Curriculum Vitae

Professional Credentials/Experience

• Attorney at Law: Admitted in the state of California (CalBar ID 260146), the US District Court for the Southern District of California, and the US District Court for the Western District of Pennsylvania.
• Certified Professional Coder (CPC) - American Academy of Professional Coders (AAPC)
• Specialty Coding Certification – American Academy of Professional Coders (AAPC)
• Certified Ambulatory Surgical Coder (CASCC)12/2008
• Certified Urology Coder (CUC) 12/2008
• Certified Chiropractic Professional Coder (CCPC) (4/2009)
• Certified Professional Compliance Officer (CPCO) 1/2011
• Certified Healthcare Compliance Consultant (CHCC) - Healthcare Compliance Resources

Expert Witness:

• Qualified as an Independent Review Organization to perform Department of Health and Human Services (HHS) Office of Inspector General (OIG) audits for providers operating under an Integrity Agreement. 10/2004
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• Qualified by Massachusetts Board of Registration to perform provider compliance auditing and corrective action training. 8/2002
• Qualified by the Chiropractic Physicians Board of Nevada to perform provider compliance auditing and corrective action training. 10/2005.
• Accepted in state and federal court and numerous administrative hearings as an expert to testify on issues of coding and health insurance fraud involving E/M coding, diagnostic testing and physical medicine services on behalf of both healthcare providers and insurance carriers.

Lecture/Instruction:

• The Coding Institute (http://codinginstitute.com)
• Audio Seminar. Course Name: Supportive Care - Justifying Treatment for Chronic Conditions, Date: 3/13/2001
• Contracted to Answer Physical Medicine and Chiropractic Subscriber Coding Questions 9/2000 - 5/2001

Practice Masters, Inc. Educational Seminars:

• Conduct compliance related seminars annually since 1996 on the following topics
• Insurance 101 - Coding Basics
• Advanced Coding
• Medical Necessity/Treatment Planning
• Collection Strategies
• Billing/Reimbursement & HIPAA Compliance
• E/M Coding and Decision Making Documentation
• Auditing Standards
• Lorman Education (http://lorman.com)
• Course Name: Healthcare Compliance
• Provided Instruction in Self-Audit Methods, Date: February 27, 2002
• Department of Defense
• E/M Coding Training WBAMC Ft. Bliss, Tx. Dates: 9/3-6/2002
• Heritage Alliance (230 Multi-Specialty IPA in NE PA)
• Contract Chart Auditor/Compliance Consultant (3/2002 - 2004)
• Training Seminar - E/M Coding 9/2002
• Greater Pittsburgh Chapter AAPC
• Decision Making and the -25 Modifier (12/2002)
• Pennsylvania Chiropractic Association
• Introductory Coding Seminar, Dates: 1/31/2002, 2/7/2002
• Palmer College of Chiropractic
• Post Graduate Continuing Education Lecture on E/M Coding and Documentation of Medical Necessity 1/10/2005.
• Approved seminar program and as a lecturer and by Palmer Post Graduate Division (Documentation and Coding) 3/2005
• Georgia Chiropractic Association
• Common Mistakes in Physical Medicine Coding 2005-2007
• Documentation and Coding Strategies for Compliance 2005-2007

Articles:

