Editorial Board

Adam is the head of ECG’s Financial Services practice. Since 1997, he has conducted valuations and appraisals of business enterprises, physician and executive compensation arrangements, funds flow arrangements, and capital and intangible assets, as well as economic damages assessments, for taxable and tax-exempt entities. He has conducted industry-leading research on drivers of physician compensation and speaks regularly on a variety of healthcare valuation topics.

Alvin Gore, MD, CHCQM Dr. Alvin Gore currently serves as the UM Director for a 2-hospital segment of the Northern California region of St. Joseph Health. Physician Advisor since 2009, he is responsible for all traditional PA duties- case reviews, denial prevention and management, CDI/CDQI projects, physicians' education and outreach, various cost of care reduction projects, as well as aspects of Population health.

Cathi Charlberg, LVN, CHCQM Cathi Charlberg has extensive knowledge in medical practice management, with last 20 years spent in acute care Utilization Management. She also has significant experience with full- and partial-risk medical group delegation services, as well as extensive appeal experience for both Medicare and commercial population. Cathi is currently the Area UM Manager for St. Joseph Health, Sonoma County, California.

Amber Soucy is a Registered Nurse working full-time on a surgical intermediate care unit at Boston Medical Center, and part-time as a Clinical Instructor/Adjunct Faculty for Labouré College. She graduated summa cum laude with a Master of Science in Nursing degree and concentration in Nursing Leadership in May 2018 from Curry College, and hopes to create and promote positive change within the inpatient hospital setting.

Amber has been a member of the Society for Participatory Medicine since 2017, and currently sits on the Board of Directors and is the society’s Social Media Lead. She integrates participatory care models within her nursing practice to encourage patient engagement, foster nurse-patient relationships, and improve the overall patient experience. Through academia, she stresses the importance of treating every patient with dignity and respect, and how students can individually tailor care plans by actively listening and collaborating with patients and families.

Twitter: @wheezynurse

ANDREW B. WACHLER is a partner with Wachler & Associates, P.C. Mr. Wachler has been practicing healthcare law for over 30 years. He counsels healthcare providers, suppliers and organizations nationwide in a variety of healthcare legal matters. In addition, he writes and speaks nationally to professional organizations and other entities on healthcare law topics such as Medicare and 3^rd party payor appeals, Stark law and Fraud and Abuse, regulatory compliance, enrollment and revocation, and other topics.  He often co-speaks with Medicare and other government officials.  Mr. Wachler has met with the Centers for Medicare & Medicaid Services (CMS) policy makers on numerous occasions to effectuate changes to Medicare policy and obtain fair and equitable reimbursement for health systems.

Emma Trivax is a Law Clerk at Wachler & Associates, P.C. Ms. Trivax has been with the firm since May 2018, assisting primarily in Fraud & Abuse matters; Medicare, Medicaid, and third-party payor audits; and licensing matters. Ms. Trivax is a third-year law student at Wayne State University Law School and graduates in May 2020. Ms. Trivax has interned with the Honorable Judge Bernard A. Friedman of the United States District Court for the Eastern District of Michigan. During law school, Ms. Trivax has participated in both Law Review and Moot Court. Ms. Trivax’s Law Review Note, to be published Spring of 2020, discusses the Medicare audit appeals process, the backlog of appeals, and jurisdictional avenues for relief from the backlog’s collateral consequences. Ms. Trivax is also to be published as co-author in the 2020 edition of the Health Law Handbook. Ms. Trivax’s passion for health law grows as she continues publishing articles and blog posts discussing various areas of health law.

 

ANDREW B. WACHLER is a partner with Wachler & Associates, P.C. Mr. Wachler has been practicing healthcare law for over 30 years. He counsels healthcare providers, suppliers and organizations nationwide in a variety of healthcare legal matters. In addition, he writes and speaks nationally to professional organizations and other entities on healthcare law topics such as Medicare and 3rd party payor appeals, Stark law and Fraud and Abuse, regulatory compliance, enrollment and revocation, and other topics. He often co-speaks with Medicare and other government officials. Mr. Wachler has met with the Centers for Medicare & Medicaid Services (CMS) policy makers on numerous occasions to effectuate changes to Medicare policy and obtain fair and equitable reimbursement for health systems.

