Debbie A. Lupton, RHIT, CHC

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***** ****** **** **** *** Williamson Road

Romney, WV 26757 Winchester, VA 22602

540-***-**** (cell preferred) – adtjlz@r.postjobfree.com OBJECTIVE/SUMMARY:

Experienced and driven Compliance Professional with a proven track record of helping to lead companies by ensuring they are functioning in complete compliance with all applicable Federal and State laws, rules and regulations. I am Certified in Healthcare Compliance (CHC) and am also a Registered Health Information Technician (RHIT). I possess excellent communication skills, allowing me to be able to work with staff in all areas of the healthcare field from entry level to the Executive Team and Boards of Directors while keeping strong ethics at the forefront of my goals. OVERVIEW OF QUALIFICATIONS:

Proactive management skills, i.e. self-starter, ability to multi-task complicated situations, with proven success while working with frequent interruptions and a demanding workload.

Excellent Project Management skills, i.e. development and centralization of multiple programs and departmental areas while developing, initiating, maintaining and revising policies and procedures for the general operation of the Compliance Program and the Company’s Code of Conduct.

Highly skilled with progressive thought processes due to a variety of experience in Compliance, Health Information Management, Utilization Review and Denials Management, and Quality Assurance areas.

Extensive experience involving HIPAA Privacy and HITECH/ARRA Act regulations and processes.

Excellent troubleshooting and on-the-spot thinking involving administrative procedures, billing processes and compliance initiatives as well as working with other departments to ensure compliance issues are directed to the appropriate areas for investigation and resolution.

Highly skilled and experienced in collaboration and coordination of compliance processes involving internal and external customers, i.e. U.S. Justice Department Office of Inspector General, Department of Social Services, Private Service Providers, Regulatory Agencies, Payors, etc.

Excellent written/verbal communication and interpersonal skills with all levels of internal and external customers.

Development and motivation of highly focused teams involving creative problem solving, proficient organization, education and planning.

Keen ability to learn and retain new regulations with ease, i.e. Licensing, payment sources, State, Federal, etc.

Excellent interpersonal skills to include collaboration with different specialties within the professional healthcare fields to include not only administrative areas but also professional clinical areas.

EMPLOYMENT HISTORY:

11/2021 – present (40+ hrs./week)

Bayhealth Medical System (Sussex & Kent Campuses) Milford & Dover, DE Compliance Officer

Debbie A. Lupton, RHIT, CHC

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Manage portion of the day-to-day operations of the Corporate Compliance Program to achieve high levels of compliance with all applicable laws and regulations while supporting the vision and mission of the organization.

Develop and administer Corporate Compliance training for new and current employees, medical staff, allied health professionals, etc. across the organization.

Remain current on compliance issues and provide timely updates to policies to ensure continuing currency and relevance in providing guidance to management and employees.

Manage and promote the Corporate Compliance Ethics & Integrity Help Line (Hotline).

Monitor/report results of compliance/ethics efforts, and provides guidance on matters related to Corporate Compliance.

Key Member of the Enterprise Risk Management Committee.

Manage the annual enterprise risk assessment.

Remain current on Federal and State regulations and communicate to appropriate department leaders to ensure compliance within Regulatory Compliance, Research Compliance, and Auditing.

Collaboration with Federal and State Regulators such as, but not limited to, OCR, HHS, OIG, and CMS on. Compliance related matters.

Management of the organizations Work Plan in coordination with areas identified by the OIG’s Work Plan.

Provide compliance direction after analysis of existing operations and operational proposals for potential compliance issues.

Conduct regular investigations/audits to ensure organization and/or department compliance with regulatory statutes.

Management of the Conflict of Interest program.

Coordinate compliance with the Sanctions/Exclusion Program in accordance with Office of Inspector General as well as multiple other sanction lists. 6/2015 – 11/2021 (40+ hrs./week)

WVU Medicine East – Berkeley & Jefferson Medical Centers & University Healthcare Physicians Martinsburg, WV

Title change from: Corporate Compliance Officer & Privacy Officer, Director Title change to: Corporate Compliance Officer, Director with split of Compliance Privacy Officer reassignment Title change to: Director, Compliance – Facility Compliance Officer (Effective January 1, 2017) Title change to: Director, Compliance - Compliance Officer WVU Medicine – East (Effective January 1, 2019)

Corporate Compliance Oversight for:

Berkeley Medical Center

Jefferson Medical Center

University Healthcare Physicians – University Healthcare Associates-East Division

University Healthcare at Home (Home Health)

Gateway at Home /Allied Health (Durable Medical Equipment)

Other miscellaneous services identified within WVU Medicine East

Responsible for overall organizational compliance education to include partial Privacy & IT Security.

