No, she doesn't wear a cape or have a sidekick named Watson, but the Sherlock Holmes of VNA Plus-also known as Stephanie Bard-spends much of her day sleuthing through patient charts not to solve a case...but to ensure that we are reporting our patient care correctly to the federal government for reimbursement. It may not sound as glamorous as being a private investigator; but medical records coding is one of the critical, behind-the-scenes jobs that keeps VNA Plus in business.

With an Associate degree in Medical Records Technology from Indiana Business College, Stephanie first worked for VNA for three years in the early 1980s. At that time, nurses were capturing notes about their patients on micro-cassette recorders, which then had to be transcribed onto patient charts. When Stephanie returned to the agency in 1999, paper was still around but computers would soon become the norm. "At least I don't have the piles I used to have on my desk!" she laughs. What has also become standard has been learning the ICD-9 codes (shorthand for International Statistical Classification of Diseases and Related Health Problems) that must be used correctly to ensure reimbursement for medical services-and then having the codes change frequently. Though Stephanie can recite from memory many of the commonly-used codes, that's about to change as well, as soon as the U.S. adopts the new ICD-10 codes already in use in other countries.

It's these challenges, however, that have enticed Stephanie to stay in her position for a dozen years. "There is something new to learn every day and the job has definitely helped me develop more patience!" she says, adding, "Plus, I love the environment here and my boss and I work so well together."

Stephanie's boss, Alicia Cave, Health Information Manager, has praise for her employee as well. "I'm so proud that Stephanie has maintained her Home Care Coding Specialist-Diagnosis credential since 2006," she states. "It requires a recertification test every other year that becomes more difficult each time as home health and hospice rules and regulations get more complicated."

In fact, the system has become so complex that many agencies now use nurses to do the coding because of the level of anatomy and physiology knowledge often required to keep an accurate patient record. "I've learned more about the human body than I ever thought I would know!" Stephanie says. She notes too that just one patient chart-such as for someone with a serious wound-can require an entire day's work to determine the background of the injury or illness, how it began, how it is being treated, and if the appropriate terminology is being used to document everything the nurse is doing. Stephanie emphasizes, "The bottom line is that every patient chart must be correct. We don't want to be overpaid by the government by a single penny; but we don't want to be underpaid either!"

We salute Stephanie, her accomplishments and her commitment to ensuring that VNA Plus maintains the highest level of fiscal responsibility to our patients, our referral sources and to the federal Medicare and Medicaid programs.