Agenda – Day 3

Dr. Ronald Hirsch is a Vice President of the Regulations and Education Group at R1 Physician Advisory Services. He received his medical degree from the Chicago Medical School in North Chicago, IL, and completed his internal medicine residency at Kaiser Permanente Medical Center in Hollywood, CA.

Dr. Hirsch was Medical Director of Case Management at Sherman Hospital in Elgin, IL from 2006 to 2012, and served on the Medical Executive Committee.

Dr. Hirsch is certified in Health Care Quality and Management by the American Board of Quality Assurance and Utilization Review Physicians, is a member of the American Case Management Association, on the Advisory Board of the American College of Physician Advisors, a Fellow of the American College of Physicians, and on the advisory board of the National Association of Healthcare Revenue Integrity. He is the co-author of The Hospital Guide to Contemporary Utilization Review, which was published in 2018.

Ernie de los Santos is Faculty Chair and Founder of Appeal Academy, and the popular online talk show, “Finally Friday!”, and TopGun Audit School. He writes regularly for Appeal Academy, and provides marketing strategy and lead generation for vendors and consultants. Before entering the healthcare industry in 2006, he spent over 20 years in research and development of marketing and production, working on projects for Fortune 100 corporations, including Coca-Cola, Kodak, and the International Olympic Committee. Before that, he spent 10 years in B2B sales and marketing for Sony and Panasonic. He holds a BA in Anthropology and Computer Science, and an MBA in Marketing.

Jessica L. Gustafson is a founding shareholder with The Health Law Partners, P.C. Ms. Gustafson represents hospitals, health systems, hospices, home health agencies, physicians and other health care providers and suppliers in an array of health care legal matters. Ms. Gustafson devotes a substantial portion of her practice to representing providers in the Recovery Audit (“RAC”) and Medicare audit appeals process. She also regularly assists clients with compliance and reimbursement matters, overpayment refunds, Medicare enrollment matters, as well as other health care regulatory matters.

Ms. Gustafson is a member of the American Health Lawyers Association, American Bar Association (Health Law Section) and Michigan Bar Association (Health Care Law Section). She is actively involved in the ABA Health Law Section, serving in multiple leadership roles. She also serves as a member of the Advisory Board to the American College of Physician Advisors.

Dr. Kanaparthy has completed his Internal Medicine training at Cook County Hospital, Chicago and began his hospitalist career in 2007 at Rochester General Hospital, Rochester, NY. He continues to practice as a hospitalist and also previously served as a Director for the Medical Admission and Transition unit which is a “step up and step down unit.” In that role he had overseen significant improvements in patient throughput with reduction in wait times for patients identified to be in need of a critical care bed. He has championed several quality improvement initiatives at RGH over the past decade and has received acknowledgement from the Society of Hospital Medicine as a Fellow in Hospital Medicine. In 2014, he took up the challenge as a Lead Physician Advisor where he played a key role in starting a physician Advisor Program at Rochester General Hospital with 1.3 Physician FTE and has since expanded the program system wide covering 5 hospitals with 10.9 Physician FTEs. The physician Advisor program is fully insourced with utilization review performed 365 days with 18 hours/day coverage. He currently serves as the System Medical Director for the Physician Advisor Program at Rochester General Health with CDI, Denials & Appeals, concurrent medical necessity reviews, patient throughput and revenue integrity as the key areas of focus.

Jennifer Bartlett has served at Infirmary Health for 18 years. She has vast knowledge and expertise in patient access, revenue cycle, payer contracts, payer processes and denials management. Her many years of extensive research and study of payer practices and behaviors have been instrumental in holding payers to a greater level of accountability. She manages all prepay and postpay clinical audits including RAC, KEPRO 2MN, CERT, MAC, Part C audits. In her organization, she’s a member of the Information Governance/HIPAA Steering Committee. In her state, she’s an active member of the Alabama Hospital Association’s Revenue Integrity/Recovery Audit Steering Committee and the Palmetto GBA Provider Outreach and Education Advisory Board, (CMS JJ MAC region) and was a presenter in 2016 and 2017 at the AlaHA/HFMA Alabama Audit Summit. As well, she served on the faculty for the 2016 & 2017 PA UR Boot Camp events.

After completing his residency at the University Of South Carolina School Of Medicine Dr. Baker was the founding and managing partner in Piedmont Physicians for Women an OB/GYN practice for 32 years. He has extensive background in managed care and contracting while acting as the President of an IPA and Chairman of the Board of a regional PHO. Initially serving as a part time Physician Advisor doing mainly second level reviews took on the role as a full time Physician Advisor and Medical Director for Case Management and CDI in 2014. Responsibilities also include denials management for Self Regional Healthcare a regional hospital in Greenwood, SC. Dr. Baker serves on several committees including Co-Chair of the Finance Committee for My Health First an upstate South Carolina ACO, Corporate Compliance Committee for My Health First, Governmental Affairs Committee ACPA as well as several committees at the South Carolina Hospital Association. He was also appointed to the inaugural class of “Hirsch’s Heroes” in 2015 for his work with the process to file complaints with CMS against Medicare Advantage Plans. He joined the Board of Directors for the American College of Physician Advisors in 2017.

