Ronald Hirsch, MD, FACP, CHCQM, CHRI

Vice President, R1 RCM Inc.

Dr. Ronald Hirsch is a Vice President of the Regulations and Education Group at R1 RCM Inc. He received his medical degree from the Chicago Medical School in North Chicago, Illinois and completed his internal medicine residency at Kaiser Permanente Medical Center in Hollywood, California. Dr. Hirsch was a general internist and HIV specialist and practiced at Signature Medical Associates, a multispecialty practice located in Elgin, Illinois.  He was Medical Director of Case Management at Sherman Hospital in Elgin from 2006 to 2012, where he also was Chairman of the Medical Records Committee from 1995 to 2012, and served on the Medical Executive Committee. Dr. Hirsch also served on the Sherman Home Care Board of Directors from 1999 to 2012, was Chairman of the Board of Health for the City of Elgin from 1997 to 2012 and was medical director at two area nursing facilities in the 1990’s. Dr. Hirsch is certified in Health Care Quality and Management by the American Board of Quality Assurance and Utilization Review Physicians.  He is on the Examination Writing Committee, the Advisory Board, and Conference Committee of the National Association of Healthcare Revenue Integrity and he is certified in healthcare revenue integrity, Dr. Hirsch is the editor of the ACPA monthly newsletter, on the editorial board of the RACmonitor.com, is a weekly guest on the Monitor Mondays national webcast, and is a course director for Athena Forum. He is a Fellow of the American College of Physicians, a member of the American Case Management Association, and the co-author of The Hospital Guide to Contemporary Utilization Review, with the second edition published in 2018.

Condition Code 44 Basics

Erica Remer, MD, FACEP, CCDS

PRESIDENT, ERICA REMER, MD, INC.

Dr. Erica Remer practiced as an emergency physician for 25 years and has extensive coding, CDI, and ICD-10 expertise. She was a Physician Advisor of a large multi-hospital system for four years before transitioning to independent consulting in July 2016. Her passion is educating CDI specialists, coders, and healthcare providers with engaging, case-based presentations on documentation, CDI, ICD-10, and denials management. She has written numerous articles and serves as the co-host of Talk Ten Tuesdays, a weekly national podcast. Dr. Remer is on the Association of Clinical Documentation Integrity Specialists (ACDIS) Advisory Board, the Board of Directors for the American College of Physician Advisors (ACPA), and she is Co-Chair for the ACPA Clinical Documentation Integrity Committee.

CDI and Quality for the Physician Advisor

DENISE WILSON, MS, RN, RRT

SENIOR VICE PRESIDENT, DENIAL RESEARCH GROUP/APPEALMASTERS

Denise Wilson is a Registered Respiratory Therapist, Registered Nurse, and has a Master’s degree in Information Systems from the University of Illinois, Springfield. Ms. Wilson has over 30 years' experience in healthcare, including clinical management, education, compliance, and appeal writing. She has extensive experience as an appeals expert and has managed thousands of appeal cases and presented hundreds of cases at the Administrative Law Judge level. As a nationally known speaker and educator on denial and appeals processes, payer behaviors, and standards of care, she has educated thousands of healthcare professionals around the country in successfully overturning medical care denials.

Medicare Appeals

Charles Locke, MD

Dr. Charles Locke has been a Physician Advisor, Utilization/Clinical Resource Management for Johns Hopkins Hospital since 2011 and the Senior Physician Advisor since 2013. He is also an Assistant Professor in the Department of Medicine, Johns Hopkins School of Medicine. He has been active in areas CMS hospital payment and audit policy, including visit status determination and the Recovery Audit (RA) program. Dr. Locke continues to have active clinical duties, including serving a preceptor for Johns Hopkins internal medicine residents in an ambulatory clinic and as an attending physician on one of the inpatient medicine services at Johns Hopkins Hospital. Dr. Locke received his medical degree from the University of Pennsylvania, completed his internship and residency in internal medicine at the University of Virginia Health Sciences Center, and is a graduate of the Johns Hopkins Faculty Development Program for Clinical Educators.

Medicare's 2 Midnight Rule

R. Phillip Baker, MD, FACOG

Dr. R. Phillip Baker is 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.

Medicare Advantage