Testified Regarding: Physician Payment, Graduate Medical Education Reimbursement, Medicare cost report, Chargemaster, billing practices, HMO contracting, pharmaceuticals, DRG Outlier payments, Skilled Nursing, Renal Dialysis, ESRD Exception Requests.


SUMMARY of QUALIFICATIONS:

As an experienced consultant and financial manager I bring to the table over 19 years of experience in healthcare finance working with over a hundred healthcare entities ranging from single physician practices to large academic medical centers. My expertise ranges from physician and hospital billing practices to administrative and strategic planning challenges faced by healthcare providers. I have specialized in renal dialysis reimbursement work with renal providers throughout the nation. Often my projects are intimately intermingled with regulatory issues.

During my tenure as first Manager of Reimbursement, and then Director of Financial Systems at a Medical Center in Chicago several of my achievements in reimbursement have been nationally recognized. Presently, I carry out the dual role of running my own consulting firm as well as academic duties at the Medical Center in Chicago. I have assisted several major accounting firms in the valuation of healthcare practices and Medicare reimbursement. I publish nationally on healthcare finance issues and frequently have been called upon to testify before a variety of tribunals. I have testified in several high profile cases regarding hospital reimbursement practices, lectured at the Health Care Finance Associations’ Annual Institute in Nashville and for the Ministry of Health in China.


EDUCATION:

UNIVERSITY OF CHICAGO, GRADUATE SCHOOL OF BUSINESS 2002
MBA, Finance, Accounting, Strategic Management, Organizational Behavior

DALHOUSIE UNIVERSITY, BS Mechanical Engineering 1993, BS Chemistry 1988

PUBLICATIONS:

Available upon Request


PROFESSIONAL EXPERIENCE:

2000 - Present

Reimbursement and Financial Consulting Services

· Medicare Cost Report Preparation and Reimbursement Consultant to major healthcare providers.

· Profitability analysis for healthcare entities.

· Valuation of physician practices and healthcare facilities.

· Strategic planning for physician practices and healthcare facilities.

· Renal Dialysis Cost Report, Exception Request, Billing and Revenue generation issues.

· Certificate of Need application assistance.


MEDICAL CENTER, Chicago, Illinois

Asst. Professor, Healthcare Finance, 1994 - Present
Director of Financial Systems 1999 - 2000
Manager of Reimbursement 1995 - 1999
Reimbursement Specialist 1993 - 1995

· Teach ten-week graduate level course in healthcare finance with particular emphasis on improving executive level financial decision-making skills.

· Lecture healthcare professionals on financial accounting for healthcare entities, focusing on optimal financial management within the context of health insurance billing and payment systems, reimbursement, cost management and compliance with regulatory mandates.

· Design lectures to sharpen the student’s ability to interpret financial reports and assess the multidimensional impact of financial decisions on the short and long term quality and profitability of healthcare delivery.

· Incorporate into financial coursework professional development sessions requiring students to apply financial analysis skills in live mock negotiation scenarios with HMO’s, shareholders and regulatory auditors.

· Structure each interactive session to require healthcare professionals to understand and employ an effective communication or negotiation skill as well as to encourage a team approach to financial problem solving.

· Upgraded billing and collection processes for inpatient services.

· Obtained payment from Medicare for significant portions of bad debt previously not reimbursed.

· Implemented accurate process for measuring aging of receivables.

· Audited medical records to ensure complete charge capture and ensure that adequate documentation existed to substantiate inpatient-billing detail.

· Analyzed reimbursement and profitability of inpatient Medicare DRG (Diagnosis-Related Group) payments as was as inpatient payments from Medicaid, commercial insurance and HMO’s (Health Maintenance Organization’s).

· Reviewed and updated hospital Chargemaster charges, codes and descriptors for inpatient services, including ancillary services, drugs, radiology and laboratory charges.

· Reviewed and updated hospital Chargemaster charges, codes and descriptors.

· Calculated impact of regulatory changes in Medicare reimbursement rules on one-thousand bed academic medical center including a Skilled Nursing Facility, Rehab Facility and Home Health Agency as well as with a medical, nursing and allied health science colleges.

· Benchmarked costs of inpatient services against other similar medical centers.

· Handled multiple issues pertaining to Medicare inpatient reimbursement via the Cost Report settlement.

· Responsible for accurately reporting and reducing accounts receivable and solving billing problems.

· Initiated, designed and implemented Internet based Graduate Medical Education (GME) database used to track all residents accounting for $ 37 million of revenue.

· Member of GME task force, which interpreted and responded to regulatory changes in resident reimbursement and set policy for number and type of resident physicians trained.

· Responsible for management and implementation of newly purchased network based multi-site billing and scheduling system.



COMPUTER SYSTEMS / INFORMATION SERVICES / FINANCIAL SYSTEMS


· Initiated, designed and implemented Internet based Graduate Medical Education (GME) database used to track all residents accounting for $ 37 million of revenue.

· Spearheaded court mandated increase of Medicare Reasonable Compensation Equivalent (RCE) payment for physicians at all hospitals in the United States.

· Negotiated Settlement of Graduate Medical Education Medicare PRRB Appeal: benefit $3.5 million.

· Settled Provider Reimbursement Review Board cases relating to Medicare cost report settlements: Prepared Legal Briefs; Negotiated with Medicare;

· Testified as expert witness twice before the Medicare PRRB regarding physician compensation and a Skilled Nursing Facility exception request.

· Increased Medicare funding for psychiatric services by successfully filing a TEFRA adjustment request.


DIALYSIS MANAGEMENT INCORPORATED, Cincinnatti, Ohio 1986 - 1993
Account Executive, Director of Recruiting, Regional Director

· Managed staff of six professionals, often working under intense pressure to meet federal deadlines.
· Responsible for marketing and management of consulting projects focusing on coding, collections and comprehensive reimbursement analysis and maximization for physician practices.
· Directed Physician Recruitment.
· Designed Contracts for physician-hospital joint ventures and consulting engagements.