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Susanne Wynne has been promoted to manager of billing compliance for USA Health.
In the new role, she is responsible for making sure billing practices throughout the hospitals and ambulatory practices meet all the latest federal regulations. Those regulations have burgeoned as the federal government works to prevent fraud and abuse, Wynne says.
“Within health care, there has been a lot of billing abuse, so everything has to be documented,” says Wynne. “Not that we abused it, but there has been a lot elsewhere. So the rules are monumental.”
She reviews Office of the Inspector General publications to keep abreast of new regulations and of areas that are coming under federal scrutiny — then reviews Health System practices to make sure they meet the current standards. Newest standards from the Centers for Medicare and Medicaid Services are also a great concern, because they are the major federal payers for USA Health services.
Wynne also works with an auditing group that reviews USA Health and several other teaching hospital systems.
Standards can be different for similar services offered within the different facilities, she says, so it is important to make sure the health system is in compliance with billing regulations. Her job is to find any discrepancies and make sure they are corrected.
“It’s always better to find it ourselves,” she says, since CMS can impose a major fine — $12,000 per line item per patient — if it uncovers an error.
The job is a perfect fit for Wynne, who loves the puzzle of auditing books — not the math necessarily, but the “picking through documents and such and bringing the results together in a report.”
Moreover, she enjoys doing the work in a field that’s devoted to helping people.
“I’m proud to say I work at USA Health,” she says, because of the system’s benefit to the community. “It’s a great health care system and it provides a lot of great care — helping those who need help the most.”
A University of South Alabama graduate, Wynne came to work in the USA Medical Center accounting department in 1989, shortly after earning Certified Public Accountant credentials. She has worked across USA Health through the years, moving from accountant to chief accountant for USA Doctors Hospital (now Children’s & Women’s), to director of billing compliance for all the hospitals until June, when she became manager of billing compliance for all of USA Health.
When she’s not puzzling over an audit, Wynne — a Mobile native who graduated from Murphy High School — enjoys working in her yard and spending time at the beach.
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