Episode 121:
Compliance and Revenue Cycle: A Shared Mission

Episode Transcript

Welcome, everybody, to another episode of Compliance Conversations. My name is CJ Wolf with Healthicity. And today's episode, these we're going to have one of my favorite type of episodes where we celebrate people who are doing great work in the field. We have an award that we give out to the compliance officer of the year. And this year, and the guest today is our award winner for the revenue cycle manager of the year, Melinda Hawk. Melinda, welcome to the show. 

Thank you so much, CJ. I appreciate that. 

You're welcome and congratulations on the award. We're going to talk a little bit more about a little bit later about some of the nice things people said when they nominated you and we'll get to know you a little bit better. But maybe you just briefly introduce yourself. Tell us kind of what you do and anything you want to share about yourself. 

Okay. Well, I've been married for 36 years and still going strong. And I have two wonderful grown sons and great friends and great family. And I have some good hobbies with cooking. I have rescue dogs, and I do computers, and I do puzzles, and I love to read, and I just love hanging out in my home with my dogs and my husband and friends and family. 

That's great. That's great. What part of the country are you from? 

I'm in Hoover, Alabama, just outside of Birmingham. 

Nice. Well, wonderful. Okay. Tell us a little bit about your work history and what's brought you to your current place. A lot of our listeners, we have people in different stages of their career. Some might be very new and just beginning, some might be mid-level, and some might have decades of experience. We'd love to hear a little bit about your journey in healthcare and what you've done. 

All right. Well, I started doing a little bit of billing for one of the hospitals in Jacksonville, Florida, when I was living there and going to school. And I liked it. I liked the work. And I was offered the opportunity to go to work at the largest rural health system in the United States at the time, which was North Mississippi Medical Center. and I worked for their home health and hospice division and I knew absolutely nothing about home health and hospice but I just immediately fell in love with people being cared for in their own home. I just thought that was quite a mission for the staff and I just wanted to be a part of it and so I had found what I wanted to do with my career. So I was there for quite a few years, for about 14 years, and received their Employee of the Year Award. It was very prestigious, and I was very honored to get that. And then I was offered... the opportunity to come work for the largest privately owned, family owned home health and hospice in the state of Alabama. And the owner was, I knew him from the industry and I knew his name and I would just really thought it would be wonderful to work with him. And so I interviewed and got the position and I was there for 15 years. And Until they sold, he wanted to retire. So they sold to Encompass, which is now Inhabit. And so basically I've had, and now I'm with the care team, Home Health and Hospice out of Michigan. And so I've basically had three employers in 35 years. So it's been nice not to flip into a new employer every other year, whatever. So I'm blessed to be able to have some very good opportunities with some excellent employers. 

Well, that's amazing. So you've spent a few decades in the home health and hospice arena. That's amazing. Yeah, about 30, about 35 years now. 

That's great. And, you know, just from a personal note, I've had loved ones who've gone through that. Right. And it is a really special type of care. And so thank you and thank you to the providers who do that kind of care. It's a tender time of life when a loved one is, you know, being cared for at home and it might be on their last few weeks or months. So thank you for doing that. 

Yeah, it's a special industry. It really is. I'm honored to be in it. And I don't do the hands-on care, but I have so much respect for our nurses and our therapists and our aid services. And I'm just... to go into somebody's home and there's not a button you can push if something terrible happens. So you have to be very self-confident and you have to have great clinical skills. And I have just the utmost respect for 

