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As of July 28, 2013, Dr. Kim Stooke is now a Certified Medical Compliance Officer. However, she is no stranger to the importance of compliance. "Prior to taking this class, I was a self-taught Compliance Officer. I did a lot of research in to various areas and did the best I could without any formal training." Dr. Stooke’s motivation and hard work began at a young age. Born and raised in Ona, WY, both of her parents were educators, and she was highly involved in sports, church, and 4-H. She graduated from Marshall University in 1985 with a Bachelor of Science in Mathematics, and completed her MD at West Virginia University Medical School in 1994. Upon completing her residency in Family Medicine at West Virginia University, she joined Mid-Ohio Valley Medical Group, where she still is a partner today. She serves as a full-time Family Practice Physician who cares for patients from newborn to the elderly. The group consists of 16 family practice physicians, 3 urologists, and over 150 employees and continues to grow in size and services at a rapid rate. And Dr. Stooke’s role in the group expanded as well. "My partners and I recognized early into our growth that we would benefit from instituting a compliance program and so I took on those responsibilities and became a self-taught compliance officer." While Dr. Stooke was already in the field of compliance, she wanted to expand her knowledge even further, and found out about PMI’s Certified Medical Compliance Officer certification through an email from a practice manager at her office. She explains, "I researched and considered other certification programs. However, none of them truly fit the needs of our practice. Most of the other courses were focused on hospital–based compliance training or home health agency compliance and very little on private medical offices." Dr. Stooke further explains, "In March of 2013, I learned of the self-paced option for the CMCO course and decided that this was a wonderful fit for me. I was able to take part in the entire program without having to cancel or move any patient appointments." She felt that the course was very well organized and beneficial, and was very satisfied with the education, materials, instructors, organization, and the learning format. "The fact that much of the training is geared to outpatient medical groups such as ours was very important to me, and everything taught was applicable to our practice." More importantly, Dr. Stooke feels that there are two main roles that she takes seriously as a CMCO. "First is to educate my partners and staff in the areas of compliance to reduce errors and liability for our group. Secondly is to also effectively handle infractions of the compliance program while working towards preventing those issues from recurring." Through her experiences both in her own personal studies of compliance and through the CMCO program, Dr. Stooke acknowledges, "Having an effective compliance program is extremely important for any medical group in today’s ever-changing medical climate." She continues, "While there will always be challenges and new situations arise, I feel much better prepared and equipped to face those issues now having taken the CMCO course. My knowledge base is deeper and I was taught approaches and methodology to strengthen the compliance program that we already had in place. I believe that other physicians would also find the course very beneficial for their personal knowledge and for risk reduction in their practice."
Memphis resident Sharon Lusk, CMC, CMCO, JD, CPA, has traveled far, both personally and professionally. Her roots stem from New Orleans, the Crescent City, but her family migrated to Memphis when she was young. "My parents didn’t like climbing on the roof during hurricane season. Also, my father had a job opportunity in Memphis." As far as her background, she explains: "My professional background is varied. I’m definitely a lifetime learner. I have active certifications as a CPA and an attorney. I am also something known as a Rule 31 Civil and Family mediator in Tennessee. Tennessee does not "certify" mediators. A Rule 31 mediator is someone that has been recognized to have the requisite experience to mediate conflicts by the Supreme Court." Sharon shares that the skills that she has learned have all played a role in positioning her where she currently is with her career. "The skills learned as a mediator help with practice formation and dissolution. Tennessee is starting to play with mediation some as an aspect of peer review and malpractice." She adds, "Other jobs I’ve held include teaching Managerial Accounting to FedEx Managers in their MBA program, acting as a Guardian Ad Litem for Juvenile Court, being an advertising executive for a company whose clients included Holiday Inn, Federal Express and Dobbs House and serving as a regional financial manager for a bus company." However, these experiences were stepping stones that would eventually lead her to practice management. Since the ‘90s, Sharon has been a co-owner of KLA Healthcare Consultants, Inc. As co-owner, she is an educator and troubleshooter whose main focus is to educate healthcare organizations on new codes and rules. She says, "We were originally a CPA firm, [but the] need has reformed the business into one focused on independent medical billing and consulting." "I stumbled into physician practice management," she continues. "One of my first CPA/Law clients was an emergency department manager. One day he called my partner and me and asked if we could do medical billing for the ER." She continues, "We were a young company and were anxious for the opportunity. At that time, there were few outside billing companies. After that, our company grew through word of mouth. Our first "billing" client is still a client." With her focus shifting to billing and practice management, she felt that she and her staff needed further training to do their jobs. Sharon first heard about PMI certifications through the live workshops that were being offered by one of the hospitals in her area. From there, Sharon actively pursued the CMC credential. "When we started looking for training, we found a few sources. PMI offered the most quality. The instructors are well-trained and knowledgeable," she explains. Later, Sharon came upon the CMCO credential, which she found through PMI’s website. "I had been looking for a way to get more compliance training. When I saw a web version announced, I was thrilled!" "With the increased scrutiny of so many of our providers, I saw a real need to learn more about compliance requirements," she continues. "As we all now know from DK [Everitt], ‘Compliance is NOT an option.’" She has found the materials and resources received in her PMI training to have been extremely valuable, and the information clear and concise. She says, "The material has become a prized reference. From time to time, we will take on a provider of a new specialty. Reading through the CMC manual for the specialty is a good first step in knowing about nuances of billing for [that] specialty." She also finds the instructors to be dynamic and knowledgeable. "Most teachers allow some time for hands-on work," she says. "For example, you aren’t just told "how" to do a chart audit, you team up with classmates and "do" an audit." She continues, "So many of PMI’s teachers seem to understand there are multiple learning styles and incorporate all when presenting the material. After a live presentation, classmates tend to leave with reference materials and a list of networking buddies." Sharon has also felt satisfied with the professionalism of how the exam process was executed, and this process has assured her that certificates earned have real meaning that extends far beyond test day. "The CEU requirements are one aspect that makes these certificates so valuable from a career perspective," she adds. She continues, "I routinely suggest the CMOM program for office managers of new practices. One of the first managers that took the course about ten years ago has helped grow her practice to one of the larger independently owned practices in the area. She does a stellar job in managing the practice." As much as Sharon appreciates the classroom setting, she is quick to express her thoughts on PMI’s newest product, Total Access, an online training system which allows supervisory personnel to assign courses to their staff and monitor their progress with online quizzes to demonstrate mastery of each course assigned. "Right now, I’m very excited about Total Access [+]. Although we do have some training in Memphis by PMI instructors, the classes are not always exactly what is needed. Plus, I can’t empty out our office when training is in town." She continues, "We just have too much work that needs to be done. With…Total Access [+] I can select relevant topics based on our staff’s skill level and job functions." Ultimately, Sharon feels that PMI is the go-to for education. "They are consistently among the best in the industry," she says. She continues, "I owe much of the knowledge that I share with providers on an almost daily basis to PMI."
