Choose a category below to browse and subscribe to specific content:
Michelle McDonald, CMS Practice Leader, Joint Commission Resources, Inc. has more than 30 years of experience as a health care professional. She has extensive experience in areas of programmatic and operational functions in acute care, long term care, assisted living, home health, and public health settings. Her expertise is in facility operations; executive leadership; care management; public health initiatives; quality initiatives; and the management of Federal contracts with the Centers for Medicare and Medicaid Services (CMS). She currently serves as the CMS Practice Leader for Joint Commission Resources. In this capacity she provides guidance, education and technical assistance in the provision of CMS content, federal laws, regulations, guidelines, federal surveillance protocols and standards governing the operation of health care facilities.
Ms. McDonald received her bachelor’s of science in nursing from Mount Saint Mary College, Newburgh, New York and her master’s of public health from New York Medical College, Valhalla, New York. Her affiliations include the American College of Healthcare Administrators, Medicare SNF Technical Advisory Panel Member for the Centers for Medicare and Medicaid Services, and served as a clinical reviewer for the MDS 3.0 RAI User Manual for the Centers for Medicare and Medicaid Services.
Sandra Routhier, Senior Healthcare Consultant, Panacea, has 25+ years of experience in health information management, revenue cycle, project management and information systems. Sandy is a Registered Health Information Administrator (RHIA), Certified Coding Specialist (CCS), and Approved ICD-10-CM/PCS Trainer through the American Health Information Management Association (AHIMA) and is past president of a regional chapter of the Michigan Health Information Management Association (MHIMA).
In her role as consultant, Sandy performs inpatient MS-DRG validation and coding reviews. Sandy’s responsibilities during these assignments include verifying the quality of coded data and supporting clinical documentation and making recommendations for improvements. Sandy provides education to coding professionals, CDI staff and physicians. Additional responsibilities include assisting hospitals with operational improvements, appeals to third-party payer denials including those from recovery auditors as well as contributing editor to MedLearn Publishing’s Getting It Right Upfront newsletter.
Prior to joining Panacea, Sandy worked as a Health Information Management/Revenue Cycle Director for an acute care hospital. Her responsibilities included the management and day-to-day operations for the medical records, admitting, billing, coding, and utilization review departments. Sandy has experience in implementing clinical documentation improvement programs, chargemaster maintenance, coordinating audits and appeals, and numerous software implementations and conversions. Sandy brings strong clinical knowledge and a passion for our profession.
Maria Matzoros, Associate Vice President of Billing Compliance at Montefiore Medical Center in the Bronx. She has been with Montefiore since 1998. She has been active in the compliance field since the mid 1990’s and worked in the healthcare setting for 20+ years. Ms. Matzoros serves as the resident subject matter expert regarding all compliance related documentation, coding, and billing matters for the medical center. She also spearheads various compliance reviews, education efforts, and hospital-wide training initiatives performed by members of her team. Ms. Matzoros regularly advises physicians and administrators regarding a wide range of compliance questions, including coding, billing, documentation, research billing compliance, electronic medical record structure and design, ancillary provider roles, site of service issues, provider-based/place of service concerns etc. She serves as the liaison and point person for regulatory agency audits, including the OIG, the NYS OMIG, and the NYS Attorney General’s Office. Ms. Matzoros leads a highly skilled team of compliance and coding professionals, trained in reviewing and assessing both professional and technical documentation, coding and billing, as well as educating and training providers.
Prior to joining Montefiore, Ms. Matzoros worked for Connecticut Health Enterprises, a Stamford Hospital MSO, in the capacity of Billing and Operations Manager. She was responsible for the effective implementation of consistent billing procedures and practices for 50+ private, multi-specialty physician clients, and her responsibilities included extensive training, research, expert advice, conducting coding and documentation seminars, and internal reviews.
Feisal Nanji is Executive Director of Techumen, an information security firm focusing exclusively on securing health care information. Feisal has over 25 years of information technology experience. Among his information security clients include a leading Academic Medical Center in the North-East US, a seventeen hospital system moving to an Accountable Care model, group of 300 Physicians affiliated with an Academic Medical Center,nationally recognized Electronic Health Record (EHR) systems vendor, and developer of on-site private health clinics for large corporations
Feisal is a frequent speaker on the topic of information security and compliance. He last presented at HIMSS 2011 (Orlando) on the topic of Securing Health Information in the Cloud.
