Usual And Customary Expert Witnesses

California

Medical Billing, Insurance - Managed Care, HMO, PPO, Medicare, Medicaid, Reasonable Value, Audit, Hospital, ERISA, Usual and Customary, Reimbursement Disputes, Claims Denials, Athena Billing, Out-of-Network, Balance Billing, Fee Schedule Analysis, Expert Testimony, Medical Necessity, Multi-State, Healthcare Reimbursement

I have over 35 years of experience in medical billing, reimbursement, and managed care systems, with expertise spanning provider operations, payer methodologies, and claims adjudication practices. My work focuses on evaluating medical billing accuracy, reimbursement methodologies, usual and customary charges, and payer denial practices. Practice includes multi-state reimbursement analysis, with extensive experience in California managed care systems, including HMO, IPA, and risk-based reimbursement structures, as well as Medicare Advantage and national payer methodologies. I have served in multiple roles, including claims examiner, billing manager, revenue cycle executive, and founder of a national medical billing and audit firm. This multidisciplinary experience allows me to analyze disputes from both the provider and payer perspectives. Experience includes analyzing billing system workflows and claims processing issues across platforms such as Athenahealth. My expert work includ...

Newbury, New Hampshire

Medical Billing, Medical Coding - ALL STATES, Medical Billing, Coding, Usual and customary, reasonable and customary, DRG, CPT, ICD-10, ICD-9, medical necessity, fees, fee schedule, billing

Mark L Friedman MD FACEP FACP is currently Chief Medical Officer Emeritus of First Stop Health. He is an emergency physician emeritus at St Vincent’s Hospital in Bridgeport, CT. He was formerly Associate Professor of Emergency Medicine at the Frank Netter School of Medicine, Chief of Emergency Medicine at St Elizabeth's Hospital of Boston, Assistant Professor of Medicine at Tufts University School of Medicine, Assistant Clinical Professor of Emergency Medicine at the University of Illinois, and Adjunct Professor of Public Health at Benedictine University. Dr. Friedman is an expert in DRG claims analysis and medical cost containment. He has helped design programs to prevent medical errors as well as malpractice litigation. He has served as an advisor to government on medical billing fraud and abuse and developed two companies that perform audits for the Medicare RAC. Dr. Friedman is the author of articles and books on medically related topics. Dr Friedman specializes in expert op...

McKinney, Texas

Medical Billing, Insurance - Managed Care, HMO, PPO, Medicare, Medicaid, Reasonable Value, Audit, Hospital, ERISA, Usual and Customary, Reimbursement Disputes, Claims Denials, Athena Billing, Out-of-Network, Balance Billing, Fee Schedule Analysis, Expert Testimony, Medical Necessity, Multi-State, Healthcare Reimbursement

I have over 35 years of experience in medical billing, reimbursement, and managed care systems, with expertise spanning provider operations, payer methodologies, and claims adjudication practices. My work focuses on evaluating medical billing accuracy, reimbursement methodologies, usual and customary charges, and payer denial practices. Practice includes multi-state reimbursement analysis, with extensive experience in California managed care systems, including HMO, IPA, and risk-based reimbursement structures, as well as Medicare Advantage and national payer methodologies. I have served in multiple roles, including claims examiner, billing manager, revenue cycle executive, and founder of a national medical billing and audit firm. This multidisciplinary experience allows me to analyze disputes from both the provider and payer perspectives. Experience includes analyzing billing system workflows and claims processing issues across platforms such as Athenahealth. My expert work includ...