A Day in the Life of a Travel Auditor

Have you ever considered a career in travel auditing? In today’s episode, we talk with auditing expert La Tanya McNair about her experience as a travel auditor. We chat about everything from the various routes one might take to land the position, the dos and don’ts of packing for a work trip (and embarrassing packing fails), the complexities of things like acquisitions, and how to take a proactive approach to auditing. La Tanya has had a long and diverse career that lends a lot of wisdom to other folks working in healthcare compliance or auditing. McNair shares tips, tricks, and frustrations of the job that every medical auditor can relate to, such as dealing with intimidated medical staff and the horrors of standardized templates and the dreaded copy and paste that comes with it.

“Sometimes, medical coders and medical office staff get a little intimidated, especially if they know the auditor is coming to that office. One of the things they like to do, unfortunately, CJ, is they like to hide medical record charts from the auditor. In today’s day, they can’t do that so much because everything is on a server, it’s electronic health records, so you can’t hide information from the auditors anymore, but a good auditor will always know you pre-audit before you go into a medical facility. Auditors always flinch when providers use templates–those copy and paste templates because we can detect phony immediately. Where you’re HPI doesn’t even match your examination components, and it’s so evident that your copying and pasting one record over another, and I was like can they outlaw templates. …I’m like, that doesn’t even pertain to this visit.”

In this episode of “Compliance Conversations With CJ Wolf MD.: Lessons Learned From a Travel Auditor,” you’ll discover:

• • What it’s like to be a travel auditor and lessons learned on the road.
  • How to take a proactive approach to auditing.
  • HIPAA issues from an auditor’s perspective.

Episode Transcript

CJ: Welcome everybody to another episode of Compliance Conversations. I am CJ Wolf with Healthicity and today’s guest is La Tanya McNair who is the client success manager with Healthicity. Welcome, La Tanya.

La Tanya: Thank you CJ, great to be here.

CJ: Yeah it’s great to have you. What area of the country are you in?

La Tanya: I am in the fabulous Las Vegas, Nevada [laughs]

CJ: Nice

La Tanya: Viva Las Vegas

CJ: Awesome, most listeners know I’m in the Salt Lake City area. I make it down to Vegas. It’s a great place. La Tanya: Oh I love it here. Everything is happening in Vegas. Come on out, come on down.

CJ: That’s awesome. Today’s topic, we’re going to talk about auditing and traveling. Auditing, La Tanya has a lot of experience there but before we get into that. La Tanya just takes a minute to tell us a little bit about yourself, and how you got into what you’re doing. You know we all kind of end up in this space from different paths and I always think it’s interesting to find out where people are coming from.

La Tanya: Right, I agree with you CJ. Well, I’ve been auditing for, oh my gosh, no actually I’ve been in healthcare for thirty [30] years.

CJ: You must have started when you were one year old.

La Tanya: Right? Well, you know what I have some interesting information for you. When we talk about how we got started in healthcare. My start, my first job in healthcare was as a PBX operator in for medical exchange.

CJ: I remember that.

La Tanya: Yes, well this was like an old school PBX system where the operators, I was an operator, would use cords to connect the physicians to their calls. Did I just date myself? [laughs]

CJ: I love it.

La Tanya: I probably just totally dated myself but it’s kind of funny you know millennials of today, or auditors today, may not even know what old-fashioned switchboards are. They used to call them to cork boards back in the day.

CJ: Yeah that’s funny.

La Tanya: Yeah but I was just a couple of shakes away from tin cans you know [laughs].

CJ: Exactly, that is so funny.

La Tanya: But through all of my thirty [30] year history in healthcare, I’ve done everything CJ from human resources training, safety training, compliance, HIPAA, privacy, and security training. Medical billing, and coding, I worked as a marketing liaison, regional finance manager, and regional auditor throughout those thirty [ 30 ] years in healthcare. But I love what I do here at Healthicity, they have amazing software here for auditing it’s incredible.

CJ: Well that’s really interesting to know a little bit about your background. It’s very broad and you have a lot of experience. Tell us a little bit about how you got into auditing yourself.

