMC Amanda San Roman, COC, CPC-P, CPMA, CIC Amarendar Gajjela, CPMA Amber Lewis, CPB Amy Louise Lanoue, CPC, CIMC, COBGC Amy Louise Lanoue, CPC, CIMC, COBGC Amy Marie declairville, CPC, CRHC Amy Marie Young, CPC, CRC Amy Stanley, CPC, CHONC Amy Walker, COC, CPC, CPB, CEDC, CRC Ana Liza M Cruz, CPC, CPMA, CEMC, COBGC Anabela Antunes, CPPM, COSC Anastasha Brashears, CPC, CPMA Andre Anderson, CPC, CUC Andrea Lise McClure, CPC, CGSC, COBGC Andrew Struse, CPC, CPB Angela Lynch, CPC, CRC Angela Redding, CPC, CGSC Angie Williams, CPB Angie Wilson, B.A., CPC, CRC Anita Fitterer, CPC, CIC Anna McAdam, COC, CPC, CPC-P, CCC, CEMC Anna McAdam, COC, CPC, CPC-P, CCC, CEMC Anne Garcia, CRC Anne Jablonski, CPMA Annette Daniels, CPC, CRC Annette M Coffey, CPC, CRC Annie Daniel, CPC, CPMA Anny Lee, CPC-A, CGSC Anusha K, CIC April M Rigdon, CPC, CPMA Aprilan Woolworth, CPC, CRC Arlene H Putnam, CPB Arun R L, CIC Ashish Chauhan, CPC-A, CIC Ashley Coleman, CPC, CPMA Ashley Connor, CRHC Ashley Fleischer, CPB Aurelia de los Reyes, CRC Aurora Monica Garcia, CPC, CGIC, CUC Aurora Monica Garcia, CPC, CGIC, CUC Bambi S Barnes, COC, CPC, CEMC, CRC Barbara (Betsy) Moore, CPPM Barbara A Wilson, CPC, CRC Barbara Armenteros, CPC, CPMA Barbara Hays, CPC, CPMA, CPC-I, CEMC, CFPC Barbara Ryan Fortson, CPC, CPMA Beatriz Hernandez, CPC, CPMA, CRC Becky Mora, CRHC Belgica Moreno, CPC-A, CPMA Ben Burton, CRC Beth Rochelle Shelton, CPC, CENTC, COSC Betty L Fumar, CPC, COBGC, CPEDC Bibi Z Chowrimootoo, CPC, CPB Blair M Ortega, CPC, CCC Bonnie Rapchak, CPMA Bonnie Sue Connors, CPC, CCC, CEMC Boy Gerald Flores, CRC Brandi Aydelott Barton, CPC, CPMA Brandi Hicks, CPC, CGIC, CUC Brandi L Earl, CPC, COBGC Brandy Wright, CPC, CGSC, CIMC, CPEDC Brenda Danielle Terry, CPC, CPMA Brenda Duell, CPB Brenda Ellis, CPB Brenda Kempf, COC, CRC Brenda Roos, CPC, CRC Brindha Ramadhas, CIC Brittany Kristine Reiber, CPC, CRC Brittney S Woolard, CPC, COSC Caitlin Connors, CPB Candace M Sexton, CPC, CPMA, CRC Cara L Crawford, CPC, CPMA Caramie Perry, CPC, CENTC, COSC, CPEDC Caramie Perry, CPC, CENTC, COSC, CPEDC Caridad Martinez, CPC-A, CPMA Carla J Townsend, CPC, CPB, CPPM Carlin Ki Krhut, CPC, CCC Carol Davis, CPC, CRC Carolyn Ann King, CPC, CRC Carrie Holstrom, CGIC Casey Pittman, CPC, CPMA, CHONC Cassandra Cartwright, CPC, CRC Catherine Bishai, CPC, CRC Catherine Paul, CPC, CGSC Cathy Hentz, CPPM Cathy R Davis, COC, CPC, CPMA, CHONC Charleen Johnson, CPC, CASCC Charlene C James, CPC, CCC Chelsi Trout, CPC, CPMA Cherie Jeannine Simpson, CPC, CRC Cheryl Barnaby, CPC, CPMA