Jan Lambert

Jan has audited dialysis facility charges, dental procedures, evaluation and management (E/M) services (outpatient part A and part B inpatient), anesthesia charges, and all surgical specialty procedures. As part of an IRO team, she has performed yearly compliance reviews for healthcare facilities that are under a Corporate Integrity Agreement. She has helped develop E/M auditing tools based on Medicare’s regulations for use for all types of E/M services.

Jan’s professional experience includes:

Due Diligence

• Dermatology Specialists – Focused on E/M with modifier 25, E/M levels, Mohs procedures (AUC Guidelines), electronic brachytherapy, superficial radiation therapy. Anesthesia Specialists – Focused on documentation of the anesthesia type, patient status, time, and post op pain control.
• Ophthalmology Specialists – Focused Cataract, Yag, and glaucoma documentation as it related to CMS policies. Interventional Pain Management Specialists – Focused on Epidural injection procedures, selective nerve root blocks, and facet nerve blocks based on CMS criteria.  Orthopedic Specialists – Focused on E/M with modifier 25, surgical procedures, and DME supplies ordered and supplied by office.  Lab facilities – Focused on ordered labs, medical necessity of the labs, and bundled lab services.
• Dental Specialties – Focused on high risk dental procedures with and without sedation. ED Specialist – Focused on high level E/M services and critical care documentation.  OB-GYN Specialist – Focused surgical procedures performed in the office, outpatient, and inpatient hospital.  Dialysis Clinics – Focused on patient weekly dialysis with review of treatment plans, orders, dosing of medications, handling of complications, and review of physician notes.

Compliance Review – Proactive

• Performed quarterly audits on large hospitalist group with education post audit results. Services performed inpatient, outpatient, SNF, and home services. Performed audits for a large dialysis facility while under a CIA.  Performed audits post acquisition audits for different specialties.
• Performed audits for E/M coding for large hospital-based physicians with post audit training. Performed audits for oncology services at provider-based clinics.  Performed audits for radiation oncology services both facility and professional documentation.
• Performed audits for dental practices for appropriate documentation and medical necessity of procedures. Performed multiple reviews at large University Centers with residency programs.  Reviewed and audited contracted hospital house physicians (OB-GYN) for appropriate coding.  Performed on site reviews of methadone clinics in the Maryland area and four facilities in different areas of California.
• Reviewed the authorization process for Tricare coverage for pediatric patients that had to be admitted to the hospital versus outpatient for dental work due to their mental/physical condition.

Compliance Review – Reactive-Government Investigation/Potential Qui Tam/Voluntary Pay Backs

• Audited records for a Medicaid investigation of potential over coding of pediatric dental services-excessive restorations and extractions. She has audited records for a DOJ investigation of large hospitalist group with overbilling of inpatient hospital stays.
• Audited records for a DOJ investigation of excessive dental services for a multiple group dental practice.

IRO Engagements

• As the lead auditor on an IRO team, Jan reviewed records for a multispecialty physician group providing services in a skilled nursing facility – year 1-5.
• As the lead auditor on an IRO team, she reviewed dental records for compliance – year 1-2.
• As the lead auditor on an IRO team, reviewed durable medical equipment products for appropriate orders and medical necessity – year 1-2.
• As the lead auditor on an IRO team, reviewed the medical necessity of motorized wheelchairs – year 1-3.

Teaching Engagements

• Jan provided training on Medicare supervision regulations, Medicare incident to/split share regulations, and OB-GYN providers on GYN/OB procedures.

EMR Reviews

• Reviewed the EMR compliance issues related to copying and pasting, cloned notes, and prefilled templates for large hospital systems in Pennsylvania and Delaware.
• Reviewed pre-implementation EMR plans for potential compliance risk areas.