Philippines native Tim del Rosario has traveled great distances both personally and professional to get where he is now. After graduating from the University of the Philippines with a Bachelors of Science in Fisheries, he arrived in the United States in 1989, and found a job working in a billing office in Los Angeles. It was during his time in Los Angeles that he really began his training in billing and coding. In 1996, Tim moved to Sugar Land, Texas and worked as a medical biller in an OB-Gyn clinic, and has remained in the field ever since. Currently, Tim is the Billing Manager for Family Futures, an OB-GYN group practice consisting of two doctors and one nurse practitioner. In his role, he oversees billing, coding, and collections for the practice. Tim‘s involvement with PMI began simply through a fax that he received with information about PMI classes. With a fax in hand and the will to better himself, Tim began taking PMI courses in 2000. While completing his courses, Tim was inspired by PMI Houston Learning Center Coordinator Donna Alwais to take the next step in furthering his education by enrolling in the Certified Medical Insurance Specialist (CMIS) certification program, earning that credential in 2002. From there, his interest in completing PMI’s credentials only grew. In 2003, Tim earned his Certified Medical Coder credential and then followed with the Certified Medical Office Manager credential in 2007. Tim’s ultimate goal is to earn all of his certifications through Practice Management Institute. Overall, he finds Practice Management Institute training professional and valuable. Tim has also expressed interest in more classes and the need for more professionals to become PMI certified. He says, "What I like about the PMI’s course materials is that they are based on real office scenarios; hence it relates to and helps with the office professional’s daily challenges," he says. As a result of earning his credentials, Tim feels that he has the upper hand on knowledge of interview processes, HIPAA, and OSHA. He explains: "Because of the knowledge a person gets from PMI certifications, it helps the practice avoid lawsuits and avoid allegations of fraud and abuse." Tim enjoyed the programs so much that he convinced two of his co-workers to go through the PMI experience as a means of furthering their knowledge and expanding their professional skillset. Because of his motivational spirit, his co-workers, Diana Perez and Yessenia Martell, now have the Certified Medical Coder credential. With working as a full time Billing Manager, three PMI credentials, and the ability to convince his co-workers to better themselves, what are Tim’s future plans? Not to rest. "I am planning to take the CMCO soon."
As a coding, billing, documentation, and staff training specialist for Total Practice Resource in Denver, Brandy Brimhall searched for a compliance course that would best fit her needs. After sifting through numerous programs, she came upon the Certified Medical Compliance Officer certification at Practice Management Institute. "Once I reviewed this course and info on the instructors, as well as spoke with the PMI staff, I made the decision that this was the best course to take for compliance," she explains. Brandy was born and raised in Stratton, Colorado. While in high school, she worked part time for a chiropractic office as a portion of the work study program offered. "[I] ...loved it so much that I immediately began to dig deeper to learn more of the practice administration side," she says. Her love for and interest in the practice administration side has led Brandy to a 14-year career in coding, billing, and office administration. She is a practice advocate and instructor for Brimhall Wellness Seminars in addition to her role at Total Practice Resource, working primarily with chiropractic practices. Brandy also serves as an instructor for ChiroCode Institute three to four times a year. Brandy’s first experience with Practice Management Institute took place in 2001. She enjoyed the classes and content provided. "Everything was well organized and well presented," she says. "I also liked the availability of the instructor." It was eleven years later when Brandy turned to PMI for her certification as a Certified Medical Compliance Officer. While in the program, Brandy found the material to be very detailed and also very well organized. "I am a detailed person, so from one page to the next, everything continued to become more and more clear," she explains. Not only did Brandy appreciate the organization and clarity of the resources provided in the classroom, but she also appreciated the knowledge and experience of the instructors teaching the course. She felt that Robert Liles was very thorough in his explanations and teaching of the class. "I appreciated that he was so welcoming to questions," she explains. "I especially appreciated that he not only gives an answer but also tells you where it can be referenced for the future," she continues. "It was very evident that he truly wanted everyone to fully understand and be able to implement all of the material that he discussed." Her sentiments for D.K. Everitt are equally admirable. "He [D.K. Everitt] is very knowledgeable and experienced. He has been a great resource thus far and I'm sure will continue to be one. I would love to follow him around for a couple of days." When asked for tips to successfully prepare for the CMCO exam, Brandy says, "I would simply tell them that they need to actively participate in the webinars and use the opportunity to ask questions." "I would also tell them to read the manual and actually perform the steps that are outlined within it," she continues. "Hearing it, seeing it and then actually doing it will make some of the exam answers more evident, and having a good grasp of the manual content itself makes it much easier to find or verify other answers." With the tools and preparation provided by Everitt and Liles, Brandy took the exam on January 18, 2013 and is now a Certified Medical Compliance Officer. Brandy plans to use the knowledge gained from the course to reach out to the practices that she serves in her positions. "Practices in general tend to be naive about what is expected of them (particularly chiropractic). It would be wonderful for this content and other necessary info to reach state organizations, and therefore, more practices. It can, of course, inform them as to their requirements, not to mention save them an immeasurable amount of money in trouble, such as fines, penalties, attorney fees, etc.," she explains. "From my own perspective, it [the CMCO certification] allows me greater tools to help practices, as well as to give them information and answers to questions they may not even know to ask."
