Lisa Elswick is a Managing Director at Ankura based in Washington, DC. She is a registered nurse with over 20 years’ experience in healthcare. She is certified in Healthcare Compliance and is a Certified Professional Coder with coding specialties in outpatient hospital, dental, and risk adjustment. Lisa’s industry healthcare experience includes clinical, operational, revenue cycle, and compliance. Her clinical experience includes hospice, intensive care, medical/surgical, oncology, orthopedic, telemetry, and wound care.
Lisa’s professional experience includes:
- Billing, Coding, and Clinical Documentation Reviews: Provided billing, coding, and documentation reviews for a variety of clinical inpatient and outpatient facility and professional services including behavioral health and substance abuse services, plastic surgery, wound care and hyperbaric, venous ablation procedures, laboratory, hospice, infusion and injection therapy services, dental, carotid artery stenting, post-acute skilled nursing services, EMG and nerve conduction studies, internal cardiac defibrillators, oncology services, evaluation of appropriate emergency department CPT code levels, and evaluation and management services.
- Risk Adjustment Reviews: Conducted risk adjustment reviews, itemized bill reviews, and reviews of the appropriate billing of hospital outpatient services with modifiers 25, 59, and 91. Conducted reviews of appropriate hospice billing, coding, and documentation requirements based on payer and regulatory requirements. Participated in a variety of engagements including observation, inpatient, and behavioral health services (including drug and alcohol clinical, coding, and billing review) and medically necessary hospitalizations (admission and discharge criteria) applying InterQual Clinical Guidelines and the applicable Code of Federal Regulations – Conditions of Participation.
- Operations Support: Assisted a large healthcare system with a successful transition of the management of a wound center outpatient department from vendor managed to hospital managed. This included development of EMR wound care documentation templates.
- Due Diligence and Compliance Assessments: Involved as a team member for due diligence and compliance assessments for a variety of services, including billing and coding of anesthesia services, behavioral health outpatient and inpatient services and drug and alcohol rehabilitation clinical review, dental services, wound care services, and outpatient and facility skilled therapy services. She has also participated in hospice due diligence and compliance assessments as she is well versed in hospice operations, billing, and clinical and regulatory requirements.
- Medicare Part C ODAG and Medicare Part D CDAG Compliance Monitoring: Provided ongoing routine compliance monitoring of Medicare Part C ODAG and Medicare Part D CDAG including universe validation and transaction reviews applying CMS’ Audit Protocol.
- Risk Adjustment: Worked with payers and providers in completing risk adjustment reviews and development of risk adjustment policies and procedures. She is knowledgeable about CMS and commercial risk adjustment regulatory and compliance procedures.
- CDI: Worked on due diligence and self-disclosures pertaining to risk areas with CDI. Lisa has a strong knowledgebase of ICD-9-CM and ICD-10-CM diagnosis coding and coding guidelines. She is well-versed in the current legal, 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 compliant provider query process.