Physician Executive Privileges /Payment Denials
Contact this Expert Witness
- Phone: 615-809-8007
- Cell: 615-809-8007
Specialties & Experience of this Expert Witness
General Specialties:
Hospital Administration and Legal MedicineKeywords/Search Terms:
Negligent Credentialing, Denial of Privileges, Denial of Credentials, Suspension of Privileges, Revocation of Privileges, MedicaL Staff Bylaws, Peer Review Process, Insurance Denials /Appeals, Physician Education on Documentation, Physician Care Protocols, Case Management, Utilization, Regulatory IssuesEducation:
DO , College of Osteopathic Medicine of the Pacific; BA, UCLAYears in Practice:
30Additional Information
30yr history of a Physician Executive, Board Certified in Internal Medicine. Served as the Chief Medical Officer on every level from facility to regional to corporate. I am an expert in all aspects of Physician Credentialing/Privileging. I have represented both the physician and the facility side of denials of initial privileges to suspension and revocation of privilege. Extensive experience in representing medical staffs & facilities with regards to complaints from the Regulatory Authorities regarding Negligent Credentialing. I have also worked with Plaintiff Counsel regarding Negligent Credentialing Issues. Have been key advisor to Medical Staffs on revisions of their bylaws with expertise surrounding privileges, credentialing, peer review, suspension and revocation of providers . I have successfully overturned 1, 2 and 3rd level Insurance Denials. Have extensive experience of presenting to the Administrative Judge to overturn these 3rd level denials, Served as an Appeals Reviewer for Medicare, State Medicaid and for Insurance Carriers. I have worked with facilities to discover patterns of inappropriate insurance denials, which were used in litigation against the Insurance Carriers. Lectured extensively to Residents, Medical Staff and Hospital Coders on Physician Documentation, as the key to avoidance of insurance denials .