Lorri Lauzze, RHIT, CHC, is the Director of Corporate Compliance for Rochester Regional Health (RRH) and has been in the department since the program’s inception more than 20 years ago. Lorri was a key contributor in designing, planning, and implementing the Corporate Compliance program. The building blocks of her career stem from her strong background as an Inpatient and Outpatient Coder and as a Clinical Documentation Specialist (CDI). She was in the right place at the right time when the Office of Inspector General (OIG) published the Compliance Program Guidance for Hospitals in 1998. “When the Compliance Department began, I applied for the job. I remember how intimidating the job description was to me, but now I look back and realize how complex the position has become.” Lorri’s role in Corporate Compliance has expanded and evolved over the years driven by the growth of the health system and by external government agency influences. Corporate Compliance is a governance function and the Board has oversight of the program. Lorri reports to the Chief Compliance Officer and leads a team who with herself advises, educates, trains, audits, and investigates potential fraud, waste and abuse within the complex world of healthcare regulations.
Lorri was first introduced to the Health Information Management (HIM) field from reading about it in the Alfred State College’s Admissions Catalog. The program was a great match for her since she was interested in working in the medical field and clinical knowledge, but without direct patient care. She graduated from Alfred State College in 1996 and earned her RHIT certification that same year. Lorri decided to test the waters of HIM before continuing with her education. She landed her first coding position at Lakeview Regional Medical Center, a private hospital outside of New Orleans where she was given the opportunity to learn all different lanes of outpatient coding such as Emergency Department, ambulatory surgery, observation, and hyperbaric wound care. She then transitioned into inpatient coding and CDI, which she liked better because it involved deeper clinical knowledge. She moved back to the Rochester area after 2 years and was hired as an Inpatient Coder at The Genesee Hospital, which was affiliated with Rochester General Hospital at the time. She was then promoted to Coding Supervisor. Lorri earned her Bachelor’s degree with a concentration in Health Systems Administration from Rochester Institute of Technology in 2015. Lorri earned her CHC (Certified Healthcare Compliance) certificate in 2013 and is currently seeking a Certified Fraud Examiner credential as well.
Corporate Compliance is a dynamic, multi-faceted program that ensures legal, ethical, and professional standards are met and communicated throughout the entire healthcare system. Healthcare Corporate Compliance is a mandated government function. “We are continuously auditing and monitoring the organization daily for non-compliance and preventing and identifying potential fraud, waste, and abuse. Advances in data analysis technology allow us to identify and prevent potential non-compliance in real time.” Lorri believes in thorough, objective investigations and analysis to identify true causes of non-compliance. “If there are staff to train and educate as a result of an audit or investigation, then we will support them. We also assist with process improvement opportunities.”
“We are multitasking every day. It’s not just coding now, it’s an investigation field and an investigator skill set is required, which goes beyond the HIM profession. We’ve build a team of experts to ensure each service line is represented by experienced advisors. Lorri enjoys employing quality assurance processes to identify and mitigate financial and reputational risks to individuals and the healthcare organization. She emphasizes the need to understand how everything works together in the revenue cycle. It is also her greatest challenge. “My greatest challenge is the revenue cycle. It is so complex with multiple roles contributing to a compliant outcome. The moment the patient arrives you need to ensure the right insurance is assigned, then providing accurate and complete clinical documentation as that drives coding and charging. Next, compliant coding will drive billing and billing personnel prepares the claims further in order to receive accurate reimbursement. Every piece has to come together and be compliant to drive compliant payment at the end.”
The COVID-19 pandemic dramatically impacted the healthcare reimbursement system and Lorri’s team reacted quickly by collaborating as a team with HIM, Revenue Cycle and others to educate and train providers on the new guidelines. “Compliance, HIM, and the Revenue Cycle had to work around the clock the moment the reimbursement system started to change with COVID. This group had to educate all of the providers on how they would provide services relative to reimbursement expectations such as the use of telehealth. The education and trainings had to be developed in the moment as the payors were changing their guidelines often.” Compliance was involved to ensure proactive risk mitigation.
Lorri’s team also facilitates and directs all regulatory agency inquiries when they relate to a reimbursement matter. “If we get a letter or a visit by a government agency, then we are there to manage the process of cooperating with the government’s investigation.”
Lorri has been working in the HIM field for over 26 years. She is pleasantly surprised by the variety of career options HIM has to offer. “I like that about working in HIM, you can break off and go in different directions, and there are many transferrable skills to apply within the healthcare industry.” In the past, Lorri visited the HIT class at Monroe Community College to teach them about Corporate Compliance and fraud, waste and abuse. She told students who were interested in a career in Corporate Compliance that coding experience is key. “Move through different kinds of coding. Be the best, and then start educating others. Behaviors are important too. You need to be professional, kind, understanding, and objective.” Lorri advises students to just go for it because the HIM degree can be a springboard for different careers.
Lorri can look back at the original job description and marvel at how much her role has changed and how the program has evolved to meet the challenges of today’s healthcare industry. “I was somebody who loved coding and clinical documentation. I loved all of it and it set me up for success to be in the compliance role to then advise others.”
Lorri’s favorite pastime is spending time with her family on the lake.
Carol Manfreda, RHIT
