Lisa Elswick

Lisa’s healthcare administrative experience includes serving as a director of clinical services and an administrator for a hospice provider. She also served as the program director for a hospital outpatient provider-based wound care center. Her responsibilities in that role included operational, clinical, and quality program oversight, revenue cycle management, provider recruitment, coding oversight, clinical documentation compliance, and community education functions. During her five years as a revenue cycle director, she supported over 50 outpatient wound care centers across 15 states conducting monthly documentation and clinical best practices training for providers, compliance, quality, and regulatory policy.

Since joining Ankura, Lisa has assisted providers, payers, and life sciences companies on a wide variety of engagements. She conducts and manages billing, coding, and documentation assessments, self-disclosures and investigations, due diligence reviews, compliance and revenue cycle assessments, compliance education, and assists providers with CDI.

Lisa’s representative engagements include:

• Worked with behavioral health clients who treat all patient populations (pediatric, adult, and geriatric), assisting them with proactive reviews, investigations, and quality of care oversight. This includes documentation review for all levels of care (inpatient acute, residential, partial hospitalization, and intensive outpatient), chemical dependency services review (including urine drug testing, frequency of provider visits and office visit levels coded and billed, and the use of medication assisted treatment (MAT)), and review of ABA autism services. Lisa has led a team who conducted onsite interviews and evaluation of addiction campuses’ revenue cycle processes and quality of documentation to support medical necessity for various levels of care. She assisted one client with recommendations for developing a consistent prior authorization process, establishing documentation criteria for each level of care, and educating center staff and providers across multiple campuses. She has also conducted numerous medical necessity reviews under privilege for behavioral health clients.
• Provided billing, coding, and documentation reviews for inpatient services (itemized bill reviews, short stay (2 midnight rule), and medically necessary hospitalizations adhering to payer or regulatory guidance), outpatient and observation services, and professional services. She has performed reviews for a variety of services including anesthesia, interventional cardiology, endoscopy, surgical procedures, wound care and hyperbarics, injection/infusion, dental, podiatry, opthalmology, imaging and diagnostic (e.g.,EMG,EKG, echocardiogram), genetic, and laboratory including urine drug testing. She has conducted numerous evaluation and management reviews, review of adherence to ‘incident to’ and split/shared documentation guidelines, and assessment of appropriate appending of modifiers, including high-risk modifiers 25 and 59 (including X modifiers). Additional reviews she has assisted clients with include IDTF services, various DME, home health, and post-acute skilled nursing services.
• Worked with teams on various investigations and self-disclosures under privilege. Some matters include incorrect coding/billing by a provider-based cancer center, the inappropriate use of modifiers 25 and 59 due to a programmatic billing edit, and various other provider services including surgical, behavioral health, evaluation and management, critical care, wound care and hyperbarics, and urology. She has presented findings to the OIG and DOJ for various clients with counsel.
• Involved with due diligence and compliance assessments for a variety of services including chemical dependency and behavioral health, ABA autism, genetic testing servics, various hospital and professional clinical services, and hospice. She is well versed in hospice operations, billing, and clinical regulatory requirements. She has conducted compliance reviews for IDTF and provider-based departments. Lisa is part of the team that provides compliance education to various healthcare providers that may include review of the existing compliance monitoring and auditing program. She provided support to a Chief Compliance Officer for a large academic health care system. This included review and education of correct coding for risk adjustment claims and assisting with ensuring routine compliance auditing and provider education was in place, mentoring a compliance manager, in addition to various other administrative tasks. She has also been involved in reviewing client revenue cycle processes to identify compliance risks and propose opportunities to strengthen controls and processes.
• Assisted a large healthcare system in the Northeast with a successful transition of the long-term management of their outpatient wound care center from vendor managed to hospital managed. This included development of policies and procedures, stabilizing staffing and provider coverage, provider education on clinical practice guidelines (including bio-engineered skin substitutes, negative pressure wound therapy, and use of other adjunctive wound treatment), and growth of the wound care program including drafting the capital expenditure proposal for the addition of a third hyperbaric chamber (granted). She assisted with the development of all wound care and hyperbaric documentation templates and forms that were integrated within the systems existing EMR platform. She revised the patient education program that included diabetes education, disease management, and nutritional counseling.
• Worked with payers and providers in conducting both proactive risk adjustment reviews and reviews in response to investigations. She is knowledgable about CMS and commercial risk adjustment regulatory and compliance procedures. She also assisted a large payer with revisions to their risk adjustment documentation and coding policies and procedures.
• Worked on a variety of clinical documentation improvement matters. She has a strong knowledge of ICD-10-CM diagnosis coding and coding guidelines. She is well-versed in the curent regulatory and ethical issues surrounding the CDI process. She has educated providers on complete and concise medical record documentation and CDI specialists on ensuring adherence to a compliance provider query process.