Kaitlin Nucci is an associate attorney at Wachler & Associates, P.C. Ms. Nucci represents providers in the defense of Medicare, Medicaid, and third party payor audits. She joined the firm in May 2019.

Angela M. Phillips, PT, is President and Chief Executive Officer of Images & Associates. A graduate of the University of Pennsylvania’s School of Allied Health Professions, she has more than 40 years of experience as a consultant, healthcare executive, hospital administrator, educator, and clinician. Ms. Phillips is one of the nation’s leading consultants assisting Inpatient Rehabilitation Facilities in operating effectively under the Medicare Prospective Payment System (PPS) and in addressing key issues related to compliance. Ms. Phillips is a member of the RACmonitor editorial board and a popular guest panelist on Monitor Mondays.

Dr. Benjamin Kartchner MD, CHCQM-PhyAdv is the physician advisor and medical director of utilization management for Multicare Health System covering the INW region in Spokane, WA. He graduated from the University of Colorado before completing his residency in Family Medicine at Grant Medical Center in Columbus, OH.V

Long time moderator for Monitor Mondays and Talk Ten Tuesdays podcasts.

Dr. Daniel Zirkman is the chief physician advisor at CarolinaEast Medical Center in New Bern, N.C. Dr. Zirkman completed medical school at the University of Texas at San Antonio, then residency in internal medicine and fellowship in nephrology at the University of Pittsburgh. He practiced privately for 23 years.  

Dr. Zirkman began physician advising work approximately five years ago. Previously, he worked at Riverview Medical Center in Red Bank, N.J., part of the Hackensack-Meridian system, before moving to New Bern in 2017 to take on his current position at CarolinaEast Medical Center. 

David Jury, MD is a staff anesthesiologist and critical care physician at Cleveland Clinic.  

Delilah Davis, RN, BSN, CCA, is the Medical Reviews/Appeals Coordinator for Blount Memorial Hospital. Previously, she worked in the fields of HHC, ICU, COU, and infection prevention. She holds an AD in Interior Design with an interest in Health Care design and oil paintings.

Denise Nash, MD has more than 20 years of experience in the healthcare industry. In her last position, she served as senior vice president of compliance and education for MiraMed Global Services, and as such she handled all compliance and education needs, including working with external clients. Dr. Nash has worked for the Centers for Medicare & Medicaid Services (CMS) in hospital auditing and has expertise in negotiation and implementation of risk contracting for managed care plans. She has also worked with individuals as well as physician groups on utilization and Physician Quality Reporting System (PQRS) management to improve financial performance for risk-based contracts and value-based purchasing programs. Dr. Nash has past experience with episode-of-care data, hierarchical condition categories (HCCs), and patient management in the Accountable Care Organization (ACO) environment. She has also worked with both hospitals and physician practices on the legal and financial aspects of adding new services to their respective facilities. Dr. Nash is a consultant on coding/compliance audits at physician practices and hospitals, and has worked for insurance plans conducting second- and third-level appeals. Her past experience also included consulting for the Office of the Inspector General of New Hampshire in its Fraud and Abuse Division.

Duane C. Abbey, PhD, CFP, is an educator, author, and management consultant working in the healthcare field. He is president of Abbey & Abbey Consultants, Inc., which specializes in healthcare consulting and related areas. His firm is based in Ames, Iowa. Dr. Abbey earned his graduate degrees at the University of Notre Dame and Iowa State University. Dr. Abbey is a member of the RACmonitor editorial board and is a frequent guest on Monitor Mondays.

