Consulting Services

I provide consulting and expert witness services to health care providers (physicians, medical groups, hospitals) to assist them in:

• Contracting (negotiating provider contracts) with Managed Care entities

• Disputing and appealing underpaid or unpaid claims (including inappropriately down-coded, bundled, and under-paid claims)

• Suing payers for appropriate payment of claims (including serving as an expert witness in such suits)

• Complying with regulations related to billing, claims coding, contracting, EMTALA, and charity care

• Advocating a position (in the media, legislatures, regulatory departments, and associations)

• Drafting court briefs (not an attorney, but I have assisted on several amicus briefs)

• Developing alternative reimbursement strategies, risk models, and risk-sharing contracts

• Marketing, selecting, and monitoring practice management and billing services

I am currently a part-time consultant to MedAmerica, Inc., a practice management company whose primary client is CEP America, a partnership of emergency physicians and other hospital-based and urgent care physicians serving over 4 million patients a year in eight states.  I am a consulting Council member of the Gerson Lehrman Group, and also have been providing independent consulting services and advice to hospital clients and other physician groups.

I served for several years as the Director of Provider Relations for CEP America before retiring from that role, and clinical practice in the emergency department.  During those years as CEP’s DPR, I negotiated or assisted in the negotiation of some half a billion dollars in managed care contracts, and supervised the appeal and dispute of hundreds of thousands of underpaid claims.  I have also testified at numerous legislative and regulatory hearings on bills and payer performance, and helped to draft language for a number of bills, regulations and amicus briefs related to health care services, at the state and federal level.

If you are interested in obtaining consulting services from me, please email me at:

myles@ficklefinger.net  

Myles Riner, MD, FACEP

 


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  1. Pingback: Health Care Cost Institute All Payer Claims Database—Can We Trust Health Plan Data? - ACEP Now

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