Editorial Board
The following thought leaders serve on the RACmonitor Editorial Board.
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Andrew B. Wachler, Esq.Andrew B. Wachler is the principal of Wachler & Associates, P.C. He graduated Cum Laude from the University of Michigan in 1974 and was the recipient of the William J. Branstom Award. He graduated Cum Laude from Wayne State University Law School in 1978. Mr. Wachler has been practicing healthcare and business law for over 25 years and has been defending Medicare and other third-party payer audits since 1980. Mr. Wachler counsels healthcare providers and organizations nationwide in a variety of legal matters. He writes and speaks nationally to professional organizations and other entities on a variety of healthcare legal topics.
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Andrew H. Hughes, MD and Charles Locke, MD, CHCQM-PHYADVAndrew H. Hughes, MD, is a fellow in health systems management, a pulmonologist, and instructor of medicine at the Johns Hopkins University School of Medicine.
Charles Locke, MD, CHCQM-PHYADV, is a senior physician advisor of care coordination and clinical resource management at Johns Hopkins and is an assistant professor at the Johns Hopkins School of Medicine. He is also a member of the board of directors of the American College of Physician Advisors.
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Andrew Wachler, Esq., and Sarah Hillegonds, Esq.Andrew B. Wachler is the principal of Wachler & Associates, P.C. He graduated Cum Laude from the University of Michigan in 1974 and was the recipient of the William J. Branstom Award. He graduated Cum Laude from Wayne State University Law School in 1978. Mr. Wachler has been practicing healthcare and business law for over 25 years and has been defending Medicare and other third-party payer audits since 1980. Mr. Wachler counsels healthcare providers and organizations nationwide in a variety of legal matters. He writes and speaks nationally to professional organizations and other entities on a variety of healthcare legal topics.
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.
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Angela Phillips, PTAngela 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.
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Christopher Halleman, DODr. Christopher Halleman is a physician advisor at Brundage Group. He is board certified in Internal Medicine and serves as an academic hospitalist and associate site medical director at Largo Medical Center. He serves as the program director of the traditional rotating internship/transitional year, the associated program director of the internal medicine residency and is a clinical assistant professor at multiple medical schools. Prior to coming to Brundage Group, he served as a physician advisor at multiple facilities throughout West Florida.
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Chuck BuckChuck Buck is the publisher of RACmonitor and is the program host and executive producer of Monitor Monday.
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Daniel Zirkman, MDDr. 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.
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David M. Glaser, Esq.David M. Glaser, Esq., is a shareholder in Fredrikson & Byron’s Health Law Group. David helps clinics, hospitals, and other healthcare entities negotiate the maze of healthcare regulations, providing advice about risk management, reimbursement, and business planning issues. He has considerable experience in healthcare regulation and litigation, including compliance, criminal and civil fraud investigations, and reimbursement disputes. David’s goal is to explain the government’s enforcement position and to analyze whether the law supports this position. David is a popular panelist on Monitor Mondays and a member of the RACmonitor editorial board.
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Denise Nash, MD, CCS, CIMDenise 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.
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Dheeraj Mahajan, MD, FACPDr. Dheeraj Mahajan is president and CEO of Chicago Internal Medicine Practice and Research (CIMPAR, SC) and leads its affiliated group of companies. Dr. Mahajan is the clinical associate professor of medicine at the University of Illinois at Chicago and is also attending physician in the geriatrics fellowship program at Hines VA hospital. He is a Fellow of American College of Physicians and Board certified in Internal Medicine and Geriatric Medicine.
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Duane Abbey, PhD, CFPDuane 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.
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Edward Roche, PhD, JDEdward 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.
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Elizabeth C. Dunbar, MD, MBA, FACEP, CHCQM-PHYADVDr. Dunbar transitioned to a physician advisor role in 2016 after 19 years in clinical practice including 14 years of night shifts in the Novant Health Charlotte Market EDs as a residency-trained, board-certified emergency physician. She enjoys the multi-faceted challenges and the collegiality of UR nursing education and staff physician education, especially in the area of documentation optimization.
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Ellen Fink-Samnick MSW, ACSW, LCSW, CCM, CRPEllen Fink-Samnick is an award-winning industry expert who empowers healthcare’s transdisciplinary workforce through professional speaking, writing, mentoring, and consultation. Known as “The Ethical Compass of Professional Case Management,” Ellen is an esteemed author with more than 100 publications to her credit. She has developed content for many of the industry’s knowledge projects for case managers, including books, chapters, articles, and continuing education on the Ethical Use of Technology, Competency-based Case Management, Collaborative Care, the Social Determinants of Health, and dimensions of Workplace Bullying. Her contributions to professional case management, ethics, and clinical social work transverse professional associations and credentialing organizations.