Previously Feisal was responsible for leading Ernst & Young’s National Application Security Service line. Among his assignments at Ernst & Young included leading a team to analyze and help remediate application and network security weaknesses for an Integrated Delivery Health Network with an installed base of several million electronic medical records.
Robert L. Roth, a partner with Hooper, Lundy & Bookman, P.C., in Washington, D.C., advises clients on matters arising under Medicare and Medicaid, focusing on payment, compliance, and licensing issues. A former senior attorney for the Centers for Medicare & Medicaid Services (CMS) of the U.S. Department of Health and Human Services (HHS), and a former Assistant Attorney General for the State of Maryland, Bob represents a wide range of clients on federal and state regulatory and business matters. He also represents clients in litigation at the state and federal trial and appellate court levels, as well as before state and federal administrative tribunals, including the Provider Reimbursement Review Board.
Bob represents providers and other clients throughout the country on matters such as reimbursement, overpayment refunds/disclosure, and coordination of benefits. He also actively counsels clients on complying with the issues surrounding all aspects of the Medicare/Medicaid programs, including the Medicare Secondary Payer (MSP) statute. Ranked by clients and peers as one of the leading health care attorneys in Washington, DC by Chambers USA, Bob was described as “zealous and committed” and as “stand[ing] out as having second-to-none knowledge of Medicare Secondary Payer issues.”
Bob received his undergraduate degree from Lehigh University in history and Latin and his juris doctorate from Syracuse University College of Law.
Paul A. Deeringer is an Associate in Hooper, Lundy & Bookman’s Business Department. Mr. Deeringer’s practice involves healthcare-related business transactions and general corporate representation, including contracts between hospitals and physicians, the purchase and sale of facilities, issues facing emerging health technology companies, and general corporate advice. Mr. Deeringer also advises clients on various regulatory issues, including fraud and abuse, health information privacy and security, and risk management and corporate compliance. Mr. Deeringer routinely counsels clients on Medicare and Medicaid overpayment analysis and self-disclosure issues, including under the so-called “60-day rule.” Mr. Deeringer is a frequent speaker and author on health law topics, including federal health reform and overpayment issues.
Mr. Deeringer received his A.B. summa cum laude from Princeton University in 2001 and his J.D. from Georgetown University Law Center cum laude in 2006. Before joining Hooper, Lundy & Bookman in 2008, Mr. Deeringer was a management consultant for McKinsey & Company in McKinsey’s New York and San Francisco offices, serving exclusively health care clients, with a practice focused on corporate growth strategy and long-term strategic planning. Prior to practicing law, Mr. Deeringer was a Research Project Manager for the Health Technology Center (now the Center for Innovation and Technology in Public Health), a non-profit research organization whose mission is to create a trusted source of objective, expert and useful information about the future of health care technologies.
Phyllis A. Patrick is President of Phyllis Patrick & Associates LLC, a consulting group specializing in providing strategic planning, information security, privacy and compliance advisory services to the health care industry.
Ms. Patrick has worked in information security, privacy, and compliance at major academic medical centers in New York, including The Mount Sinai Medical Center in Manhattan, where she was named the first Information Security Officer. As Vice President and Chief Compliance Officer at Hospital for Special Surgery, she created and directed the organization’s Compliance Program, which included the Privacy and Security Programs. She served as Compliance and Privacy Officer for Greenwich Hospital, an affiliate of the Yale New Haven Health System.
Ms. Patrick is certified in health care administration (FACHE) and health care compliance (CHC). She is a member of the Board of Examiners for the Malcolm Baldrige Performance Excellence Program and has served as an Examiner since 2007.
Ms. Patrick is a frequent speaker at national and regional conferences and professional associations, including the HIPAA Summit, the AMC Privacy and Security conferences, Health Care Financial Management Association (HFMA), Health Care Compliance Association (HCCA), Association of Healthcare Internal Auditors (AHIA), and others.
