The year was 1991. A young RN and the single mom of a three-year-old, with no support, I moved from British Columbia, Canada, to Harlingen, Texas. For the first few years I worked in the emergency department. I loved it, but with a tiny daughter, the shifts were hard to manage. In 1994 I moved into home health care.
Over the next 10 years, working weekends and holidays for nothing extra, and basically being told “you’re an employee, so shut up,” I made a lot of money for people who possibly didn’t deserve it. As the saying goes, the best horse in the stable gets the heaviest load. A friend and I often talked about going into consulting but didn’t know which direction to take. Meanwhile, I managed to move up the ladder at this large corporate entity, to Compliance Officer then to Director of Professional Services.
With superb timing, Vickie Milazzo Institute’s information packet on how to become a Certified Legal Nurse Consultant arrived in my mailbox. Her positive philosophy intrigued me, so I showed the material to my best friend, Luana.
For both of us, Vickie’s message triggered a decision-making, life-changing moment. We were done with working for this thankless company and ready to start our own.
Vickie Milazzo Changed My Perspective
The year now was 2006. My daughter was in high school, and I was married to a wonderful, supportive man. We had two boys, six and four. My husband took time off from work to care for the boys during the time that Luana and I attended the CLNC Certification Seminar.
Vickie’s legal nurse consulting training was spectacular, of course, meticulously complete, from analyzing medical records to writing stunning reports to creating marketing materials, but for Luana and me, her message went beyond these excellent disciplines. Vickie shared a philosophy that I’m sure everyone hears but possibly doesn’t truly take to heart.
What we heard was, “You are awesome! You are a nurse and you can do anything.” Luana and I looked at each other knowing we’d gotten the message we needed. What we learned was better than just the doing, it was the being.
We Focused on Becoming Experts
At the corporation, we were hard workers who believed in doing a job right but received little respect for following the rules. Vickie made us realize we weren’t crazy for believing there is a right way to do things, and her perspective has served us well.
Luana and I incorporated our business as R & L Medical Legal Consulting. We began deepening our ten-plus years of practical knowledge and experience with further study in the legal aspects of home care regulations – the Federal Register, Program Integrity Manual, Medicare Benefit Policy Manual and Conditions of Participation governing our area.
Meanwhile, we started putting out feelers in the medical community, presenting ourselves as experts in home health care regulations. Clients started hiring us to clean up their agencies. We didn’t intend to move only into the home care field, but we became so busy with it, we didn’t look anywhere else. And because of Vickie’s “you can do anything” philosophy, we even bridged the national economic downturn.
In 2010, when President Obama passed the Heath Care Affordability and Accountability Act, which required tremendous oversight in every area of health care, we started getting even more “please help us” requests from agencies. Fortunately, we had the answers they needed at our fingertips.
We Expanded Beyond Injury Cases
We usually think of Certified Legal Nurse Consultants consulting on medical malpractice, toxic torts and personal injury, but our corner of health care law was new. Eventually, we were hired by a large health care law firm out of Washington, D.C., and found ourselves arguing for clients against the Department of Justice and the Office of the Inspector General (OIG).
Once again, Vickie’s training was wonderful because she always took us back to the law. Regulation is law. Statute is law. Although applied in a completely different format when it comes to health care, it’s still law. We’ve moved into an arena where we defend home health care firms that represent Medicare patients who need to continue receiving home health services.
We testify at the administrative law judge (ALJ) level. We state the care given as evidenced by the medical record, and how it supports and complies with the standards and regulations that govern the coverage of the Medicare benefit for home health care.
Our Legal Nurse Consulting Business Skyrocketed
Before long we were traveling like crazy – Chicago, Lexington, Washington D.C., Nashville and New Orleans. We had clients all over the country, home health care agencies as well as attorneys. And we got burnt out. Exhausted.
As a nurse, I capped out at a yearly salary of $90,000. At our peak, R & L Consulting was earning more than $600,000 a year. But was I happy? Before I knew it, seven years had gone by and I felt trapped again, like a lab rat spinning on its little wheel. I began asking myself, “What is success as a legal nurse consultant? Is it running yourself ragged going through airport security and living out of a suitcase six days a week and not being with your family?”
