For this installment of Compliance Conversations, we interviewed Jake Geertsen, a Technical Manager in the documentation and coding, who specializes in telehealth. It’s a fast-growing segment of healthcare, which has spawned a lot of questions around the field. Not least of which is: What exactly is telehealth? According to Geertsen, telehealth is “a collection of means or methods for enhancing healthcare, public health, and health education delivery and support, using telecommunication technologies.”Just ten years ago, few of us were carrying around the computing power we commonly find in our pockets and purses today. Nor did we know the benefits this technology could have to, as Geertsen puts it, “to the patient, the healthcare organization looking to cut costs, to insurance companies also looking to cut costs. In many scenarios, this is an area of innovation and improvement.” Understand the History and Evolution of TelehealthImplement Proper Coding and Billing Compliance PracticesStay Current with Ever-changing Medicare Regulations and Payer Policie

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I sat down with Tyler Griffeth, a Technical Manager of Professional Documentation and Coding at Intermountain Healthcare, to discuss a couple of his favorite Medicare Internet Only Manuals (IOMs), specifically the National Correct Coding Initiative (NCCI) Policy Manual and the Claims Processing Manual. The NCCI Manual, about which he jokingly said, “I’ve got mine laminated, I can read it in the tub with a little bit of bubbly” is just one of his favorites. Meanwhile, the Claims Processing Manual, “Is a really great resource if you’re dealing with things like denials, but also if you’re involved in a RAC audit.” Tune in to my most recent episode of Compliance Conversations, How to Earn a Huge ROI from Medicare’s IOMs, and learn how to:Use the NCCI Policy Manual to Clarify Procedure Codes to PhysiciansLeverage the Claims Processing Manual to Avoid DenialsApply Situational Modifiers in Conjunction with Codes

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Whether you’re dealing with medical devices or new drugs–regardless if it’s a product or a service, and whether that product or service ever even leaves the United States, export controls affect every organization in one way or another. That’s why I was so excited to sit down with Export Controls and Compliance expert, Wendy Epley, the president of Epley Consulting, for this episode of Compliance Conversations. As a compliance professional in healthcare, you might hear the word “export” and think ‘I don’t ship anything out of the country, so export controls don’t apply to me.’ But surprisingly it does! Epley explained, “[export controls] is referring to a very complicated network of federal agencies and regulations that are interconnected to regulate or control how things are to be protected in order that they are not used in a way that would cause harm...regardless of where those persons are located, including if they are here within the United States.” Epley also went into detail about the foreign corrupt practices act, an important act for many of you in various healthcare compliance roles. “Just a few years ago, Teva Pharmaceutical Industries paid nearly five hundred and twenty million...for its role in violations with the FCPA.” Said Epley. Find out how export controls apply to all of you healthcare compliance professionals out there. Tune in to my latest episode of Compliance Conversations, Export Controls: The Most Important Compliance Element You Probably Haven’t Heard Of, to learn why: One Doctor Went to Prison For His ResearchSome Medical Equipment and New Drugs Pose A Risk You Need to Institute Export Protocols and Training in a Research Uni SettingTeva Pharmaceutical Industries Paid Nearly $520 Million in Violations

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Listen to this most recent episode of Compliance Conversations, How to Build a Mutually Beneficial Relationship with Your Compliance Committee, with special guest, Judith Maber-Fox, to learn how to:Build a Mutually Beneficial Relationship with your Compliance CommitteeEngage Sr. Leadership to Actively Support the CommitteeCreate Opportunities That Give You a Seat at the Table

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For this Compliance Conversations episode, I’ve got a special treat for you: Dr. Ira Specter. He spent many years as a practicing OBGYN physician and is also a certified coder and medical auditor. After practicing medicine for a few decades he went on to run a large medical management company, where they did billing collection, coding, compliance, and ICC10 courses for sixty-five physicians. Because of his unique perspective, we tackled bridging the gap between coding and auditing and physician documentation. I asked Dr. Specter, “what’s the biggest area for improvement for physician documentation?” After a brief pause, he said, “Let me start by saying, by and large, most physicians are under coding.” It seems, according to Specter, that physicians are “cutting off their own legs,” and also “cherry picking” codes. What does that mean?Listen to this episode to find out what Dr. Specter views as the biggest mistakes physicians are currently making and learn: What Coders/Auditors Should Look Out For in Physicians DocumentationWhy Physicians Should Never Cherry Pick CodesThe Pitfalls of Copying and Cloning.