David Wilburn, CMOM, CMCO, and Director of Business Services for Houston Eye Associates, continues to make an impact on healthcare revenue cycle management as extensive as his home state of Texas. As the largest ophthalmology practice in the country, Houston Eye Associates (HEA) currently has a team of 48 board-certified ophthalmologists with advanced fellowship and specialty training in the field of ophthalmology. In addition to its physicians, HEA has 11 optometrists and 2 audiologists serving 23 locations, with more locations planned for 2013. "My primary focus is to protect HEA's revenue by bringing successful financial results through the daily management and oversight of all billing, coding and collection activities for all the physicians, optical locations and the surgery center," he explains. However, David's responsibilities don't just include HEA's present-day operations, but also its future. "Another facet of my duties is to create and implement innovative business practices through ... available and emerging technologies to expedite revenue dollars with cost effective, expense-reducing methodologies and best business practices." A lifelong Houston-area resident, David has been employed in healthcare finance for over 35 years, beginning his career with a small billing company of physicians practicing out of Memorial City Hospital in the 1970s. David soon moved on to positions at Baylor College of Medicine, American Medical International (AMI), Texas Eye Institute and others before ending up at his current position at HEA, where he is now in his sixth year. "While my position is important and has many demands, it's also enjoyable, and never dull. I attribute this to the HEA organization itself. I have watched HEA grow to have some 500 employees now, and even with all the growth I've seen HEA go through, it's retained a true "family" work environment," he explains. "I am sincere when I tell you all the senior management team members get along, and we truly work together in problem solving and keeping HEA a strong, viable, high-quality organization." That camaraderie, along with David's efforts, have resulted in concrete improvements to HEA's bottom line. "I have a budget amount for bad debt placements of 1% of gross charges per month, and we struggle to place even one half of one percent of gross charges with the agencies because of our front and back end collection processes," he says. In spite of his successes, a challenge of his position is staying on top of current healthcare rules and regulations. "PMI, however, offsets this challenge and does the majority of the "homework"... and develops programs with that information and source documentation, without me spending countless hours reading, for example the Federal Registry or CMS manuals exhaustively," he says. David's experience with PMI began while still working at Texas Eye Institute when a PMI class was held next door to his office at Southwest Memorial Hermann Hospital. After attending several more of them, David learned of the CMOM program and received that certification in 2003. "I was very impressed with its [PMI's] ability to present factual, up-to-date instruction on a large variety of topics and issues germane to the financial and legal aspects of the delivery of healthcare services," he says. "The class sizes were "just right" in size--not too small, not too big," he continues. "The instructors have all been very seasoned professionals giving real-life solutions to issues, and answers to the respective topics they presented on." With David's duties expanding into compliance-related responsibilities, (he is also charged with maintaining HEA's full compliance with all local, state and federal laws and regulations), the CMCO certification he earned in 2011 has certainly been useful. "The CMCO certification for myself was the most rewarding, personally," he says. "CMCO certification also provides you with specific legal source documentation that can be utilized in addressing problematic recoupment requests which fall outside applicable statutes and also insulates the practice so that money due back to a payer is paid within mandated timelines, thus remaining complaint and demonstrating excellent corporate citizenship. " "The PMI certifications, once earned, put any individual in a unique position in the healthcare arena because it automatically makes you stand out in the crowd," he elaborates. "It brings significant individual credibility to your name, and your potential contribution to an employer or future employer. When I encounter applicants for positions at Houston Eye Associates, and I see any PMI certification, that individual becomes a more viable candidate because those credentials represent the caliber of professional I want working at Houston Eye Associates." David also continues to back PMI training for current HEA employees. "Those here who have been sent to various PMI classroom programs, webinars, or in utilizing Total Access [PMI's webinar subscription service] have clearly grown into more seasoned and articulate employees because they apply the information learned through PMI," he explains. David is quick to attribute his company, especially HEA's CEO, Rick Canady, for empowering him to enhance both training opportunities for his staff, as well as HEA's profitability. However, he also credits a very personal figure in his life for his success. "My mother, who was a business woman herself, raised me that your personal/professional integrity is the most valuable asset you have in this life, and what you do in the performance of your duties, at whatever job you have, is a public declaration of your character and your ethics, and it reflects upon you forever," he says. "And always keep in mind – performance pays the bills."
