Services

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.