Getting To Know You Series-Part One: Paula Digby

On January 3, 2018, in Biographies, New Blog, by Rucha Purohit

Hi everyone! First, I’d like to encourage any of you out there who have not yet figured out what you want to do to just keep searching and keep showing up each day! That’s how it was for me. Believe it or not, I had no idea that healthcare consulting would be my love and passion until probably in my thirties after I had been in the field a while. Some days it feels like I just fell into it. Initially, I was hired through a temp agency to work in a durable medical equipment (“DME”) billing office. I had the best boss at that job. She taught me how to familiarize myself with the claim form to ensure it was properly filled out. From there grew a desire to learn the back story of each claim and the relationship between the codes and payment. I then supervised a customer service call center in that DME world and was very satisfied with being able to describe the process and work with patients to resolve issues and get their insurance companies to pay.

After a few years, I moved into a physician office and began billing, balancing the daily charges and acting as a receptionist in an internal medicine practice, from there to an Ear, Nose and Throat and facial plastic surgery center where I originally taught myself to code, then into a general surgery practice at which time I decided to get certified with the AAPC, shortly after the AAPC became an organization. I moved on to an ambulatory surgery center where I performed coding, billing and managed front desk operations for multiple specialties. It was then that I began teaching a class to people who wanted to become certified coders and my love for teaching was born! My broad expertise and teaching led me to work at a forensic accounting firm performing healthcare investigations for all provider types. I began working with the Department of Justice in several states as well as the Medicaid Anti-Fraud Unit in Georgia or fraud related files.

Shortly after, a partner and I started a company to perform revenue recovery services for provider claims. This process included reviewing payer and provider contracts and seeking payment for claims where the payer did not settle the claim in agreement with the terms of the contracts. Understanding coding, billing, contract language, fraud and compliance was extremely helpful in recouping proper payments for providers. Due to the investigative work with the forensic accounting firm and the government, providers started to seek us out for compliance and chart to bill reviews. The knowledge I had gained of the revenue cycle process quickly grew into a consulting firm that was multifaceted: assisting providers with creation of revenue cycle teams, clinical documentation improvement, charge capture appropriateness, process redesign, working with attorneys in matters of healthcare litigation support; working with device manufacturers to research and determine reimbursement for their products; and, a unique very detailed understanding of Inpatient Rehab Facility Services (coding including IGC selection, billing, clinical documentation and process redesign and improvement). Through my work history I have worked with almost every provider type but specialize now mainly with physicians, acute hospitals and inpatient rehabilitation facilities (“IRF”).

Our firm specializes in finding the root causes of revenue opportunities through medical record reviews and working with the provider to correct those root causes. We also provide online and in person education.  WE love it! It’s our passion, it drives us to perfection and seeing providers get the revenue they deserve is very satisfying to each of us.

 

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