Marchelle Cagle, CMOM, has lived in or near Birmingham, Alabama her entire life. Her career, however, has traveled a different journey. Today she serves as the Director of Revenue Cycle for Cardiology P.C., a well-established, multi-physician practice, as well as Manager/Owner of Cagle Medical Consulting, LLC , a billing and reimbursement consulting firm. However, Marchelle has taken many steps to arrive there, getting her start in the industry as a teenager fresh out of high school. "I started in the insurance industry at 18 years old as a mail clerk for Provident Life and Accident company [which] at the time paid health benefits for some major companies," she says. After leaving Provident for a short time to learn more about medical billing, as well as serve in a supervisory accounts position, all by the age of 20, Marchelle returned to the company and trained as a health insurance claims adjuster. "This is where I really started to get my footing in the industry, [and] I loved that job, by the way." When the company closed its health division and moved out of Birmingham, Marchelle embarked on her first position in a physician's office, soon being promoted to Office Manager. "Dr. Smith was a wonderful mentor and teacher... I worked for him, and eventually the Carraway Clinic System for seven years," she says. Afterwards, she began an 11-year tenure with Princeton Pulmonary Group as Practice Administrator until 2009, when she began her current position with Cardiology, P.C. Her responsibilities for Cardiology, P.C. include running and managing all aspects of the clinic's revenue cycle, ensuring that all processes on the front end, from coding to collections, produce profits on the back end. "We have a 97% first clean claim yield now at Cardiology [P.C.] after a year or two of hard work," she says. And of course, when she's not at Cardiology, P.C., Marchelle continues to aid her training and consulting clients at Cagle Medical Consulting. "I enjoy helping practice administrators, physicians, and the employees that come along to reach the goals needed to have a successful practice," she explains. ‘I have had, myself, very good mentors so far in my career and when those people come along that want help, I get a lot of satisfaction from mentoring and investing in others that are hungry to succeed," she continues. However, Marchelle's positions have not been without challenges, including keeping on top of mandates from both the government and the insurance industry. "There is so much information out there you can drown in it," she says. " It's important to decide which organizations benefit each person and pertain to what you do on a daily basis and to make long-term decisions, as well from changes coming down the pike, so to speak," she continues. But Marchelle has identified some common issues that affect all practices."HIPAA is still an area that needs attention," she explains. "Getting the first time around billing to the insurance companies is a must. Medicare beneficiaries are 50% of America's insured. When billing the Medicare/Medicaid Federal and State-ran programs, there must be understanding of how to do this properly. Practices want and must lower the rate of returning monies to the carriers and lower the risk of multiple audits." Ultimately, she believes that training and education are the solutions to such issues. "There are so many branches of the government that oversee this process, [that] it can be really confusing, especially if one has not kept up and watch this process evolve." "I mean HIPAA was enacted in 1996 and mandated in 1997 with the Clinton administration. That was a while ago, but there are still people out there that need help in these areas," she continues. "A second area of great concern is correct coding and medical record documentation by the physicians, NPs, PAs, [and others], then by the coders/billing services coding and billing these services out." However, Marchelle maintains a positive attitude as she continues her professional journey. "I am very excited and blessed for the mentors and opportunities that have been put behind me and before me to come. I enjoy helping people with the talents I have been given."
Along with her partner and Chief Operating Officer Diana Riojas, Gretta Kinsella operates Physician's Joint Resource, LTD., a one-stop shop for all services billing, coding, and compliance related in the Dallas-Ft.Worth Metroplex. Read on to find out more about Gretta's extensive background in billing, coding, and compliance, and how she and Diana used their experience and certifications to fight the Office of the Inspector General (OIG) and win. Your personal/professional background: I am a retired military wife. I've lived in a lot of states, moved quite a bit. I first started out...my senior year of high school. My family and my dad [were] very sick, and my family would always go to the pharmacy to get their medicines. And we had an issue at the pharmacy one day that claims wouldn't go, so the pharmacist wasn't going to get paid. So being diligent, and being a tinkerer, I went in and figured out how to get the claims to go, and read the book, and became his backup as far as his coding and billing were concerned. So that's how I started – in the pharmacy area, and just moved forward. I did long-term care billing for nursing, physician billing, and I've also worked on the EHR and practice management sides to facilitate and help have software that would be utilized and be user-friendly [for] practices. I have been a billing service manager, coding manager, and I've also been an EDI Implementation Consultant, which gives you the ability to convert your data into an electronic 837. So I have that little niche. A lot of billing managers don't know how to read an 837, and you call the insurance carrier and ask them what's wrong with their claim. I can tell them what loop and segment is missing and convert it back to a HCFA 1500. So I consider that my gem in the box. I've also been a billing specialist in Radiology. I've been a front-desk person. I've checked someone in. So I started at the ground level and worked myself up to where I am today. Describe your current job position: I'm actually the Billing Services Manager for a billing, coding, consulting, and auditing service. We kind of do all of the above. We have billing clients where we code their charts. We have clients that send us the superbills, and we enter their codes to send the claims out. However we also do compliance audits. Ten percent of all their claims that we send out, we do audit as we know that's required by billing services now. You can't just sit on the back burner and say, "Oh, I just send the claims." That's not the