them. That's right. And, you know, I've been working in health care for about 25 years and I always took kind of a similar approach. thought processes, though I might not be providing the hands-on care, I am doing important work to free people up from the administrative burden so that they can do the hands-on care, which is the ultimate mission and goal. And so, compliant billing and appropriate revenue cycle management so that organizations are financially stable enough to offer those services, It's a real important part. And even though we might not be touching patients, we are affecting the outcomes of the organization. Yes. No margin, no mission. That's right. Exactly. So, Melinda, I want to share a couple comments from some of the people who nominated you. So, for our listeners, we usually will announce when the... nominations can be offered. Again, we have a compliance officer of the year process and now a revenue cycle manager of the year. And so individuals can nominate people. And so we had a lot of great candidates. And so it's really hard to select just one. But Melinda, here's what some people said. Quote, our revenue cycle manager, Melinda Hawk, is passionate about compliant billing. She works a true partnership with the compliance department to ensure that our billing is ethical, accurate, and follows the regulations. She is quick to reach out and ask for a compliance review if something doesn't look right. Stay in the know compliance. She stays on top of updates and trainings by CMS and the MACs and forwards information and opportunities to the compliance team members as well. She communicates and collaborates like a pro. She has worked hand-in-hand with the compliance officer during TPE and ADRs and third-party audits. We communicate through Teams, chats, and video calls throughout the day, almost every day. She immediately notifies us of reviews that are processed and or denied. She turns challenges into solutions. And they praised your work about handling your own HQRP and HIS submissions and working through that so that revenue could be appropriately received. And on top of everything, she has always got a smile on her face and an encouraging word. She's always ready to help in any way I can to quote her. That was from one person. And then a second person wrote, she is a genius when it comes to billing and coding. So a couple of nice words. What do you think about those nice words from your team members? I'm very 

honored to have such wonderful things said about me and my work. I I try very hard to always be kind and to stay on top of regulations and to stay on top of my knowledge. And I would just be devastated to do something, you know, to let something slide. So I try to stay involved in CMS and what's going on with them and RMAX and the OIG. and the Federal Register. I just try to make sure that I read everything that's coming out and I try to understand it. And I also try to educate my staff what's coming down the pike and what to be prepared for and what to be thinking about. 

That's great. How do you stay on top of all those things? Are you just kind of on a regular basis visiting these websites or do you have kind of email reminders? What do you do? I know in talking to a lot of people in the industry, that's often one of their biggest concerns is just staying on top of everything. So how do you kind of manage that? 

I sign up for all of the latest updates. You just go on to their websites and you can sign up and then you just click the boxes that you're interested in. So for CMS, I click the boxes for home health and hospice and for OIG, you know, I always want to see what their review list is looking like each year and what they're interested in, what's going on, why are they looking at certain items. And then I start thinking, are we prepared for that? Have we thought about that? Are we doing everything that when we should be doing it. And then, you know, I work with my staff and get their input. Well, what do you think about this? They're interested in looking at this issue this year. Do you feel like we have a good process in place? What does our standard operating procedures look like? And, you know, I just try to stay in the know. And then I'm also on one of the MACs on their provider advisory group. And in that case, Also keeps me up to date with what's going on. They have an excellent quarterly meeting and then the director of that is great. a great manager that I've worked with for years and years at the MAC and he is very knowledgeable and just helps to have people that you trust, that you can ask questions to and have a good relationship as far as working together to make sure that you're doing things the way you should be doing them and making sure that your patients can continue to get the great care that we're providing. 

That's great. It sounds like you're very involved. And I haven't met a lot of people who are on the advisory committee or process. Is that an opportunity for providers to share with the MAC maybe things that they're struggling with or things that they need additional guidance or regulations on. Tell me a little bit about that if you don't 

mind. Yes, it's two ways. So there's a great agenda that comes out ahead of time. And this is what's coming out from CMS. These are maybe some issues that we have going on at our particular MAC. Here's some things that we're seeing with our claims processing. Here's some new tools that you can try as a provider. You can look up your claims in this way. We're changing the way we do our call-ins for provider services. And so they give us all those updates. And at the same time, there's a question and answer. And the providers' representatives are able to ask questions of the MAC. Very informative. I learn things every time I attend that meeting. I learn something new. And hopefully, you know, when something comes up that I really am the expert in, then I can offer a lot of guidance and direction in those areas. 

That's great. That's such a great example. You're a great example in being involved, and there are opportunities to be involved like that. So thank you for kind of leading by example in that way. Melinda, we're going to take a quick break, and then we're going to come back. I want to learn some more about your thoughts on this industry. So hang in there, everybody, with us for a little while, and we'll be right back after the break. Welcome back from the break, everybody. We're talking to Melinda Hawk, who is our Revenue Cycle Manager of the Year. Melinda, you shared how you stay on top of regulations by visiting OIG and MAC websites and those sorts of things. Are there any good professional societies that kind of help in the home health and hospice area that are also providing some good information or certifications in those areas? I'm just curious if there's other, like from a coding standpoint, I'm members of a coding association and these other things that aren't necessarily government run, but they do provide some conferences or webinars and those sorts of things. Is any of that helpful? 