Development and management of concurrent and retrospective audits to monitor high-risk areas as identified by the OIG’s Work Plan and the Entity’s Work Plans.

Oversight of auditing processes of other areas as necessary regarding both current and new services offered.

Debbie A. Lupton, RHIT, CHC

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Collaboration, education and assistance given in areas such as billing, coding, chargemaster, documentation for medical necessity and managed care.

Oversight of compliance efforts in obtaining and maintaining compliance with federal and state laws and regulations to include but not be exclusive to Medicare and Medicaid.

Coordination of the new and/or continued denials management issues for all payors through the Denials Management Team offering assistance as requested by the Revenue Cycle Team.

Oversight of the chargemaster process for Berkeley Medical Center and Jefferson Medical Center.

Assist with 340B Pharmacy Committee, i.e. developing policies and procedures, auditing, etc.

Assist in coordination and oversight of payor audits.

Work with providers and their staff with initiation of new services to include Medication Assisted Treatment (MAT) Programs in the Family Medicine and Behavioral Health Physician Practices.

Review coding and billing processes to ensure appropriate billing submission. 1995- Present (Various hours)

Debbie's Record Review Romney, WV

Owner/Operator/Consultant

Provision of consulting services and training regarding HIPAA; Regulatory Compliance; Risk Management; Affordable Care Act; Meaningful Use; Corporate Integrity Agreements with the U.S. Office of Inspector General (OIG); Documentation; and Coding for Reimbursement. Consulting services also includes development of policies and procedures; program startup, provider professional fee audits etc.

7/2014- 5/2015 (40+ hrs./week)

Sentara Rockingham Memorial Hospital Harrisonburg, VA Coding and Data Quality Manager

Coordination and supervision of 18 FTE’s, 15 of which work remotely from their home environment.

Member of multiple committees using skills to assist in resolving issues and being proactive in preventing potential errors in coding for reimbursement.

Responsible for oversight and education relating to all inpatient, outpatient, clinic, physician office and same day surgery ICD-9-CM, CPT-4 & HCPCS coding and abstracting.

Work closely with the Medical Staff and other peers within the organization to ensure meeting all coding rules and reimbursement reporting requirements.

Responsible for the oversight and direction of Policies and Procedures and Educational activities for all hospital coders to include ICD-10 training, review and assessment.

Responsible for further development of the Coding Manager position. 8/2013 – 3/2014 (37.5+ hrs./week)

Loudoun County Community Services Board Leesburg, VA Health Information Management (HIM) & Records Administrator This position was in the development stages and duties were basically as outlined under previous employers below. Primary responsibilities included centralization of services for the Health Information Management area of the Quality Assurance/Compliance Program. Initial priorities were focused on the new prior authorization system transition from KePRO to Magellan, BHSA, for the Virginia Department Debbie A. Lupton, RHIT, CHC

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of Medical Assistance Services (DMAS) and correctly implementing CPT-4 Evaluation and Management

(E/M) coding for Medication Management Services which included review of documentation standards to meet the requirements of the E/M code billed for each service. 8/2008 – 8/2013 (37.5+ hrs./week)

Northwestern Community Services Board Front Royal, VA Health Information Management/Compliance Coordinator; HIPAA Privacy Officer & VICAP Project Lead

Development of the Compliance Department, encompassing Health Information Management, Transcription as well as the development of programs such as the Therapeutic Day Treatment Program and the Virginia Independent Clinical Assessment Program (VICAP).

Development and oversight of the agency’s prior authorization system for Medicaid and Managed Care Organizations.

Development, presentation and oversight of training modules for clinical and non-clinical staff in the following areas:

Utilization review activities and documentation requirements for prior authorizations for services provided;

Virginia Independent Clinical Assessment Program (VICAP) for children;

Internal/external audit programs and processes;

Corrective action plans;

Reporting of incidents, abuse, neglect and possible exploitation as mandated reporters;

Dictation/transcription for documentation;

The use and documentation requirements of CPT-4 Evaluation and Management (E/M) codes for reimbursement of medical and behavioral health services.