For some people that is success, and I respect that, but it wasn’t success for me. My youngest son, who is now 15, didn’t speak until he was four. He had speech problems and the doctors wanted to put him on a bunch of pills, which I didn’t agree with. The school system did not have a good way of dealing with his difficulties, so I home-schooled him. With the constant travel, that became impossible. I could afford private tutors, but they weren’t doing the job as I would have.
We Intentionally Changed Courses
Luana and I went to Chicago for a conference. We stayed in the financial district near the old Cadillac Theater, and during a break we visited a tea room. We were seated by a wide window. This was about 5:00pm, and people were streaming by, rushing to catch their trains. Until I experienced this mass departure, I had never understood the term “rat race.”
It freaked me out. Heads down, eyes down, this rat race of inhabitants plodded along the sidewalk one way or the other, exchanging no communication, no energy with people they passed or walked next to. No one was connecting. At heart, I’m a country girl. Even though I’d been in numerous big cities, that sight was as bizarre to me as if an alien spaceship landed outside our window.
“So they get up in the morning, go to the city, march to their jobs and then march back home in the evenings,” I said to Luana. “Is that living?” Keep in mind, I was around 45 years old at this time.
On our flight back, we had a long discussion. Luana, after many years of trying to conceive, finally had the baby she’d always wanted. Unfortunately, she had also gone through a divorce. Shortly after that, my father passed away, so we were both experiencing personal life changes. And my two little boys at home weren’t getting the attention I felt they needed from me. We made the decision to stop. Not to stop working as Certified Legal Nurse Consultants, of course, but to stop running the rat race. We decided to change courses.
Once Again We Became Experts
Our reason for attending the conference in Chicago was to be recertified for the International Classification of Diseases, (ICD-10). Part of the government’s new health care reform is to get the world on the same page in reporting disease so that researchers can track fluctuation. Anyone working on a claim is mandated to follow the same rules and use the same set of codes. These codes have to be accurate, which means another level of oversight.
Again, everybody wanted help. So we became experts in coding – and it served us well in our decision to change directions.
Luana and I work in our separate home offices, coding, crafting rebuttals to claim denials or audit denials and still testify at high government levels, usually by video-conference. One day, I was deposed for nine hours on 220 claims by the Department of Justice. I never heard anyone ask one question in so many ways.
We still do the expert job Vickie taught us, and our business comes by referral. We travel only once every six months or so, and at noon on a Thursday we might ditch work for the afternoon to take the kids to the beach. Still, we continue to maintain personal legal nurse consultant salaries of $130,000 or more.
Success Is a Personal Calculation
Not every Certified Legal Nurse Consultant wants her name in lights. We’re not all alike, and that diversity makes us shine in our own way. Not everyone measures success by a bigger and bigger bank account. Success to me is joy. How much joy do I have in my life?
I’m the commander of my own boat, and I can tweak my sail any way I want to go. Growing up on a big ranch in Canada, I ran wild and free, and I’ve tried to reproduce that feeling for my own kids. We have only an acre of land, but we have a garden. We have chickens. Those are perks you can’t put a price on.
It started with Vickie Milazzo telling me that I am worthy. Yes, she teaches important disciplines and provides legal nurse consulting certification, but I’m not sure she realizes that she does so much more than that. She makes you understand that you have what it takes – all you have to do is own it.
Through Vickie’s philosophy, Luana and I have both come into alignment with who we are. This morning, we received a request from a big firm out of Michigan. “Can you help?” they asked. Of course we can. That’s what we do. As Certified Legal Nurse Consultants, we happen to be experts in home health care.
Guest Blogger Profile
Rebecca De La Fuente, RN, HCS-O, HCS-D, CLNC owns R & L Medical Legal Consulting, LLC. She is an expert in home health care, regulatory compliance, Medicare appeals and life.
P.S. Comment here to congratulate Rebecca on her CLNC Success.