Session Topic

Panel Discussion:
The Nitty Gritty of Medical Decision Making - Complexity of Care, Severity, and Medical Necessity

2020 Evaluation and Management Symposium: Virtual Conference

Presented Thursday, September 24, 2020


Moderator:  David Womack, President, CEO Practice Management Institute

How do payers, providers, and attorneys evaluate a note for medically necessary services and complexity of care differently? Is it the same? How can non-clinician coders and auditors do the same? In this panel session, four experts from diverse professions in healthcare related fields join forces to tackle your questions and will provide insights from their unique perspectives on important concepts related to Medical Decision Making (MDM).

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  Linda Parsi, MD, MBA, CPEDC, CMC, CMOM, FAAP
Dr. Parsi has presented at numerous national pediatric conferences, runs a private pediatric practice and presently heads an education and consulting company that helps practicing pediatricians with coding and practice management. She earned her medical degree in 1994 and her pediatric residency in 1997 at Baylor College of Medicine. She received her MBA in 2008 at University of Texas at San Antonio. She holds numerous certifications and is a certified medical coder and certified pediatric coder. Currently, she serves on the American Academy of Pediatrics (AAP) Committee on Coding and Nomenclature. In addition, she is the Chair of the Editorial Advisory Board and the editor of the coding publications for the AAP. She has served on numerous boards and was the President of the San Antonio Pediatric Society from 2011 to 2013.
  Fredrick "Rick" Watson, DO, MBA — Medical Director, Cigna Healthcare
Dr. Watson’s main responsibilities for CIGNA in the North Texas and Oklahoma region include: Physician and Facility engagement, Total Market Cost oversight, Strategic planning and Client Sales Support. He also chairs the West National Credentialing and the National Peer Review Committees. He previously served as the Senior Medical Director for the Texas Market of HealthSpring, Inc, a Medicare Advantage company.

Dr. Watson graduated from the Kirksville College of Osteopathic Medicine in Missouri in 1997. He completed his internship and residency in family practice at Botsford Hospital in Farmington Hills, Michigan, where he was named chief resident in 1999-2000. During that time, he also completed a fellowship in medical education and teaching through the Statewide Campus System and Michigan State University. After practicing for 8 years, Dr. Watson obtained an MBA from the University of Tennessee Knoxville, which spurred his interest in the administrative aspects of medicine. In 2015 he was named one of the “Most Influential People in Medicine” in Dallas-Fort Worth in the Dallas Business Journal.
  David Glaser, J.D. — Healthcare Attorney, Shareholder, Fredrikson & Byron Law Health Law Group
David M. Glaser is a shareholder in Fredrikson & Byron's Health Law Group. David assists clinics, hospitals, and other health care entities negotiate the maze of health care regulations, providing advice about risk management, reimbursement, and business planning issues. He has considerable experience in health care regulation and litigation, including compliance, criminal and civil fraud investigations, and reimbursement disputes. David's goal is to explain the government's enforcement position, and to analyze whether this position is supported by the law or represents government overreaching.
Thursday 24th
10:00 - 10:55
  Ashley Morgan, JD – Senior Counsel, Liles Parker, PLLC

Ashley Morgan is Senior Counsel at Liles Parker PLLC and focuses her practice on regulatory health care compliance matters, fraud and abuse, and reimbursement issues. Ashley represents health care providers across the country in connection with a wide variety of health law issues including coverage disputes, documentation concerns, compliance, medical board complaints, and revocation / exclusion issues. Ashley has worked with an assortment of providers including dentists, home health companies, hospice agencies, primary care and specialty physicians, mental health professionals, physical therapists, durable medical equipment suppliers, and licensed acupuncturists.

Ashley has handled claims disputes with major payors including Medicare, Medicaid, various BlueCross BlueShield entities, UnitedHealthcare, and Delta Dental. She has extensive experience working on administrative appeals of large alleged extrapolated overpayments assessed by the Centers for Medicare and Medicaid Services’ (CMS) contractors including Unified Program Integrity Contractors (UPICs) and Medicare Administrative Contractors (MACs) and by private payors. Ashley has also successfully defended providers against medical board and nursing board complaints.

Ashley is a Certified Medical Compliance Officer and helps clients implement effective compliance programs and provides counsel on mandatory state and industry-specific policies and procedures. In this capacity, Ashley provides on-site walk-throughs to review OSHA compliance and performs training for staff members on HIPAA and other mandatory compliance regulations. Ashley is also a Certified Professional Coder in addition to a Certified Medical Reimbursement Specialist and conducts GAP Analyses of provider’s medical record documentation to determine areas for improvement with any CMS or private payor documentation requirements.

Ashley is originally from Bethany Beach, Delaware and now lives with her husband and son in Northern Virginia and works in Liles Parker’s Washington, DC office.