Tamie is an Assistant Administrator at Stillwater Medical Center in Stillwater, Oklahoma. She is responsible for the continuity of revenue cycle processes across SMC hospital departments and clinics in addition to providing oversight for consolidated business office services. Prior to joining SMC in 2009, Tamie enjoyed a successful consulting career assisting hospitals and clinics nation wide to implement improved business processes and realize the importance of providing patient focused business services to their communities. Tamie also served as Director of Patient Financial Services at 2 facilities within a large Oklahoma health system for more than 10 years.

Ms. Young’s career history in leading health care teams to achieve dramatic operational and receivable improvement also leads her to public speaking and education engagements where she is honored to share her knowledge and passion for the healthcare revenue cycle.

Tamie is a Past President of Oklahoma’s Healthcare Financial Management Association chapter and served on HFMA’s National Advisory Council. Tamie also volunteers as a board member of a local community health clinic serving Stillwater’s uninsured.

Ferdinand Richards III graduated from the University of Florida College of Medicine in 1980. He completed his residency training in Internal Medicine through the University of Virginia in 1985, which included a Chief Residency year. He is currently practicing Emergency Medicine at Tampa General Hospital, where he has been Attending Physician and Clinical Faculty for the University of South Florida since 1986. He began work in the Medicare QIO program in 1988 when it was known at the PRO program and is currently the CMO for KEPRO, the BFCC-QIO for areas 2, 3, and 4.

Ed Norwood, President of ERN/The National Council of Reimbursement Advocacy (NCRA), Ed has first –hand experience with problematic payors and is thoroughly familiar with public policy laws designed to help participants fight unfair payment practices that impact quality of care (and reimbursement) in their facility. Ed also serves as the Chief Compliance Officer of the National Reimbursement Firm (TRAF). Multi-faceted, with a creative ability to inspire his audience, Ed combines his healthcare influence and expertise with his passion to help providers advocate for medically appropriate healthcare pursuant to federal and state laws.

Sommer Slavin has been with the University of Rochester’s Medical Center for over 15 years. She has been involved with Utilization Management, CDI, and Appeals Management for the last 9 years.

Her educational background is in Nursing, Leadership in Healthcare, & Competitive & Organizational Strategy.

She assumed the role of Utilization Management Program Coordinator in 2016 after having been the Utilization Manager for 8 years. As a Program Coordinator, Sommer oversees and assists as a UM resource in the areas of standardization of UM practices across the URMC enterprise, integration of UM & new hospital technology systems across all affiliates, regulatory & compliance guidance as related to UM, and data analysis of CMI data across the enterprise including affiliate hospitals and HHC.

Day Egusquiza is President of AR Systems, Inc. and brings over 38 years experience in health care reimbursement, hospital business office operations, contracting and compliance implementation. During her 20 years as Director of Revenue and Reimbursement at a community hospital in Idaho, she also was Director of a Physician Medical Management billing service, where she completed an integrated business office between a hospital and a large physician clinic. Her work includes providing guidance as a compliance & APC educator while providing operational insight on the revenue cycle impacts of RAC/Medicare Recovery Audit Contractors. Ms Egusquiza is a nationally recognized speaker on continuous quality improvement (CQI), benchmarking, redesigning, reimbursement systems and implementing an operational focus of compliance – both in hospitals and practices. She has been on the AAHAM National Advisory Council, HFMA National Advisory Council, and is a past President of the Idaho HFMA Chapter & recently received the Lifetime Achievement Award. Attendees at HFMA’s ANI rated her in the top 25% for each year she has presented, earning her the ‘Distinguished Speaker’ award.

Day Egusquiza is President of AR Systems, Inc. and brings over 38 years experience in health care reimbursement, hospital business office operations, contracting and compliance implementation. During her 20 years as Director of Revenue and Reimbursement at a community hospital in Idaho, she also was Director of a Physician Medical Management billing service, where she completed an integrated business office between a hospital and a large physician clinic. Her work includes providing guidance as a compliance & APC educator while providing operational insight on the revenue cycle impacts of RAC/Medicare Recovery Audit Contractors. Ms Egusquiza is a nationally recognized speaker on continuous quality improvement (CQI), benchmarking, redesigning, reimbursement systems and implementing an operational focus of compliance – both in hospitals and practices. She has been on the AAHAM National Advisory Council, HFMA National Advisory Council, and is a past President of the Idaho HFMA Chapter & recently received the Lifetime Achievement Award. Attendees at HFMA’s ANI rated her in the top 25% for each year she has presented, earning her the ‘Distinguished Speaker’ award.