Choo Hooi (Janice) Khoo, CRHC Christi McMinn, CPC-A, CANPC Christina Banaka, CPB Christina Becker, CPC, CIC Christina Myers, CPC, CPB, CPMA Christine Gomez, CRC Christine L Mitchell, CPC, CPB, CANPC Christine R Carbonaro, CPC, CPC-P, CPMA, CRC Cindy Brempong, CPC, CRC Cindy Stothers, CPC, CEMC Clayton Howard, CPPM Crystal Hornbuckle, COBGC Cynthia C Duat, CPC-A, CIMC, CPEDC Cynthia Louise Brown, COC, CPC, CRC Damarys Ayala, CRC Danette Ingland, CPB Danielle Ingle, CPB Darlene Britton, CPC, CPMA, CPC-I, CEDC Darlfene Abano, CPC-A, CEDC Darsha Harper, CANPC Dawn Richey, CPCO Deanna Obiedzinski, CRC Debbie Camden, CPC, CPMA, CRC Debbie Culberson, CPB Debbie Solti, CPC, CRC Deborah L Groves, CPC, CPB Debra Ann Duguid, CPC, CPMA Debra J Garcia, CPC, CRC Debra L Love, CPC, CPMA Deidre Jandeska, CCC Deidre Jandeska, CCC Deirdra A Nehf, CPC, CPMA Deitra Dee Payne, CPC, CPMA, CRC Delly Parham, CPC, CPMA Demetria Bonner Woodson, CPC, CRC Denise Dobbin, COC, CPC, CRC Denise Schery, CRHC Diana Lynn Davis, CPC, CUC Diane Hyler, CPC, CPMA Diane Benskin, COC, CIRCC Diane Fulton, CPPM Dianne Lenhardt, CPC, CPMA Donna Becker, COC, CRC Donna Gray, CPC, CRHC Donna L Reddick, CPC, CIMC, COBGC, CPEDC Donna Louise Heleniak, CPC, CGIC, CUC Donna M Carlson RN,, CPC, CRC Dorene Kelsey, CPC, CPMA Doret Lyn DeBarros, CPC, CEMC Dunia Aljure, COC, CPMA Edmund Kowalski, CRC Edward Cartledge, CRC Edward Leone, CPC, CPC-P, CPMA, COSC Edwin Moon, CPC-A, CRC Eileen J Costigan, CPC, CEMC Eilene Louie, CPC, COBGC Elizabeth Ann Freiberg, COC, CPC, CRC Elizabeth Facundo, CPC, CPB, CHONC Elizabeth G Jackson, CPC, CPCD Elizabeth M Moppins, CPC, CGSC, CIMC Elizabeth M Moppins, CPC, CGSC, CIMC Elizabeth McAllister, COC, CPC, CPC-I, CEMC, CRC Elizabeth Perry, CRC Elizabeth Wolfarth, CPC, CEMC, CUC Erin Bristow, CPC, CRC Erin M Spada, CPC, CGSC Estrella Matheu Morales, CPC, CPMA, CRC Etwaria R Singh Gillette, COC, CPMA Eveleen G Gill, CRC Farine Faria Ali, CPC-A, CENTC, CIMC, COSC Faye Hogeland, CPC, CIC Frances A Geltch, CPC, CPMA, CPC-I Frances Perez, CPCO, CPB Frederica Castellanos, CPC, CIMC, CPEDC Funke Giwa, CPPM Gabriel Ruiz, CPC, CRC Gabrielle Mizell, CPC, CUC Gail Woytek, CRC Geneva Fitzhugh Bryan, CPC, CPB, CPMA Genevieve E Francisco, CPC, CIMC, COBGC, CPEDC Geraldine O Reggeti, CPC, CPMA Gwen Hucker, CPC, CRC Gwendolyn A VanHeest, CPC, CPCO, CPEDC H Patricia Haller, CPC, CEDC, CEMC Haley Dodd, CPC-A, CENTC Heidi Ann Cantermen, CPC, CRC Heidi Ann Husman, CPC-A, CGIC, CIMC, CPEDC, CUC Heidi Ann Husman, CPC-A, CGIC, CIMC, CPEDC, CUC Heidi Marie