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 Expert  725000

Expert in Healthcare, Medical Device, Diagnostics, Pharmaceuticals coding, reimbursement


Available for your Consulting and Expert Witness Needs

Arizona (AZ)
USA
Education Work History Career AccomplishmentsPublicationsConsulting Services Expert Witness Market Research

Summary of Expertise: Listed with other top experts in: 
Expert, MD FACP AGAF FASGE FACG is a physician whose focus is strategy for coverage, reimbursement, quality improvement, bundled payments and accountable care.

He is Board Certified in Internal Medicine and Gastroenterology. He has run risk-bearing Independent Practice Associations and Physician-Hospital Organizations in California and Arizona. He is the Medical Director for Expert's Firm, Inc. and the Chief Medical Officer of Expert's Firm. He has held management positions and currently serves on Scientific Advisory Boards / Committees for several managed care companies, Section Editor for GI & Hepatology News, and a member of the Editorial Advisory Boards for several journals. He works extensively with the Centers for Medicare and Medicaid Services (CMS) and the American Medical Association (AMA) on coding, coverage and reimbursement issues, served as the Co-Chair of the Part D medication measures Technical Expert Panel for CMS, and works with specialty societies and other organizations on quality improvement, accountable care, bundled payment, and measure development projects.

He participates in the CPT Editorial Panel and the AMA RBRVS Update Committee (RUC). He is the author of several guidelines / quality measures in Gastroenterology and Preventive Services, and the lead physician for the American Gastroenterological Association (AGA) Bundled Payment Project, which has developed an episode methodology, claims payment, warranty and outcomes measures for outpatient procedures. He is the co-founder of the AGA Center for GI Innovation and Technology, which has developed observational comparative effectiveness registries.

Expert is an Assistant Clinical Professor of Medicine at the University of Arizona College of Medicine, and an Adjunct Assistant Professor of Medicine at Midwestern University.

He received his undergraduate A.B. Biology at the University of California, Los Angeles, and graduated from the Rosalind Franklin University of Medicine and Science - Chicago Medical School. He completed his Internship and Residency in Internal Medicine at the UCLA – San Fernando Valley Program, and a fellowship in Gastroenterology at Los Angeles County – USC Medical Center. He completed the Management Program for Health Care Organizations at the UCLA School of Public Health.

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endoscope

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gastroenterology

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Current Procedural Terminology

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medical coding

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medical device coding

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Medicaid


Show Secondary and Basic Areas of Expertise
Localities:
Expert may consult nationally and internationally, and is also local to the following cities: Phoenix, Arizona;  Tucson, Arizona;  Mesa, Arizona;  Glendale, Arizona;  Scottsdale, Arizona;  Chandler, Arizona;  Tempe, Arizona;  Gilbert, Arizona;  and Peoria, Arizona.

Often requested
with this expert:

Laboratory Medicine, Pathology, CPT Coding
Physician CPT Coding, Billing and Chart Reviews,...
Gastroenterology
Pediatric Gastroenterology

Education:
Year   Degree   Subject   Institution   Honors
1980   MD   Medicine   Chicago Medical School  
1976   AB   Biology   UCLA   Magna Cum Laude

Work History:
Years   Employer   Title   Responsibilities

2011 to

 

(Undisclosed)

 

Medical Director

 

Executive clinician with 30 years of experience providing strategic leadership and medical oversight to large data-driven health organizations. Skilled in strategy, development and implementation of innovative health programs, products and payment systems, with extensive experience in clinical practice and research. Clinical subject matter expert in developing products including Workers' Compensation; ambulatory surgery centers, medical/surgical professional services; injectable/infused pharmaceuticals; laboratory and molecular diagnostic services; durable medical equipment; Medicare GapFill; bundled/episode products for selected clinical procedures and conditions; and consumer-facing products.

2003 to

 

(Undisclosed)

 

Chief Medical Officer

 

Expert, MD CHCQM AGAF FASGE FACG is Chief Medical Officer of Expert's Firm, which performs predictive modeling analysis of medical and pharmaceutical claims data and implements proactive patient care management solutions. His areas of focus include coding and reimbursement methodologies for emerging medical devices and pharmaceuticals, healthcare business strategy, quality improvement and medical management.

2001 to 2003

 

CLS Services

 

Chief Medical Officer

 

Consulting group that assisted clients to establish comprehensive outpatient rehabilitation facilities and independent diagnostic testing facilities, providing services in rehabilitation medicine and diagnostic sleep testing.

1999 to 2001

 

Expert, MD

 

physician

 


1997 to 1999

 

Gila River Health Care Corporation

 

Chief Medical Officer

 

Working with the Rural Health Office at the University of Arizona, he assisted in the development of a model enabling American Indian tribes to privatize their health care system from the Indian Health Service.

1995 to 1997

 

Blue Shield of California

 

Medical Director

 


1985 to 1995

 

Covington, Menz, Expert

 

Gastroenterologist

 



Career Accomplishments:
Associations/Societies

American Gastroenterological Association American Society for Gastrointestinal Endoscopy American College of Physicians American College of Gastroenterology American Medical Association

Licenses/Certifications

MD

Professional Appointments

Assistant Clinical Professor of Medicine at the University of Arizona School of Medicine. Adjunct Assistant Professor of Medicine at Midwestern University


Publications:
Selected Publications and Publishers  
 - Elsevier Saunders  

Consulting Services:
Selected Consulting Examples:
  • Assisted professional society with achieving CPT codes for their procedure
  • Assisted in development of new CPT codes and reimbursement for infusion therapy
Recent Client Requests:
  • Expert for consulting on We need an in Pathology AMA CPT Coding.
  • Certified coder expert for consulting on Require Certified Coding for a Medicare Audit.
Click the green button above to contact Expert for a free initial screening call regarding your expert consulting needs.  Expert is available for consulting to corporate, legal and government clients.  Remember, your initial screening call to speak with Expert is free.

Expert Witness:
Recent Litigation Client Requests:
  • Gastroenterology coding expert witness for consulting on Need for Gastroenterology Coding.
  • Expert in forensic immunology vaccines for consulting on doctor's final report for litigation.
Click the green button above to contact Expert for a free initial screening call regarding expert testimony, litigation consulting and support, forensic services, or any related expert witness services.  A few litigation needs include product liability, personal injury, economic loss, intellectual property (patent, trademark, trade secret, copyright), and insurance matters.  Remember, your initial screening call to speak with Expert is free.

Market Research:
Expert is Board Certified in Internal Medicine and Gastroenterology, and has practiced for over three decades in California and Arizona. He has assisted payor organizations, employers, physician groups and specialty societies develop and implement programs to improve patient care. Expert has held management positions with several managed care companies including Blue Shield of California and Prudential Health Care. He has worked extensively with the Centers for Medicare and Medicaid Services (CMS) and the American Medical Association (AMA) on coverage and reimbursement issues and, in 2005, served as the Co-Chair of the Part D medication measures Technical Expert Panel for CMS.

Click the green button above to contact Expert for a free initial screening call regarding your marketing research, industry research, and company research needs.  For research needs involving multiple experts or secondary research, a Research Director can be assigned to coordinate the work into a custom report for you as a potentially quicker and more cost effective alternative to doing this work yourself or hiring a boutique consultancy.  Remember, your initial screening call to speak with Expert is free.

Additional Skills and Services:
Other Skills and Services

In 2004, the AMA presented the Burgess L. Gordon Memorial Award to Expert for outstanding service to the CPT process.


 

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