Jessica L. Gustafson is a founding shareholder with The Health Law Partners, P.C. Ms. Gustafson represents hospitals, health systems, hospices, home health agencies, physicians and other health care providers and suppliers in an array of health care legal matters. Ms. Gustafson devotes a substantial portion of her practice to representing providers in the Recovery Audit (“RAC”) and Medicare audit appeals process. She also regularly assists clients with compliance and reimbursement matters, overpayment refunds, Medicare enrollment matters, as well as other health care regulatory matters.

Ms. Gustafson is a member of the American Health Lawyers Association, American Bar Association (Health Law Section) and Michigan Bar Association (Health Care Law Section). She is actively involved in the ABA Health Law Section, serving in multiple leadership roles. She also serves as a member of the Advisory Board to the American College of Physician Advisors.

Abby Pendleton is a founding shareholder of The Health Law Partners, P.C. Ms. Pendleton has been practicing healthcare law since 1996. She regularly provides counsel to healthcare providers and organizations in a number of areas, including but not limited to: compliance, Recovery Audit (“RAC”), Medicare and other payor audits, fraud and abuse, reimbursement matters, and HIPAA Privacy and Security, and physician staff privilege and licensure matters.

Ms. Pendleton is a member of the State Bar of Michigan (Member, Health Care Law Section) and State Bar of New York (Member, Health Law Section); the American Bar Association; the American Health Lawyer’s Association; the Health Care Compliance Association; the Medical Group Management Association and the Michigan Medical Group Management Association.

Cheyenne Santiago’s mission is to help providers navigate the world of Medicare compliance. Trained as a Registered Nurse, she has a unique 11-year background building bridges between providers and Medicare contractors. Working most recently with WPS, Cheyenne specializes in policy interpretation and application, as well as MAC medical review processes.

Ferdinand Richards III graduated from the University of Florida College of Medicine in 1980. He completed his residency training in Internal Medicine through the University of Virginia in 1985, which included a Chief Residency year. He is currently practicing Emergency Medicine at Tampa General Hospital, where he has been Attending Physician and Clinical Faculty for the University of South Florida since 1986. He began work in the Medicare QIO program in 1988 when it was known at the PRO program and is currently the CMO for KEPRO, the BFCC-QIO for areas 2, 3, and 4.

Dr. Maria Johar is the System Physician Advisor at University Hospitals Health System in Cleveland and serves as an consultant for healthcare businesses.

She is a physician and was certified as a professional in healthcare quality. She comes with over twenty years of experience in the fields Of Utilization Review, Quality, Denials and Appeals, Joint Commission, Clinical Documentation, Safety and Infection Control. She is trained in LEAN methodology for system improvements.

Prior to working with UH Health system, she worked with ProMedica Health System, Mercy Health System, Lima memorial Health System and Liberty Medical Center. She has worked with Ohio State Medicaid board on several process improvement initiatives. She has worked as a private consultant to physician offices and Hospitals. She is published author, writing a book called DRG Tools in 2011. She was awarded the Inventor of the year in 2016.

She lives in Toledo with her family. She sits on the Lucas county suicide prevention board, and is a member of the American College of Physician Advisors, National and State case management associations and the National Association of Healthcare Quality.

Jennifer Bartlett has served at Infirmary Health for 18 years. She has vast knowledge and expertise in patient access, revenue cycle, payer contracts, payer processes and denials management. Her many years of extensive research and study of payer practices and behaviors have been instrumental in holding payers to a greater level of accountability. She manages all prepay and postpay clinical audits including RAC, KEPRO 2MN, CERT, MAC, Part C audits. In her organization, she’s a member of the Information Governance/HIPAA Steering Committee. In her state, she’s an active member of the Alabama Hospital Association’s Revenue Integrity/Recovery Audit Steering Committee and the Palmetto GBA Provider Outreach and Education Advisory Board, (CMS JJ MAC region) and was a presenter in 2016 and 2017 at the AlaHA/HFMA Alabama Audit Summit. As well, she served on the faculty for the 2016 & 2017 PA UR Boot Camp events.