Yeah, so there's the National Association of Home Health and Hospice, and it used to be NOC, and now I have to look at my notes. It's the National Alliance for Care at Home. Okay. So, yes, they have conferences, and they have lots and lots and lots of tools and tips and listservs and things. all sorts of things that you can sign up with that. And then, um, most of the states I think have local, I have state organizations that provide, um, opportunities for, um, conferences, learning opportunities, educational offerings, and, um, again, email updates, just sign up for them. And, you know, you're on that. If something comes up, you're on there and you can kind of hear something that came, um, that you might want to be aware of. So, um, So yes, there's all sorts of tools that those have. And then I've been involved with several consulting companies for home health, for the industry, for home health and hospice over the years. I've worked with Black Tree Consulting, the wonderful people that founded that company, and also with Simeone. And I think Simeone was the first consulting company that was only for this industry for home health and hospice. And those two consulting companies have merged. I believe it's Symmetry now. Excellent, excellent folks there. I've never had a bad experience. They're just experts in their field. And when you need help, you can call on them. This is going on. Do y'all know anything about them? So having some folks that you know in the field that also stay on top of things, that help providers with issues that come up, having those contacts, I think is really important. You see them at conferences and you see them at educational opportunities throughout the year and just hearing their presentations and knowing what kind of deep knowledge that they have of the industry and being able to call on them. Especially after 35 years, I still learn something new just about every single day. So it's a very regulated industry and I try to have resources at every place I can possibly have them. 

Yeah, and that's such a good... kind of way to think about this. Even for our listeners who might not specifically be in home health and hospice, what Melinda just shared, I think, is the way to go about it. If you work for a hospital or a physician group, there's gonna be state organizations, there's gonna be national organizations. And so just get as involved as you can because there's a lot of good resources there. 

Yes, and you can't do it by yourself. It really does take a village. And the whole health care industry is just so, so, so overly, overly regulated. And it is so difficult to understand, even if you're right in the middle of it and you do it for 80 hours a week or whatever. If you're in it all the time up to your neck, just think about the patients. 

They have no clue. And so I've always been really passionate about making sure if we get a patient call, let's do the very best we can to explain it to them, to reassure them, whatever it is, we're going to try to fix it for you. We might not be able to fix it right this second, but I'm going to research it and try to get you a good answer and try to help you to understand what's going on with the billing side of the services that you're being That's right. Well, that's wonderful. So tell me a little bit about your team and how you manage and what kinds of things would you say? Let's pretend I'm an early career manager that was just hired in a job that's similar to you and what you have. What kind of advice would you give me to be a good manager? 

Well, I have a couple of managers that I have two managers, one that basically manages the front end task of bringing new patients on service and and another that handles the billing and posting the payments from our insurance payers. And I just try to be a very good mentor to them. I'm always trying to train the next generation. Won't be... much longer and I won't be in this anymore. I'll be retired, hopefully. So I want to make sure that the next generation is prepared to also give excellent service to these agencies, to the industry, and to our patients and our caregivers that are out there working very hard with these patients. So try to be good mentors, what I tell them. When I'm teaching you what's coming down, also share it with your staff. When I'm asking you if you've seen this happen, if you don't know, also ask your staff. Let them be a part of this so that they feel included, also so that they learn and they become more educated. Again, very regulated. You're gonna learn something new all the time. It's very important that managers know that And that they know that with it and that their staff know that they don't always know it all. You have to be open to to learning something new. 

Yeah. 

Even when you've been in it 35 years. 

Absolutely. And that keeps the job interesting, trying to learn new things and things are changing all the time. And so that for me personally, that kind of keeps the job interesting and learning new things is always exciting. Yeah. Melinda, let's talk a little bit about kind of discussing the bridge between compliance and revenue cycle. What are your thoughts on the importance of that? 