Edward Roche is the director of scientific intelligence for Barraclough NY, LLC. Mr. Roche is also a member of the California Bar. Prior to his career in health law, he served as the chief research officer of the Gartner Group, a leading ICT advisory firm. He was chief scientist of the Concours Group, both leading IT consulting and research organizations. Mr. Roche is a member of the RACmonitor editorial board as an investigative reporter and is a popular panelist on Monitor Mondays.

Ellen Fink-Samnick is an award-winning healthcare industry expert. She is the esteemed author of books, articles, white papers, and knowledge products. A subject matter expert on the Social Determinants of Health, her latest books, The Essential Guide to Interprofessional Ethics for Healthcare Case Management,  Social Determinants of Health: Case Management’s Next Frontier (with Foreword by Dr. Ronald Hirsch), and End of Life Care for Case Management are published through HCPro. She is a panelist on Monitor Mondays, frequent contributor to Talk-Ten-Tuesdays, and member of the Editorial Advisory Boards of Professional Case Management, Case Management Monthly, and RAC Monitor. Ellen also serves as the Lead for Rise Association’s Social Determinants of Health Community.

Erica Remer, MD, CCDS has a unique perspective as a practicing emergency physician for 25 years, with extensive coding, clinical documentation improvement (CDI), and ICD-10 expertise. As a physician advisor for University Hospitals Health System in Cleveland, Ohio for four years, she has trained 2,700 providers in ICD-10, closed hundreds of queries, fought numerous DRG clinical determination and medical necessity denials, and educated CDI specialists and healthcare providers with engaging, case-based presentations. She transitioned to independent consulting in July 2016. Dr. Remer is a member of the ICD10monitor editorial board and the co-host of Talk Ten Tuesdays. She is also on the board of directors of the American College of Physician Advisors.

Frank Cohen is the director of analytics and business Intelligence for DoctorsManagement, a Knoxville, Tenn. consulting firm. He specializes in data mining, applied statistics, practice analytics, decision support, and process improvement. He is a member of the RACmonitor editorial board and a popular contributor on Monitor Monday.

Gloryanne is a coding and health information management (HIM) professional with 35 years of experience. She is the past president of the California Health Information Association. Gloryanne is a member of the ICD10monitor editorial board and is a popular panelist on Talk Ten Tuesdays.

Holly Louie is the compliance officer for Practice Management Inc., a multi-specialty billing company in Boise, Idaho. Holly is the past president of the Healthcare Business and Management Association (HBMA). Holly is also a national healthcare consultant and testifying expert on matters related to physician coding, billing, and regulatory compliance. She is a member of the ICD10monitor editorial board.

Janelle Ali-Dinar, PhD is a rural healthcare expert and advocate with more than 15 years of healthcare executive experience in many key areas addressing critical access hospitals (CAHs), rural health clinics (RHCs), physicians, and patients. Dr. Ali-Dinar is a sought-after speaker on Capitol Hill. A former hospital CEO and regional rural strategy executive, Janelle is also a past National Rural Health Association rural fellow, Rural Congress member, and Nebraska Rural Health Association president. She is currently the Nebraska DHHS chair of The Office of Minority Health Statewide Council, addressing needs of rural, public, minority, tribal, and refugee health, and she serves on the Regional Health Equity Region VII council as co-chair of Rural Health and Partnerships. Janelle holds a master’s degree and doctorate in communications and is a recent graduate in public health leadership. Janelle is currently the vice president of rural health for MyGenetx and is a member of the RACmonitor editorial board.  

Jessica Forster is an associate at Wachler & Associates, P.C. She dedicates a considerable portion of her practice to defending healthcare providers and suppliers in the defense of RAC, Medicare, Medicaid and third party payer audits. Her practice also includes the representation of clients in Stark, anti-kickback, and fraud and abuse matters.

John K. Hall, MD, JD, MBA, FCLM, FRCPC is a licensed physician in several jurisdictions and is admitted to the California bar. He is also the founder of The Aegis Firm, a healthcare consulting firm providing consultative and litigation support on a wide variety of criminal and civil matters related to healthcare. He lectures frequently on black-letter health law, mediation, medical staff relations, and medical ethics, as well as patient and physician rights.

