Ensuring Compliance

HIM Associate

Daphne began her career in Long Term Care in 1997 as a Certified Nursing Assistant. As she continued her career into Medical Records her responsibilities also grew into such roles as HIPAA compliance officer, Compliance Officer, and a member of the Quality Assurance Committee.

As the Health Information Associate for Surety Compliance, Daphne’s responsibilities include pulling and releasing documents for medical records request from residents, families, insurance companies and attorney offices.

Director of Compliance/Risk Management

Robin began her career in healthcare in 1989. She worked as an LPN while first completing her Associate Degree in Nursing and then her Bachelor of Science in Nursing. She has been a Registered Nurse since 1994.

Robin worked for a fortune five hundred healthcare company for 17 years and she has held various positions in long-term care. Her experience includes 5 years as a Director of Nursing Services, multi-site clinical operations management, enterprise and clinical risk management, and compliance. Most recently Robin was the Vice President of Compliance for an Indiana based Long Term Care provider where she assisted with further development and sophistication of the corporate compliance program. She holds a certification in Healthcare Compliance and is a Certified Professional Healthcare Risk Manager.

As the Director of Compliance/Risk Management for Surety Compliance, Robin’s responsibilities include helping facility staff recognize clinical risk and assist with mitigation of such risk including working closely with liability claims, providing education, and assisting with action plans.

Director of Compliance/Rehab

Elvan started her Compliance career working in the field as a Speech Therapist understanding therapy practice in SNF, Home Health, Outpatient and Private Practice settings. Her overall appreciation for working in a team environment lead her into Therapy Management where she learned therapy business operations and clinical outcomes management in SNF, Outpatient and Home Health settings as well as Senior Living Operations. Growing her skillset, Elvan led operational leadership in navigating the ever-changing therapy industry expectations, regulations, and standards as a Compliance department member in a contract therapy company.

As the Director of Compliance/Rehab for Surety Compliance, Elvan’s responsibilities include completing Rehab Investigations, Incidents, Hotline calls and Adjustments, serving as HIPAA and Privacy Director for Rehab and SNF, completing Rehab audits and education, reviewing, and maintaining Rehab Compliance Policies and Procedures and FWA manual for rehab, and supporting all Licensure/ Scope of Practice issues and policies for clinical providers.

Rehab Medical Records and Appeals Coordinator

Marcie began her career in Long Term Care 16 years ago, as a Physical Therapist Assistant. Marcie transitioned to the role of Audit Review Specialist, auditing therapy charts and compiling and reviewing documentation prior to submitting to insurance companies. During this time, she increased her knowledge of CMS requirements and provided education to therapists to improve their documentation which then led her to become an Appeals Coordinator. As an Appeals Coordinator, Marcie provided support and guidance to facilities and therapists during Medicare Audits, as well communicating with QA and Compliance departments and assisting in the development of education for therapists.

As the Rehab Medical Records and Appeals Coordinator for Surety Compliance, Marcie’s responsibilities include providing and tracking of Rehab Records for all ADR, Appeals, and record requests, writing Appeal letters to support Rehab services provided, and review records of completeness and trending.

DIRECTOR OF COMPLIANCE/INTERNAL AUDIT

Terry is no stranger to the Long-Term Care Industry.

Terry began her career in Long Term Care 30 years ago, as a Business Office Manager, Regional Business Office Consultant and Director of Collections and Accounts Receivable, where her responsibilities included collections, resident trust liability, and accurate billing practices.

From there, Terry moved to a Clinical and Software support analyst role, working closely with Clinical Reimbursement, Accounts Receivable, Legal and Software support.  Worked with developers on new software product design and roll out.  

Terry is certified in Project Management and specializes in education and management around new software/application rollouts.  

As the Director of Compliance/Internal Audit for Surety Compliance, Terry’s duties include planning, leading and conducting internal audit reviews to test controls and identify process improvements.   In coordination with the Internal Audit and Compliance team, prepare, oversee, and conduct internal audits of varying complexity and scope, including financial, operational, compliance and strategy-focused audits. 

CHIEF COMPLIANCE OFFICER

Jean has a world of knowledge and experience when it comes to the long-term care industry.
Jean began working in long-term care in the mid-1985, as a Speech Language Pathology and quickly moved to work within a Therapy Consulting Company as Account Executive over a large, long- term care organization’s Rehabilitation Program.

At the turn of the Prospective Payment System (PPS) in 1997, Jean started her own Consulting Company focusing on the transition to PPS and the surrounding compliance of the new program.

In 2002, Jean joined a large Long-Term Care group where she served in many roles from Vice President of Rehab Services, Corporate Compliance Officer/Privacy Officer, Vice President of Strategic Initiatives and Vice President of Clinical Reimbursement.

As the Corporate Compliance Officer and Privacy Officer, Jean was crucial in the advancement of the company’s compliance program to include expansion and management of the Risk Scorecard, formalization of Compliance Training Modules, guidance with regard to Excluded Persons, HIPAA violations, Hotline inquires and working closely with the legal department to strengthen the companies Quality Assurance and Process Improvement programs.

Responsibility also included the development of processes for company policy review to assure compliance to all rules, laws and regulations, audit of identified risk areas and when necessary revision of company policies. To provide education and training to laws, regulations and rules affecting the company business. Assuring well-designed reporting system to allow for anonymous reporting of violations to company policies, federal and state laws, and regulations.