La Tanya: So one year I was working as a marketing liaison and we had these different regional directors that would come into these medical facilities just to check on the facility. Well one day this regional director comes in and he asks me for data so I went to the computer I like creating Excel documents so I created the data that he wanted on an Excel document and I presented it to him. Well, he was really impressed with the document because it was really professional how it was done and one of the reasons why he was really fascinated with the Excel document was because he was previously in another office visiting and he asked someone there for the same data and the person there gave him the data in the form of a handwritten sticky note. [CJ laughs] And so he was horrified. He really liked my presentation and how professional I was and he was like I need this woman on my regional team. So then I was promoted, I just kept getting one promotion after another because I was promoted to like a medical biller and coder and from there I went to regional finance so in working the whole West Coast region I had several offices in different states and from there I became a regional auditor. So that was my start, it all started with an Excel document. Go figure [laughs].

CJ: Well there you go and I’m curious, you have a lot of credentials, certified coder, and those sorts of things.

Question: Did those come early on or midstream?

La Tanya: It came with the promotion because they took me under their wing and said we are going to invest in this person here. We’re going to invest in La Tanya. From there I was trained in medical billing and coding, I was trained to be an auditor and I worked with some of the best auditors in the world they took me under their wing and they showed me what to look for and educated me. It was amazing.

CJ: Yeah mentorship and having a mentor is such a great thing. In one of our previous podcasts, I was speaking with Brian Burton about the importance of having a mentor that changed my career and now that we’re a little bit further in our careers we need to be mentors too.

La Tanya: Totally agree.

CJ: I’m glad you had that experience. So let’s get a little bit into specifics and some questions that I think you have the experience to answer.

Question: What makes auditing tough during, let’s say a new acquisition?

La Tanya: Well, acquisitions can be tough and it all depends on the facility that’s being acquired. There are two types of acquisitions that I consider. Some are friendly acquisitions and some are hostile. So what does that look like? What is a friendly acquisition? A friendly acquisition is one where the organization, the provider has gotten with the staff, has informed the staff that they’re getting bought out or taken over by another company and that physician is able to soften the blow and the anxiety of the staff by letting them know it’s going to be okay. These people are going to come in; they’re going to make us bigger and better and greater. They’re here to support us. That’s a friendly acquisition. The hostile acquisition comes in when the providers don’t communicate with their staff. And all of sudden you have a team of auditors coming in and you’re like what’s happening? And you find out at the last minute that your organization has been bought out by another company then that fear and that anxiety the staff are more like what’s happening? What about our jobs? How do we go about doing things?

[crosstalk]

Exactly, it’s very common. So as an auditor, when you talk about CJ, paying it forward, going in, and being that mentor. We really serve as mentors to go in and help people to be successful. We want to encourage that success in them. We don’t want them to fear us to be intimidated. We want them to bring us into their world and as a good auditor, you really need to know your people. Let them bring you into their world and embrace you, then you take your knowledge and their knowledge and you tweak it just a little bit so it’s not a culture shock. Right? No one likes to be bulldozed so you don’t do that to people.

CJ: Exactly, so when you’re doing an acquisition audit. Are you doing things like due diligence? Like are you checking for coding liabilities before the acquisition or operations moving forward or both? Tell us a little bit about those specifics.

La Tanya: Yes, you’re actually doing both because, first of all, before you do an acquisition you really need to know the portfolio of the organization that you’re taking over. You want to know if they’re a compliant organization, you want to know if they’re getting it right, you want to know if they’re up coding to increase their revenue. You’re going to do a lot of homework on that facility to see what type of organization they are. You’re going to look and see if they had any previous sanctions and fines and what they look like. That type of thing. So you’re going to do some homework in the beginning.

CJ: Yeah, that makes a lot of sense. You know I’ve done a lot of auditing over the years too and I put my compliance and auditing work into two buckets; proactive and reactive. A lot of times we spend so much time on reactive. We’re just reacting to an external audit or some sort of hotline call or allegation that’s raised internally but in the perfect world, we’d be more proactive about it.

Question: Could you talk about an approach to proactive auditing?

La Tanya: Yes, when you’re doing things on a proactive level CJ, you want to do your homework. You want to make sure that you know as much about that organization as possible. So you’re going to create a checklist. So in you’re going to make sure that you’re proactively running reports, taking a look at clinical documentation and billing records to see trends, you’re going to do a trend analysis, you’re going to know who your players are and their history. That type of thing.