Botts, CPC, CGIC, CUC Heidi Marie Botts, CPC, CGIC, CUC Hilda Frenes Torres, CPB Ines D Bibiano, CPC, CIMC, COBGC Ines D Bibiano, CPC, CIMC, COBGC Isis Farlow, CPB Ivy Lynn Thompson, CPC, CRC Jackie Prado, CPC, CRC Jacob Swartzwelder, CPC, CEMC, CRC Jacqueline Morris, CPC, CRC Jacqueline Sparks, CPC, COBGC Jacquelyn Starns, CPC, CPCO, CPMA Jaime L. R. Benn, CPC, CGIC James Harold Holmes, CPC, CIRCC James John Pacifico, CPC, CRC Jamie Ortega-Silva, CPC, CEDC Jana Caulk, CPC, CRC Janet Cavanzo, CPC, CPMA, CRC Janet Skurski, CPC, CPCO, CPMA Janet Woolley, CPC, CPMA Janie A. Van Noy, CPC, CPMA, CANPC Jarris Scollick, CPPM Jasmine Ensley, CPC, CPPM Jean I Thomas, CPC, CRC Jeanne M Alwardt, CPMA Jeffrey Sullivan, COC-A, CPB Jenifer Smith, CRC Jennifer Ann Theien, CPC, CPMA, CRC Jennifer DeLong, CPC, CEDC Jennifer Dipasquale, CPC, CEMC Jennifer Lyman, CPC, CEMC Jennifer Norton, COC, CPC, CPMA, CEMC, COSC Jennifer Oskolkoff-Miller, CPC, CPB Jennifer Pena, CPPM Jennifer Valiton, CPC, CPMA Jennilee Ortega, CPC, CPMA, CRC Jessica J Franzese, CPC, CPMA Jill Barnes, CGSC Jill Denyse Kaminski, CPC, CGSC Jill M Tom, COC, CPC, CPMA, CPC-I Jill Reynolds, CPC, CRC Jodi DiBiasi, CPC, CPCO, CPB, CPMA, CEMC Jody Bell, CPC-A, CPB Jody Oaks, COC, CPC, CPCO, CIC John Sunderland, CPC-A, CPMA Johnna Sharon Derain, COBGC, CRC Jolene M Ferrier, CPB Joni K Balch, CPC, CPMA Joshua Cronan, CPC, CEDC Joy Hipolito, CPB Joyce Anne Kilgore, CPC, CRC Judy K Holder, CPC, CPPM Judy Mayor-Davies, CPB Julee Shiley, CPC, CPMA Julia Allen, CPC, CPMA Julia Kenney-Hall, CPC, CCC, CEMC Julianne Johnson, CPC-A, CGIC Julie H Price, CPC, CIRCC, CIMC Julie Painter, CPMA, CCVTC Kadie Gibson-Karanikas, CPC, CPCO, CPPM, CCVTC Kali Serrano, CPPM Kara McVey, CPC-A, CPMA Kara Snowman-Wulff, CRC Karen Ann Frank, CPC, CPPM Karen Downing, COC-A, CPB, CPMA Karen Lankisch, CPC-A, CPPM Karen M Tolbert, COC, CPC, COBGC Karen Stefanese, CPC, CPMA, CRC Karen Varnedoe, CPC, COSC Karen Y Marble, CPC, CPC-I, CCVTC Karla Calvet, CPC, CPMA Karla Grimwood, CPC, CPMA, CEMC Karla Hughes, CPC, COSC Kasia Stasiak, CPC, CPMA Katharine E Hieber, CPC, CGSC, CIMC Katharine E Hieber, CPC, CGSC, CIMC Kathi Hall, CGSC Kathleen Ann Roza, COC, CPC, CIC Kathleen Ann Shera, CPC, CPB Kathleen Forsman, CPPM Kathrine Lowe, CPC-A, CFPC Kathryn A Heimerman, CPC, CGIC, CGSC Kathryn L Williams, CPC, CPMA Kathy L Van Es, CPC, COBGC Kathy W Gunnerson, CPC, CENTC Katrina Girard, CPC, CPMA Katrina Yvonne Taylor, CPC, CPMA Kelly Schwartz, CPPM Kelsey Williams, CPC, CRC Kerri Corn, CPC, CGSC, CPEDC 64 Healthcare Business Monthly

