Agenda – Day 3

Denise Wilson is the Vice President at Denial Research Group’s AppealMasters.

Denise is a Registered Respiratory Therapist, Registered Nurse, and holds a Master’s degree in Management Information Systems.

Denise has over thirty years experience in healthcare, including clinical management, education, compliance, audit, denials and Medicare appeals focus positions.

Denise has extensive experience as a Medicare Appeals Expert and has personally managed hundreds of Medicare appeal cases and presented over a hundred cases at the Administrative Law Judge level with a 95% success rate. Denise is tenacious in obtaining wins with a well organized and assertive appeal methodology.

Denise is a nationally known speaker and dynamic educator on the RAC program and the Medicare Appeals system. She has educated thousands of healthcare professionals around the country in successfully overturning Medicare denials. Denise’s special area of expertise is in writing and conducting successful appeals.

After completing his residency at the University Of South Carolina School Of Medicine Dr. Baker was the founding and managing partner in Piedmont Physicians for Women an OB/GYN practice for 32 years. He has extensive background in managed care and contracting. Initially serving as a part time Physician Advisor doing mainly second level reviews took on the role as a full time Physician Advisor for clinical Excellence in 2014. Responsibilities include Medical Director for Case Management, Physician Champion for CDI and dealing with denials for Self Regional Healthcare a regional hospital in Greenwood, SC. He also serves on several committees including Co-Chair of the Finance Committee for My Health First an upstate South Carolina ACO as well as several committees at the South Carolina Hospital Association.

Jennifer Bartlett has served at Infirmary Health for 18 years. She has vast knowledge and expertise in patient access, revenue cycle, payer contracts, payer processes and denials management. Her many years of extensive research and study of payer practices and behaviors have been instrumental in holding payers to a greater level of accountability. She manages all prepay and postpay clinical audits including RAC, KePro 2MN, CERT, MAC, Part C audits. In her organization, sheís a member of the Information Governance/HIPAA Steering Committee. In her state, sheís an active member of the Alabama Hospital Associationís Revenue Integrity/Recovery Audit Steering Committee and the Cahaba Provider Outreach and Education Advisory Board, (CMS JJ MAC region) and was a presenter in 2016 and 2017 at the AlaHA/HFMA Alabama Audit Summit. As well, she served on the faculty for the 2016 at the 4th Annual PA UR Boot Camp in San Antonio, TX.

Mary Murray Battiste has served at Infirmary Health for two years, through her vast knowledge and expertise in finance, clinical operations, and documentation integrity. In her current role, she has expanded the CDI role and is moving the department from traditional chart review to encompass all medical record documentation, including nursing documentation and quality metrics. This expertise allows her to effectively align the financial and administrative side to clinical processes to connect with the medical staff. She has begun teaching part of the nursing residency program, medical school students, as well as all new providers that enter the organization to ensure that the culture begins with a heavy focus on complete patient care and accurate documentation of such.

Ms. Lamkin is a national speaker and author on operations, quality, utilization, and billing compliance.

She has over 25 years of experience as a hospital CEO and has served in teaching hospitals, and non-profit and investor owned sectors of healthcare where she developed forward thinking systems to improve quality and utilization.

Ms. Lamkin is CEO and Partner in PACE Healthcare Consulting, LLC offering strategy, operations, analytics and software solutions to hospitals, physicians and other sectors of healthcare.

Ms. Lamkin holds a Masterís in Healthcare Administration, from the University of South Carolina, Columbia BA Cum Laude, Core in Business Administration, from the University of South Carolina.

Dr. Ronald Hirsch is a Vice President of the Regulations and Education Group at R1 Physician Advisory Services. He completed his internal medicine residency at Kaiser Permanente Medical Center in Hollywood, CA.

Dr. Hirsch was a general internist and HIV specialist and practiced at Signature Medical Associates, a multispecialty practice located in Elgin, IL. He was Medical Director of Case Management at Sherman Hospital in Elgin, IL from 2006 to 2012.

Dr. Hirsch is certified in Health Care Quality and Management by the American Board of Quality Assurance and Utilization Review Physicians, is a member of the American Case Management Association, on the Advisory Board of the American College of Physician Advisors, a Fellow of the American College of Physicians, and on the advisory board of the National Association of Healthcare Revenue Integrity. He is the co-author of The Hospital Guide to Contemporary Utilization Review, which was published in 2015.

Jessica L. Gustafson is a founding shareholder with The Health Law Partners, P.C. She represents hospitals, health systems, physicians and physician group practices, hospices, home health agencies and other health care providers and suppliers in an array of health care legal matters. Ms. Gustafson devotes a substantial portion of her practice to representing providers in the Recovery Audit (ìRACî) and Medicare audit appeals process. She also regularly assists clients with compliance and reimbursement matters, overpayment refunds, as well as other health care regulatory matters.