Jean was also responsible for directing the Internal Audit and Medical Review department which includes management of Probes, RAC, CERT, ADR, TPE, ALJ hearings, UPIC, OIG investigations and Integrity Audits.

DIRECTOR OF COMPLIANCE/CLINICAL REIMBURSEMENT

Lyra is a lifelong leader and an educator in the Long-term Care industry.   She has been a Registered Nurse for other 30 years.   

Lyra has worked in all areas of the nursing field from ICU, Surgery and Quality and Risk Management.

Her career in Long-Term Care/Skilled Nursing began in 1995 as a night shift supervisor then leading her to Staff Development and Infection Control/CQI, Director of Nursing and lastly MDS Nurse.

Lyra moved forward in her career to become a successful and effective Clinical Reimbursement Consultant for several large Long-Term Care companies.   Lyra continues to be an active member of the American Association of Nurse Assessment Coordinators (AANAC)

As the Director of Compliance/Clinical Reimbursement for Surety Compliance, her duties include conducting Audits around MDS accuracy and Coding, PDPM regulatory guidance, Skilled Documentation, and assurance of accurate billing and payment around services provided.

COMPLIANCE ASSOCIATE/PROJECT MANAGER

Tina Frederick has been in the healthcare industry since 2006 and the long-term care industry since 2019.  She has completed her Bachelor’s in Healthcare Administration and has held multiple positions during her healthcare career including Office Administrator, Executive Assistant and Project Manager.  

Tina was instrumental in managing projects including the implementation of the Patient Driven Payment Model (PDPM) in Long-Term Care organizations.  Tina proudly proved her abilities by successfully tracking progress with multiple business lines Strategic Plan, compiling results, and reporting.

As the Compliance Associate/Project Manager at Surety Compliance, her duties include performing complex administrative and analytical functions while working with the Compliance, Internal Audit, and Medical Review Departments. Tina is key in maintaining revisions to compliance policies, procedures, and reports.

• Supports company in development, implementation, and evaluation of the Compliance program, addressing both Federal and State requirements 
  • Fraud Waste and Abuse 
    • False Claims
    • Anti-Kickback
    • Stark
  • Patient Privacy
    • HIPAA
    • HIM/Security/Privacy
  • Employment
    • Discrimination 
  • Compliance Policies and Procedures review, revisions, and Implementation
    • Disciplinary Standards and Guidelines 
    • Retaliation
    • Discrimination
    • Elder Justice
• Code of Conduct 

• Completion of Risk Assessment – Compliance and Privacy Security (ongoing).  Trending of findings
  • Audit, Continuous improvement, periodic testing, review

• Lead Executive Management Compliance Committee (EMCC) meeting, 4 x per year, to review and evaluate the actions, process, work plan and discoveries of the Compliance Program.  Maintains and monitors QAPI process around
  • Provide quarterly reports on the progress and components of the client’s compliance program

• Annual meeting to discuss Compliance program effectiveness, annual goals, and summary of work plan (teleconference or video conference)

• Policy and Procedure updates (design, comprehension, accessibility, gatekeeper)

• Ongoing evaluation of the Compliance Program 

• Participate in Mergers and Acquisitions compliance program evaluation

• Privacy and Security Management to include
  • Medical Records/HIM policy management and guidance
  • HIPAA education, investigation and required reporting (breach management)
  • Electronic Medical record security and access management

• Compliance program audits monthly and annually (Employee Handbook, Admission agreement, Medical Director/Advisory Physician Agreements, Vendor agreements)

• Assistant with all other audits such as Medicare, OIG, DOJ, State Medicaid 

• Compliance Audits as identified through Risk Assessment, OIG work plan, industry focuses, regulatory changes of high exposure facilities and related processes

• Conduct Medical Director and practitioner credentialing, assure completeness.

• Vendor/contract relationships compliance evaluation, training, and support
  • Third party management (Vendors)
    • Is vendor currently performing work?
    • Monitoring
    • Controls 

Anonymous reporting system – Toll-free Compliance Hotline provided and managed by consultant, along with Compliance Hotline trend reporting.  

Assist with investigations that involve Compliance issues, from hotline calls, grievances, state and federal agencies, labor boards, EEOC, OSHA, OIG, and DOJ

Help desk for management – Telephone and email support

SENIOR DIRECTOR OF COMPLIANCE

Dena Edwards, RN, has been in the long-term care industry since 1997. She has held multiple positions during her nursing career including MDS Coordinator, Director of Nursing and Clinical Nurse Educator. As Director of Nursing, Dena was successful in turning facilities around following poor survey outcomes.

Dena was instrumental in developing and implementing solid Medical Review and Appeals departments for several large Long-Term Care organizations. Dena proudly proves her abilities with a success rate of 95% in getting claims paid.

As the Senior Director of Compliance with Surety Compliance, her duties include working with the facilities to organize, review and prepare medical records for various requests such as claims (ADR/Appeals) reviews, family and legal requests, Medicare and Medicaid audits (PROBE, RAC, CERT). Dena is key in maintaining all HIPAA and HIM related policies and procedures as well as education around each.

Dena is currently pursuing her bachelor’s in nursing and is an active member of the American Association of Nurse Assessment Coordinators (AANAC)

• Training, education, and support of company compliance personnel – for development, implementation, and evaluation of the compliance program

• Staff and Management training – Monthly Education. Maintain Attendance sheets.