65 NEWLY CREDENTIALED MEMBERS Kerri Corn, CPC, CGSC, CPEDC Kerry Beth Atkins, COC, CPC, CPCO, CPMA, CEMC, COBGC Kerry Ducey, CPC, CPMA Kim A Wells, CPC, CPMA, CEMC Kim Breisch, CPPM Kimberlee S Davis, CPC, CRC Kimberley Ramsey, CPB Kimberly Ann Bush, CPC, CPB Kimberly Ann Shoemaker-Bias, CPC, CPMA Kimberly Hoffman, CPC, CGSC, CIMC Kimberly Hoffman, CPC, CGSC, CIMC Kimberly Konopnicki, CPC, CPMA Kimberly McDermott, CPC, CPMA, COBGC King Sarino, CPC, CRC Kirsty Marie Dela Cruz, CRC Kolette Cotropia, CPC, CRC Kristen Reed-Pearson, CRC Kristen Worden, CPC, CANPC, CEMC Kristi S Bartkowiak, CPC, CPMA, CHONC Kristina Reyes, COC, CPC, CPMA, CRC Kristine Finck, CPC, CRC Kristine Johnson, CPC, CPB Kyle Williams, CPC, CPMA, CIC L Susan Stahl, CPC, CPMA Lahoma Brasfield, CPC, CIC La-Keisha Michelle White, CPC, CANPC Laura Beck, CPC, CPCO Laura G Bertke, CPC, CPMA Laura Goodman, CPC, CRC Laura J Higdon, CPC, CPMA Laura L Davis, CPC, CPMA, CENTC, COSC Lauri Herbert, CPB Laurianne R Toney, CPC, CRC Laurie Lynn Kagels, CPC, CIC Laurie Sierra, CPC, COBGC Lavanya Bandollu, CIC LeJeanne Harris, CPC, CPMA Lenier Danilo Delgado Diaz, CPC, CPMA Lesa Danelle Moore, CPC, CRC Lesa Titus, CPC, CIMC, COBGC, CPEDC Leslie Marie Pitt, CPC, CRC Leslie Marie Pou, CPC, CEMC, CFPC, CRC Lilit Martirosyan, CPC, CRC Linda Colangelo, COC, CPC, CPMA Linda Huggins, CIC Linda L Oakes, CPC, COSC Linda M. Danesi, CPC, CPB Linda Scott, CPC, CPMA Lindsay Ireland, CPC, CGSC Lisa A Wyatt, COC, CEDC Lisa Gebhardt, CPC, CPB Lisa Hornick, CPC, CPMA Lisa K Shelton, CPC, CPPM Lisa Marie Valentin, CUC Lisa Nolan, CPC, CCC Lisa Ratliff Mize, COC, CIC Liset Estevez, CPC, CPMA Lissa B Singer, CPC, CPCO, CPC-I Lola Nichole Elder, COC, CPC, COBGC Lori J Sagide, CPC, CPC-P, CPMA, CPC-I, CRC Lori Petrozza, CPC, CPB, CRC Lori Renee Logan, CPC, CEMC Lucina Gort, CHONC Lydia Satterfield, CPC, CFPC Lynda P Ingram, CASCC Lynda P Ingram, CASCC Lynn B Easley, CPC, CEDC Lynn Graham, CPC, CPMA, CCVTC Lynn Punturi, CPC, CRC Maggie Garner, CPB Mai Kelley, CPC-A, CEMC Mansi Parikh, CPC, CEMC, CHONC Maranda Goldsmith, CPC, COBGC Marcedita Acevedo-Feliciano, CPC-A, CPMA Mari Vance, CPPM Maria Brooks-Swims, CRC Maria Cristina Ladores Rolle, CPC, CRC Maria Elena Garcia, CGIC Maria Licon, CPC, CRC Maria Linda V Devers, CPC, CRC Maria Soto, CPB Marianne Nykiel, CPC, CPB Maribel Moctezuma, CPC, CRC Marie Adler, CPEDC Marilyn Rundle Schwartz, CPC, CPMA Marissa R Cartagena, CPC-A, CRC Marjorie A Belanger, CPC, CPC-P, CRC Mark Painter, CPMA Marriym Lateefah Lofton, CPC, CGIC, CUC