CJ: Yeah, I’m thinking when I did proactive auditing I have a limited amount of time and resources. Let’s get the biggest bang for our buck and rather than just do random, I know random can be appropriate at times, but like you said I would like to get to know that provider and say what are your bread and butt services? So let’s say you’re a cardiologist. Is he doing cardiac caths all day, is that representing 80% of his revenue? It makes sense to focus your proactive efforts on either known risks, so maybe OIG has some work plan item or your local MAC is doing some local auditing but then knowing your provider and what their bread and butter services are.

Question: Would you agree with some of that?

La Tanya: Oh wholeheartedly. Let me just elaborate on that for a minute. Like, say, for example, I was auditing a medical oncology group. Now a medical oncology group will 100% fail an audit if their medical coders are not coding what they call Isodose plans properly. So Isodose plans could be 2D, 3D, or IMRT plans so in a proactive approach to make these auditors successful in what they do, I first went out to learn for myself, how do I read an Isodose plan. So I can take that knowledge back to those coders so they don’t fail these audits. So I went out first, I first learned, I sat with the physicist and the dosimetrist and I said teach me how to determine from a 2D to a 3D from an IMRT plan. So I took that knowledge back to my people, trained them on how to identify those, and you know CJ my team never failed an audit.

CJ: I think what you describe is similar to some of my experiences. You try to learn and I think most of the people in the medical profession, doctors, nurses, physicists, and those sorts of folks are willing to teach. If you approach them the right way you can learn a lot, you bring that back, and now there’s more of a collegial type of relationship versus I’m out to get you type of thing.

La Tanya: Absolutely, 100% correct. When people are passionate about what they do they will share their knowledge with you if you show some type of interest and I always show interest in what they’re doing because it’s genuine, I really want to know because my job as an auditor and as a trainer is to make sure I have a team that’s successful. When they’re successful I’m successful so I do the groundwork.<,/p>

CJ: Well you have probably learned a lot of lessons as an auditor over these years.

Question: What would you say is one of the biggest lessons you’ve learned as an auditor?

La Tanya: Oh my gosh. One of the biggest lessons I ever learned, CJ, was to never say anything that I could not prove. You know as auditors we hate when people fail audits and immediately we’ll go in and say how can I help? But this one provider failed the audit and when you fail the audit you have to show them why. You have to sit down with them and show them what they’re doing wrong and you have to bring guidelines to the table and say I am auditing you according to the guidelines. And so once I forgot to bring the guidelines with me and so I was able to show the provider all the guidelines for why he failed the audit except for one guideline he questioned me on and I didn’t have it at that time but I was able to correct that behavior and say when I get back to the office I’m going to email you those guidelines. That type of thing.

CJ: That’s a good point. It takes weeks and months and years to build credibility with providers but it can be lost in a heartbeat.

La Tanya: In a heartbeat, I agree.

CJ: I think some people that are drawn to auditing probably have those characteristics where they are precise and want to dot all the I’s and cross all the t’s. I think most the personalities will try to be prepared but if you miss it once you have to rebuild that.

La Tanya: Exactly, and as an auditor, you don’t want to lose credibility, you want to get it right the first time.

CJ: Exactly, I thought it was interesting, before the podcast you mentioned you were a traveling auditor.

Question: Could you tell us about that and maybe what was the craziest thing that ever happened to you as a traveling auditor?

La Tanya: Oh my gosh, I traveled all over the world. As an auditor, sometimes we get assignments where we are in specific states for weeks at a time. We’re going back week after week after week. I remember going to this one hotel and every time I’d go to check in they were familiar with me. So I would walk in with my little traveling laptop bag and they would always welcome me. They would tell me “Welcome back” and give me my hotel key and off I go to my room. So weeks at a time, “Welcome back,” here’s you key, and I’d go off to my room. Well this one day I walk in and the same reaction, she says, “Welcome back” and I say “Thank you” and goes here’s your key and I take the key and I’m off down the corridor to go to my room and she says, “Oh, by the way, your husband is in the room waiting for you.”

