Name: Carol Coots
Title: Auditor, Owner
Company: Medical Consulting From A to Z
Location: Indianapolis
What is your current job/title?
My current title is owner of Medical Consulting From A to Z. I specialize in auditing.
How did you get into the field of auditing and billing?
I have a B.S. in Biology. I moved to Indiana 18 years ago and was offered a position in coding for the Emergency Room Physicians at Ball Hospital. I changed positions and gained more experience for initial coding, audits, and billing. I have worked in consulting, and traveling the US for physicians. I worked for a state Medicaid contractor performing audits for three state Medicaid programs. I taught coding and billing certification programs for over two years. I now perform healthcare audits for my own company I started in February 2008.
How long have you worked in healthcare?
20 years
What is one aspect of your job that you enjoy?
I love the challenge of this ever changing field, while earning more credibility with physicians at understanding many of the procedures they perform. If you can show a physician you can understand the basics of what they are trying to achieve, you can gain a greater respect and more help from your physician.
What drives you to stay in this line of work?
I love learning something new everyday about auditing, billing or coding. I find this area interesting and challenging. I worked with Amy Blum, at the National Center for Healthcare Statistics, to create the ICD-9 fifth digits for lower extremity ulcers several years ago. I kept having to appeal claims and used this information in my quest for a solution to denials for treatment of the same ulcer. At that time, Amy notified me that I was the only individual coder to succeed in such a quest. This is usually a challenge the American Medical Association would take on.
What do you think are some of the big challenges facing auditors today?
One of the biggest challenges is staying on top of the ever changing billing rules and regulations. As the medical industry feels a squeeze in their reimbursement costs, the expectations of the staff duties grows. Make sure you stay on top of your area of practice, even if you have to get training on your own time.
What advice would you give to others in field to help them be successful in their position?
Never stop learning and be open to the ever growing changes in this field. If you find a problem without a solution, research how the problem can be fixed and ask for the change from an insurance carrier, Medicare, or the federal government. If you show how your solution can save money for both providers and insurance processors, including Medicare you will get their attention very quickly.