Ms. Patrick received her B.S. in Psychology from the Pennsylvania State University and her M.B.A. in Health Care Administration from Cornell University.
Richard Phillip Kusserow. Richard is the CEO of Strategic Management Services, LLC. (SMS), a Virginia-based company that provides consultative services to health care providers on government health programs, and specializing in developing, implementing and measuring effective compliance programs for health care businesses. He served as the DHHS Inspector General for eleven years and established what is now the OIG List of Excluded Individuals and Entities (LEIE).
Jillian M. Bower, MPA. Jillian is Manager of the Compliance Resource Center (CRC), a comprehensive and integrated end-to-end compliance management tool, that includes the Sanction Screening Services (S³). She has been a Senior Associate health care consultant and analyst. She worked directly with Health Resources and Services Administration on auditing the source data of the HIPDB.
Rayellen K. GillesCoding Suite Customer Solutions
Rayellen is currently the customer solutions manager for the Coding Suite products. In this role, Rayellen works directly with clients and development to create the best in class coding and reimbursement resources. The Coding Suite is a Wolters Kluwer product that blends MediRegs, CCH and Aspen publications to assist health care compliance and coding professionals product manager for coding and reimbursement resources at MediRegs.
Rayellen has been with MediRegs since its inception and has been instrumental in developing coding and reimbursement resources. Ms. Gilles has acted in various roles at MediRegs including being an editor, content specialist, developer, trainer and product manager. Some of her special areas of interest include e-learning, life science reimbursement, workflow tool usability, and finding creative ways to keep reimbursement professionals up-to-date with the ever-changing Medicare landscape.
Lynne Rinehimer, JD, Manager of Compliance Services, Wolters Kluwer Law & Business, has spent her career in health care compliance and is currently the Manager of Compliance Services for the MediRegs component of Wolters Kluwer. In this role, Lynne manages the compliance content in ComplyTrack, leads software demonstrations and assists in client training and methodology. Prior to joining MediRegs and Wolters Kluwer, Lynne was Director of the Compliance and Regulatory Services Division for Precyse Solutions, where she oversaw compliance and HIPAA consulting services offerings and served as product manager for the Compliance Assessment & Management Tool (CAMT) software product. Prior to Precyse, Lynne was a Senior Compliance Attorney for QuadraMed Corporation and was responsible for researching, drafting and implementing corporate compliance programs, and assessing health care providers to ensure compliance with applicable laws, regulations, and guidance.
Lynne received her Juris Doctorate in May 1998 from the Villanova University School of Law, Villanova, PA. She received her Bachelor of Arts in History from the University of Maryland in May 1995. She is a member of the Pennsylvania Bar Association, the American Bar Association, and the American Health Lawyers Association.Coding Advisory Board:
Beth Browne, RN, MSN, NP, CCS
Beth is a Clinical and Reimbursement Consultant at JR Associates, Inc. JR Associates is a medical reimbursement consultancy that provides comprehensive coding, coverage and payment solutions and strategies for device manufacturers, venture capital firms and healthcare practitioners, worldwide.
Prior to her engagement at JR Associates, Beth served as Vice President of Reimbursement Consulting Services at The JGS Group, Inc., a Washington, DC area reimbursement consulting firm. Over the past two decades, Beth has played multiple roles in the healthcare industry - as a clinician, administrator and consultant. Her clinical experience is diverse - spanning critical care, emergency medicine, primary care, public health, cardiac rehabilitation and interventional cardiology. After years in hospital administration, she understands first-hand the intricacies associated with the reimbursement process. As a consultant, Beth has developed coding and reimbursement research assessments and recommendations, fostered relationships with commercial insurance payers, prepared and submitted coding applications, and functioned as a liaison with CMS. She has also been instrumental in developing and managing reimbursement call centers.
She is a registered nurse and board certified nurse practitioner. She received an MS from the University of Colorado and a BS from Thomas Jefferson University. Beth is also an AHIMA Certified Coding Specialist.