CJ: [Laughs]

La Tanya: I was like what? So I stopped dead in my tracks and I said, “What’s my name?” She goes aren’t you blah blah blah” and I go NO.” [laughs] CJ, she gave me a room key to a man who was in there waiting for his wife to come.

CJ: It’s a good thing you did not open the door.

La Tanya: Yes, it’s ironic. What was ironic about that whole situation is the man was a traveler like I was and he would frequent that hotel weekly same as I and the kicker is he had a wife that they tell me looks just like me. So they would always get us mixed up. I would always get his folio for his room charges, he would get mine. They just could not get it together, they always mixed us up. But like you were saying, thank God I did not walk into that room on that man. That would have been a nightmare.

CJ: That’s so funny. It sounds like you’ve done a lot more traveling than I have. I remember once coming back from a consulting trip my flight was really early, like 4:30 in the morning so I was at the hotel and I set my alarm but I must have hit snooze a couple of times and I literally, when I noticed the time, I had 22 minutes before my flight was departing and I was still in bed. I made it through. Fortunately, I had everything packed and I just ran out of there, the hotel was close to the airport, I ran through security, I was running the whole way, I was the last person on the plane and I made it.

La Tanya: Oh my gosh. I can’t believe it. Wow.

CJ: What’s the craziest thing that’s happened to you at an airport.

La Tanya: Okay, I had a connecting flight and it was in one of those states where it’s cold and windy and rainy and something happened and they had to ground all flights and this particular flight was in the middle of the night. So once they grounded all the flights they closed the airport. We were like a herd of cattle trying to get to various airports, we were just being shuttled over to various airports. I wasn’t very seasoned to know how to have carry-on luggage so I checked my bag and when I got to the hotel I was cold, I didn’t have any clothes, I didn’t have my bags, I was miserable. I had no luggage and I actually had to sleep in one of the hotel towels. I was miserable. That was one of the craziest things that ever happened to me when they closed that airport and I had no luggage. I thought this is awful [laughs].

CJ: That does sound terrible.

Question: So I’m interested in some of the other lessons you’ve learned as a traveling auditor. Could you talk about that?

La Tanya: Between the airline, the flights being grounded, and me having to sleep in a hotel without my clothes, once the airline lost my luggage and I had to show up to the office in a tank dress and flip flops because the airline lost my luggage for two days. Then once I missed the connecting flight, I wasn’t like you CJ, I actually missed the connecting flight because I wasn’t seasoned and I wasn’t paying attention to the time zones. The time zone thing got me all caught up and I actually missed the connecting flight once. But I think one of the biggest lessons that I learned was how to travel with carry-on luggage. I remember once I was traveling with a regional team. I’m talking big executives I’m traveling with and we got to our final destination I held up the whole team because I had a checked bag so when we got to our destination we couldn’t hit the ground running. Everyone had to go to the luggage carousel to wait on my bag. I was horrified. I was like oh my God La Tanya you are holding up a whole regional team. So what I ended up doing was a good friend of mine came over to teach me how to pack so that I could pack my luggage to learn how to use one carry-on bag. So I learned how to roll my clothing, how to pack clothing that didn’t wrinkle, how to travel with travel-sized toiletries, things of that nature, things that made it conducive to having a carry-on bag. That was one of the huge lessons learned about traveling is hand carry-on that bag. Don’t check your luggage.

CJ: Exactly, what I would do is if I was staying for a while and I had to check a bag. I made sure I had at least one day’s worth of something that I would need like a professional dress and that can help. So as an auditor you’re probably dealing with paper copies of patient records, maybe traveling with that, or like a laptop and EPHI, as compliance professionals, we want to make sure we’re staying compliant with HIPAA.

Question: Any tips that you recommend as far as traveling with HIPAA-type issues?

