Jeannie Kelly

RN, MHA, BA, CCDS, LHRM

Senior Consultant

Jeannie Kelly

Fort Myers, FL

561-704-3935
jkelly@askphc.com

A skilled and accomplished healthcare consultant with over 25 years of experience, Jeannie possesses extensive experience in healthcare provider quality of care and Medicare payment safeguard functions, including Medicare policies and procedures, coverage and subrogation, as well as, case management, risk management, reconsideration and appeals, fraud and abuse, compliance, and provider and beneficiary education.

As an Operations Manager for a Fiscal Intermediary, Jeannie managed Part A and Part B programs and has directed a variety of Medicare projects such as projects focused on program integrity verification and validation, Medicare secondary payer, Medicare medical review (including medical necessity reviews), reconsideration and appeals, fraud and abuse, and DMERC (a.k.a. DMEPOS) program operations. Jeannie has also conducted claims research and claims scripting for 1-800-MEDICARE.

While serving as a Quality Assurance Officer for a healthcare consulting firm, Jeannie oversaw QA initiatives for a variety of client projects related to Medicare and Risk Management.  She served as Subject Matter Expert on federal and state quality requirements for inpatient hospitals, ambulatory surgery centers and other healthcare providers, and developed a variety of successful business opportunities with optimal returns. Jeannie is a Subject Matter Expert in CMS Two Midnight Rule and medical necessity determinations.

Jeannie serves on the Association of Clinical Documentation Specialists (ACDIS) Regulatory Committee, tasked with reviewing regulatory policy and coding and clinical updates, commenting to agencies on behalf of ACDIS, and providing summary, interpretation, and analysis to the ACDIS membership.

Professional Designations and Affiliations:

  • Registered Nurse – Florida, Rhode Island and California
  • Licensed Healthcare Risk Manager – Florida
  • Notary Public – Florida

Federally trained and certified to conduct surveys of the following entities:

  • Ambulatory surgery centers
  • Acute care hospitals
  • Long term care facilities (SMQT)
  • Home health agencies
  • Hospice
  • EMTALA
  • End stage renal disease
  • Intermediate care facilities
Highlights
  • Skilled and accomplished healthcare consultant with more than 25 years of experience
  • Extensive experience in healthcare provider quality of care and Medicare payment safeguards
  • Subject Matter Expert on federal and state quality reqs for hospitals, ASCs and other providers
  • Subject Matter Expert in CMS Two Midnight Rule and medical necessity determinations
  • Serves on the Association of Clinical Documentation Specialists (ACDIS) Regulatory Committee