• Policy For Use of the -25 Modifier In Physical Medicine Encounters
• Decision Making and Use of the -25 modifier
• Understanding E/M Coding and Objective Auditing Methods to Determine the Level of Service
• Three Steps to Correct Coding of Physical Medicine Procedures
• Traction as A Billable Therapy - CCI Impact and Reimbursement for Axial Traction
• Supportive Care: Justifying Reimbursement for Treatment of Chronic Conditions
• Proper Reporting of Time-Based Procedures
• HIPAA and Fraud: Application of the Health Insurance Portability and Accountability Act of 1996 to your Daily Operations
• Delegation of Services to Unlicensed Personnel: An Analysis of BPOA Policy
• Application of Separate Procedure Rules in Neuromuscular Diagnostic Testing
• Semantics in Coding: CPT Meaning of the Term Therapist for Direct One-On-One Contact Therapy Procedures
• Mastering the Documentation Game
• The Reasonableness Element of Reasonable and Necessary.
• The Necessary Element of Reasonable and Necessary.
• Proper Use of the "-59" modifier for Billing of Separate Therapy Procedures in the CMT Comprehensive Code Pairing
• Time Based Coding: Proper Reporting of Time-Based Physical Medicine Procedures
• Joint Dysfunction: An Analysis of the Significance of Joint Dysfunction and Its Impact to the Reporting of Manipulation in Rehabilitative Encounters.
• Contributing Author, Health Care Compliance Association, Monitoring and Auditing Manual, Evaluation and Management Scoring Tutorial and Audit Worksheet.
• Medical Necessity – Condition, Care Type Definitions, and Documentation Requirements
• Analysis of 2006 CPT Changes and Impact to PMR Providers
• Analysis of HIPAA Security Regulations
• Electrodiagnostic Service Coding; Documentation and Coding for EDX Services
• Documentation: Reasonableness; The First Step to Justifying Medical Necessity
• Proper Use of the “-59” modifier for Billing of Separate Therapy Procedures
• Time Based Evaluation and Management Service Reporting Coding
• Up-coding or Under-documentation? Common Documentation Mistakes Related to E/M Services
• Electrodiagnostic Services; Review of Documentation, Billing and Bundling Rules

Professional Memberships

• American Academy of Professional Coders
• American Health Lawyers Association
• Health Care Compliance Association
• Professional Management Consultants Association
• Healthcare Compliance Resources

Work Experience

• 1978-1980 Miscoe Chiropractic Clinic, PC
  • Billing/Collections Clerk
• 1985 - 1988 US Army
  • Aviation Officer Basic Course - Distinguished Graduate
  • US Army Air Assault School, US Army Airborne School, US Army Rotary Wing Aviator Course - Distinguished Graduate, US Army Attack Helicopter Qualification Course, US Air Force Air Load Planner School
    • Current Status - Disabled Veteran
• 1989 - 1991 Texas Instruments - Procurement Quality Assurance Engineer/Mgr
  • Engineer, Defense Systems Electronics Group - Certified in Performance of MIL-I-45208 and MIL-Q-9858 Quality System Audits
  • Developed Statistical Quality Inspection program using statistical sampling methodologies to insure acceptability of subcontracted parts orders.
  • Manager of Procurement Quality, Information Technology Group
• 1992 - 1995 Practice Plus, Inc. - Director of Program Design.
  • Developed Part B Billing and Receivables Software Systems and Performed Network Design and Installation Services for Software Clients
• Miscoe Chiropractic Clinic, PC
  • Rehabilitation Assistant
  • Certified in Performance of Neurologic Testing Using Neurometer by Neurotron Inc. November 1994.
  • Supervisor - Billing/Collections Department
• 1996 - Present Practice Masters, Inc.
  • Developed and Instructed Compliance Oriented Lecture Series and have performed over 1000 hours of instruction to large and small provider groups, state provider associations and colleges. Topics include Basic and Advanced PMR Coding, E/M Coding, Documentation of Medical Necessity, Auditing Methods, HIPAA Privacy Compliance and a variety of healthcare compliance issues.
  • Assumed Position as President of Corporation 1/2000
  • Credentialed as a Certified Professional Coder (CPC) by the American Academy of Professional Coders 8/2001.
  • Credentialed as a Certified Healthcare Compliance Consultant (CHCC) by Healthcare Compliance Resources 8/2001.
  • Credentialed as a Certified Rehabilitation Assistant by Texas College of Chiropractic 6/2002. (56 Hours of Instruction)
  • Attended Pain Management Coding and Compliance Seminar (15 CE hours) 6/2002.
  • Appointed as public member of the American College of Chiropractic Rehabilitation Science 3/2003.
  • Performed numerous benchmark and annual follow-up compliance audits related to formal and informal compliance program implementation for a variety of provider specialties.
  • Appointed to American Academy of Professional Coders National Advisory Board 3/2007. Chair of Off-Shore Code Certification Task Force. Member of AAPC Ethics Committee.

Education and Honors

• 1980 - 1981 University of Pittsburgh at Johnstown - General Studies
• 1981 - 1985 United States Military Academy, West Point, NY
  • ABET Accredited Degree, BS - Electrical Engineering - "Deans List"
• 2004-2008 Concord Law School - JD - “With Highest Honors”

Current as of 8/2/2007. Contact PMI for an up-to-date CV.