Liaison with clinical staff and KePRO (DMAS/Virginia Medicaid prior authorization provider) for utilization management and documentation.

Development, implementation and oversight, of action plans to correct any barriers toward compliance with records management policy and procedure, including citations by the Department of Behavioral Health Services (DBHDS) or by third party payors.

Investigation and assignment of investigations of critical incidents within the organization ensuring that all incidents were reported to the appropriate regulatory agencies.

Coordination and supervision of personnel in the following areas:

Quality assurance and documentation compliance activities (3 FTE’s)

Transcription (4 FTE’s)

Medical Record/Health Information Management area (1 FTE)

Virginia Independent Clinical Assessment program (3 FTE’s)

Collaboration and coordination with regulatory auditors, both state and federal, i.e. Department of Medical Assistance Services (DMAS), Department of Behavioral Health and Developmental Services (DBHDS), Department of Social Services (DSS), etc.

Assisted with risk management oversight activities, working with DBHDS, Human Rights & payor sources.

Crisis Prevention Institute (CPI) Trainer utilizing the philosophy of providing the best Care, Welfare, Safety and Security training to all staff to remain a restraint free organization.

Member of the Senior Management Team and of the Virginia Association of Community Services Board (VACSB) Quality Management Committee

Debbie A. Lupton, RHIT, CHC

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10/2008- 07/2009 (20 hrs./week)

EastRidge Health Systems Martinsburg, WV

Quality Assurance & Compliance Manager

(Contracted through Debbie’s Record Review)

Continued oversight of all compliance and billing activities to include incident investigations and training in relationship to the Corporate Integrity Agreement with The Office of the Inspector General.

Consultation of approximately 40-60 hours per month. 2/2006 - 10/2008 (40+ hrs./week)

EastRidge Health Systems Martinsburg, WV

Quality Assurance & Compliance Manager (Supervision of 2 FTE's, 1 PTE's) HIPAA Privacy & Security Officer and Director of Medical Record Department

Liaison to the U.S. Department of Health and Human Resources, Office of Inspector General

(OIG) regarding the agency’s Corporate Integrity Agreement (CIA)

Developed training modules and provided or coordinated training at all levels regarding the Corporate Integrity Agreement with the OIG, The Deficit Reduction Act, The False Claims Act, Operation Restore Trust, Health Insurance Portability and Accountability Act of 1996 (HIPAA), the Agency's Code of Conduct; Policies and Procedures as mandated by the Corporate Integrity Agreement and all compliance activities as well as how and what to report in regard to abuse and neglect incidents to Adult Protective Services and Child Protective Services.

Reviewed all federal and state funded programs and grant funded programs for billing (coding) daily (100% of Medicare claims) and documentation compliance with successful Independent Review Organization audit receiving less than a 5% error rate for Medicare claims as well as Grant funded programs in 2008, improvement from 21% error rate in 2006.

Investigated or assigned investigations of all critical adverse incidents within the organization ensuring that all incidents were reported to the appropriate state and/or federal agency, i.e. Office of Health Facility Licensure and Certification (OHFLAC), Adult Protective Services (APS), Child Protective Services (CPS), Office of Behavioral Health Services (OBHS), Office of the Inspector General (OIG), etc.

Coordinated and supervised personnel engaged in quality assurance, billing (coding) and documentation compliance activities including billing write-offs and self-identified paybacks to payor sources regarding coding and billing.

Reviewed and approved write-offs for all payor sources regarding non-compliance of billing and coding issues.

Worked with all outside auditing agencies, both state and federal. (Marked improvement had been documented regarding all audits over the 2-3 year period.)

Work with providers and their staff with initiation of new services to include the Medication Assisted Treatment (MAT) Program and the Crisis Stabilization Unit (CSU).

Coordinated and supervised personnel engaged in assembling, analyzing, transcribing and filing documentation for a complete and accurate medical record.

Chairperson for:

Compliance Committee, Safety Committee and Forms Committee

Member of:

Credentialing Committee, Policy and Procedure Committee, Medicaid Eligibility Committee, Admissions Compliance Workgroup, and the Senior Management Team Debbie A. Lupton, RHIT, CHC

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12/2005 - 2/2006 (40+ hrs./week)

Western Correctional Institution Cumberland, MD

Medical Record Director

Coordinated and supervised personnel engaged in assembling, analyzing and filing material for a complete and accurate medical record.

Daily, weekly and monthly statistical reports as required by contract and record assembly.