way the OIG [Office of the Inspector General] and the insurance carriers see it now. You are an integral part of sending any fraudulent claims, should they be sent. We also do consulting. I would say that D.K. (Everitt) and Robert Liles (Compliance experts and instructors of PMI's CMCO certification course) really got us passionate about that, as far as doing consulting for compliance. And then we also do follow-up. We are the practice's billing person. We take phone calls and pretty much do everything from A to Z. Tell me how you first get involved with PMI: I had recently moved to Texas. My husband had decided that this was where he wanted to retire after his military career. I went to work for a billing service, [as a POD manager, which basically oversaw all the day-to-day operations of a particular client], and that billing service required all of their POD managers to have at least a Certified Medical Coder certification. What was your first impression of PMI? I thought that it was very thorough. I thought the information was presented to us in an organized fashion...and gave me the ability and the initiative to want to learn it. That is the important part of any coding classes that you're taking. If you don't have the instructor in front of you that's passionate about what they're teaching, then you're not going to get that. I feel that all the instructors I've come in contact with at PMI are passionate about what they're teaching because they're in the industry themselves... They're willing to give you their personal e-mails. They're willing to talk with you, to communicate with you even after you've passed your certifications. They're willing to be there as your mentor. They're willing to guide you because they're truly passionate about the profession. How has your PMI certification helped you, personally and/or professionally? I felt that before I got my certification, I had a knowledge base... However, now that I have my certification, not only can I show a doctor by speaking with them, guiding them and educating them on how to do things, now I can say, "Look, I have a certification that says that I know what I'm doing, that says I'm going to guide you down the right path because I've taken the time and taken my passion and gone beyond to get these certifications." Your office was recently audited by Medicaid. Tell us what happened. This story actually started when a major third-party carrier group for a pediatric office placed the entire office on a prepayment audit. Every 99214 that was submitted would have to be dropped to paper with documentation sent to them in order to be audited beforehand. Twelve-hundred (1,200) claims of 99214 were denied and we were told that they were 99213s. We fought them and defended the pediatrician's original coding position of a 99214. We were then placed on a prepayment review for 60 days before they took us off and all 1,200 claims were paid at a 99214 level. Now fast forward to June 2011. Just after we received our CMCO certification, we received a letter from the same insurance carrier stating that the sample probe they had conducted on the office in late November 2008 with 60 medical records dated from 2006-2008 had been forwarded to the Health and Human Services Commission (HHSC)/OIG. Based on their findings, they found that the error rate, again in regards to the 99214s (as indicated in the medical records and using the OIG's RAT-STATS program) resulted in an overpayment of over $102,000 to our office. We were asked to pay it back ASAP and to have the doctor in question sign a Provider Integrity Agreement. We once again appealed their decision in regards to the medical records being 99214 and NOT 99213. This time they came back to us changing the amount of the recoupment to just over $42,000. Once again, we told them NO in a nice way and proceeded to have the extrapolation thrown out. Finally we received a letter from the carrier stating that because of the low error rate, they had decided to waive the extrapolation and direct overpayment. The pediatric office ended up winning and not having to pay a single penny to the insurance carrier, or in attorney fees. What is the favorite part of your position? Helping a practice get out of trouble, to be honest. Knowing that I go into a practice, and they've called us because they've already gotten an extrapolation letter, and they decided to go ahead and pay it, but they‘ve decided that they need to get things done correctly. Seeing the light go on for a doctor. Realizing that Business 101 is just as important as Medical 101. Or to see an office manager say, "I didn't know we couldn't do that." And just to teach them a knowledge base. That makes my job worth anything. I understand that doctors have rules and regulations to follow. But they're not taught that in medical school. It's our job to teach them. What do you find to be the most challenging about your position? Doctors as well. Because some are receptive, and receive that information, and some say, "Why are you telling me what to do? Who are you?" Doctors are kind of the "show me" kind of guys, [the] "show me" kind of girls. Show me in writing. Sometimes that is the most challenging because it is so complex. It is so complex of the Federal Registry, so complex of the compliance part of my job, to teach a doctor how to be compliant. Because sometimes when you're teaching a doctor how to be compliant, you're messing with their revenue. Because they're doing something that really is fraudulent, and they shouldn't be doing it that way. Or they're pushing the envelope and they're blowing out all sides of the envelope. They're throwing up red flags. They don't understand migrating of data. They don't understand extrapolation. They just want to practice medicine, and they don't understand the requirements. What are the challenges in healthcare today? Doctors used to say, "Oh, I'll never get audited. I'm too small. I'm such a tiny practice." It's not if, it's when. They're coming to your door. If you're taking Medicare, Medicaid, or any kind of federal program, they're going to be at your door. The challenge is getting practices to understand that "when" is coming and [with] what you're doing, you need to be compliant. So that's the challenge for most practices these days, to be profitable, but also to be compliant. And is there anything else you'd like for us to know about you? I am a passionate person about compliance. I am a passionate person about coding. I work for an awesome company. They've paid for my schooling. I just wish other practices would realize that the investment in their staff could also invest in your practice. I'm grateful for PMI. I'm grateful for what I've learned.
