Principal, Richard K Baer, MD & Associates, LLC Healthcare Consulting
Dr. Baer has served as a Medical Director for the Medicare program for over 20 years and has provided consulting services to private payers, providers, industry, and the US Department of Justice. Dr. Baer consults on a variety of medical issues, including compliance in medical coverage for government and private payers, clinical trials design and other medical billing compliance, documentation compliance, medical device and drug marketing, ICD-10 readiness, and medical claims data analysis. Dr. Baer recently served as Medical Director for the Medicare Recovery Audit Contractor, Region A. Previously he was Lead Medical Director for the Medicare program for National Government Services, Inc. (NGS). As Medicare Medical Director, his activities include the support of Medical Review and Fraud and Abuse activities, and to represent the Medicare program in local, regional, and national meetings and committees. Dr. Baer has been especially active in developing medical policies in the area of physician services, home health, hospice, and institutional services. Richard Baer was born in Oak Park, Illinois, on February 12, 1952. Dr. Baer attended the University of Illinois, Abraham Lincoln School of Medicine in Chicago and received his medical degree in 1978. He completed residency training in psychiatry at the University of Illinois Hospitals in 1982. After psychiatric residency, Dr. Baer pursued training at the Institute for Psychoanalysis in Chicago and during the next 12 years treated a wide variety of patients of all ages, including Karen Overhill. After treating Karen, Dr. Baer pursued a master’s degree in creative writing at Northwestern University and graduated in 2006. He wrote Switching Time, published by Random House in 2007, a depiction of treating Karen's 17 personalities. Specialties: Physician Leadership, Medical Policy, Claims Data Analysis, Medical Review, Medicare Subject Matter Expert, Expert Witness
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Jun 2014 - Present
Richard K. Baer, MD & Asociates, LLC
Dr. Baer provides consultative services in compliance in medical coverage for government and private payers, clinical trials design and other medical billing compliance, documentation compliance, medical device and drug marketing, ICD-10 readiness, and medical claims data analysis. Dr. Baer also has extensive experience working with and testifying for the Department of Justice and private law firms in Medicare rules and regulations compliance.
Jan 2010 - Present
Emerson Consultants, Inc.
Medical Consultant for Medical Device coverage strategy and clinical trial design.
Oct 2017 - Aug 2019
AdvanceMed UPIC Midwestern Region
Consulting Contractor Medical Director
Consulting Contractor Medical Director for Medicare's Midwest Fraud contractor
Dec 2014 - Sep 2015
Price Waterhouse Coopers Healthcare Advisory
Consulting Medical Director
Working through PwC, provided leadership in developing medical policy for a large, multi-state Medicaid health plan. Duties involved claims data analysis, medical policy development, medical policy Web site development, and claims edit implementation.
Jul 2011 - Jun 2014
Performant Recovery, Inc.
Chief Medical Officer
Medical Director for Medicare Recovery Audit Contractor for Region A (northeast United States).
Dec 2009 - Jun 2011
Meade & Roach, LLP
Medical consultant for clinical trial compliance and Medicare rules and regulations
Dec 2009 - Jun 2011
Provider Resources, Inc.
Served as Medical Director for several government contracts, primarily for the CMS Medicare Recovery Auditor Validation Contractor. This contractor validated the audits and reviewed and approved the issues pursued by the four CMD Recovery Auditors.
Feb 2009 - Dec 2009
National Government Services
Lead Medical Director
From February, 2009 – Present Lead Medical Director National Government Services, Inc. Reports to: Mary Ludden, Director, Medical Review & Appeals Melanie Alexander, Director, Medical Management (through August, 2009) Duties and Responsibilities: 1. Serves as Lead Medical Director for all National Government Services Medical Policy and Medical Review. Directs, manages, and leads physician efforts for National Government Services medical policy development; 2. Supervises medical necessity decision making for Medical Review, Claims, Data Analysis, Provider Outreach and Education, and Appeals departments; 3. Leads the multi-departmental team that develop claims processing system edits as a result of the local coverage determinations (LCDs) and CMS national policy; 4. Provides oversight for Medical Review and Appeals guidelines and clinical review activities; 5. Develops clinical guidelines for claims adjudication; 6. Leads Contractor Medical Directors’ (CMDs) relationships with physicians and other health care practitioners, and the Contractor Advisory Committees, related to LCDs and CMS Medicare coverage policies; 7. Leads CMD activities with provider groups and institutional organizations for education concerning LCDs, National Government Services operations, and CMS Medicare coverage policies; 8. Leads the data analysis enterprise for Medical Review and Medical Policy.
