The Company
The Team
In the new era of an alphabet of healthcare oversight including - Recovery Audit Contractors (RACs),
Medicare Administrative Contractor (MACs), Comprehensive Error Rate Testing (CERTs), Payment Error
Rate Measurement (PERMs), the Office of the Inspector General (OIG), the Office of the Medicaid
Inspector General (OMIG), Managed Care Organizations (MCOs), and many others Proven Healthcare
Solutions' Admission Review Management Service provides hospitals and healthcare systems
a flexible, cost-effective, turn key solution to address the ever-challenging requirements
of ensuring real time, point of service medical necessity review determinations of patients
coming in through the Emergency Department. This includes utilization review using the latest evidence-based
screening criteria to determine the right level of care to be provided to these patients- inpatient, outpatient
observation status or discharge for outpatient follow-up.
Proven Healthcare Solutions is an industry leader with more than 30 years
experience focusing on hospitals and healthcare systems. Our multi-disciplinary
leadership and management team bring the experience of providing expert solutions
to the operational, compliance, and clinical challenges faced by hospitals and healthcare systems.
Using our state-of-the-art Electronic Admission Review Management (E-ARM™) software, our seasoned
RN Admission Review Screeners will provide your facility with the flexibility of just-in-time review,
at the point of service.
By taking a Six Sigma, lean manufacturing approach; Proven Healthcare Solutions is designed
to accommodate all of your Admission Review needs from providing night, weekend or holiday
coverage, or any combination in between, to screening 100% of your facility's Emergency Department
patients, at the point of service. No more Monday morning chaos or backlogs for your hospital
to review, no more retrospective admission denials.
John Fontanetta, MD, FACEP
Chief Medical Officer
Dr. Fontanetta is a practicing emergency physician and a regional leader in health
information technology for the Emergency Department and in Rapid Discharge Unit design,
implementation and operations. He is a professional society member of the
New Jersey Chapter of the American College of Emergency Physicians and American
Medical Association. He was awarded the Presidential Scholar for Phi Beta Kappa,
Alpha Honor Society. He graduated Summa Cum Laude at Fordham University in Bronx,
New York and received his medical degree at Cornell University Medical College
in New York, New York.
Dr. Fontanetta completed his Internal Medicine Residency at Thomas Jefferson University
Hospital in Philadelphia, Pennsylvania and fellowship in Pulmonary Medicine at Albert
Einstein College of Medicine, Bronx Municipal Hospital Center in Bronx, New York.
He is a Diplomat of the American Board of Emergency Medicine, Diplomat of the
American Board of Internal Medicine, Diplomat of Subspecialty Pulmonary Medicine,
and board eligible in Critical Care Medicine. Dr. Fontanetta is also a Fellow of the
American College of Emergency Physician.
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Nancy A. Mendes, RHIT
Chief Operating Officer
Nancy Mendes has over 30 years experience in healthcare,
including the management of coding, DRG validation,
utilization review, and quality improvement activities
throughout numerous New Jersey acute care facilities.
Working with New Jersey's Medicare Quality Improvement
Organizations (QIO) she has directed multiple local, state,
federal and private contracts in the positions of Data
Quality Manager, Director of Case Review, Director of
Research and Analytical Services, Hospital Payment
Monitoring Program Leader, and the Inpatient and Outpatient
Quality Improvement Leader.
Ms. Mendes has also been the Contract Leader to perform data
validation and medical record review for the State of NJ
Department of Health and Senior Services' Low Risk Cardiac
Catheterization Pilot Project, Subacute Care Project and the
Open Heart Surgery Data Validation Project. Currently
she directs private/state contracts with major insurers to
perform Independent Utilization Review Appeals and perform
retrospective review for medical necessity, appropriateness
of setting, coding, DRG assignment and appropriateness
of billing. She has a degree in Health Information Management
and is a Registered Health Information Technician, certified
by the American Health Information Management Association.
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Scott Serbin
Director of Marketing
Scott Serbin, Director of Marketing and Sales, brings over 19 years of
multi-faceted health care experience to Proven Healthcare
Solutions, including expertise in physician group management,
emergency department marketing and sales, retail health care,
managed care, medical education and corporate training.
He holds a Bachelor of Science Degree in Education from East
Stroudsburg University-East Stroudsburg, PA and a Bachelor
of Arts Degree in Communications from William Paterson
University-Wayne, NJ.
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With over 30 years of multi-disciplinary healthcare experience and more than three (3)
million medical record reviews, our comprehensive team includes:
- Nationally Recognized Physician Leaders
- Board Certified Physicians
- Hospital Executives
- Nurse Executives
- Experienced Nurse Reviewers
- Certified Coding Specialists
- Experienced RAC Reviewers
- Data Analytics Experts
- Healthcare Research Experts
WHO WE ARE