Doug Arrington, Ph.D., FNP, CMC, CPC, CPC-H, CPMA, has come a long way from the farm and ranch in Idaho where he grew up. "Grew up in a little town called Kimberly, Idaho," he says. "I milked 17 head of cows every morning and night from the time I was 10 until I graduated from high school." Doug found that the work ethic he had learned working on a farm when he was young has helped him throughout his life, especially when he decided to pursue a career in the sciences upon graduating from high school at 16. "In school I always enjoyed science. When I went to my first year of college, I took a microbiology class, which had some nursing students in it. I was fascinated with the things they talked about," he explains. "So I went over to the nursing school on campus. They seemed a little surprised, as they thought I was lost and needed direction. (This was some 30+ years ago). I told them that I was interested in finding out about the program. I applied and was accepted that fall." While finishing his Bachelors of Science in Nursing at the University of Utah, he decided that he wanted to continue his education, and traveled to Tennessee to obtain a Master's Degree as a Family Nurse Practitioner at Vanderbilt University, one of the few programs that offered the degree at the time. "I found a job and on my first day as a real nurse practitioner, I was introduced to CPT codes and diagnosis codes. That was in the good old days when you billed based on time with the patient!" In his current position as Director of Billing Compliance at The University of Texas Southwestern Medical Center, a position he has held since 2001, Doug is responsible for overseeing professional, hospital, and research billing for 1550+ healthcare professionals and two hospitals affiliated with the system. "The most enjoyable part of my job is being able to educate healthcare providers, billers, coders, and others about the "rules of the road" that we have to play by," he says. "It is fun to come up with creative ways of delivering this information so that they are able to retain this information and apply it to their practice environment. The visual feedback from individuals that they understand the concept that you are trying to educate them on makes my hard work worthwhile." Doug's involvement with PMI began in 2007 when he decided to renew his lapsed coding certification. One of his staff mentioned the CMC. Doug registered for the [self-paced] version, downloaded his recordings to IPod, and did his assignments in the evening. He passed the exam on his first attempt. "Being a certified medical coder has helped me demonstrate that I understand how to apply both the ICD and HCPCS codes to the practice of healthcare," he says. Doug believes that the biggest challenge in today's healthcare environment is addressing how the healthcare system is going to have to change to meet upcoming changes in reimbursement methods. "Additionally, with the Healthcare Affordability Act, one of the major focuses is on preventing fraud and abuse," he explains. "Therefore, those of us who work in the compliance area are going to be charged with ensuring that our agencies' healthcare documentation and claims will stand up to the most rigorous "bounty hunter agencies" that will be working for the federal government to ensure that the healthcare services delivered were indeed needed and documented correctly." "Call it job security, but the rules and regulations and the retrospective reviews are going frequent and in depth," he continues. "It is going to require that we keep our knowledge current and keep our healthcare provider educated as well. Then add ICD-10 on top of this and you have a whole new environment," he says. "In today's rapidly changing healthcare environment it is imperative that we demonstrate to the state and federal agencies that we are billing and coding healthcare claims correctly. I can think of no better way to demonstrate this than being certified by PMI." Patricia Abou-Samra, CMOM
"I grew up in Ventura, California in a medical family," she explains. "My father is a surgeon and came home every day excited with stories about his work. I have a very clear memory of my father teaching me what brain aneurysms are and how neurosurgeons repair them; I wish I still had the napkin with the drawing of brain vessels!" While she's now employed at Ventura County Neurological Associates in Ventura, CA as a Billing Manager for three Neurosurgeons, and Assistant Office Manager of the practice, a career path following her family members' footsteps into the healthcare field was an eventual decision rather than an immediate one. "Out of college, I started working for Marriott International," she says. "I worked as a Front Office Manager and a Guest Services Manager in various resorts. I was working halfway around the world when I decided I wanted to be closer to my family and I wanted to explore other aspects of the hospitality industry." She returned to Ventura where she enrolled in an aesthetics program and became a licensed aesthetician. During that time she also held a part-time job billing for one physician. "While doing both, billing and aesthetics, I realized that I love the client-care side of aesthetics and the patient-care side of billing; I thought that becoming a medical office manager would provide the best of both worlds." And Patricia has never looked back. Now in her present position for the past two years, she is currently working toward re-writing managed care and operational contracts, as well as developing the practice's first website. "I'm making a difference in our community by helping our doctors and staff be the best they can be and guiding our patients through a difficult time in their lives," she says. "After all, there is nothing worse that being sick or in pain and not knowing all your options, personally, medically and financially." Her involvement with PMI began when she enrolled in a CMOM course after hearing about PMI from her local medical association. "I was looking for ways to expand my knowledge in the medical field," she explains. Patricia was impressed by her instructor for the course, Sunjanel Avecilla. "[Sunjanel is] fun, upbeat, knowledgeable, hardworking, smart, caring and engaging." "I believe having my CMOM helped me become more confident and resourceful," she continues. "I also feel secure in recommending new process guidelines for our practice." "[And] PMI is an amazing resource. The more you get involved, the more you feel like family; everybody is there to help. In this business sometimes it feels as if everything is against you, but PMI has given me incredible support and the knowledge that I am not alone!" Those issues include overcoming day-to-day frustrations with insurance companies, such as denials, underpayments, and low-paying contracts, as well as the constant changes in laws and regulations at both the state and the federal levels. "The challenges in healthcare today are endless. From insurance companies to government regulations, [to] patient expectations to deadlines, the list goes on," she explains. "I believe the most important thing we can do is to remember why we are in this field in the first place: to help people!" she continues. "Training our staff to be hospitable, taking as much stress off the patients as possible and knowing the "business" of medicine allows our doctors to do the most important thing: concentrate on providing excellent patient care. Effective staff makes it possible for patients to have the best possible medical experience." What Does It Mean to Have Your Certification? Part II: "Maintaining Your Certification - Lynnette's Story"