Coordinated off-site scheduling for appointments to outside consultants.

Utilization Management and Performance Improvement to assess the need for outside consultations, tests and/or hospitalizations.

Coordinated on-site specialty clinical appointments for the following clinics: Endocrine, Neurology, Cardiovascular, Pulmonary, Infectious Disease, Physical Therapy, Optometry, Dental and Internal Medicine.

Medical Liaison for coordination of transportation for outside appointments and/or hospitalizations.

Member of the Western Maryland Regional Quality Improvement Committee, the Mortality and Morbidity Committee, and the Regional Medical Record Committee. 8/2000 - 9/2005 (40+ hrs./week)

Selma Medical Associates, Inc. Winchester, VA

Health Information Management Director (Supervision of 17 FTE's)

*Appointed HIPAA Privacy Officer, July 2001

*Appointed Information Security Officer - January 18, 2005

Development, Centralization and Supervision of the Health Information Management Department, Transcription, Switchboard and Courier Services.

Planned, developed and coordinated policies and procedures for the Health Information Management Department.

Conducted CPT-4 E/M Coding audits to ensure documentation supported services billed for specialty services i.e. Cardiology, Internal Medicine, Family Practice, Infectious Diseases, and ancillary services such as Radiology, Laboratory and Nuclear Medicine studies.

Provided training of all staff regarding documentation to meet standards of multiple payors.

Developed, implemented, monitored and maintained the facility’s policies and procedures regarding privacy and security under the Health Insurance Portability and Accountability Act of 1996 (HIPAA).

Educated work-force (@ 100+ staff members) including the Physician and non-physician providers and students of local colleges and high schools regarding HIPAA.

Counseled and educated individuals/patients when requested, on their rights as governed by HIPAA and the release of information processes.

Assisted in processes regarding JCAHO accreditation of the Infectious Disease Infusion Unit.

Senior Management Team member.

1998- 2000 (PRN)

Paramedical Health Consultants Follansbee, WV

Consultant

Coding and Abstracting

Consulted with Nursing Facilities that had state licenses put into a suspension period for Debbie A. Lupton, RHIT, CHC

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Medicaid payor source until which time consultants could get the facility back into compliance with meeting state standards.

7/1996-8/2000 (40+ hrs./week)

Western Correctional Institution Cumberland, MD

Medical Record Director

Developed, Coordinated and Supervised Medical Record Personnel engaged in assembling, analyzing and filing material for a complete and accurate medical record.

Development and processing of daily, weekly and monthly statistical reports as required by contract and record assembly.

Responsibility for billing codes submitted.

Medical Liaison and Coordinator for scheduling of off-site appointments to outside consultants, outpatient tests and/or hospitalizations.

Instrumental in obtaining a 100% rating on the MCCS audit. (This audit is similar to State Licensure Surveys and JCAHO surveys. This is the first time in the history of the Maryland Department of Public Safety and Correctional Services (DPSCS) that this rating was obtained for initial startup of a Medical Unit on the first audit.)

Coordinated on-site specialty clinical appointments and quality assurance reviews for the following clinics: Endocrine, Neurology, Cardiovascular, Pulmonary, Infectious Disease, Physical Therapy, Optometry, Dental and Internal Medicine.

Coordinator of the Western Maryland Regional Quality Improvement Committee (only non- clinical QI Coordinator in the DPSCS due to extensive prior experience).

Member of the Mortality and Morbidity Committee, and the Regional Medical Record Committee.

5/1986- 10/1995 (40+ hrs./week)

Hampshire Memorial Hospital, Inc. Romney, WV

Medical Record Director & Long-Term Care Consultant

Developed, Coordinated and Supervised Medical Record Personnel engaged in transcribing, assembling, analyzing and filing material for a complete and accurate medical record.

Responsible for all inpatient ICD-9-CM coding and abstracting as well as all outpatient CPT-4 & HCPCS coding and abstracting.

Utilization Review for insurance reimbursement to include Medicare and Medicaid and private payor sources.

Development of the denial appeals process.

Worked closely with the Medical Staff, Peer Review Organization reviewer, State Licensure

(OHFLAC) Surveyors, Medical Malpractice Insurance Representatives and other Allied Health Care Staff as required.

Coordinated Medical Staff Appointments, Re-appointments and Credentialing.

Organized and submitted Medical Staff information to the National Practitioner's Data Bank for credentialing.