Kim T. Charland, BA, RHIT, CCS
Kim is the Vice President of Consulting for Medical Learning (MedLearn) and has more than 20 years of experience in health information and reimbursement management for hospitals and physician offices. Her responsibilities include overseeing MedLearn’s Consulting division to ensure the delivery of up-to-date and compliant consulting products while also overseeing the development of new consulting products. She is also responsible for the clinical coordination of information for MedLearn’s Publication, Seminar, and On-Line divisions.
She has published articles in the Journal of the AHIMA, Advance for Health Information Professionals, MedLearn’s Reimbursement Management Update newsletter, and MedLearn’s Anesthesia newsletter. In addition to contributing to MedLearn's CPT Coding Workbook, Kim has developed the following instructional manuals: Coding and Reimbursement for Professional Anesthesia Services, Coding for Ambulatory Surgery Procedures and Emergency Services Reimbursement. Kim currently maintains professional affiliations with several organizations, including AHIMA and NYHIMA.
Georgeann Edford, RN, MBA, CCS-P
President and Founder, Coding Compliance Solutions
Author and frequent presenter to hospitals and physician groups, Georgeann is a recognized leader in the coding and medical records fields.
Georgeann has served as an expert witness on numerous occasions and is an Advisory Board Member for Dennis Barry’s Reimbursement Advisor as well as serving her third term as a CCH & MediRegs Coding Advisory Board Member.
Vicki Fry, MS, MBA
Vicki is a senior consultant with Prospective Payment Specialist (PPS), a firm focusing on Chargemaster Reviews and Maintenance, Pricing Rate Analyses, Coding and Compliance Audits, and RAC Audit Support Services. Vicki’s PPS Chargemaster, Audit, and Rate Analysis engagements have been for hospitals ranging from small Critical Assess hospitals to university medical centers to large hospital systems.
Prior to joining PPS, Vicki held senior positions at Ernst & Young, Ingenix, 3M Health Information Systems, and the University Of Utah School Of Medicine. She also was the Contributing Editor for a major HIM journal, has published over fifty coding and reimbursement articles, and has been a speaker for the American Academy of Professional Coders (AAPC) National Convention, Healthcare Financial Management Association (HFMA), and a trainer for the American Health Information Management Association (AHIMA.)
Jana Gill, CPC
Jana joined Wolters Kluwer in the fall of 2010 and is currently a Product Engineer and Developer for Regulatory and Reimbursement software suites. Her expertise in coding and compliance has been integral to client and product development. She has more than eighteen years of experience in healthcare including coding, compliance, mergers & acquisitions, physician integrations and healthcare litigation.
Jana also is the Principal of Gill Compliance Solutions, LLC which specializes in physician compliance, developing internal auditing programs, government appeals (RAC/CERT), coding risk assessments, due diligence for physician/hospital integrations and revenue analyses of hospitalist services. She also develops mobile coding applications for coding and tracking physician services. In her previous role as a Director of Coding and Compliance, she managed over 300 NW based physicians providing direction in federal and state audits. Additionally she implemented compliance programs and developed risk assessments for hospital/physician integrations. Jana also served as a Manager for a National Healthcare Consulting firm providing expert testimony for regional counsel in compliance and fraud investigations along with self-disclosures and claims review.
Jana was fortunate to be selected as a Rotary Scholar and pursued her advance studies overseas. She holds a Masters (International Diploma) of Commerce from the University of Auckland, New Zealand and a B.A. in Business Administration and Accounting from the College of Idaho. She has served several years on the Wolters Kluwer Coding Advisory Board, past President and founder of the Idaho AAPC Chapter and software advisory team for Context 4 Healthcare. She’s a national speaker for chapters of the MGMA, AAPC and Wolters Kluwer. She’s also contributed to multiple healthcare newsletters and publications including the RACMonitor, CCH & MediRegs Coding Compliance Advisor Newsletter and blog.
Gina L. Hobert, MBA, CHC, CPC-I, CECM, CMOM
Gina currently serves as the Billing Compliance Manager of MaineHealth Audit and Compliance, the parent company of Maine Medical Center. Gina manages billing compliance and medical audit functions, conducts educational sessions and serves as a primary contact regarding billing compliance issues for MaineHealth and its affiliates. Prior to joining MaineHealth, Gina was the Director of The Coding Center, a program of the Maine Medical Association, which provided chart auditing services for providers, on-site coding education programs to both physicians and staff, and coding certification courses.