In these times, it's smart to weigh the necessities against the niceties. Many of us are taking extra care to examine regular expenditures to see where we can nip and tuck to keep our financial health in check. Lynnette Long, Professional Services Coordinator for Practice Management Institute, recently took time to sit down with us to share some advice for those concerned about keeping their certification current each year. Lynnette enjoys helping people in their profession. Prior to working with PMI, she worked in chiropractics as a staff trainer for five clinics, and also worked in a nuclear medicine endocrinology practice as a front office associate. Now Lynnette assists hundreds of PMI's customers each week, pointing them to information and resources to solve their respective issues, from where to find a link on PMI's website to offering advice for getting those last-minute CEUs. Presently in her ninth year of service with PMI, she says what she loves most about her job is being able to help people and answer their questions, or to direct them to appropriate assistance. She told us about some calls she had received recently from some certified professionals who were contemplating whether to renew their certification or allow it to lapse. "My physician paid for the initial certification but won't pay for the continuing education or the renewal fee," say some. Others have said that they cannot afford to keep up with their CEUs. Lynnette says the issue is that people need to understand the value of their certification and the importance of keeping it current. She says even if the employer initially paid for the program and exam, it is an individual's responsibility and right to keep the credentials current. "It's yours no matter where you go. If you lose sight of that, you rationalize that you don't need it. What if you're not working there next week or next year? There's been a lot of layoffs, but they [people] haven't thought about it that way. They need some assurance about what is prudent to cut back on and what's essential to keep," explains Lynnette. PMI has noted a sharp increase in the number of lapsed certified professionals who are working to reinstate their certification to active status this year. A key reason for this is more competition for fewer jobs. "We are going to see a big increase in the number of people coming into the healthcare field from other professions that are not faring so well like banking and real estate. If you lose your job, your certification and your experience will keep your resume at the top of the stack when you are competing with hundreds of other applicants. Sometimes it just takes a different perspective to take stock in what is important for your career." Now, more than ever, it's important to keep your certification up-to-date. It increases your credibility as a currency that validates your level of advanced knowledge to your employer and colleagues. For the employer, your certification gives them peace of mind that you are working within federally-enforced compliance guidelines and contributing to a higher rate of paid claims. In a nutshell, it offers them assurance that you understand current rules and how to apply them so your physician(s) gets paid. But getting the certification is just the beginning. Keeping it current is arguably as important as earning it in the first place. The continuing education required by most certifications to keep them current helps provide assurance that your knowledge is current in a profession where the rules are constantly changing. "There's probably very few certified professionals out there who I haven't talked to in the past nine years," she explains. "The reason I've been here as long as I have is because I understand what we have to offer the medical staff to improve their careers, knowledge, [and] capabilities," she continues. "I understand the meat, the substance of the course and the credibility in the marketplace for what we teach. The caliber of our speakers, conferences and training is second to none in the healthcare training arena. Knowing that is what gives me the ability to be self-assured, [and] sometimes bold about what I'm saying." Currently, PMI provides four certifications for medical office professionals, including coding, insurance processing, medical office management, and medical office compliance. The company's faculty is backed by a team of committed program managers and support staff working behind the scenes to ensure that PMI's training, certifications and customer service continue to meet and exceed today's high standards. "You worked hard to earn that certification and it didn't come cheaply. It takes a lot of time to study and take the exam. People invest a lot of money, time and dedication to earn their certification. But you can't lose sight of what you accomplished because your employer isn't going to pay for it," lynnette says. "Look at the bigger picture. Your credential is a career accomplishment and a personal responsibility. It's not something that your employer can take away from you." Barbara Good: Crusader for Physician Practices
"I was hired for a Pharmaceutical Sales position," she explains. "One position has led me to another as my skills have increased." Those positions included being employed as a Supervisor of Provider Relations in managed care (in a start-up HMO), Executive Director for a physicians' network, and as an Area Manager for a national dialysis company. However, Barbara joined the WVSMA nearly six years ago in the newly-created position of Physician Practice Advocate. In that role, she campaigns for physicians and other medical professionals regarding reimbursement and other medical practice issues, while also developing resources for them to improve. "My position is ever evolving, and that keeps every day fresh and exciting! I enjoy the daily interactions with physicians and their practices. I like knowing that each day will bring some new challenge and I truly like being able to solve problems. The practices continue to challenge me, too!" she explains. "Some days (most days)! I feel like a juggler!" she continues. "I think it comes from being a Type E personality ---- everything to everyone. I believe that each office deserves my personal attention and I try to give each the individual attention they need." Barbara first (unknowingly) became involved with PMI when she took a half-day course in 2004, prior to working for the WVSMA. However, it was only after joining the WVSMA that she interacted with one of PMI's faculty members, Rose Moore, who encouraged her to explore holding CMOM courses for her organization. "One thing led to another, and I began working with Michael Moore [PMI's Director of Outreach, Network, and Business Development, and no relation to Rose Moore]. The rest is history!" The relationship between WVSMA and PMI has only grown since then, with Barbara even forging additional partnerships with the West Virginia State Office Manager's Association, numerous hospital systems, and others to offer PMI's classes. In 2011, she was awarded PMI's Best Client Host, and has been selected to serve as a member of PMI's Advisory Board for 2012-2013. "I have been highly impressed with PMI, the people and the product," she says. "From the beginning