Marsha McGraw, CPMA, CRHC Marsha Sporhase, CPC, CPMA Mary A Wilson, CPC, CRC Mary C Cripps, COC, CPC, CPC-P, CHONC, CRC, CRHC Mary J Crawford, CPC, CGSC, CIMC Mary J Crawford, CPC, CGSC, CIMC Mary Kaleleihokuonalani Umeka Brookins, CPC, CRC Mary Lovely Concepcion, CRC Mary Savino, CPC, CEMC Mary Typhair, CPC-A, CPMA Maryann C Palmeter, CPC, CPCO, CENTC Mary-Ellen Johnson, CPMA Matthew Hobizal, CPCD Matthew Stein, CRC Mayra A Lazo, CPC, CENTC, COSC Mayra A Lazo, CPC, CENTC, COSC Meily Nodal, CPC, CPMA Melanie B Scott, CPC, CRHC Melanie McKee, CPC, CPPM Melissa Brown, CPC, CFPC Melissa Conyers, CPB Melissa French, CPC, CCVTC Melissa Gee, COC-A, CPB Melissa L Kulavic, CPC, CPMA Melodie L.R. Bauer, CPC, CIMC, COBGC, CPEDC Mendy Pemberton, CEDC Mercedes Sandoval, CPC, CPMA Mey Saelee, CPCD Michael Alexander Martinez, CPC, CPMA Michael Atalia Cerbo, CPC-A, CPMA Michael M Sandoval, CPC-A, CIMC, COBGC, CPEDC Michael M Sandoval, CPC-A, CIMC, COBGC, CPEDC Michaelle Waters, CPC, CPMA Michelle Bassett, CPC, CPB Michelle Hildreth, CPC, CPMA Michelle Laubach, CPCO Michelle M O Neil, CPC, CCC Michelle Mills, CPC, COSC, CSFAC Michelle Morgan, CPC, CRC Michelle Zumbrun, COBGC Migdalia Martinez, CEDC Miranda Agosto, CPB Misty Tinch, CPC, CPMA Mitzi McCallister, CPC, CPB, CPMA, COSC Molly Shumway, CPC, COBGC Mona Nanavati, CPC-A, CPMA Monica A Lavergne Diaz, CPC, CPB, CRC Monica Cutino, CPC, CIMC, COBGC, CPEDC Monica Lyn Edwards, CPC, CGSC Monica Pizana, CPC, CRC Monika Sanders, CPC, CPB Monique Boyd, CPC-A, CRC Mownika Gandla, CIC Mylene L Sabile, CPC, CGIC, CUC Mylene L Sabile, CPC, CGIC, CUC Nancy Bass, CPB Nancy Ramirez, CRC Nancy Walker, CPB Nancy Zizelman, CPC, CPB Nathan Monroe, CPC-A, CPMA, CEMC Nera Kathleen Benton, CPC, CPB, CPMA Nichole Fournier, CPMA Nicole DeBien, CPB Nicole Kiggans, CEMC Nicole Morgan Ready, CGSC Norma Iris Fellows, CPC, COSC Okezie D Iroz-Nnanta, CPC, CCVTC Pam Gould, CPC, CPB Pamela Jacobson, CPC, CRC Pamela Love, CPC, CPMA Pamela Pietras, CPPM Patina L Green, CPC, CPMA, CRC Patricia A Basa, CPC, CPMA, CCVTC, CEMC Patricia A Lynch, CPC, CENTC Patricia Ball, CPC, CRC Patricia Demming, CPC, CEMC Patricia Heck, CPC, CPMA, CEMC Patricia Louise Dodge, CPC, COBGC Patti Daniels, CPCO Paul Bieser, CPB Paula C Salva, CPC, CPMA Paula Sauder, CPC, CPCO, CPMA Pavan Kalyan Prattipati, CIC Pavel Dubrovka, CPC-A, CPMA, CANPC Penny C Allemand, CPC, CPPM Pervina Annette Gilmer, COC, CRC Phillip B Talbert, CPC-A, CPB Phylicia Doty, CPC, CPMA Premanjali Kurumella, CIC Priscilla Witwer, CPB Priyanka Kumari, CIC