I love this. So there's a couple of different bridges that I really love. I'm very passionate about. And one of them is having open, daily, continuous opportunities. cooperation, communication between the revenue cycle team and the compliance team. I value their input. They're also, they have clinical folks on their team that I don't have on my team. I don't have any registered nurses on my team. And so, and they're also very versed in the regulatory aspect. So I can ask them a question about, does this look like from a clinical standpoint, should we be doing this? particular kind of visit, is it billable according to the regulatory guidance that's in place? love having their input. If something comes up, you know, I'm seeing where these hit the invoice to Medicare, but I'm not familiar with seeing that before. Or I'm not seeing some things that should be hitting the invoice. And so can we take a look at this? Can we do an audit? And love having that cooperation and communication between the two departments. The internal auditing also, what are we looking at internally to make sure that we're prepared for external audits? And also the communication part of it. If we're doing all this hard work with all these audits, are we communicating it to leadership? Are we communicating it to our clinical staffs in the branch? Wouldn't they love to know that they received 100% scores on their quarterly clinical audits? And are we communicating our plans for improvement. If they got, you know, even if they got 95%, that's wonderful. But wouldn't you like to be at 96? And, you know, what do you, what does the staff think would be something good for us to look at next time? Just, I think, communicating the great work that is being done with leadership and with the actual visiting staff and the managers in our branch offices. Keep everybody engaged and involved in doing excellent work. according to the guidelines that we have to work under and to make sure that we're not missing anything that's a requirement. So I love having that communication and cooperation. I love helping do graphs and spreadsheets and sending out updates of the work that we're doing between the two departments. I also love if they're doing a clinical audit that I'm really not involved in, but they want my opinion or they want to know how to have a look at the invoice. How does it play into the services that were provided versus the services that were billed? So I think that's just a great bridge to have. And you've got to have that open, daily, continuous cooperation and communication. It fosters trust, I think, between the departments. And I think it also fosters trust all the way down to the visiting staff. I want them to be very comfortable with my name and where to find my phone number. And if they're in a home with a patient and the patient has a question, let me call Melinda. I think she'll be able to help you with that. And I want them to be that comfortable with it. And you have to have this ability and you have to make sure that they know who you are and how you can be helpful to them. Otherwise, they don't know they have a tool in their pocket. 

Yeah. Yeah. Absolutely. You just demonstrated some of those key principles, just hearing you speak, trust, the word of trust and relationships and regular communication. Those are all such important elements of a culture of compliance, right? So it's one thing to have kind of the mechanics, but it's another to have this culture where people trust and where people can pick up the phone and that kind of builds and you get this momentum of everyone wanting to do it the right way and working together to get there. So it's obvious that you're a key part of that. 

Very passionate about the industry and doing things right. Yes. 

I love that. Well, Melinda, we're getting towards the end of our time. I'm just if you I'm curious if you have any last minute thoughts or advice or words of wisdom or what might you say to our listeners before we end our time here together? 

just have great tools. Healthicity is a great tool. So happy that we got that implemented. We have all of our contracts in the same place. I can look them up from the revenue cycle area. The clinical managers can look up the contracts. The compliance department has access at their fingertips and not having to find them all over, you know, shared drives and shared, you know, sites. And you don't know where it is so having everything in one place makes makes it very easy to find what you need. And so get good tools in place. Keep your communication throughout the department, throughout the agency, across departments. Talk to each other. Talk about things that you can improve on and talk about things that you're doing great on and pat people on the back and work on plans for improvement and always have something to engage your staff, to teach them something new. It can get a little dry. So teach them something new. Let them have a little fun with what they're doing. 

Great advice. And then be a great mentor. If you love the industry and you really believe in it, be a great mentor so that you can help inspire other people to do their very best in this industry. 

Yeah, wonderful advice. Thank you so much. It's been a pleasure talking to you today. Thank you for taking some time to share a little bit about yourself. 

You're very welcome. And thank you for the award. It was really, really made my day and really a great reward to receive from your fellow staff members that you have conversations with every day. It's great to hear their thoughts. 

Absolutely. And congratulations again. Just in the short time we've spent together, it's obvious why they have nominated you and why you won this award. So again, congratulations and thank you to all our listeners. Thank you for listening to another episode. If you have a guest that you think would be or a person in mind that you think would make a great guest, please reach out to us. Or if you have a topic that you'd like to hear, maybe we can find a guest that could speak on that topic. So we want the podcast to be as helpful and as pertinent to you as possible. So thanks everybody. Until next time, take care.

All right, thanks.