Ms. Gustafson is a member of the American Health Lawyers Association, American Bar Association (Health Law Section) and Michigan Bar Association (Health Care Law Section). She is actively involved in the ABA Health Law Section, serving on the Membership Committee, as a Vice-Chair of the Physician Issues Interest Group and as a Vice-Chair of the Editorial Board of the publication ABA Health eSource.

While in law school, Ms. Gustafson served as a member of the Wayne Law Review Editorial Board as a Senior Articles Editor. She also served as a judicial intern to the Honorable Robert H. Cleland, United States District Court, Eastern District of Michigan.

Abby Pendleton is a founding shareholder with The Health Law Partners, P.C. She regularly provides counsel to healthcare providers and organizations in a number of areas, including but not limited to: compliance, Recovery Audit Contractors (ìRACî), Medicare and other payor audits, fraud and abuse, reimbursement matters, and HIPAA Privacy and Security, and physician staff privilege and licensure matters. Ms. Pendleton also specializes in legal issues impacting billing and management companies, anesthesia and pain management providers, hospice providers and mental health agencies.

Ms. Pendleton is a member of the State Bar of Michigan (Member, Health Care Law Section) and State Bar of New York (Member, Health Law Section); the American Bar Association; the American Health Lawyer’s Association; the Health Care Compliance Association; the Medical Group Management Association and the Michigan Medical Group Management Association.

Ms. Pendleton graduated Magna Cum Laude from Wayne State University Law School in 1996 and is a member of the Order of the Coif. Ms. Pendleton was a member of the Wayne State Law Review and served on its editorial board as a Senior Articles Editor. While at Wayne State, she was a recipient of the American Jurisprudence Book Awards in Contracts and Criminal Law as well as the Deloitte and Touche LLP Award for her achievement in tax law.

Day Egusquiza is President of AR Systems, Inc. and brings over 30 years experience in health care reimbursement, hospital business office operations, contracting and compliance implementation. During her 20 years as Director of Revenue and Reimbursement at a community hospital in Idaho, she also was Director of a Physician Medical Management billing service, where she completed an integrated business office between a hospital and a large physician clinic. Her work includes providing guidance as a compliance & APC educator while providing operational insight on the revenue cycle impacts of RAC/Medicare Recovery Audit Contractors. Ms Egusquiza is a nationally recognized speaker on continuous quality improvement (CQI), benchmarking, redesigning, reimbursement systems and implementing an operational focus of compliance – both in hospitals and practices. She has been on the AAHAM National Advisory Council, HFMA National Advisory Council, and is a past President of the Idaho HFMA Chapter & recently received the Lifetime Achievement Award. Attendees at HFMA’s ANI rated her in the top 25% for each year she has presented, earning her the ‘Distinguished Speaker’ award.

Dr. Maria Johar is the Medical Director and System Physician Advisor at ProMedica Health System.

ProMedica, a mission-driven, not-for-profit, nationally distinguished health care system serving northwest Ohio and southeast Michigan. Established in 1986, ProMedica is a locally owned, nationally recognized, not-for-profit healthcare network based in Toledo, Ohio. Our expansive network includes more than 2,300 physicians and more than 17,000 employees treating 4.7 million patients annually at 332 sites. It has been acknowledged as the Top 100 hundred hospitals and recognized as one the best employers for 2017 by Forbes magazine.

She joined the ProMedica family in Oct 2012. She comes with over twenty years of experience in the fields Of Utilization Review, Quality, Appeals, Joint Commission, Clinical Documentation, Safety and Infection Control. She is trained in LEAN methodology for system improvements.

Prior to working with ProMedica Health System, she worked with Mercy Health System, Lima memorial Health System and Liberty Medical Center. She has worked with Ohio State Medicaid board on several process improvement initiatives. She has worked as a private consultant to physician offices and Hospitals as well as writing a book called DRG Tools. She has recently been recognized with an ” Inventor of the year ” for a software solution that will help healthcare systems across the nation have compliant billing.

She lives in Toledo with her husband, two boys and three dogs. She is sits on the Lucas county suicide prevention board, and is associated with the National Physician Advisors Association, national and state case management associations and the National Association of Healthcare Quality.

Jennifer Bartlett has served at Infirmary Health for 18 years. She has vast knowledge and expertise in patient access, revenue cycle, payer contracts, payer processes and denials management. Her many years of extensive research and study of payer practices and behaviors have been instrumental in holding payers to a greater level of accountability. She manages all prepay and postpay clinical audits including RAC, KePro 2MN, CERT, MAC, Part C audits. In her organization, sheís a member of the Information Governance/HIPAA Steering Committee. In her state, sheís an active member of the Alabama Hospital Associationís Revenue Integrity/Recovery Audit Steering Committee and the Cahaba Provider Outreach and Education Advisory Board, (CMS JJ MAC region) and was a presenter in 2016 and 2017 at the AlaHA/HFMA Alabama Audit Summit. As well, she served on the faculty for the 2016 at the 4th Annual PA UR Boot Camp in San Antonio, TX.