Rachel D Brunswick, CPC, CHONC Rachel Gomez, CPB Radha Rai, CPC, CRC Radhakrishnan Annamalai, COC, CPC, CPC-P, CIRCC, CPMA, CANPC, CASCC, CEMC, CIC Ramasubbu Subburayalu, COC, CPC, CPCO, CPC-P, CIRCC, CPB, CPMA, CPPM, CASCC, CCC, CCVTC, CEDC, CENTC, CFPC, CGIC, CGSC, CHONC, CIMC, COBGC, COSC, CPCD, CPEDC, CPRC, CRC, CRHC, CSFAC, CUC Rana Sebai, CPC, CPPM Rebecca Doll, CPC, CCC, CCVTC Rebecca Elizabeth Simmers, CPC, CPMA, CRC Rebecca Poff, CPC, CPMA, CHONC, CPCD Rebecca R King, CPC, CPMA ReGina Ford, CPC, CGIC Regina Wells, CCC Renato Millama, CRC Rene Lopez Roman, CPC-A, CRC Renetta Deanne Ruedemann, CPC, CRC Reshma Sashittal, CPB Rhonda F Schlesinger, CPC, CPMA, CCC Rhonda Humphrey, CPC, CPB, CPPM Rhonda S Holley, CPC, CPCO, CPPM, CSFAC Rizwan Ali, CPC, CIC Robin A. Lambert, CGSC Robin L Frey, CPC, CHONC Robin L Mason, CPC, CPPM Robin Norman, CPC, CPMA, CRC Robin Tucker, CRC Robyn Gutherless, CPC, CUC Roger L Hettinger, COC, CPC, CPCO, CPB, CPMA Romulo Villanueva Jr., CPC, CRC Rose Trevino, CFPC Roxanne Betton, CPC, CEMC, CFPC Ruben Anthony Posada, CPC-A, CIMC, COBGC, CPEDC Ruben Anthony Posada, CPC-A, CIMC, COBGC, CPEDC Rupa Mehta, CPC, CPB Sally Lyster, CRHC Samantha Daughtry, CPC, CCC, CCVTC Samantha Daughtry, CPC, CCC, CCVTC Samantha Lueck, CPB Samantha Reid, CPC, COBGC Samantha Summerlin, CPB Sandra C Welsh, COC, CPC, CPMA Sandra Newstein, COC, CPC, CPC-P, CPMA, CEMC Sandra P Carnaroli, CPC, CRC Sanjana Sharma, CPC, CPMA Santosh Kumar Meriyala, COC, CPC, CPC- P, CPB, CPMA, CASCC, CCVTC, CGSC, CEMC, CENTC, CFPC, CGIC, CGSC, CHONC, CIC, CIMC, COBGC, COSC, CPCD, CPEDC, CPRC, CRC, CRHC, CSFAC, CUC Sara Burns, CPC, CPMA Sara Elliott, CPC, CPPM, CRC Sara Klimkiewicz, COBGC Sarah E Dunkin, CPC-A, CCVTC, CIMC Sarah F Fair, CPC, CPMA Scarlett DeMott, CPC, CRC Scotisha Beckford, COC, CPC, CEDC, CEMC Shalan Taylor Corlieto Natale, CPC, CGSC Shanetta Laurice Bell, CPC, CRC Shania Maqbool-Schwartz, CPC, CIMC, COBGC, CPEDC Shania Maqbool-Schwartz, CPC, CIMC, COBGC, CPEDC Shannon B Davis McGivern, CPC, CPB Shannon N Jackson, COC, CPC, COSC Shannon Reece, CIRCC Shanon Ashley, CPCO, CPPM Shantell Christian, CPPM Shari L Irving, CPC, CRC Sharon Davis, COC-A, CPMA, CEMC Sharon Espanola, CIC Sharon McGue, COC, CCC Shawneice N Smith, CPC, CGIC Sheila M Rozmirsky, CPC, CPMA Shelley Howard, COBGC Sheri Knight, CPB Sheri L Rogan, CPC, CEMC Sherrina M Hansen, CPC, CPCO, CPMA Sherry L Bryant, CANPC Sherryle Givens, CPC, CPMA Shirley Thompson, CPC, CPMA, CPC-I Shobhit Malik, CPC, CIC Shujun Wang, COC, CPC, CGSC Siji G P, CIC Silvia