Jacqueline Voss

Her accomplishments include the development and implementation of comprehensive compliance frameworks, leading to notable improvements in documentation quality, billing accuracy, and operational efficiency. Jacqueline’s strategic recommendations have consistently enhanced compliance postures, minimized error rates, and ensured adherence to federal and state regulations for numerous healthcare organizations.

Jacqueline has played a critical role in leading Independent Review Organization (IRO) engagements, conducting healthcare regulatory compliance investigations, and overseeing due diligence projects. Her proficiency in analyzing clinical practices and addressing legal allegations has established her as a key resource in the industry. Her ability to merge clinical insights with analytical rigor makes her an invaluable asset in addressing and resolving complex healthcare challenges, affirming her status as a trusted advisor and leader in healthcare compliance.

Professional Experience Summary:

Independent Review Organization (IRO)

• Engagement Manager for IRO Projects: Spearheaded a diverse range of IRO projects across healthcare compliance programs, skilled nursing facilities, durable medical equipment (DME) services, medical coding, outpatient services, and third-party payors, adhering to stringent corporate integrity agreement requirements.
• Collaboration on Testing Protocols: Played a pivotal role in developing testing protocols in alignment with the Office of the Inspector General (OIG) standards, ensuring acceptance by OIG, clients, and internal IRO teams. Demonstrated exceptional ability to bridge regulatory requirements with practical implementation strategies.
• Comprehensive Compliance Analyses: Conducted in-depth analyses covering claims testing, including essential billing and coding and clinical best practice documentation, arrangements systems, transactions reviews, and billing and coding process reviews. These analyses were critical in identifying compliance risks and operational improvements.
• Annual Findings Reporting: Led the compilation and presentation of annual findings reports, offering actionable insights and recommendations to senior management and stakeholders. These reports have been instrumental in driving strategic decisions and enhancing overall compliance and operational efficiency.

Compliance Investigations and Reviews:

• Directed OIG Investigations: Spearheaded comprehensive investigations into skilled nursing facilities, Medicare Part A, and Long-Term Care, emphasizing the scrutiny of technical and clinical medical record documentation to assess its impact on federal payments. Demonstrated an exceptional ability to navigate complex regulatory requirements, identifying and addressing compliance gaps.
• Home Health Investigations: Led critical investigations for the Department of Justice (DOJ) into home health agencies, focusing on face-to-face examinations, plans of care, and determinations of homebound status. Ensured the highest standards of integrity and compliance, driving actionable insights and enhancements in healthcare practices.
• Hospice Investigations: Managed OIG self-disclosure reviews and Administrative Law Judge (ALJ) appeals concerning hospice claims, evaluating hospice certifications, eligibility, medical necessity, diagnoses, level of care, and coverage criteria to ensure the substantiation of care continuation and required documentation.
• DMEPOS Compliance Review: Oversaw comprehensive billing and coding compliance reviews for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS), including conducting internal audits and government investigations. Provided expert regulatory, documentation, coding, and process recommendations to significantly improve DMEPOS compliance and billing accuracy.
• Innovative System Reviews: Conducted self-disclosure internal reviews of outpatient billing & coding IT systems, identifying critical areas for compliance enhancement and system optimization. Achievements led to improved operational efficiency and compliance with regulatory standards.
• Inpatient Rehabilitation Facilities (IRF) Review: Played a pivotal role in assisting with in-depth internal reviews focused on the medical necessity of admissions and the adequacy of documentation within Inpatient Rehabilitation Facilities. These efforts were instrumental in identifying and rectifying compliance gaps, ensuring adherence to healthcare regulations, and enhancing patient care quality.
• Emergency Department and Inpatient/Observation Status Investigations: Actively contributed to comprehensive investigations of emergency department practices and inpatient/observation admission statuses which involved a meticulous review of regulatory documentation and coding practices to confirm alignment with stringent healthcare standards. Through detailed analysis and collaborative review processes, I helped foster improvements in operational compliance and efficiency, directly impacting patient management and care outcomes.
• Medical Services Compliance: Defended against Targeted Probe and Educate (TPE) investigations of Emergency Medical Services, focusing on billing processes for air and ground transportation, and ensuring adherence to regulatory compliance.
• Expert Testimony Assistance: Provided expert testimony related to CARES Act disputes and payer-provider disagreements over healthcare coding and medical necessity.

Due Diligence:

• Documentation Review and Analysis: Specialized in the review and analysis of documentation for due diligence engagements, with a sharp focus on regulatory compliance, and billing/coding accuracy.
• Provider Specialization: Concentrated efforts on a diverse set of providers, including hospitalist providers, contract rehabilitation providers, and outpatient physical therapy providers, ensuring comprehensive coverage of due diligence requirements.