Jessica L. Gustafson is a founding shareholder with The Health Law Partners, P.C. She represents hospitals, health systems, physicians and physician group practices, hospices, home health agencies and other health care providers and suppliers in an array of health care legal matters. Ms. Gustafson devotes a substantial portion of her practice to representing providers in the Recovery Audit (ìRACî) and Medicare audit appeals process. She also regularly assists clients with compliance and reimbursement matters, overpayment refunds, as well as other health care regulatory matters.

Ms. Gustafson is a member of the American Health Lawyers Association, American Bar Association (Health Law Section) and Michigan Bar Association (Health Care Law Section). She is actively involved in the ABA Health Law Section, serving on the Membership Committee, as a Vice-Chair of the Physician Issues Interest Group and as a Vice-Chair of the Editorial Board of the publication ABA Health eSource.

While in law school, Ms. Gustafson served as a member of the Wayne Law Review Editorial Board as a Senior Articles Editor. She also served as a judicial intern to the Honorable Robert H. Cleland, United States District Court, Eastern District of Michigan.

Abby Pendleton is a founding shareholder with The Health Law Partners, P.C. She regularly provides counsel to healthcare providers and organizations in a number of areas, including but not limited to: compliance, Recovery Audit Contractors (ìRACî), Medicare and other payor audits, fraud and abuse, reimbursement matters, and HIPAA Privacy and Security, and physician staff privilege and licensure matters. Ms. Pendleton also specializes in legal issues impacting billing and management companies, anesthesia and pain management providers, hospice providers and mental health agencies.

Ms. Pendleton is a member of the State Bar of Michigan (Member, Health Care Law Section) and State Bar of New York (Member, Health Law Section); the American Bar Association; the American Health Lawyer’s Association; the Health Care Compliance Association; the Medical Group Management Association and the Michigan Medical Group Management Association.

Ms. Pendleton graduated Magna Cum Laude from Wayne State University Law School in 1996 and is a member of the Order of the Coif. Ms. Pendleton was a member of the Wayne State Law Review and served on its editorial board as a Senior Articles Editor. While at Wayne State, she was a recipient of the American Jurisprudence Book Awards in Contracts and Criminal Law as well as the Deloitte and Touche LLP Award for her achievement in tax law.

Dr. Ronald Hirsch is a Vice President of the Regulations and Education Group at R1 Physician Advisory Services. He completed his internal medicine residency at Kaiser Permanente Medical Center in Hollywood, CA.

Dr. Hirsch was a general internist and HIV specialist and practiced at Signature Medical Associates, a multispecialty practice located in Elgin, IL. He was Medical Director of Case Management at Sherman Hospital in Elgin, IL from 2006 to 2012.

Dr. Hirsch is certified in Health Care Quality and Management by the American Board of Quality Assurance and Utilization Review Physicians, is a member of the American Case Management Association, on the Advisory Board of the American College of Physician Advisors, a Fellow of the American College of Physicians, and on the advisory board of the National Association of Healthcare Revenue Integrity. He is the co-author of The Hospital Guide to Contemporary Utilization Review, which was published in 2015.

Ernie de los Santos is Faculty Chair and Founder of Appeal Academy, and the popular online talk show, “Finally Friday!”, and TopGun Audit School. He writes regularly for Appeal Academy, and provides marketing strategy and lead generation for vendors and consultants. Before entering the healthcare industry in 2006, he spent over 20 years in research and development of marketing and production, working on projects for Fortune 100 corporations, including Coca-Cola, Kodak, and the International Olympic Committee. Before that, he spent 10 years in B2B sales and marketing for Sony and Panasonic. He holds a BA in Anthropology and Computer Science, and an MBA in Marketing.

Day Egusquiza is President of AR Systems, Inc. and brings over 30 years experience in health care reimbursement, hospital business office operations, contracting and compliance implementation. During her 20 years as Director of Revenue and Reimbursement at a community hospital in Idaho, she also was Director of a Physician Medical Management billing service, where she completed an integrated business office between a hospital and a large physician clinic. Her work includes providing guidance as a compliance & APC educator while providing operational insight on the revenue cycle impacts of RAC/Medicare Recovery Audit Contractors. Ms Egusquiza is a nationally recognized speaker on continuous quality improvement (CQI), benchmarking, redesigning, reimbursement systems and implementing an operational focus of compliance – both in hospitals and practices. She has been on the AAHAM National Advisory Council, HFMA National Advisory Council, and is a past President of the Idaho HFMA Chapter & recently received the Lifetime Achievement Award. Attendees at HFMA’s ANI rated her in the top 25% for each year she has presented, earning her the ‘Distinguished Speaker’ award.