As the Compliance/ChargeMaster Manager for Franklin Memorial Hospital (FMH), Gina served as the authority of billing, payer, and coding information and regulations for all levels of the hospital’s management. Gina’s FMH responsibilities also included assessing areas of compliance risk for the hospital by directing the compliance audit programs, overseeing the monitoring and auditing activities for the professional fee, facility fee and billing system, and administering, maintaining, and setting charges to the hospital’s chargemaster to ensure timely, accurate claims processing and data collection.
Sandra Inocencio, RN, CPC, CCP
Sandra is the ChargeMaster and Billing Compliance Manager at Phoenix Children’s Hospital, where she conducts claims review, denial management, pro-active audits to ensure billing compliance, and chargemaster reviews and maintenance.
Sandra offers more than a decade of accomplishment-laden experience in healthcare; specializing in chargemaster, denials management, and billing and coding compliance. Throughout her career both in hospital facilities and as an executive and consultant in the healthcare industry, Sandra has established herself as a strong resource, combining clinical knowledge and her coding background to educate and facilitate revenue compliance.
Lynn Kuehn MS, RHIA, CCS-P, FAHIMA
Lynn Kuehn is a health care consultant with more than 25 years of experience working in the health care profession. She is the founder of Kuehn Consulting, LLC. Prior to her own business, she held a number of leadership positions in large physician organizations, both privately owned and hospital-based. Her experience includes operational assessment, physician service coding and reimbursement systems, data quality, compliance training, and information systems management for physician offices, surgery centers and ancillary diagnostic service providers.
Ms. Kuehn's technical expertise and experience have led her to co-author CPT/HCPCS Coding and Reimbursement for Physician Services for the American Health Information Management Association (AHIMA), now in the eighth edition, as well as several other texts. She has published numerous articles on health information management issues in many industry publications.
Ms. Kuehn holds a M.S. degree in Health Services Administration from Cardinal Stritch University and a B.S. degree in Health Information Administration from the Viterbo University. She is a Registered Health Information Administrator (RHIA), a Certified Coding Specialist for Physicians (CCS-P) and a Fellow of the American Health Information Management Association.
Christy A. May, MS, RHIA
Christy May is a Coding & Medical Content Specialist for ProVation Medical, a Wolters Kluwer company, where she primarily focuses on physician clinical coding, ICD-9, ICD-10 and CPT coding. She also focuses on terminology coding which involves analyzing data from SNOMED-CT, RxNorm, LONIC and MEDCIN.
Christy is a health information professional with over 15 years experience achieving results aligned to business goals. She is known for developing strategic partnerships that transcend traditional boundaries within an organization to accomplish business objectives. Her experiences range from rural, physician-owned clinics up to integrated healthcare delivery systems with stops in the insurance and consulting industry.
Christy holds a M.S. degree in Health Information and Informatics Management from the College of St. Scholastica as well as a B.S. degree from St Cloud State University and an A.A.S degree from Rasmussen College. She is a Registered Health Information Administrator (RHIA).
Melody W. Mulaik, MSHS
Melody is the President and Co-Founder of Coding Strategies, Inc. and Coding Metrix, Inc. located in Atlanta, GA. She is a frequent speaker and author for CSI and other nationally recognized professional organizations and publications. Melody's areas of expertise include billing and collections, coding and compliance, revenue enhancement, front-end hospital operations, management engineering, medical school relations and operations improvement.
Prior to founding CSI, Melody held the position of Vice-President of Billing Compliance for the largest national billing company, where she was responsible for the implementation and maintenance of the billing compliance program. In a direct operational capacity, Melody provided her expertise at three Atlanta area hospitals in operations, finance and management engineering disciplines. Melody holds a Master of Science in Health Systems (MSHS) degree and a Bachelor of Industrial Engineering (BIE) degree, both from the number one nationally ranked Industrial &Systems Engineering School at the Georgia Institute of Technology (Georgia Tech), in Atlanta, Georgia. She also holds the professional certification of Professional Coding Specialist (PCS), Facility Coding Specialist (FCS), Certified Professional Coder (CPC), Certified Professional Coder - Hospital (CPC-H), Advanced Coding Specialist – Radiology (ACSRA) and Radiology Certified Coder (RCC). Melody is on the Executive Board as the Treasurer of the AmericanCollege of Medical Coding Specialists (ACMCS) and is an active member of AAPC, AHIMA, AHRA, RBMA, HBMA and HCCA.
