Editorial Board

Amanda Gilliland, RN, BSN, is the revenue integrity nurse auditor at UW Health, Madison, WI., holding similar positions there since 1985. She handles third party payer denials and is a provider representative on two state work comp committees. 

Andrew 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.

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. 

SHillegonds@wachler.com

Dr. 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.

Chuck Buck is the publisher of RACmonitor and is the program host and executive producer of Monitor Monday.

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.

Dr. 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.

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 and Social Determinants of Health: Case Management’s Next Frontier (with foreword by Dr. Ronald Hirsch), are published through HCPro. She is a panelist on Monitor Mondays, frequent contributor to Talk Ten Tuesdays, and member of the RACmonitor Editorial Board.

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.

Glenn Krauss is well-recognized and respected subject matter expert in the revenue cycle with a specialized emphasis and focuses upon collaborating and working closely with physicians in promoting, advocating for, educating and achieving sustainable improvement in clinical documentation that accurately reflects and reports the communication of fully informed coordinated patient care. His experiences include working with a wide variety of healthcare systems spanning the entire spectrum ranging from critical access hospitals, community hospitals, Federal Qualified Healthcare Centers to large academic medical centers and fully integrated healthcare systems. Glenn is a member of the ICD10monitor editorial board and makes frequent appearances on Talk Ten Tuesdays.

In 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.

J. Paul Spencer is a senior healthcare consultant for DoctorsManagement. Is the national correspondent for Monitor Mondays, the live Internet radio broadcast produced by RACmonitor.

Dr. 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.

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.

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.

Lori 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.

Marvin 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.

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.

Maureen Testoni is the president and CEO of 340B Health.

Melinda Battaile, MD, FHM, MMCI, CHCQM-PHYADV, CCDS is a graduate of the University of Maryland School of Medicine with a Masters in Management of Clinical Informatics from Duke University. She works full time as a physician advisor for CDI at Vidant Health and still does clinical shifts as well.

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.

Ronald 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).

Sean 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.

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.

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.