Brian R Boyce, MHA, BSHS, CPC, CRC, CPC-I Expert Witness
Curriculum Vitae

Contact Information

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Specialties & Experience

General Specialties:

Medical Coding and Business Operations

Specialty Focus:

Risk Adjustment, HCC, Part C, Part D, RADV, HRADV, Medicare Advantage, ACA, Affordable Care Act, Medicare fraud, medical record review, clinical bioethics, medical management, compliance, clinical documentation, clinical informatics, coding audit, medical billing, ICD-9, ICD-10, OIG audits

Education:

MHA, The George Washington University, Milken Institute School of Public Health; BSHS, Old Dominion University ; Clinical Bioethics Certification, Georgetown University

Years in Practice:

30

Additional Information

Clinician, Author, Speaker, Educator, USAF veteran. Author of the CRC (certified risk adjustment coder) credential curriculum - offered nationally by the AAPC. National Risk Adjustment expertise working with Medicare, Medicaid, and the Affordable Care Act (ACA) models nationally. Support for health plans, ACO's, and physicians in numerous medical coding and documentation audits. Experience working on national cases before the OIG and DOJ. National independent validation auditor (IVA) for many health plans for government regulatory audits for Medicare Advantage Risk Adjustment Data Validation (RADV) , and the ACA (HRADV). Experience in HEDIS and other quality measure programs. Experience in CLIA and OSHA in healthcare settings- especially CLIA-waived testing performed in outpatient settings. Trained in Total Quality Management (USAF) and Six Sigma (Juran Institute). Former ethics participant on internal review board (IRB) for local hospital system. Experience managing physician practices and groups locally and nationally. Key speaker for national and local healthcare conferences such as MGMA (Medical Group Management Association), AAPC, CMS, and many local chapter meetings for medical coders and healthcare professionals. Designer of several medical coding and auditing platforms. Nationally approved medical coding instructor and ICD-10-CM trainer. Creation and review of policies and procedures while maintaining regulatory compliance for physician practices, health plans, and hospital organizations. Experience in business development, acquisitions, and divestitures. Experience in performing investigations of medical practices, clinical documentation, business operations, and fraud, waste, and abuse claims. President and CEO of a nationally renowned, technology-enabled healthcare consulting firm that reviews medical records and claims data for record review, audit, and data analysis. Expertise in defensive medical coding methods.