of our "telephonic" relationship, PMI has been encouraging and supportive. Our first CMOM class (Spring 2010) drew a packed classroom of 33 attendees and I had a waiting list, so I scheduled a fall class. Last May, I attended the PMI Conference and met many people from the PMI family. It is a terrific and talented group!" PMI's certification training has not only developed the competencies of medical professionals all over West Virginia, but Barbara as well. "My CMOM certification has given me more confidence in my management knowledge. I am also better able to "coach" others in management positions," she says. "The CMC certification has enabled me to better help our physician practices with their coding and billing issues. I am also able to better understand the dilemmas that medical practices face in their daily routine. I also know that I am more credible because I am certified." As someone who addresses public health issues on a daily basis, she also believes in the power of education to battle the challenges in today's healthcare climate. "Administrators and staff are being required to do more with less and it appears that will be the norm. The variety of staff educational levels in the medical practices is astounding. I feel that we need to educate constantly." "I believe that practices want to do things correctly but sometimes just aren't sure how," she continues. "If they're getting $$$ [money] in, they think all is well; however, many are already finding their practices being audited. We need to educate on compliance in all forms. " As a result of that commitment to education, Barbara continues to spearhead these kinds of opportunities for WVSMA members, with PMI serving as a valuable component to making them happen. "I think that by working together (PMI and WVSMA) we can continue to bring valuable and needed educational programs to WV physicians and their medical staffs." Debra Matthews, CMOM, CMIS, CMCO
Debbie started out on the clinical side, pursuing a degree in Nursing. She was in her last quarter of school when life threw her a curve ball and she found herself a divorced single mom with limited education and income. She had to find a solution fast. She was hired by a physician who offered to foot the bill for her education if she would agree to run his office for him. She took a coding class but needed more training on the business side, and she needed it soon. She didn't have time to take a two or three-year college program. "I had a small child and no time to go back to school for three or four years to learn what I needed to know," she says. She researched classes online and signed up for a Certified Medical Office Manager (CMOM) class offered by PMI in Greenville, SC. The class was three and a half hours away, but she was determined to do it. "I had to rent a car because my car was so old and shot. I was afraid to go that far," she says. "The CMOM class was a major help to me." She went on to earn her Certified Medical Insurance Specialist (CMIS) designation, and is now in her fourteenth year at her practice. At one point, when she thought her physician employer was going to retire, she put out job feelers. The hospital system in the area told her that they would not have considered her without her CMOM certification, which she said really opened doors for her. She discovered that her certifications would net her $10-$18,000 more than the amount she was currently making. Ultimately, the physician she was working for decided not to retire and instead gave her a raise. "I'm in a better situation now, financially, with a great benefits package." "I just believe in PMI. It changed the way that people look at me. The MGMA [Medical Group Management Association] is big in this area, and I've found that when I go to their conferences I can hold my own with everything." Debbie's training at PMI has not only benefitted her in the outer medical management community, but in her physician's practice as well. "My doc is old school, 65, not trained in auditing charts, doing E & Ms and codes, and I can tell him, ‘no you don't understand. This is what is going to be done now.' It's like pulling teeth, [such as] when I held up his paycheck because he hadn't given...documentation." "I really thought he would fire me," she continues. "But when I showed him the documentation... he got it in." However, Debbie understands the importance of ongoing training to keep her skills and knowledge up to par. She says she has a hard time getting away for training with only six employees in her office. So she signed up for PMI's TOTAL ACCESS weekly webinar subscription programming. "It [TOTAL ACCESS] keeps me here and I really feel like I've got a grasp on things." "Business goes on. I've got to keep up with these classes," she continues. "We have been audited twice. The first one I had only been hired less than a month prior. I cried a lot. More recently, we got a request for audit through mail, and we turned in everything in a timely manner." "I try to do monthly audits to make sure we're in line with what we would be." No longer a scared single mother with nowhere to go, Debbie is now an accomplished medical practice professional who continues to pursue new goals stemming from the training she has received. She serves as a PMI Professional Proctor, and in her next endeavor, has expressed interest in training others in her area as an Associate Instructor for PMI. Throughout her years of experience, Debbie has maintained her emphasis on the value of continued training, not just for herself, but for everyone working in her field. "We'll never know [about healthcare] because it changes faster than we can keep up with it. I always say, ‘You aren't required to know the answer immediately, but you're required to find out. It's his job to save lives. It's my job to run his business.'" |
Nancy McKinney, CMC, CMIS, CMOM, CMCO
Dr. Kim Stooke, CMCO
Sharon Lusk, CMC, CMCO
Tim del Rosario, CMIS, CMC, CMOM 
Brandy Brimhall, CMCO
David Wilburn, CMOM, CMCO
Marchelle Cagle, CMOM
Gretta Kinsella, CMC, CMOM, CMCO, CMIS
Doug Arrington, Ph.D., FNP, CMC, CPC, CPC-H, CPMA
Recently-minted CMOM, Patricia "Patty" Abou-Samra, is new to the PMI family, but not so much to the medical profession. In fact, it's in her blood. 
Like most certified professionals, you probably spend a few days each year sorting through your education files, pulling together documentation and adding up CEUs for annual certification renewal. With tough economic times already in place, some certified professionals are feeling the financial squeeze and may be compelled to evaluate the cost-benefit of their certification.
Keeping physician practices updated and well educated is a high priority for Barbara Good, CMC, CMOM, and Physician Advocate for the West Virginia State Medical Association (WVSMA). A West Virginia native with a Master's Degree in Special Education, Barbara was an instructor for children with learning disabilities when her career took an unanticipated turn into the healthcare realm. 
Debra (Debbie) Matthews is a Certified Medical Office Manager, a Certified Medical Insurance Specialist, and just received her Certified Medical Compliance Officer designation. She is the epitome of enthusiasm for what she does as an Office Manager for a Family Practice physician in Florence, South Carolina. When asked how she maintains that level of energy and passion, she credits her confidence to the knowledge she has gained from her training. 