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Erica E. Remer, MD, FACEP, CCDSErica Remer, MD, FACEP, 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.
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Erin Diesel Roumayah, Esq.Erin Diesel Roumayah is an associate attorney at Wachler & Associates, PC. Ms. Roumayah represents healthcare providers and suppliers in Medicare, Medicaid, and third-party payer audits. She devotes a substantial portion of her practice representing healthcare providers and suppliers in the audit administrative appeals process. In addition, Ms. Roumayah represents healthcare providers in regulatory compliance matters and healthcare litigation. Ms. Roumayah graduated from Wayne State University Law School.
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Frank D. Cohen, MPA, MBBFrank 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.
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Gloryanne Bryant, RHIA, RHIT, CCS, CCDSGloryanne 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.
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Greg FordIn his role as director of requester relations and receivables administration for MRO, Greg Ford serves as a liaison between MRO’s healthcare provider clients and payers requesting large volumes of medical records for purposes of post-payment audits, as well as HEDIS and risk adjustment reviews. He oversees payer audit and review projects end-to-end, from educating and supporting clients on proper billing practices and procedural obligations to streamlining processes to ensure timely delivery of medical documentation to the requesting payers. Prior to joining MRO, Ford worked as director of operations and sales at ARC Document Solutions for 15 years. He received his B.A. from Delaware Valley University.
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Holly Louie, RN, CHBMEHolly 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.
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J. Paul Spencer, CPC, COCJ. Paul Spencer is a senior healthcare consultant for DoctorsManagement. Is the national correspondent for Monitor Mondays, the live Internet radio broadcast produced by RACmonitor.
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Janelle Ali-Dinar, PhDJanelle 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.
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Jeffrey D. Lehrman DPM, FASPS, MAPWCADr. Lehrman is a diplomate of the American Board of Foot and Ankle Surgery, fellow of the American Society of Podiatric Surgeons, fellow of the American College of Foot and Ankle Surgeons, and fellow of the American Academy of Podiatric Practice Management, and he is recognized as a master of the American Professional Wound Care Association. He is the Chair of the Board of Directors of the American Society of Podiatric Surgeons. He is also on the Board of Directors of the American Professional Wound Care Association. He is an expert panelist on Codingline.com and sits on the APMA Coding Committee. Dr. Lehrman has lectured nationally and internationally on practice management and other topics.
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Jessica Forster, Esq.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. -
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Juliet B. Ugarte Hopkins, MD, CHCQM-PHYADVJuliet B. Ugarte Hopkins, MD, CHCQM-PHYADV, is a physician advisor for case management, utilization, and clinical documentation at ProHealth Care, Inc. in Wisconsin. Dr. Ugarte Hopkins practiced as a pediatric hospitalist for a decade. She was also medical director of pediatric hospital medicine and vice chair of pediatrics in Northern Illinois before transitioning into her current role. She is the first physician board member for the Wisconsin chapter of the American Case Management Association (ACMA), a member of the board of directors for the American College of Physician Advisors (ACPA). Dr. Ugarte Hopkins also makes frequent appearances on Monitor Mondays and is a member of the RACmonitor editorial board.
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Kathleen K. Borchard, BSN, RN-ACMKathleen 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.
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Kim T. Charland, BA, RHIT, CCSKim 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.
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Knicole C. Emanuel Esq.Knicole C. Emanuel is a partner at the Potomac Law Group, PLLC.
For more than 19 years, Ms. Emanuel has maintained a litigation practice, concentrating on Medicare and Medicaid litigation,
healthcare regulatory compliance, administrative law, and regulatory law. She understands the intricate Medicare and Medicaid payment system, the unique business of healthcare providers, the overlay of federal and state Medicare and Medicaid rules and regulations, and actions of state agencies that affect the way healthcare entities operate. Ms. Emanuel has tried over 1,000 administrative cases and has appeared before arbitration panels and in various appellate forums. She is a member of the RACmonitor editorial board and makes frequent appearances on Monitor Monday.
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Kristi Pollard, RHIT, CCS, CPC, CIRCC, AHIMA-approved ICD-10-CM/PCS trainerKristi 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.
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Laurie M. Johnson, MS, RHIA, FAHIMALaurie M. Johnson, MS, RHIA, FAHIMA is currently a senior healthcare consultant for Revenue Cycle Solutions, based in Pittsburgh, Pa. Laurie is an American Health Information Management Association (AHIMA) approved ICD-10-CM/PCS trainer. She has more than 35 years of experience in health information management and specializes in coding and related functions. She has been a featured speaker in over 40 conferences. Laurie is a member of the ICD10monitor editorial board and makes frequent appearances on Talk Ten Tuesdays.