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There are a lot of barriers in compliance. In this installment of Compliance Conversations, I chat with Eric Dominguez, the chief compliance officer at Emerus, a management company that specializes in healthcare systems. “Part of the services we provide to these joint ventures is a compliance program.” Dominguez explains some of the common hurdles of aligning with partners. “It’s a challenge and at the same time, it’s really a great opportunity for growth.” So how do Dominguez and his group manage compliance on such a big scale? And how can we get better at it ourselves? Listen to this episode to learn how to: Tackle Compliance Like a Large Hospital GroupManage the Unique Challenges of Micro-Hospitals Navigate Policies and Procedures for Hospital Licensing

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Whether it’s an EMR or a compliance software solution, you want technology to do the work for you, not make you do extra work. Knowing where tech disappoints has helped Healthicity’s president, and my guest on my most recent episode of Compliance Conversations, Barry Johnson, D.D.S., to create software solutions that healthcare organizations really want. And, according to the US Government, solutions that healthcare organizations really need. “Recently at HCCA, we heard government officials telling the people that were at the meeting that compliance has got to move into the digital age and start doing things with software rather than spreadsheets.”It doesn’t matter if you’re an early adopter or tech-adverse, this informative and fun episode will bring you up to speed on all things healthcare technology from the largest challenges to the newest tools and gadgets that save lives or make your workday a whole lot easier. If tech has got you down: Johnson just might have a solution for you. Tune into this episode of Compliance Conversations, Taking the Trauma out of Technology with Barry Johnson, D.D.S., to learn: * Tech Trends (and Failures) in Healthcare* Upcoming Advances in Healthcare to Watch For* How to Make Tech Work For You * What the US Government Has to Say About Technology in Compliance

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I’ve been getting a lot of requests to do a show about coding and billing and I couldn’t think of a better guest than my friend and former colleague, Jay McVean, an expert in billing and coding compliance with the University of Texas Health Science Center in Houston. Starting out, I had to ask: What’s the biggest coding and billing compliance issues in medical school, with faculty, and academic medical centers? This is where McVean’s expertise really shines and it’s an area that doesn’t get talked about nearly enough. McVean explained, “One of the biggest challenges we face in this ever-growing clinical world is that our teaching physicians really must understand who they’re working with...When various people are touching the notes, documenting portions of the visit, at the end of the day physicians are really confused about if they have a TPA situation, or if this is a shared split visit if I’m in the hospital, and how much of the note to document versus an NP or a PA.” From there, we talked about physician pressures and productivity and how it plays into billing and coding compliance. Listen in to our latest episode, What You Need to Know About Billing Compliance in Academic Medical Centers, with expert Jay McVean. In this episode we chat about: Teaching Physician TrapsDocumentation IssuesThe Complexity of the Clinical EnvironmentEducation and TrainingPotential EMR Concerns

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In this episode of Compliance Conversations, I chatted with Charla Prillaman, the Regional Vice President of Audit Services and 30-year compliance veteran, about the crucial differences between Medical Necessity and Medical Decision Making (MDM). Prillaman pointed out that both terms are incorrectly used interchangeably, though they have distinctly different meanings. “Medical Necessity is the foundation for payment for all medical services. We find the original or the beginning statement about medical necessity being the overarching criteria all the way back into the social security act…Now the complexity of medical decision making is that it’s intended to somehow or another quantify a provider’s cognitive work in a specific encounter with the patient.” Said Prillaman. In this highly requested conversation, Prillaman breaks down how to properly document medical necessity and medical decision making and how to quantify something as difficult as “cognitive effort” for MDM. Tune into this episode of Compliance Conversations, “Recognizing the Differences Between Medical Necessity and Medical Decision Making” with me, CJ Wolf, and Charla Prillaman for the full scoop on Medical Necessity and MDM, including: The History of Both Medical Necessity and MDMKey Differences of Medical Necessity and MDMWays to Properly Quantify and Document MDM

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I recently spoke with Brooklyn Trumpy on what it’s like to be new to compliance. Trumpy graduated in 2009 with a degree in Operations Management and ended up in compliance five years ago when she took a role at Community Health Systems and worked her way into a compliance role. Trumpy found that being new to compliance was a challenge. She explained how it can be intimidating to learn all of the new rules and regulations and how to piece together the puzzle that is compliance. She initially struggled to make connections and find her tribe within Compliance and it took some time to learn how to stay organized. Trumpy had some expert advice for new compliance professionals that will help them have an easier transition into the world of compliance. Listen to this episode of Compliance Conversations, "Tips for When You’re the New Kid on the Compliance Block," to learn: * Which Personality Types are Drawn to Compliance in the First Place * How to Set Expectations as a New Compliance Professional* Why It's Okay not to Know Everything Right Out of the Gate

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