Joseph Rivet, Esq.

Joseph Rivet, Esq., founder of Rivet Health Law, PLC in Norton Shores, Michigan, occupies a unique niche in health care reimbursement, beginning with a career in emergency medicine coding and continuing with increasing levels of responsibility and expertise as a manager in varied health care provider and payor settings.

The broad spectrum of Joe’s health care experience includes inpatient and outpatient coding, teaching-physician services, integrated healthcare delivery systems, evaluation and management (E/M) coding, emergency medical services (ambulance) coding and billing, and Medicare and Medicaid rules. Joe’s extensive payor and provider coding compliance experience underscores his depth of knowledge with respect to ever-changing regulations and sometimes perplexing Medicaid jurisdictional variations.

Before Joe became an attorney, he worked in numerous health care settings, including community hospitals, large medical groups, and one of the nation’s largest integrated delivery systems. A coding expert and educator whose responsibilities have included ensuring coding and revenue cycle integrity, Joe has served as the lead coding instructor at the U.S. Department of Justice Medicaid Integrity Institute, which provides training in fraud investigations, data mining and analysis, provider enrollment, managed care oversight, emerging trends, and case development to help protect the integrity of the Medicaid program.

Joe has led the fraud, waste, and abuse (FWA) divisions of two large health plans. The depth and breadth of his payor experience provides invaluable insight for providers with respect to payor audits, the claims adjudication process, appeals, payor policies, managed care contracts, and audit operations.

Joe’s healthcare reimbursement experience includes response management during numerous federal (e.g., Target Probe and Educate (TPE), Recovery Audit Contractor (RAC)), state Office of Inspector General (OIG), and private payor audits including Special Investigation Unit (SIU), Aetna ® , WellCare ® , Centene ® and many others. A nationally recognized coding, billing, reimbursement, and regulatory expert, Joe frequently explains the nuances of these topics at national and regional healthcare conferences and seminars.

Education

  • Western Michigan University Thomas M. Cooley Law School, JD
  • Baker College, Health Administration, BS

Bar Admission

  • Michigan

Affiliations

  • American Bar Association (ABA)
  • American Health Lawyers Association (AHLA)
  • Grand Rapids Bar Association
  • Health Care Compliance Association (HCCA)
  • American Academy of Professional Coders (AAPC)
  • Institute of Internal Controls (IIC)

Credentials

  • Certified Coding Specialist – Physician Based (CCS-P)
  • Certified in Healthcare Compliance (CHC)
  • Certified Evaluation and Management Coder (CEMC)
  • Certified Professional Coder (CPC)
  • Certified Professional Medical Auditor (CPMA)
  • Certified Internal Controls Auditor (CICA)
  • Certified in Healthcare Research Compliance (CHRC)
  • Certified in Healthcare Privacy Compliance (CHPC)
  • Certified Compliance and Ethics Professional (CCEP)
  • Certified Ambulance Coder (CAC)
  • Certified Ambulance Compliance Officer (CACO)
  • AHIMA-Approved ICD-10-CM Certified Trainer

Publications

E/M Auditing: A Step-by-Step Guide to Updated Coding, Reimbursement, and Compliance, HPCro, 2021 – book

Third Party Payor Day, Medical Group Management Association (MiMGMA), November 13, 2020 – speaker

Telemedicine Panel, Illinois Medical Group Management Association (IlMGMA), November 13, 2020 – speaker

Navigating Third-Party Audits Successfully, American Medical Billing Association, 2020 National Conference, October 15, 2020 – speaker

Successfully Navigating Third-Party Audits, American Health Information Management Association (AHIMA), 2020 National Conference, October 15, 2020 – speaker

CMS Interim Final Rule in a Nutshell, National Association of Healthcare Revenue Integrity (NAHRI), webinar April 2020, – presenter

Special Edition: COVID-19 Telehealth Coding and Documentation, Michigan Medical Group Management Association (MGMA®), webinar March 2020, – presenter

HIPAA Enforcement: Increased Risk Landscape, Michigan Medical Group Management Association (MGMA®), webinar March 2020,– presenter

Clarifying New Guidance for Pressure Ulcers, Deep-Tissue Damage, Revenue Cycle Advisor, , January 10, 2020 – article

The Anatomy of the ICD-10-PCS Code, Association of Clinical Documentation Integrity Specialists, , Vol. 12, Issue 134, November 5, 2019 – article

Sepsis: Start with the ICD-10-CM Documentation Basics, JustCoding Inpatient, HCPro, February, 20, 2019 – article

FY 2020 Guidelines Updates: Stay Current with Skin Ulcer Reporting, JustCoding Inpatient, HCPro, October 2, 2019 – article

Refresh your Knowledge with ICD-10-PCS Coding Basics, JustCoding Inpatient, HCPro, October 16, 2019 – article

Break Down 2020 IPPS Policies and ICD-10-PCS Reporting Guidelines, JustCoding Inpatient, HCPro, August 7, 2019 – article

Medicare Overpayment Final Rule: Guidelines for Avoiding FCA Liability, Compliance Today, Health Care Compliance Association, December 2016 – article

Medical Billing Companies Can Be False Claims Targets, Healthcare Business Monthly, American Academy of Professional Coders, November 15, 2016 – article

Are Auditors, Billers, and Coders Liable for False Claims?, Healthcare Business Monthly, American Academy of Professional Coders, May 1, 2016 – article

Auditing Evaluation and Management Services: A Step-by-Step Guide to Accurate Coding, Reimbursement, and Compliance, Second Edition, HPCro, 2011 – book

E/M Coding Pocket Guide for Physician Practices, HCPro, September 29, 2006 – pocket guide