La Tanya: Exactly, now when we talk about HIPAA, security, privacy, and safety, I remember one day going through. You know how TSA has to scan all your laptops, you have to put them in a bin and they have to scan that through. Well, I put my company laptop in one of those bins and now I’m on the other side waiting for my laptop to come through and I noticed that two laptops are coming out of that scanner and they are identical. SO there’s a man standing there and he grabs this laptop that looks just like mine so I’m like, “Wait, hold up. I said I need you to open that laptop.” Because inside mine was my name, I had a label with my name but it was on the inside of my laptop. And so he did and the other laptop comes through and I opened that one and I said okay we are good you can go now [laughs]. But I think one of the biggest lessons learned from that is I am thankful that I had my name on the inside of the laptop but if I wanted to double down on that I would put a label on the outside also.

CJ: Yeah, that’s smart.

La Tanya: Just to easily identify it.

CJ: A neon purple sticker just to say that’s my laptop. I deal a lot with clients, like HIPAA security and those sorts of things. One of the number one reasons for breaches these days is a stolen or lost laptop that’s unencrypted. If it’s encrypted and you’re encrypting to a certain level it’s not going to be deemed a breach because it’s a very low probability of anyone getting that information and you wouldn’t even necessarily need to report it to OCR if it’s encrypted appropriately so I’m sure you would probably recommend similar things like making sure thumb drives and anything your transporting is encrypted.

La Tanya: Exactly, and you know sometimes we have a lot of downtimes while traveling depending on where we’re going. So often when we have a layover flight we will pop open those laptops and work. One of the biggest things I’ve learned is to never use one of those charging stations because hackers were doing things at those charging stations. So you never want to use charging stations because there were bypassing plug-ins they were using and so if you plug into those and there is a bypass device those people are stealing information, downloading information from your computer. I learned to always plug into the wall if you’re going to be working at an airport. Also, I learned it’s very common for people to just sit and open up their laptop and people are walking behind you and they are seeing everything you’re seeing so I would always make sure my back is against the wall so no one can look over my shoulder to see what I’m looking at, that whole thing with the privacy and security.

CJ: One of my favorite cartoons that I’ve shared in some compliance presentations I’ve done is of two gentlemen sitting on a plane and one is working on his laptop and the other one looks over and says, “You spelled confidentiality wrong.”

La Tanya: Oh my [laughs].

CJ: To your point, you don’t want them just peeking over and that sort of thing.

La Tanya: No, you really don’t. Good point, I love it.

CJ: So, let me ask you because you have so much experience in auditing

Question: What would you say are some of the most common audit problems when you’re auditing records?

Obviously, each one is going to be different but I’m sure you’ve come across some common mistakes and errors.

La Tanya: Yes. Sometimes, medical coders and medical office staff, they get a little intimidated, especially if they know the auditor is coming to that office. One of the things they like to do, unfortunately, CJ, is they like to hide medical record charts from the auditor. Well in today’s day they can’t do that so much because everything is on a server, it's electronic health records so you can’t hide information from the auditors anymore but a good auditor will always know you always pre-audit before you go into a medical facility. Auditors always flinch when providers are using templates, those copy and paste templates, because we can detect phony immediately. Where you’re HPI doesn’t even match your examination components and it’s so evident that your copying and pasting one record over another and I was like can they outlaw templates. Those standardized templates that allow them to copy and paste because they don’t read, they’re just copying over and I’m like that doesn’t even pertain to this visit.

CJ: Yeah and I’ve ever seen where a provider may have copied from, let’s say two different patients that presented similar clinically and copied a really nice note from another patient because they knew that clinically a lot of the key information was in there and then they pasted it but what was funny is they pasted it from a younger woman who was pregnant to an 85-year-old and you are like wait, she’s pregnant? So to your point, I’m a clinician by training, so I can understand the desire to use good documentation from someplace else to say you took your time but to your point, you have to read it, you have to make sure it’s specific to that patient, you have to make sure it’s accurate because you're attesting to its accuracy.

La Tanya: Exactly, and to your point CJ, I once had a provider that documented that he checked the prostate of a female patient and I go okay [laughs].

CJ: That’s a miracle.

La Tanya: You have to amend this document. Make a correction here.

CJ: Write that up in a medical journal as a case study, a woman with a prostate.

La Tanya: Exactly, so if we talk about the biggest problems it would be that template.

CJ: Cloning and stuff.

Question: What about stuff like physician orders?

