Deborah Stafford

28+ years of experience, including 25 years in management, in coding and auditing physicians, in-patient and outpatient facility documentation. Extensive experience in evaluation and management guidelines, multispecialty providers, both in-patient and outpatient facility documentation, billing and educating physicians and staff on compliance guidelines. Bringing to the job the skill and ability to ensure Medicare guidelines as well as NCCI edits and Federal Regulations are being followed for all aspects of coding and documentation, as well as ICD-10 coding.

Experience in understanding Privacy as well as General Compliance.

Experience working with markets, physicians, and staff to avoid denials or delays in billing helping to increase revenue. Working with OIG investigations, specialty projects related to investigations on findings from Not For Cause Routine reviews. Present data and statistics as well as metrics to the Executive Compliance Committee.

Manager Compliance Auditing and Monitoring at Erlanger Health System (2020-11 – Present)

Erlanger Health System became a 501 C 3 Not for profit organization and is the largest trauma center in the area. Employees over 700+ providers as well as being a Teaching Hospital where Residents are used in almost every aspect of service.

• Presented to the Executive Compliance Committee, and Organizational Compliance Committee, every quarter results from reviews that had been performed by the Compliance Department
• Lead a team to perform Attorney Client Privilege (ACP) reviews as warranted by the organization
• Managed a team of certified coders and auditors performing audits and investigations across the organization. Team performed reviews on a quarterly basis and provided education to each provider scoring below set threshold
• Trained new employees on the use of EPIC and MD audit
• Ran reports for any areas of risk or potential risk areas and performed reviews or investigations for these subjects
• Worked with outside vendors for Medical Necessity review and coordinated meetings with the providers
• Worked with HIPAA and Privacy related concerns
• Assisted with building the Physician Compliance Program within the Organization
• Worked with EPIC teams to adjust or build new templates or areas that need revamping
• Worked with coding team to educate coders and billers on both professional and facility teams
• Multiple other compliance and auditing duties as required
• Used the RAT-STATS OIG software to run randomly statistically valued samples of accounts for Compliance Reviews
• Created and managed a team of 4 compliance auditors to successfully complete reviews for all 700+ providers as well as multiple facility reviews per quarter
• Reviewed and performed research for Trauma billing and documentation for Emergency Room services
• Performed reviews For cause and Not For cause, on facility claims, ensuring the documentation in the chart supported all codes billed on the UB04 claim
• Worked closely with the Chief Compliance and Privacy Officer to update or implement polices that were either out of date or new policies were warranted
• Worked with inside counsel and outside counsel on OIG investigations and research or reviews to support any findings
• Worked with Revenue Integrity Team to ensure any areas for the Facility billing were documented and supported
• Worked with Department heads across the organization to develop better processes for documentation and capture billing
• Worked with EPIC training team to ensure providers and staff were educated on the appropriate use of scribes and what the requirements were to support the billing
• Presented coding and documentation criteria at departmental team (Midlevel, residents, Hospitalist) team meetings
• Presented Compliance Guidance for HCCA and AAPC on multiple topics
• Regular member of the 340B drug quarterly meeting
• Work with Medical Affairs in updating Physician and Non-Physician contracts
• Worked with FQHC's and Urgent Care Clinics with billing and coding compliance
• Writing reports to Executive leadership regarding outcomes on investigations or reviews

Manager Physician Coding Compliance at LifePoint Health (2010-01 – 2020-12)

Since the formation of LifePoint in 1999, it has grown to include more than 70 hospitals in numerous states. It is a leading Healthcare company dedicated to making communities healthier. LifePoint owns and operates more than 1800 physician practices as well as several hospitals.

It is a multi-million dollar company with more than 10,000 employees. Position included auditing multi-speciality physicians' Evaluation and Management services as well as surgical procedure services. Focus was Cardiology, Vascular and Interventional operative notes with education provided to the coders as well as the physicians on ways to improve documentation and enhance revenue.

• Provided education to physicians as well as coders and billers on Medicare guidelines to avoid denials and code accurately to increase reimbursement for the practice
• Prepared executive summaries and action plans based on audits to communicate to hospital administration and executive teams
• Properly managed time while working remotely
• Worked to obtain knowledge in multiple EMRs for reporting and patient documents
• Worked with the legal department on completing pre-bill reviews for Due Diligence, while still completing regularly scheduled work plan
• At times- team performed pre-bill procedure reviews on Specialty specific providers who failed procedure audits and provided education to staff and physicians
• Educated team members on DRG coding as well as ICD-10 PCS for facility billing

Lead Coder and Auditor at East Tennessee Heart Consultants (2000-01 – 2009-12)

East Tennessee Heart Consultants is a group practice with multiple locations around the Knoxville area. They have over 33 physicians that specialize in Cardiology, Vascular, Pulmonary, interventional medicine, as well as cardiac surgery. Position involved coding and billing cardiology services which included both evaluation and management as well as surgical operative procedures.

Provided education to the physicians once the process of coding and auditing were completed. Developed an audit program to cross-check the billing once complete to ensure all documentation was complete and documentation requirements met.

• Performed random audits on the 42 employed physicians regularly
• Coded cardiac procedures as well as the office services and facility services that were performed
• Implemented an audit program to ensure all physicians were following Medicare rules
• Educated staff to ensure up-to-date information was relayed and understood

Billing and Coding Degree in Billing and Coding – Tennessee Technology Center (2007-12)