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Lori O’Hara, MA, CCC-SLPLori O’Hara is the lead of the ADR, Appeals and Clinical Review Team for Ensign Services. She has more than 25 years of experience in the post-acute setting, ranging from hands-on clinician to interdisciplinary rehabilitation director. She currently supports her organization’s SNF line of business through claim defense and proactive development of documentation processes.
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Mark SpiveyMark Spivey is a national correspondent for ICDmonitor.com, RACmonitor and ICD10monitor who has been writing on numerous topics facing the nation’s healthcare system (and federal oversight of it) for eight years.
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Marvin D Mitchell, RN, BSN, MBAMarvin D. Mitchell, RN, BSN, MBA, is the director of case management and social work at San Gorgonio Memorial Hospital, east of Los Angeles. Building programs from the ground up has been his passion in every venue where case management is practiced. Mitchell is a member of the RACmonitor editorial board and makes frequent appearances on Monitor Mondays.
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Mary Beth Pace, RN, BSN, MBA, ACM, CMACMary Beth Pace is vice president of care management at Trinity Health.
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Mary Inman, Esq. and Max Voldman, Esq.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.
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Michael A. Salvatore, MD, FACPDr. 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.
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Michael Rosen, Esq.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.
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Nancy J. Beckley, MB, MBA, CHCNancy Beckley is founder and president of Nancy Beckley & Associates LLC, providing compliance planning and outsourced compliance services to rehab providers in hospitals, rehab agencies, and private practices. Nancy is certified in healthcare compliance by the Healthcare Compliance Certification Board. She is on the board of the National Association of Rehabilitation Providers and Agencies. She previously served on the CMS Professional Expert Technical Panel for Comprehensive Outpatient Rehabilitation Facilities. Nancy is a familiar voice on Monitor Mondays, where she serves as a senior national correspondent.
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Nena Scott, MSEd, RHIA, CCS, CCS-P, CCDSNena 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.
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Ralph Wuebker, MD, MBADr. 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.
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Ronald Hirsch, MD, FACP, CHCQMRonald Hirsch, MD, FACP, CHCQM is vice president of the Regulations and Education Group at R1 Physician Advisory Services. Dr. Hirsch’s career in medicine includes many clinical leadership roles at healthcare organizations ranging from acute-care hospitals and home health agencies to long-term care facilities and group medical practices. In addition to serving as a medical director of case management and medical necessity reviewer throughout his career, Dr. Hirsch has delivered numerous peer lectures on case management best practices and is a published author on the topic. He is a member of the Advisory Board of the American College of Physician Advisors, a member of the American Case Management Association, and a Fellow of the American College of Physicians. Dr. Hirsch is a member of the RACmonitor editorial board and is regular panelist on Monitor Mondays.
The opinions expressed are those of the author and do not necessarily reflect the views, policies, or opinions of R1 RCM, Inc. or R1 Physician Advisory Services (R1 PAS).
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Sarah Hillegonds, Esq.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.
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Sean M. Weiss, CEMA, CMCO, CPMA, CPC-P, CMPE, CMPM, CPC-PSean Weiss is a partner and vice president of compliance with DoctorsManagement, LLC. Sean has dedicated his career to helping healthcare facilities reduce the risk of noncompliance and achieve measurable financial results. He has protected thousands of physicians, medical practice groups, and hospitals from undue compliance penalties.
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Shannon Deconda, CPC, CPC-I, CEMC, CMSCS, CPMA®Shannon DeConda is the founder and president of the National Alliance of Medical Auditing Specialists (NAMAS) as well as the president of coding and billing services and a partner at DoctorsManagement, LLC. Ms. DeConda has more than 16 years of experience as a multi-specialty auditor and coder. She has helped coders, medical chart auditors, and medical practices optimize business processes and maximize reimbursement by identifying lost revenue. Since founding NAMAS in 2007, Ms. DeConda has developed the NAMAS CPMA® Certification Training, written the NAMAS CPMA® Study Guide, and launched a wide variety of educational products and web-based educational tools to help coders, auditors, and medical providers improve their efficiencies. Shannon is a member of the RACmonitor editorial board and is a popular guest on Monitor Mondays.
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Steven J. Meyerson, MD, CHCQM-PHYADVSteven 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.
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Timothy Powell, CPA CHCPTimothy Powell is a nationally recognized expert on regulatory matters, including the False Claims Act, Zone Program Integrity Contractor (ZPIC) audits, and U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) compliance. He is a member of the RACmonitor editorial board and a national correspondent for Monitor Mondays.