Tufts MC True Blue Recipient: Debra Barnum
Appeals Coordinator, Case Management
Nomination from Alison Boone, Case Management Manager:
"When I think about an employee who truly deserves True Blue recognition, the first person that comes to my mind is Debra Barnum. Words that come to mind when thinking about Debra include dependability, loyalty, high standards, intelligence, commitment, quality and professionalism. Debra has the enormous responsibility of handling all of the denials that Tufts Medical Center receives from Medicare and Medicaid. Once a denial occurs, which typically happens on a daily, weekly and monthly basis, Debra must investigate the case, carefully dissecting the medical record for level of care guidelines and comparing the stay to national benchmarks for inpatient level of care. Next, she is responsible for writing an appeal letter to the government to defend the case. This requires Deb to use her immense knowledge base as well as various medical information services, and comprises our defense for the inpatient stay in letter format. She also huddles with the physicians involved in the case, and works with them to obtain the physician portion of the appeal.
"Debra’s job requires intensive coordination and organization, but the payoff is huge. Every time Debra overturns a denial, she ensures the hospital receives the appropriate payment from Medicare and Medicaid, which is a financially significant number, thousands of dollars compared to only hundreds if denied. I am so grateful to have Debra Barnum working in Case Management, and feel that the Medical Center is truly lucky to have such an efficient, effective employee in this position.
“Deb's work revolves around very tight and rigid deadlines and she compulsively meets them all. In the past two years, federal and state audits have significantly increased, as the government is looking for ways to save money, thereby penalizing hospitals. This increase has a great impact on the number of denials a hospital receives, as the government is looking at high cost hospital stays and forcing hospitals to defend the care given to patients in order to be fairly paid. Debra’s role in these audits is huge, very time consuming and stressful…. Debra has kept up with the increased demands and somehow managing to meet her deadlines and respond 100 percent to these potential denials. Her overturn rate is 70 percent for all and 100 percent at the [federal] level. She is an extreme expert at what she does, and is very passionate about her work.”
Congratulations, Debra. We are so proud of you! You truly represent Tufts MC True Blue.