M Bosmenier, CPC-A, CPMA Silvio R Martinez MD, CPC, CPMA, CRC Siva Chaitanya Pasupuleti, CIC Siva Teja Kumar, CIC Soledad Myers, CPC-A, COSC Sonia Hernandez, CPC, CIMC, CPEDC Sonya Denise Floyd, CPC, COBGC Staci Bell, COC, CEMC Stacie Zimmerman, CPB Stacy Leigh Blodgett, CPC, CRC Stacy Lynn Ehret, CPC, CRC Stephanie Carver, CPC, CASCC Stephanie Mathis, CPC, CRC Stephen Blatt, CPMA Steve Lee, CPC, CRC Stevie Calvert, CPC, CPMA SuiQi Jiang, CPC, CPMA Susan Jackson, CPC, CEDC Susan K Hunt, CPC, CRC Susan L Waterman, CPC, CRC Susan Lynne Irvin, CPC, CRC Susan Melo Dasilva, CPC, CEMC, CRC Susan Weimer, CCC Suzanne Jacobs, CPC, CRC Suzanne L Mucha, COC, CPC, CPMA, CCVTC, CEMC, CHONC Syla Poy, CPC, CGSC, CIMC Syla Poy, CPC, CGSC, CIMC Tamantha Young, CRC Tamara Reed-Sims, CPC, CEMC Tamela J Walker, CPC, COBGC Tammy Lynn Atkins, CPC, CRC Tammy Toll, CPC, CPMA Tamra H McLain, COC, CPC, CPB, CEMC Tanya Citron, CPCO, CPMA Tara Jane Pease, CPC, CEMC Tarndra Maduskuie, CPC, CGSC Teresa Jewell, CPMA Teresa L Garner, COC, CPC, CHONC Terri Barry, CIRCC Terry Cronin, CPC, CPMA, CEMC Terry Ellen Tompkins, CPC, CEMC Theresa Almeroth, CPC, COSC Therese Jentz, CPC, CRC Tiffany Buckley, CPB Tiffany Lee Cribb, CPC, CPMA, CEMC Tiffany Yuppa, CRC Timothy Buxton, COC, CPC, CIC, CRC Tina Carr, CPPM Tina Chyko, CPC, CRC Tina Leslie, CPC, CPMA Tina Marie Palmer, CPC, CPMA, CPC-I, CRC Tina Muela, CPC, CIRCC, CCC, CCVTC, CIMC Toi S Taylor, CPC, CRC Torri Rubertus, CPC, CIC Tracy Dixson, CPB, CPEDC Tracy Menosky, CPC, CASCC Tracy R Johnson, CPC, CPMA, CRC Tricia Lee Dicey, CPC, CENTC Tridev Biswas, CIC Trina F Neilson, CPC, CPMA Udaybhasker Akoju, CIC Va Lee Lo, CPC, CGIC, CUC Valarie Norman, CPC, CPCO, CPPM Valerie Herrera, CPC, CGIC Valerie Silva, CRC Vanessa Elizabeth Lowe, CPC, CPCO Vanessa McCarthy, CPC, CGIC, CIMC, CPEDC, CUC Vanessa McCarthy, CPC, CGIC, CIMC, CPEDC, CUC Vanessa McCarthy, CPC, CGIC, CIMC, CPEDC, CUC Vereen Watson CCS, CPC, CRC Vicki Flores, COC, CPC, CPMA Vickie Lytle, CPC, CCVTC Vicky Diane Mansur, CPC, CIC Victor Mee Teck Mo, CPC-A, CPPM, CRHC Victoria Benedict, CPC, CEMC Victoria Commons, CPC-A, CUC Vivienne Broughton, CPC, CPMA, CEDC Wendy A Miller, CPC, CRC Wendy Anderson, CPC, CPMA, COBGC, CUC Wendy L Cottrell, CPC, CPMA Wendy L Del Real, CPC, CPC-P, CPMA, CGSC Wendy Olson, CPC-A, CHONC Westley Garcia, CRC Yadira I. Mendez, CRC Yamila Pereiro, CPC, CPMA Yamila Prendes, COC, CPC, CPMA, CRC Yelena Slutskaya, CPC, CPPM Yosley Carballosa, COC, CPC, CPMA, CRC Yvonne Mendelson, CPC, CRC Zoraida Diaz, CIC December

