Consolidated Consultants' your source for Free Nationwide Expert Witness Referrals.Consolidated Consultants Free Nationwide Expert Witness Referrals

Medical Billing Coding Fraud Expert Witness

Keywords

Billing Coding Fraud, RHIA, Registered Health Information Administrator, Medicare Fraud, Medicare Abuse, Medicaid Fraud, Medicaid Abuse, Forensic Audits, ICD 9 CM, CPT Coding, E M Coding, Medicare Cost Reports, Document Analysis, DRG APC Validation, Medical Record Review, Utilization Review, Audit Service, Medical Coding, Medicare Fraud Abuse, Medicaid Fraud Abuse, Medical Coding Billing, Forensic Billing Audits, Forensic Coding Audits, DRGs, Diagnosis Related Groups, APCs, Ambulatory Payment Classifications, PMCC, Professional Medical Coding Curriculum, Medical Billing Experts, Medical Billing Specialists, Medical Coding Billing, Health Record Review

Arizona

Expert Witness No. 865

Experience

2000 - Present
A Consulting Firm for Medical Coding and Billing
President & CEO

1992 - 2000
At a University Medical Center
Director, Health Information & Outcomes Management
Expert 865 directed operations of Health Information, Patient Financial Services, Quality Improvement, Case and Disease Management departments in 365-bed university affiliated teaching facility with associated outpatient clinics. Management of 130 FTEs, including program director, six managers, coding compliance staff. Areas of responsibility included Patient Financial Services, Transcription Services, Coding & Abstracting, Files, Cancer Registry, Quality Improvement, Data Management, Utilization Review, Case Management, Disease Management and Social Services.

Expert 865 developed Coding Compliance Program to address coding in following venues: Inpatient coding, outpatient services and hospital-based physician office practices.

Expert 865 is an active member of APC Steering Committee and UB-92 Committee designed to address organizational data flow from point of patient entry into system to billing and receipt of payment.

Member of Corporate Compliance Committee.

Expert 865 developed denial management program to address claims edits/denials.
Met or exceeded JCAHO and other regulatory requirements during 1993, 1996, and 1999 surveys. Center of Excellence designation for Improving Organizational Performance.

Prepared and administered annual operating and capital budgets totaling $5 million.

Actively participated in continuous improvement teams reviewing organizationalinformation systems and patient assessment standards.

Project leader and coordinator for DRG Options program.

1990 - 1992
At a County Medical Blue Shield
Vice President, Medicare
Expert 865 administered Part B Medicare contract for a State, including processing of 8.6 million claims. Directed activities of 250+ FTEs, including five directors and Medical Director. Oversight of nine subcontractor locations and shared system maintenance and processing contract with a State. Areas of responsibility included Claims Processing, Program Integrity (Fraud & Abuse), Appeals, Fair Hearings, Provider Relations, Medicare Secondary Payer, Adjustments, Medical/Utilization Review, Coverage and Medicare IT.

Expert 865 assumed prime contractor responsibilities from previous contractor with no cessation of services statewide.

Expert 865 developed organizational structure and processes, resulting in improved performance as first year contractor.

Expert 865 prepared and administered Medicare and corporate budgets of $17.3 million, including $1.7 million in productivity investment monies.

Expert 865 improved administrative and operational performance as first year contractor, resulting in contract renewal for FY '92 and FY '93.

Expert 865 dissolved six subcontractor sites, successfully transferring responsibilities to prime contractor location during 90 day period.

1987 - 1990
At a Medical Center
Director, Medical Records and Patient Accounts
Expert 865 directed operations of Medical Records and Patient Accounting departments in 303-bed acute care facility. Managed 90 staff, including five supervisors, seven leads and quality control manager.

Expert 865 met or exceeded JCAHO and other regulatory requirements.

Expert 865 negotiated and administered contract for Emergency Department transcription services.

Expert 865 negotiated acquisition and installation of automated systems, including PC-based release of information system, Medicus encoder, abstractor and ad hoc reporter with successful interfaces to ADT, Casemix and HFC/AMEX systems; Learned Mahn; Lanier VoiceWriter dictation system.

Expert 865 prepared and administered operating budgets totaling $2 million.

Expert 865 reduced A/R from 93 to 72 days.

Expert 865 disseminated DRG and practice pattern information to medical staff, administration and ancillary departments.

1984 - 1987
At a V.A. Medical Center
Chief, Medical Information Section
Expert 865 directed operation of Medical Information Section in 488-bed university affiliated teaching facility with associated 60-bed SNF and outpatient clinics. Managed 53 FTEs, including assistant chief, staff RRA and two supervisors.

Education

1982
University of Kansas - Bachelor of Science
Health Information Management

1978
Rockhurst College - Bachelor of Arts
Political Science/History

Current Certification: Registered Health Information Administrator (RHIA)

Professional Affiliations

American Health Information Management Association
Arizona Health Information Management Association
American Academy of Professional Coders
Health Care Compliance Association
American Association of Healthcare Administrative Management

Publications

Modern Healthcare: Interview
Briefings on APCs
Radiology News
American Healthcare Radiology Administrators Link Coding Q&A
HcPRO APC Answer Letter Advisory Board Member/Contributor

Awards

Available Upon Request

Other

Speaker: Emergency Conference on APCs, Washington, DC; PPS & APCs; Chicago, Ill. ; APC Conference, Las Vegas, Nevada & St. Petersburg, Florida; American Healthcare Radiology Administrators (AHRA) Changing Workforce conference, Phoenix, Arizona; California Coalition of Nurse Practitioners, San Diego, California; HFMA San Diego Chapter Conference, San Diego, California.


Summer 2010 Newsletter

Return to Summer 2010 Newsletter

Request an Expert and get a Free 15 Minute Qualifying Conference Call
Position:

If "Other"
please specify:
Type of Witness Needed: 
Specialties of Expert Needed:
Type of Case:
Short Description of the Case:
Geographical Preference
for the Expert Needed:
Time Frame needed to find Expert
Please be specific
(i.e., two days, one week)

Please Check The Human Verification Checkbox Before Submitting




Newsletter ArchiveExpert Witness Directory of Categories
Consolidated Forensic Experts BBB Business Review
Forensic Medical Expert, Expert Witnesses, Court Testimony. Copyright © 1995-2014
Consolidated Forensic Experts (a CA corp.)/dba Consolidated Consultants Company
289 Church Ave., Chula Vista, CA 91910 Litigation Topic Check