Dr. Hall hopes to help explain complex problems at the intersection of medicine and law and prepare providers to manage those problems.

Juliet B. Ugarte Hopkins, MD, CHCQM-PHYADV, FABQAURP practiced as a pediatric hospitalist and now serves as Physician Advisor for Case Management, Hospital Utilization, and Clinical Documentation for ProHealth Care, Inc. in Wisconsin. She is President of the American College of Physician Advisors (ACPA) and serves on the RACmonitor editorial board.

Kathleen K. Borchard is a registered nurse with 36 years of experience that has spanned a multitude of nursing genres. Kathleen, a graduate of South Dakota State University, began specializing in case management in 2004, serving Milwaukee’s frail elder population. In 2010, Kathleen transitioned to acute case management at ProHealth Care Waukesha Memorial Hospital. Kathleen’s most recent accomplishment was obtaining her case management certification in 2016.

Kim Charland has over 30 years of experience in health information and revenue cycle management for hospitals and physicians. Kim has spent most of her career in product development related to healthcare consulting services, education, publishing, and software. She was responsible for the operations of a healthcare audit consulting division for many years and launched an Internet news and information platform, VBPmonitor, that focused on the transition to value-based payments. She was also the co-host of ICD10monitor’s weekly Internet news program, Talk-Ten-Tuesdays, for many years. Kim speaks nationally on topics such as quality and value-based payment initiatives, clinical documentation improvement (CDI), and documentation, coding, revenue cycle, and compliance-related issues. Kim is also the president of the New York Health Information Management Association.

Kristi Pollard is a senior coding consultant at Haugen Consulting Group. Kristi has more than 20 years of industry experience. She develops web-based and instructor-led training material and conducts training in ICD-10-CM/PCS. Kristi has an extensive background in coding education and consulting and is a national speaker on topics related to ICD-9, ICD-10, and CPT coding, as well as code-based reimbursement.

Leslie Marsh, the chief executive of Lexington Regional Health Center in Lincoln, Nebraska.

Madison Ellen is the daughter of Knicole Emanuel, Esq., a permanent member of Monitor Mondays and a longtime contributor to RACmonitor.

Mark Spivey is a national correspondent for RACmonitor.com, ICD10monitor.com, and Auditor Monitor who has been writing and editing material about the federal oversight of American healthcare for more than a decade. He can be reached at mcspivey@hotmail.com.

Mary Beth Pace is vice president of care management at Trinity Health.

Mary Inman is a partner in the London office of Constantine Cannon, where she specializes in representing whistleblowers from the United States, Europe, and around the world under the various American whistleblower reward programs, including the False Claims Acts and the SEC, CFTC, IRS, and DOT whistleblower programs.

Max Voldman is an associate in Constantine Cannon’s Washington D.C. office.

Matthew Albright is the chief legislative affairs officer at Zelis Healthcare. Previously, Albright was senior manager at CAQH CORE, and earlier, he was the acting deputy director of the Office of E-Health and Services for the Centers for Medicare & Medicaid Services.

Max Voldman is an associate in Constantine Cannon’s Washington D.C. office.

Dr. Michael Salvatore was a pulmonary medicine/critical care physician for 35 years. Since 2012 he has been the physician advisor and medical director of the palliative care team at Beebe Healthcare in Delaware. After earning his MD at the University of Arizona, he trained in internal medicine and PULM/CCM at Duke University. Dr. Salvatore is a member of the RACmonitor editorial board.

Michael Rosen brings more than 20 years of experience in founding and leading service-oriented businesses. He co-founded Background America, Inc., which was acquired by Kroll Inc. He was promoted to president of the Background Screening Division, which employed 1,000 people in seven countries.