66 I Am AAPC #IamAAPC ALLISON WEIR, CPC-A At 16 I knew I wanted to work in the healthcare field. My first interest was sparked when my healthcare science teacher described her experiences in nursing school and how the field of nursing had evolved since then. I had a class book, which listed a position profile for each member of the healthcare team. I was fascinated with this book and researched many positions to help me decide on a good fit. I feel very lucky to have found my niche and I am excited to begin my career as a coder in the midst of ICD-10, one of the most significant changes in healthcare history. Decisions, Decisions Would I be a sonographer, a phlebotomist, or a registered nurse? Would I work in the business of healthcare? It was a tough choice. Finally, I chose to enroll in the Medical Office Administration program at my local community college. Out of all the business career options, medical billing and coding interested me most. Coding remained an elusive choice for me. I wanted to learn more about coding, but did not have the resources to train for certification. After graduating with an associate degree, I found an entry level job as a medical billing specialist. After much trial and error, I learned the steps for getting denied claims paid. I used payer contract knowledge to organize a process that minimizes billing errors and helps secure clean claims. Diving Into the Science of Coding I gained experience working with insurance systems, but I also was interested in the science of medicine. I made the decision to use my savings to take a training course in coding. As I learned more about coding, I became fascinated with how the complexities of disease processes and medical treatments can be condensed into one system and re-organized in a way that allows the patient s clinical picture to be explained in a concise and logical manner on the claim form. Staying Connected Is Key The biggest goal I have as a newly credentialed coder is to stay as keenly connected as possible to the issues underlying reimbursement. No one knows how proposed changes to reimbursement structure may affect the role of coders. I am not sure where this will lead me in my career, but I do know that I will embrace change. I feel very lucky to have found my niche and I am excited to begin my career as a coder in the midst of ICD-10, one of the most significant changes in healthcare history. #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). 66 Healthcare Business Monthly

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