Marianne Russo, CPC, CMC
Marianne is the Reimbursement Manager for Clinical Practice Management Plan, where she has been employed for over 25 years. She currently manages the regulatory guidelines of the Medicare and Medicaid programs for 18 multi-specialty clinical practices.
Gail I. Smith, MA, RHIA, CCS-P
Gail I. Smith, MA, RHIA, CCS-P is President of Gail I. Smith Consulting in Cincinnati, Ohio. Prior to starting a consulting business in 2011, Gail was an Associate Professor and Director of the Health Information Management (HIM) program at the University of Cincinnati. Before joining the University of Cincinnati, she served as the Director of the HIM program at Cincinnati State Technical and Community College for eighteen years. Before a career in education, Smith held management positions in two Cincinnati hospitals. On a part-time basis, Gail has served as a coding consultant for over 20 years. Her projects include developing content for courses/workshops, delivering presentations, performing coding reviews and mapping ICD-10-CM/PCS for database conversions.
Ms. Smith has authored several coding textbooks including AHIMA’s Basic Current Procedural Terminology and HCPCS Coding. She is also a national speaker and content expert on eLearning and instructional design.
Gail has served as president of the Ohio Health Information Management Association and received the Professional Achievement Award in 1996 and Distinguished Member Award in 2005. Gail also served on the Board of Directors of the American Health Information Management Association from 2003-2006.
Ms. Smith received her bachelor's degree in HIM from The Ohio State University and her master's degree in education from The College of Mt. St. Joseph in Cincinnati, Ohio.
Patty Curoe Telgener RN, MBA
Patty Telgener is a Senior Director of Reimbursement at Emerson Consultants, Inc. a company focused on offering Reimbursement, Regulatory, Clinical and Market Development consulting to the medical device, biologic and pharmaceutical industries. . Currently, Patty is working with numerous medical device, diagnostic, and biologic companies, from start-ups to multi-billion dollar organizations.
Prior to joining Emerson Consultant’s, Patty was Director of Reimbursement for Medtronic Neurological and Medtronic Diabetes for over 14 years. Patty was also a healthcare consultant with Deloitte and Touche where she conducted hospital financial analyses and implemented new patient care delivery systems.
Patty’s reimbursement experience includes development and implementation of reimbursement strategies. She has experience successfully lobbying for new legislation to secure reimbursement of a new technology, working with professional societies to obtain CPT codes, working with CMS to obtain ICD-9-CM codes and payment for new technologies. Patty has also successfully obtained payments for new technologies and has worked directly with physicians, hospitals and payers to ensure appropriate coverage and payment.
Patty has been involved in research and due diligence activities for numerous new technologies. These market research activities included clinical research, competitive analysis (devices and pharmaceutical interventions) and economic analysis. Patty has also leveraged this research to help payer and provider customers understand the clinical and economic impact of new technologies. Patty has a strong understanding of what clinical and economic data is necessary to bring a product to market and secure positive coverage and payment determinations.
Patty has an MBA from the American Graduate School (Thunderbird) and a Bachelor of Science in Nursing from Marquette University.
Robin Miller Zweifel, BS, MT (ASCP)
For 10 years, beginning in 2000, Robin served as a senior healthcare consultant and chargemaster domain expert for a national consulting firm. In 2010, she entered the consulting industry as an independent contractor specializing in CPT coding and chargemaster assessments; as well as operations and regulatory compliance reviews. Robin’s consulting reviews focus extensively on the billing of infusion services, pharmaceuticals and operation assessments for the diagnostic laboratory.
MediBlog - A Resource for the MediRegs User Group. MediBlog was designed to allow you the opportunity to communicate directly with MediRegs specialists as well as colleagues that work in your field of work.