HLN offers Peer-reviewed methodologies and Appellate court proven testimony by experienced professionals who have provided consulting services and conducted audits and investigations for hundreds of hospitals, physicians and other healthcare providers nationwide. HLN's experts have provided expert testimony in administrative and regulatory proceedings, as well as in state and federal courts for civil and criminal cases, for plaintiffs and defendants.
HLN provides experts in: medical billing, reasonableness of charges, reasonable value of medical services, Medicare & Medicaid reimbursement and compliance, clinical documentation, medical record coding, economic damages, insurance disputes, lost profits and false claims. HLN's founder co-authored two editions of the AMA's best selling Mastering the Reimbursement Process book.
Revised and updated with more than 200 pages of new information, this outstanding book guides users through the reimbursement process from start to finish. Perfect for trainers, students, and veteran reimbursement professionals alike, this Third Edition offers concise, informative, and easy-to-understand overviews of insurance basics, types of insurance and payers, coding systems, insurance processing, and review and appeals.
Jacqueline N. Bloink, MBA, RHIA, CHC, CFE, CPC, CPC-I, CPCO, CMRS has over 20 years of experience on the business side of Healthcare that includes: Medical Coding / Reimbursement (Reasonable Value of Billed Amounts), Revenue Cycle Managment, Healthcare Coimpliance and Healthcare Fraud.
Background - Ms. Bloink served as the Director of Compliance for the largest provider group in Arizona. For several years she worked as a Medical Coding Manager, Reimbursement Manager, and Compliance Liaison for a University Physician Group - Department of Medicine, and as Corporate Responsibility Auditor for a large 3 Hospital network. Ms. Bloink is a Professor and Instructor in the area of Medical Coding, Billing, Health Information Management, and Healthcare Fraud. She also served as a Compliance Officer for a Telehealth organization and works with healthcare providers of multispeciality departments assisting them to better understand medical coding and billing guidelines. She is a national, state and local speaker (author) for such groups as ACFE, HCCA, AAPC, AMBA, American College of Physicians, CLM, Coalition Against Insurance Fraud, CA AHIMA, and others. As a co-designer and presenter with CMS (MLN) and OIG in 2014 webinar - ACA Provider Compliance Program - she assisted in reaching thousands of healthcare providers learn more about healthcare compliance. In 2015, she was honored to be the recipient of the Arizona ACFE Sentinel Award “Truth Over Self” that acknowledged her assistance to the Office of Inspector General / Department of Justice with the largest Healthcare Fraud Case (FCA) in Arizona history.
Litigation Support - Jacqueline N. Bloink is a knowledgeable expert witness with Healthcare Fraud litigation support history and proven experience with evaluating case allegations and calculating Usual, Reasonable and Customary charges (reasonable value of billed amounts.) She offers services to expert witness firms, attorneys, health plans, providers, forensic consulting firms, governments, and IROs.
Areas of Expertise:
Medical Fraud Prevention and Identification
False Claims Act
Reverse False Claims
Regulatory Health Information Admin. (RHIA)
Usual, Reasonable and Customary (UCR) Reasonable Billed Amount Values
Michael F. Arrigo is the Managing Partner, Healthcare Practice for No World Borders. They work with health systems, health IT companies, and health plans. His recent retentions have been by the U.S. Department of Justice (DOJ) - drug pricing, patent infringement, medical coding and billing, and Qui Tam False Claims Act and fraud case specialties.
Mr. Arrigo has in-depth experience in HIPAA mandates, the HITECH Act and Patient Protection and Affordable Care Act (PPACA) and is a published author and regular speaker. He consults to clients including Health IT investors, Health IT companies, and health plans and hospital systems in matters regarding:
HIPAA Privacy Rule, HIPAA Security Rule, HIPAA Breaches, Revenue Cycle Management, Hospital Liens in Personal Injury Cases without considering insurance as a collateral source.
Quality Measures for Medicare Advantage Hospital Value-Based Purchasing
Medicare Advantage HEDIS 5-Star Ratings for Health Plans Mr. Arrigo was recently quoted in the Wall Street Journal Venture Capital Dispatch regarding medical coding standards and Wall Street Journal Health Blog regarding venture-backed information-technology companies that serve hospitals and health insurers.
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Clinical documentation improvement (CDI) initiatives are underway in healthcare organizations across the country, with the aims of improving care and reducing costs. Are they working? At least one such initiative, at Baptist Health South Florida, is providing solid return on investment.