Coordinated Quality Assurance activities for the Medical Record Department.

Developed and coordinated the Quality Assurance Program for the Medical Staff and the Hospital-Wide Quality Assurance Committee.

Debbie A. Lupton, RHIT, CHC

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1993-1995 (PRN)

ParaMedical Record Consultants, Inc. Elkview, WV

Consultant - to include coding, abstracting and long-term care consulting. 1988-1989 (PRN)

McLean County General Hospital, Inc. Calhoun, KY

Consultant - to include coding, abstracting and small hospital documentation audits. 1985-1986 (40 hrs./week)

Sacred Heart Hospital Cumberland, MD

Coder/Abstractor

1984-1985 (40 hrs./week)

Culpeper Memorial Hospital, Inc. Culpeper, VA

Accredited Record Technician – Release of Information & Coder/Abstractor EDUCATION:

Shepherd University (December 2019) – Shepherdstown, WV

Regents Bachelor of Arts (RBA)

Fairmont State College (May 1983) (Fairmont University) - Fairmont, WV

A.A.S. in Medical Record Technology (Health Information Technology)

Numerous CEU’s obtained to maintain licensing/certifications as listed below. TECHNOLOGY:

OPERATING SYSTEMS USED:

Windows XP - Vista- Windows 7, 8 & 8.1, 10, 11

ELECTRONIC MEDICAL/HEALTH RECORD SYSTEMS:

EPIC, NextGen, AS400 Physician Portal, Medic/Misys, CMHC, Sage/Intergy's Medical Manager, Cerner’s Anasazi, 3M Encoder, and Meditech.

SOFTWARE USED:

Microsoft Office 365

Microsoft Office Suite 2000/2003/2007/2010/2013/2016/2017 - Word, Excel, Access, PowerPoint, Publisher, and Outlook

LICENSING/CERTIFICATIONS:

**Multiple educational courses taken to maintain licensure/certification through CEU’s, no less than 40 per 2-year cycle to include ICD-10 coding.

Certification in Healthcare Compliance (CHC) (ID #145171) Registered Health Information Technician (RHIT) (Certification #0380733) Certified Mandt Instructor (Inactice)

Certified Crisis Prevention Institute (CPI) Trainer (Inactive) Debbie A. Lupton, RHIT, CHC

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PROFESSIONAL AFFILIATIONS:

Health Care Compliance Association (HCCA)

Certified in Healthcare Compliance (CHC)

American Health Information Management Association (AHIMA) Membership Status: Active Registered Health Information Technician (RHIT) April 1984 to present (Initially ART - Accredited Records Technician)

West Virginia Health Information Management Association (WVHIMA) Membership Status: Active Registered Health Information Technician

(RHIT) since April 1984 (Initially ART - Accredited Records Technician) o Professional Awards/Acknowledgements

2015 WVHIMA Distinguished Member Award

o WVHIMA Board of Director Activities

• Appointed Distinguished Member Committee, Chairman, 2015 - present

• Elected Director to Board of Directors, 2008 - 2012

• Appointed Achievement Awards Chairman, 2007 - 2009

• Elected Nominating Committee Member, 2006 - 2007

• Elected Nominating Committee Member, 2005 - 2006

• Appointed Membership Chairman, 2005 - 2006

• Elected Director to Board of Directors, 2000 - 2003

• Appointed Member Board of Directors, 1995 - 2003. 2005 - 2012

• Appointed Education Committee, Co- Chairman, 2000 - 2002

• Appointed Long Term Care Section, Co-Chairman, 2000 - 2001

• Appointed Technology Committee, Co-Chairman, 1999 - 2000

• Elected Nominating Committee Member, 1997 - 2000

• Appointed Long Term Care Section, Co-Chairman, 1996 - 1999

• Appointed Distinguished Member Committee, Chairman, 1995 – 1996 INTERVIEWS FOR PUBLICATIONS:

Journal of AHIMA (American Health Information Management Association) (Interview) April 1998, page 42-46; Forging New Relationships: HIM and Managed Care. Medical Office HIPAA Alert (The Coding Institute) (Interview) July 2005, page 49-50; Test Your Compliance Program with These Top Methods.

COMMUNITY SERVICES AFFILIATIONS:

Kirby American Legion Auxiliary -Lifetime Member since 1985 Volunteers in Policing (VIP) for the Winchester City Police Department; Winchester, VA

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