Home Health and Hospice clinical compliance expert
Nationally recognized educator on Medicare regulations and documentation, with a history of over 12 years working as an employee, and then a contractor for the Medicare fiscal intermediaries
Successful private consultant for angencies struggling with compliance, outcomes, and ADR's with a proven track record of successful surveys, completion of medical review audits and appeals, and improved outcome and process meaasure scores
PROVIDER INSIGHTS, INC. 2007 - CURRENT
Founder and President
Founded a resource to provide education and consultation on a national scale for Home Health and Hospice agencies, bridging the gap between regulations and operations in the mot efficient manner. This is typically accompished with a 360 degree review of the agencies, including audit, operational overview, tandem visits with staff, leadership interviews and analysis of trends. Provider Insights, Inc. is also currently contracted to provide professional consultative services by OASIS Answers, Inc, The Corridor Group, Briggs, Beacon Health, state home health and hospice associations.
CMS fiscal intermediary and Medicare Administrative Contractors, Cahaba GBA and CGS have contracted Annette Lee/Prover Insights, Inc. to provide edcucation to their home health and hospice agencies, as well as internally to the Medical Review department.
Authoreed "Medicare Audits in Home Health", published by HC Pro
Authored numerous articles, chapters and performed review for HC Pro, such as writing of "Reimbursement" in "Home Health Administrator's Guide"
Assisted numerous agencies who were found in "immediate jeopardy" by Survey to become compiant and found deficiency-free upon re-survey. This was a holistic approach, which included mentoring of leadership, education and follow up with staff to improve quality and documentation.
Educated over 100 agencies who were on Medicare targeted review on implementing processes to support compliance and aided the successful graduation from the audit.
Provided content for educational web-based learning modules for numerous clients, including Medicare Intermediaries (Cahaba GBA and CGS), The Corridor Group, and Silverchair.
Proven track record in increasing agencies' reimbursement, and efficiencies while maintaining or improving quality, as proven in the agency CASPER reports and Home Health Compare Scores
Implements and trains staff on Quality Assurance and Performance Improvement, resulting in increased OBQI (Outcome Based Quality Improvement) scores.
CAHABA GBA MEDICARE INTERMEDIARY 2000 - 2007
AHIMA ICD-10 Certified Trainer
Home Care Specialist in ICD-9 Coding (HCS-D)
OASIS - C Certified (COS-C)
(Word, Access, PowerPoint, Excel)
Fiscal Intermediary Shared System
"IAHC has contracted with Provider Insights to deliver education to our home health agency members and we routinely receive positive feedback, including comments such as “Annette is a fabulous educator” and “Annette is very knowledgeable”."
2010 - present
2010 - present
Clinical Education Consultant
Developed and delivered training material for home health and hospice agencies, both on an individual basis (when referred by Medical Review or Data Analysis), or in large groups. Educated on basic coverage in the Home Health and Hospice Medicare benefits, and how to ensure compliance in practice and documentation. Permormed duties as a staff liaison interdepartmentally and intra-departmentally to ensure consistency in processes and information provided.
Interfaced with both state and national associations for Home Health and Hospice to ensure educational consistencies
Collaborated with agencies of all sized and assisted with documentation and understanding of the Benefits
Provided four-five webinars monthly, along with educational written resources for agencies
Medical Review and Appeals Reviewer
Reviewed medical records for home health and hospice services in order to determine appropriate payment.