Clinical (and career) validation: Richelle Marting on legal aspects of HIM, CDI

Earning your RHIA (Registered Health Information Administrator) is a huge accomplishment, and for some marks the end of a four-year academic journey and an entry into HIM. For Richelle Marting, it was only the beginning. In pursuit of her RHIA, which she eventually earned, my guest on today’s episode took a class on the legal aspects of HIM. That course planted the seed for a career in law—and eventually led her to start her own law firm. All while raising two twin girls. I don’t know how she managed all this, but that’s why I got Richelle on Off the Record. On this show we discuss: Richelle’s story from RHIA to JD. How difficult was the bar exam? Becoming an entrepreneur and starting her own law firm Most frequent type of healthcare cases: Clinical validation audits and DRG validation The coding guidelines she sees most frequently ignored or twisted to the payer’s benefit, and other shady tactics What do healthcare organizations make too big a deal out of—and what are they not worried about enough? Qui Tam and the recent spate of cases initiated by organizational whistleblowers, in particular Medicare Advantage organizations Managed care contracting: Legal issues around contract negotiation, how claims get paid, timely filing, and payment policies. How quickly must plans respond to appeals, and should you put a diagnosis definition in a payer contract? What advice would she give to someone who is in HIM and considering a career in law—what does she know now that she wishes she knew then?