He is now the co-founder of ProviderTrust, Inc. a national healthcare compliance service that helps facilities stay in compliance. He has received numerous accolades, including the Inc. Magazine 500 Award, Nashville Chamber of Commerce Small Business of the Year award, and the Music City Future 50 Award.

Nena Scott is the director of coding quality and professional development at TrustHCS. She has served as an educator in the healthcare industry across numerous organizations over the past two decades. Her experience includes the creation and successful implementation of a Registered Health Information Technology program at a community college in Northern Mississippi, where she served as the program director and lead instructor for over a decade. As a professional educator, Nena’s experience spans a wide range of health information topics, including quality improvement, healthcare law, ethics, and billing.

Dr. Ralph Wuebker serves as Chief Medical Officer of Executive Health Resources. In this role, Dr. Wuebker provides clinical leadership within the company and works closely with hospital leaders to ensure strong utilization review and compliance programs. Additionally, Dr. Wuebker oversees Executive Health Resources’ Client Services teams, who provide onsite education for physicians, case managers, and hospital administrative personnel and help hospitals identify potential compliance vulnerabilities through ongoing internal audit.

An expert in CMS regulations, medical necessity compliance, utilization review, denials management, and program integrity efforts, Dr. Wuebker also serves as an industry thought leader and editorial advisor to the media, as well as a highly respected and distinguished industry speaker.

Robin Sewell, CDIP, CCS, CPC, CIC, is a 25-year healthcare consultant with a background that includes outpatient and inpatient revenue cycle as well as RAC and clinical validation audits on the payer side of healthcare. Robin is the founder and creator of Cleopatra "Queen of Denial" revenue cycle denial management application on behalf of hospitals.

Sarah Hillegonds is an associate attorney at Wachler & Associates, P.C.  Ms. Hillegonds practices in all areas of healthcare law and devotes a substantial portion of her practice to representing healthcare entities in the defense of RAC, Medicare, Medicaid, and third-party payer audits.  Ms. Hillegonds also represents healthcare providers in licensing matters. 

Stanley Nachimson, MS is principal of Nachimson Advisors, a health IT consulting firm dedicated to finding innovative uses for health information technology and encouraging its adoption.   The firm serves a number of clients, including WEDI, EHNAC, the Cooperative Exchange, the Association of American Medical Colleges, and No World Borders.  Stanley is focusing on assisting health care providers and plans with their ICD-10 implementation and is the director of the NCHICA-WEDI Timeline Initiative.  He serves on the Board of Advisors for QualEDIx Corporation.

Stanley served for over 30 years in the US Department of Health and Human Services in a variety of statistical, management, and health technology positions.  His last ten years prior to his 2007 retirement were spent in developing HIPAA policy, regulations, and implementation planning and monitoring, beginning CMS’s work on Personal Health Records and serving as the CMS liaison with several industry organizations, including WEDI and HITSP.  He brings a wealth of experience and information regarding the use of standards and technology in the health care industry.

Stefani Daniels, RN, MSNA, CMAC, ACM, is the founder and managing partner of Phoenix Medical Management, Inc. She is a former hospital executive, chief nursing officer, and senior consultant with Johnson & Johnson. Stefani held faculty appointments at University of Pennsylvania, Nova Southeastern University, in the Graduate Division of the School of Business and Entrepreneurship and Columbia University in New York.

Steven Meyerson, MD, CHCQM-PHYADV, is the founder of Steven Meyerson Consulting. Dr. Meyerson is a nationally recognized expert and consultant in the physician advisor role, case management, and hospital Medicare compliance. He is board certified in internal medicine and geriatrics and serves on the board of the American College of Physician Advisors (ACPA). He edits and writes for the ACPA online blog.

Trinity Buck is a senior at Grossmont High School in San Diego. She’s an aspiring actress and has performed in numerous high school musicals. She is the granddaughter of Chuck Buck, publisher of RACmonitor and ICD10monitor and host of Monitor Mondays and Talk Ten Tuesdays.