Jennifer Bartlett has served at Infirmary Health for 18 years. She has vast knowledge and expertise in patient access, revenue cycle, payer contracts, payer processes and denials management. Her many years of extensive research and study of payer practices and behaviors have been instrumental in holding payers to a greater level of accountability. She manages all prepay and postpay clinical audits including RAC, KEPRO 2MN, CERT, MAC, Part C audits. In her organization, she’s a member of the Information Governance/HIPAA Steering Committee. In her state, she’s an active member of the Alabama Hospital Association’s Revenue Integrity/Recovery Audit Steering Committee and the Palmetto GBA Provider Outreach and Education Advisory Board, (CMS JJ MAC region) and was a presenter in 2016 and 2017 at the AlaHA/HFMA Alabama Audit Summit. As well, she served on the faculty for the 2016 & 2017 PA UR Boot Camp events.

Jessica L. Gustafson is a founding shareholder with The Health Law Partners, P.C. Ms. Gustafson represents hospitals, health systems, hospices, home health agencies, physicians and other health care providers and suppliers in an array of health care legal matters. Ms. Gustafson devotes a substantial portion of her practice to representing providers in the Recovery Audit (“RAC”) and Medicare audit appeals process. She also regularly assists clients with compliance and reimbursement matters, overpayment refunds, Medicare enrollment matters, as well as other health care regulatory matters.

Ms. Gustafson is a member of the American Health Lawyers Association, American Bar Association (Health Law Section) and Michigan Bar Association (Health Care Law Section). She is actively involved in the ABA Health Law Section, serving in multiple leadership roles. She also serves as a member of the Advisory Board to the American College of Physician Advisors.

Dr. Maria Johar is the System Physician Advisor at University Hospitals Health System in Cleveland and serves as an consultant for healthcare businesses.

She is a physician and was certified as a professional in healthcare quality. She comes with over twenty years of experience in the fields Of Utilization Review, Quality, Denials and Appeals, Joint Commission, Clinical Documentation, Safety and Infection Control. She is trained in LEAN methodology for system improvements.

Prior to working with UH Health system, she worked with ProMedica Health System, Mercy Health System, Lima memorial Health System and Liberty Medical Center. She has worked with Ohio State Medicaid board on several process improvement initiatives. She has worked as a private consultant to physician offices and Hospitals. She is published author, writing a book called DRG Tools in 2011. She was awarded the Inventor of the year in 2016.

She lives in Toledo with her family. She sits on the Lucas county suicide prevention board, and is a member of the American College of Physician Advisors, National and State case management associations and the National Association of Healthcare Quality.

Abby Pendleton is a founding shareholder of The Health Law Partners, P.C. Ms. Pendleton has been practicing healthcare law since 1996. She regularly provides counsel to healthcare providers and organizations in a number of areas, including but not limited to: compliance, Recovery Audit (“RAC”), Medicare and other payor audits, fraud and abuse, reimbursement matters, and HIPAA Privacy and Security, and physician staff privilege and licensure matters.

Ms. Pendleton is a member of the State Bar of Michigan (Member, Health Care Law Section) and State Bar of New York (Member, Health Law Section); the American Bar Association; the American Health Lawyer’s Association; the Health Care Compliance Association; the Medical Group Management Association and the Michigan Medical Group Management Association.

Ferdinand Richards III graduated from the University of Florida College of Medicine in 1980. He completed his residency training in Internal Medicine through the University of Virginia in 1985, which included a Chief Residency year. He is currently practicing Emergency Medicine at Tampa General Hospital, where he has been Attending Physician and Clinical Faculty for the University of South Florida since 1986. He began work in the Medicare QIO program in 1988 when it was known at the PRO program and is currently the CMO for KEPRO, the BFCC-QIO for areas 2, 3, and 4.

Cheyenne Santiago’s mission is to help providers navigate the world of Medicare compliance. Trained as a Registered Nurse, she has a unique 11-year background building bridges between providers and Medicare contractors. Working most recently with WPS, Cheyenne specializes in policy interpretation and application, as well as MAC medical review processes.

Day Egusquiza is President of AR Systems, Inc. and brings over 38 years experience in health care reimbursement, hospital business office operations, contracting and compliance implementation. During her 20 years as Director of Revenue and Reimbursement at a community hospital in Idaho, she also was Director of a Physician Medical Management billing service, where she completed an integrated business office between a hospital and a large physician clinic. Her work includes providing guidance as a compliance & APC educator while providing operational insight on the revenue cycle impacts of RAC/Medicare Recovery Audit Contractors. Ms Egusquiza is a nationally recognized speaker on continuous quality improvement (CQI), benchmarking, redesigning, reimbursement systems and implementing an operational focus of compliance – both in hospitals and practices. She has been on the AAHAM National Advisory Council, HFMA National Advisory Council, and is a past President of the Idaho HFMA Chapter & recently received the Lifetime Achievement Award. Attendees at HFMA’s ANI rated her in the top 25% for each year she has presented, earning her the ‘Distinguished Speaker’ award.