A day and a life featuring

Melissa Arena, RHIT, CHCCorporate Compliance Officer & HIM ManagerSt. Ann’s Community

marena@mystanns.com

1998: Back to school after many layoffs, MCC HIT Program from 1998 to 2002.

2000 :Gained Employment at SAC,PT File Clerk 2002: Promoted to HIM Manager, FT in 2002 2003: Sat for RHIT exam in 2003 – Passed. 2011: Promoted to CCO b& HIM Manager 2012: Sat for HCCA’s CHC exam – Passed 2015: ??? Who knows???

Third largest health care provider in Monroe Co.

One of the largest private employers in Monroe County: 1200+ employees

Multi-level 65+ population provider Patient Centered Care Focused Been in existence for 140 years Founded by the Sisters of St. Joseph in 1893 Approximately 600 residents and patients

St. Ann’s Home: 388 bed LTC SNF Wegman’s Transitional Care Center: 72 bed

Rehab Leo Center for Caring: 10 Bed Hospice Wound Care Center for Healing: Joint

collaboration with RGH: Hyperbaric Chambers Chapel Oaks: 125 Full service 65+ independent

condo units Adult Day Care Services: 3 locations, 1 Medical

model and 2 social models Home Connection: Medical platform Adult Daycare

Center Memory Care – SCU: Specialize in Dementia 30

bed

St. Ann’s Care Center: 72 bed LTC SNF The Glen: Assisted Living Rainier Grove Memory Care at Cherry

Ridge: Memory Care unit specializing in Dementia

Assisted Living: Apartment type living, 24 assistance

Cottage Homes: Independent patio homes Apartment Living: Independent Living IronWeb Medical Practice: Location on

both campuses

Multiple changes in LTC regulations in past 15 yrs.

Budgeting restraints Negative outlook for HIM Dept. & staff Implementation of E.H.R systems Possible department elimination Brainstormed ways to keep HIM alive Identified skills needed to stay

marketable.

Fairly new field to health care arena <10years

Low number of credentialed professionals in the marketplace

Forecasted strong professional growth and career advancement

Open new doors for HIM professionals

HIM & CC complement each others goals, responsibilities and skill sets:. Knowledge of state and federal guidelines Knowledge of all coding systems Understand billing and reimbursement dynamics Understand clinical workflows Maneuver between paper based & E.H.R.

systems Interact with most internal departments

Stringent federal and state regulations Government focus on Medicare and

Medicaid $ DHHS’s OIG Compliance Program Regulation OIG & OMIG Work Plan Multiple billing & reimbursement systems Many possible areas for Fraud and Abuse

Report to two separate department heads

HIM Manager – ITS Director and CFO Corporate Compliance Officer: CEO and BOD

Manage two budgets Two Job descriptions:

One each for Manager, CCO One each for HIM Staff and CC Staff

Two sets of professional standards

Clinical Audits Provider Orders Touchscreen C.N.A treatments Minimum Data Set (MDS) and Case Mix

Index (CMI): CMI 7-day look back period documentation

LTC/Rehab Diagnosis coding Assessment schedules Physician Billing and Coding

Non Clinical New Hire background checks – HR Monthly monitor of the List of Excluded

Individuals / Entities (LEIE) for all staff, BOD, Venders & Contractors

CMS’s PEPPER Report (Program for Evaluating Payment Patterns Electric Report)Internal Systems Infrastructure and who has accessContracts and BAA’s

Internal Policy & Procedures

Reporting and investigating all “Hot Line” Calls Investigate and follow-up Internal External

issues and complaints Government Regulation Research ROI Staff Education about both HIM and

Compliance Standards of Ethical Conduct Scanning all hard copy documents

Everyday is different. Adding Compliance to my HIM career brought it to the next level. I can’t imagine not working in this field and advocating for our senior community as well as supporting both AHIMA and HCCA and their very similar missions.

Questions?