Aug 1998 - Feb 2009
National Government Services, Inc.
Medical Director, Medicare Part A
Duties and Responsibilities: 1. Served as Medical Director for Medicare Part A for Illinois, Indiana, Kentucky, and Ohio; 2. Identified the need for, and the development of, local medical guidelines and policies for Medicare Part A, including assessment of information on new procedures and technologies; 3. Rendered medical coverage and coding decisions in support of pre-payment and post-payment medical review, fair hearings requests, and fraud and abuse investigations; 4. Served as an internal and external medical information resource, particularly in the interpretation and application of coverage and coding; 5. Supervised medical review personnel on the use of internal medical review guidelines; 6. Represented the fiscal intermediary at national, regional, and local meetings of Medicare Medical Directors, including participation on national workgroups; 7. Spoke on behalf of the intermediary to professional medical organizations, locally, regionally, and nationally, on timely Medicare issues and contractor activities; 8. Undertook special projects in medical aspects of Medicare claims processing operations; 9. Coordinated the regionalization of Part A and B LCDs within National Government Services and with other local Medicare contractors; 10. Created and led the Data Analysis Team (DAT). The DAT coordinates all data analysis for pre- and post pay medical review and medical policy for all National Government Services contracts. Achievements: • Chaired two national Contractor Medical Director Workgroups: Fiscal Intermediary Workgroup and Psychiatry/Psychology Workgroup; • Developed national Template LCDs for national distribution; • Developed LCDs on many different medical issues; • Presented best practices in data analysis at national Contractor Medical Directors meeting; • Served as expert witness for the Department of Justice in several Medicare fraud trials.
Nov 2001 - Feb 2002
AdminaStar Federal, Inc
Interim Medical Director, Medicare Part B
Interim Medical Director, Medicare Part B Indiana and Kentucky
Apr 1994 - Oct 1997
Health Care Service Corporation
Associate Medical Director, Medicare Part B, Medical Director, RHHI
Associate Medical Director, Medicare Part B, Illinois, Medical Director, RHHI, Illinois, Indiana, Ohio
Jul 1982 - Dec 1995
Richard K. Baer, MD
Private practice in psychiatry
Private practice in psychiatry, psychoanalysis and addiction medicine Professional Associations and Committees: American Psychiatric Association, 1979 - Present Fellow, 1991, Distinguished Fellow, 2003 Illinois Psychiatric Society, 1979 - Present President, 1992-1993 President - Elect, 1991-1992 Councilor, 1985-1987 Editor, IPS Report (Society newsletter), 1984-1994 Committee memberships: Chair, Ethics Committee, 1993-1995 Member, Ethics Committee, 1987-1995 Member, Managed Care Committee, 1991-1993 Member, Budget and Finance Committee, 1991-1993 Chair, Committee on Public Relations, 1984 -1988, 1993-1994 Co-chair, Residents Committee, 1980-1982 American Psychoanalytic Association, 1983 - 1999 Committee on Confidentiality, 1986 - 1988 Chicago Psychoanalytic Society, 1983 - 1999 Committee on Legislative Affairs, 1993 - 1997 American Medical Association, 1990 - Present Illinois State Medical Society, 1990 - Present Chair, Council on Mental Health and Addiction, 1993-1994 Member, Council on Mental Health and Addiction, 1992-1995 Medicare Carrier Advisory Committee, 1992-1994
Oct 1991 - Jul 1994
Illinois Masonic Hospital Medical Center
Vice Chairman, Department of Psychiatry
Duties and Responsibilities: 1. Assigned and supervise patients for 46 multispecialty mental health providers, including psychiatrists, clinical psychologists, licensed clinical social workers, clinical nurse specialists, and students from these disciplines; 2. Developed policies and procedures regarding standards for evaluation and treatment; 3. Developed policies and procedures for the administrative flow of work within the Center; 4. Designed curriculum for the learning of psychotherapy.
Feb 1990 - Jul 1991
Illinois Masonic Hospital Medical Center
Director, Integrated Therapies Unit
Duties and Responsibilities: 1. Developed, instituted, and supervised an inpatient psychiatric treatment program for a ten-bed unit emphasizing an integrated biopsychosocial approach; 2. Developed an inservice education program for training in psychoanalytically informed approaches to the treatment of major mental illness; 3. Approved all patient admissions and monitored quality and appropriateness of care.
1974 - 1978
2007 - 2008
2003 - 2006
MA, Creative Writing
1983 - 1998
Institute for Psychoanalysis, Chicago, Illinois
1970 - 1974
BA, Major - English Literature, Minors, Rhetoric & Chemistry