SummaryThe conversation delves into the evolving role of artificial intelligence (AI) in healthcare, particularly its implications for compliance, documentation, and evaluation and management services. The speakers discuss the benefits and challenges of AI, emphasizing the need for providers to understand its limitations and the importance of maintaining accurate documentation. They also explore the complexities of billing for evaluation and management services, highlighting the risks associated with improper documentation and the scrutiny from insurance companies.Takeaways<ul><li>AI is significantly impacting healthcare, especially in diagnostics.</li><li>Providers must ensure they understand AI's limitations and capabilities.</li><li>Compliance and documentation are critical when using AI tools.</li><li>There are many pitfalls in AI that providers need to be aware of.</li><li>Patients have the right to opt out of AI-assisted documentation.</li><li>The importance of accurate documentation cannot be overstated.</li><li>Modifiers like 25 and 59 are often misused in billing.</li><li>Commercial payers are becoming more aggressive in audits.</li><li>Public comments can lead to better regulatory outcomes.</li><li>Documentation manipulation is a serious concern in healthcare.</li></ul>

Summary The conversation delves into the evolving role of artificial intelligence (AI) in healthcare, particularly its implications for compliance, documentation, and evaluation and management services. The speakers discuss the benefits and challenges of AI, emphasizing the need for providers to understand its limitations and the importance of maintaining accurate documentation. They also explore the complexities of billing for evaluation and management services, highlighting the risks associated with improper documentation and the scrutiny from insurance companies. TakeawaysAI is significantly impacting healthcare, especially in diagnostics.Providers must ensure they understand AI's limitations and capabilities.Compliance and documentation are critical when using AI tools.There are many pitfalls in AI that providers need to be aware of.Patients have the right to opt out of AI-assisted documentation.The importance of accurate documentation cannot be overstated.Modifiers like 25 and 59 are often misused in billing.Commercial payers are becoming more aggressive in audits.Public comments can lead to better regulatory outcomes.Documentation manipulation is a serious concern in healthcare.

Episode 355 - The Wild World of Healthcare Compliance

Sean is the host of “The Compliance Guy” a live production dedicated to the intersection of regulatory compliance and the business of medicine. The show provides timely, accurate, and easy to digest information to healthcare professionals.
The show features interviews of industry leaders, government officials, and others helping to shape the healthcare landscape.
Sean M. Weiss (AKA – The Compliance Guy) has been an industry respected name for more than 25-years. A physician and health system advocate, Sean engages with clients to ensure a “level-playing-field” and due process when allegations and/or accusations of impropriety are leveled by a payor or government investigation agency.


When Sean is not engaging in administrative, civil and criminal matters on behalf of more than 30 nationally recognized law firms and clients, he is serving as a third-party compliance officer for a dozen organization across the country ranging in size and specialty to ensure a “Culture of Compliance”!


Sean is a proud member in good-standing with the National Society of Certified Healthcare Business Consultants (NSCHBC), American Health Lawyers Association (AHLA), National Alliance of Medical Auditing Specialists (NAMAS), and the American Academy of Professional Coders (AAPC). Sean holds (CHC, CEMA, CMCO, CPMA, CPC-P, CMPE, CPC, CMC, CMIS, CMOM) national certifications from the Health Care Compliance Association, The National Alliance of Medical Auditing Specialists, The American Academy of Professional Coders and Practice Management Institute.

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Sean is the host of “The Compliance Guy” a live production dedicated to the intersection of regulatory compliance and the business of medicine. The show provides timely, accurate, and easy to digest information to healthcare professionals. The show features interviews of industry leaders, government officials, and others helping to shape the healthcare landscape. Sean M. Weiss (AKA – The Compliance Guy) has been an industry respected name for more than 25-years. A physician and health system advocate, Sean engages with clients to ensure a “level-playing-field” and due process when allegations and/or accusations of impropriety are leveled by a payor or government investigation agency. When Sean is not engaging in administrative, civil and criminal matters on behalf of more than 30 nationally recognized law firms and clients, he is serving as a third-party compliance officer for a dozen organization across the country ranging in size and specialty to ensure a “Culture of Compliance”! Sean is a proud member in good-standing with the National Society of Certified Healthcare Business Consultants (NSCHBC), American Health Lawyers Association (AHLA), National Alliance of Medical Auditing Specialists (NAMAS), and the American Academy of Professional Coders (AAPC). Sean holds (CHC, CEMA, CMCO, CPMA, CPC-P, CMPE, CPC, CMC, CMIS, CMOM) national certifications from the Health Care Compliance Association, The National Alliance of Medical Auditing Specialists, The American Academy of Professional Coders and Practice Management Institute.

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Episode 355 - The Wild World of Healthcare Compliance

Episode 355 - The Wild World of Healthcare Compliance

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