Biography:
David Zetter is the founder and President of Zetter HealthCare, LLC in Mechanicsburg, PA and has over 24 years of operational and healthcare experience.
David is nationally recognized for his speaking, presentations and healthcare business expertise. He is well versed in regulatory requirements, revenue cycle management, credentialing and contracting, compliance, coding and documentation. He is considered an expert on Medicare, not only by his clients, but his consultant colleagues and healthcare attorneys across the country. David is an expert on ERISA regulations which protect over 80% of the claims in the US and knows how to stop payor recoupments dead in their tracks and what is legal and illegal in many payor contracts. David’s firm works with healthcare professional clients and facilities coast to coast, in all areas of practice and facility management including start?ups, buy?ins, compensation, exit strategies, reimbursement enhancement, practice financial modeling, governance documentation, policy and procedure development and implementation, credentialing and contracting, human resources staffing and management, compliance, coding and chart reviews, physician education and many other areas. David has helped to maximize both profitability and reimbursement of physician practices, facility and ambulatory practices, re?engineered operational and human resources, and addressed coding and billing issues for providers to curtail fraud, abuse, kickback, OIG, and IRS issues. He is also an original member of CMS’ PECOS Power User Group, CMS Compliance Focus Group and MIPS Design Lean Work Group which provides feedback and recommendations to Medicare’s Center for Program Integrity and Provider Enrollment Operations Group on design and improvements to the PECOS enrollment environment, as well as, NPPES and MIPS. His firm also assists with CAQH Proview and Proview for Groups development and beta testing. David was also on the original CMS contracted team awarded the PECOS 2.0 contract to rebuild PECOS from the ground up. David has also conducted chart audits on behalf of Medicare contractors and Blue Cross/Blue Shield early in his career, so he has knowledge of what the expectations are from the payers. He has evaluated existing ambulatory care facilities and practices with respect to patient flow, operations, marketing, fee structures, use of ancillary services and financial considerations; developing strategic plans to improve profitability and productivity. His activities in management and compliance include physician practices, IDTFs, hospitals, ASCs, pharmacy, DME and other facility types, including coding and broad?based regulatory issues.