La Tanya: Oh gosh, incomplete yes. Incomplete orders for some reason. They’ll start the order but they’ll never finish it. I’m like come on. That or you are right in the middle of an audit and you’ll find that the consents are missing, treatment plans are missing; maybe the billing was incomplete or fraudulent. Unfortunately, I’ve come across fraudulent billing.

CJ: Any specific examples on that? Obviously, you don’t want to share information you can’t but just in general. What are they? Are they modifiers? What types of things?

La Tanya: It was worse than that CJ, it was where the provider was actually performing one type of surgery but documenting a more extensive type of surgery.

CJ: Gotchya, I actually just read a press release from the DOJ about a physician that was scheduling more basic hysterectomies, and then when they got in there they were doing radical hysterectomies to up code the procedure. So that was an example and they’re putting a patient’s health at risk going from a basic hysterectomy to a radical hysterectomy and then billing for it. So I think those are kind of flat-out fraud type of things as well.

La Tanya: Exactly, and there’s no cause for that. If you’re a surgeon you are automatically going to make a certain amount of money. There’s no cause to do that.

CJ: Yeah.

La Tanya: But, you know what, in all due respect to whistleblowers because they will bring that type of information to the board and auditors will go in to validate if that was true or not.

CJ: Yeah, exactly. In running compliance programs, one of the most important things I felt was making sure the culture was such that people could speak up and internally report. I always appreciated, even if I got reports that turned out not to be substantiated, at least people felt comfortable raising concerns because, quite frankly, in most reports the person just didn’t know the full story, and as you dug further deeper what was going on was fine. The only way you’re going to uncover those truly fraudulent and non-compliant issues is to get people to feel comfortable reporting. So having a system internally that does that is a really important aspect of compliance work.

La Tanya: It really is and you know what CJ, me being a certified compliance officer as well when I teach compliance I always make sure that the staff knows to see something say something. We want a culture that way.

CJ: Right and it doesn’t hurt if it doesn’t turn out to be something. Like I said most of them don’t. Usually, people don’t know the full story or they don’t have the full history but having them speak up lends to that culture of reporting.

La Tanya, we’re coming to the end here and I want to make sure I’m giving you the opportunity to share anything else that you might want to share. Maybe I’ll end with this question then you can be thinking if there’s anything I didn’t ask you that you’d like to share. So you’re now working with Healthicity as an auditing manager.

Question: Tell us a little about that and your work with that product and why you like it and how you think it could help people?

La Tanya: Well you know CJ, in my thirty years in healthcare, when I first started out as an auditor everything was manual. We had to manually pull charts, the auditing tool, we had to manually score the audit, we had manually created, everything was paper and when I took a look at Healthicity’s audit feature it was like heaven. I was like all of the work that we used to do manually was now in electronic form that was so professionally done, that was customized especially for the auditor, it was amazing. I love that it was user friendly, it was so easy to go in and score, it was so easy to create reports for reporting to show patterns and trends and actually to view different drafts so you can show the provider okay this is what you were doing and this what shouldn’t be doing according to your medical record documentation. Amazing difference, I love the audit manager, I’m a huge advocate.

CJ: So now you spend a lot of your time working with clients, teaching them how to use it and that sort of thing?

La Tanya: Teaching them how to use the audit manager and how easy it is and how to customize various reports within the audit manager. Yes.

CJ: Well, excellent.

Question: Is there anything I didn’t share that you’d like to share with our listeners? This has been wonderful and time always flies.

La Tanya: I know, time flies when you’re having fun. You know what CJ, I also serve for Healthicity as a subject matter expert so I have lots coming to me if they have questions or concerns, they want to know how to do certain types of billing, are coding something correctly, and they can always reach out to me. I am always willing to help people because it’s all about success. The success of the people, the success of the organization, and making sure the organization is a complaint organization. It means a lot. But no, I appreciate you CJ.

CJ: Yes, La Tanya. So we have been spending time with La Tanya McNair, Healthicity’s client success manager, dealing with audit manager products and it has been wonderful talking to you and learning from you and I hope our listeners will reach you, and maybe if the timing is right we will have you back as another guest. Thank you so much.

La Tanya: I would love that CJ. Thank you so much.

CJ: And thank you to all our listeners for listening to another episode of compliance conversations. Until next time be safe and happy.