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Richard K. Baer, MD
Consulting Medical Director
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Dr. Baer has more than 25 years’ experience in medical director roles for Medicare Administrative Contractors (MACs), Recovery Auditors (RACs), regional home health and hospice contractors, and most recently for the Unified Program Integrity Contractor (UPIC), Midwest Region.  During his tenure with Medicare program contractors, Dr. Baer authored hundreds of local coverage determinations (LCDs) and other policy documents and articles for new technologies, pharmaceuticals, and other highly utilized services.  He has also provided policy assistance to CMS on national coverage issues.

 

Dr. Baer has extensive experience as a consultant and expert witness on Medicare coverage issues.  He has worked with Assistant U.S. Attorneys in several jurisdictions to assist with record review, case development, and testimony at trial.  He has also worked extensively with the provider community to assist with internally and externally initiated investigations of suspected non-compliance with Medicare payor requirements.  

 

Dr. Baer is available to provide consultative services on medical policy and Medicare coverage requirements.  He has assisted providers in policy development, clinical trials design, ICD-10 training, and compliance audit and investigation activities involving documentation and medical necessity issues.  His training and background as a practicing physician allows him to be highly effective in explaining Medicare documentation and medical necessity requirements to physicians and other clinicians.  

 

Dr. Baer is a Distinguished Life Fellow of the American Psychiatric Association and a member of state and national medical societies.  He served as President of the Illinois Psychiatric Society, Editor of its newsletter, and Chairman of its Ethics Committee.  Dr. Baer authored Switching Time, the true-life story of his treatment of a patient with multiple personality disorder.  Published in the U.S. by Crown Books in 2007, Switching Time has also been published in the U.K., Sweden, Netherlands, Japan, China, and Indonesia.  Dr. Baer has appeared on Good Morning America and Fox News in the Morning and has been featured by Newsweek, Chicago Magazine, and in other articles published in the U.S. and abroad.

Representative Matters:
  • Consulted with a large west coast hospital system to educate physicians on documentation requirements for ICD-10 coding.

 

  • Conducted numerous government audits for multiple provider types, including assisting the DHHS OIG and FBI in case development and testimony at trial.

 

  • Consulted with numerous major pharma and medical device manufacturers on bringing new technology to market with a focus on compliance with regulatory requirements and clinical trial design.

 

  • Counseled university medical centers on compliance with clinical trial billing and medical necessity of services.

 

  • Led a team that analyzed claims data, developed enterprise wide medical policies, and implemented them into the claims process systems for a large Medicaid payor organization.

Education 

MD, University of Illinois, Abraham Lincoln School of Medicine (James Scholar in 

Independent study)

 

MA, Creative Writing, Northwestern University

 

Certification

 

Board Certified by the National Board of Medical Examiners (1978)

 

Board Certified by the American Board of Psychiatry and Neurology, Psychiatry, Part I (1984), and Part II (1985)

 

AHIMA-Approved ICD-10-CM/PCS Trainer