Inside Track: Attorney turns medical problem into career

Joe Rivet took a job in health care just to get insurance; now he’s an expert on the subject.
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Corporate restructuring during COVID-19 prompted Joe Rivet to start his own law firm. Courtesy Anna Cillan

Joe Rivet inadvertently catapulted himself into the health care industry as a teenager and has made a career out of it ever since, recently becoming the founder and principal attorney for Rivet Health Care Law PLC, and an arbitrator for the American Health Law Association.

Born on the western side of the state of Washington, Rivet and his family experienced the ebbs and flows of the lumber and fishing industries.

Rivet’s father worked at lumber mills that were located throughout the region. Prosperity at the time hinged on the domestic and international trade of lumber, which fell victim to the eruption of Mount St. Helens in 1980 when Rivet was a toddler. 

“After the eruption, there were thousands of acres of wooded land that were owned by the lumber industry that were wiped out,” he said. “It was just devastating. There was nothing there for the workers to harvest. There was no product to cut down. There was no product to manufacture. There were tens of thousands of acres and not all of them were disrupted. But they were at different parts of their growth cycle, so they weren’t ready to be harvested because it took a lot of time. Those trees took long to grow in order for them to be harvested so just thousands of acres were wiped out, which impacted the lumber industry.”

The effects of the eruption lingered for decades, greatly impacting families that had to rely on food banks for nonperishable foods and the Salvation Army Angel Tree program for shoes and coats, as well as other community access programs and resources. 

Despite the devastation, residents still returned to work in the lumber industry because it and fishing were the top two economic drivers in northwest Washington.

Rivet, however, decided he wanted to chart his own course. He worked at a local convenience store and a hotel as a teenager, but he needed health insurance because he no longer was covered by his parents’ policy when he turned 18 at the time.

JOE RIVET
Organization:
Rivet Health Law
Position: Founder and principal attorney
Age: 42
Birthplace: Longview, Washington
Residence: Grand Haven
Family: Wife; Cindy, and children Corbin (20), Evan (11), Audrey (9) and Adam (8)
Business/Community Involvement: Board member of the Young Lawyers Association of the Grand Rapids Bar Association, member of the State Bar Payer Subcommittee, pro bono attorney for the Michigan Indian Legal Service, reimbursement chair for the Michigan Group Medical Association and member of the American Bar Association Solo, Small Firm and General Practice Division
Biggest Career Break: “Many years ago when my boss at the time actually moved me into an entry level coding position to code medical records. I didn’t have a credential at that time, I never did it before, but she believed in me and she made the investment to train me and from then on, I’ve just been on this path. Had it not been for that, I don’t know that the path would have led me here, practicing law in health care.”

“I needed to find a job that provided health insurance because I had horrible teeth,” he said. “We didn’t have money for an orthodontist or a dentist. We had state Medicaid for dental, which unless your tooth was hanging by the root there weren’t a lot of options.”

Rivet was able to pay to get braces at 19 after a woman who worked at a local hospital suggested he apply at the hospital for a transporter job. That position ended up being the foundation for a career in the health care industry.

He spent about two years as a transporter, moving people and items throughout the hospital such as in x-ray rooms, emergency rooms, patients’ rooms and administration offices, among other places.

Rivet later accepted a position as a registrar, where he registered patients in the emergency department by collecting and verifying their insurance information and having them sign different forms of paperwork. He then took a new position called charge entry specialist.

“I was just entering all of these charges onto patients’ accounts,” he said. “I had no idea what the numbers were, I just knew that they had to balance. But what was behind that were all the codes, coding. They would take a record and put it into a CPT (Current Procedural Terminology) code or a diagnosis code.

“So, over the half-wall partition were all of the coders reading over the medical records from positions and putting them into a numeric value, which were these CPT or diagnoses codes. I thought they were brilliant people because they sounded like doctors and I said, ‘I want to do that.’

CPT codes describe medical, surgical and diagnostic services that were provided to a patient. To become a coder, Rivet said he had to become certified, so he took some of the study guides that were not being used in the department home with him and began studying.

Rivet said typically to get that credential, a person would have to work in coding for at least three years. So while he was studying, he got the opportunity to become an emergency department coder, which allowed him to do coding for the first time. He later passed his exam on the first try and earned his credential.

Rivet moved on to an auditing role where he did evaluation and management codes for physicians who saw patients in the office, nursing homes or in a medical room at the hospital. He served in that role for a couple of years until he moved to Michigan where his wife’s family resides.

The Washington state native took a medical auditing position at Henry Ford Health System where he audited the bills and services of providers to ensure that their documentation supported the services that were being billed. Rivet later transitioned to a revenue cycle management position at Henry Ford.

He was in charge of revenue for 13 different departments, including hematology, oncology and medical anthropology. Rivet said he was tasked with ensuring that all the charges from both in-patient and out-patient care were captured and charged correctly on patients’ accounts. 

While at Henry Ford, Rivet was invited to present at several speaking engagements about evaluation and management services and since has authored three books on the subject.

After spending five years at the Detroit health system, Rivet joined the law firm of Hall, Render, Killian Heath & Lyman as a coding compliance specialist. One of his primary responsibilities was to research reimbursement issues that clients had and share that information with the health law attorneys who would look at the legal aspect of it and make the necessary legal decisions.

Despite having success in his previous positions at different places, Rivet began to pursue his bachelor’s degree in health administration by taking online classes at Baker College while he was working at the law firm.

Rivet decided to continue his education and went to what was then Western Michigan University Thomas M. Cooley Law School in 2012 to earn his law degree while still working. He attended school mostly part-time and graduated with his law degree in January 2017.

During his time in law school, Rivet worked at Wayne State University Physician Group as a corporate compliance and privacy officer for a year. He became the director of fraud and abuse services at Priority Health and then the director of payment integrity at Health Alliance Plan.

After graduating from Cooley, he became the vice president, coding compliance and audit/EMS compliance officer at a Chicago-based international revenue cycle company called R1 RCM. 

“I was responsible for conducting the coding audits for our clients to make sure that the coders were coding the records correctly,” he said. “I was also the EMS compliance officer. The company had bought a billing and coding company and most of our clients were municipalities like the city of New York, the city of Chicago, the city of Philadelphia and many others. I worked with government entities, with the various cities to make sure we were doing things that we were supposed to be doing as far as coding and billing for ambulance services and they were all ground ambulances. We had some air ambulances. If they had any third-party audits like United Health Care or Aetna and they had an audit and said you had an overpayment, then I was responsible for reviewing that and drafting any appropriate appeals.”

Rivet spent three years at R1 RCM before its corporate restructure that was accelerated by the COVID-19 pandemic. As a result, many corporate roles were eliminated, including Rivet’s positions in July 2020.

“That was when I said, ‘I am going to take the leap and start my own law practice’ and that was exactly what I did.”

Rivet became a licensed attorney in January 2020 and he opened his Norton Shores-based law firm, Rivet Health Law PLC, in July of 2020, amid the pandemic. He assists clients in understanding coding and billing regulations within Medicare and Medicaid.

“Having my own firm is exciting,” he said. “This is invigorating. My intent is to be a business partner and try to have solutions for providers and really be that foresight, looking forward to proposed rules and regulations and things that could have an impact on my clients.”

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