Summary
In this conversation, Sean and Terry discuss the critical importance of conducting audits in healthcare practices, emphasizing the need for both internal and external reviews to ensure compliance and accuracy in coding and billing. They highlight real-world examples of practices that have suffered due to a lack of audits and the biases that can occur in internal reviews. The discussion also touches on the role of compliance in healthcare and the upcoming topic of prior authorizations.
Takeaways
<ul>
 <li>Many practices have never conducted an audit of their coding and billing.</li>
 <li>Internal audits can be biased and may not capture all issues.</li>
 <li>External audits provide an objective perspective on compliance.</li>
 <li>Providers often make assumptions about documentation that can lead to errors.</li>
 <li>The Department of Justice emphasizes independence in auditing practices.</li>
 <li>Training and education are crucial for coding staff.</li>
 <li>Practices can lose significant revenue due to improper billing.</li>
 <li>Compliance plans should include prior authorization processes.</li>
 <li>Auditing is essential for identifying fraud and ensuring compliance.</li>
 <li>Investing in audits can save practices money in the long run.</li>
</ul>

Summary In this conversation, Sean and Terry discuss the critical importance of conducting audits in healthcare practices, emphasizing the need for both internal and external reviews to ensure compliance and accuracy in coding and billing. They highlight real-world examples of practices that have suffered due to a lack of audits and the biases that can occur in internal reviews. The discussion also touches on the role of compliance in healthcare and the upcoming topic of prior authorizations. Takeaways Many practices have never conducted an audit of their coding and billing. Internal audits can be biased and may not capture all issues. External audits provide an objective perspective on compliance. Providers often make assumptions about documentation that can lead to errors. The Department of Justice emphasizes independence in auditing practices. Training and education are crucial for coding staff. Practices can lose significant revenue due to improper billing. Compliance plans should include prior authorization processes. Auditing is essential for identifying fraud and ensuring compliance. Investing in audits can save practices money in the long run.

Season 7 - Episode 50 - #TerryTuesday - Independence and Objectivity in Auditing!

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.

Business

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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Season 7 - Episode 50 - #TerryTuesday - Independence and Objectivity in Auditing!

Season 7 - Episode 50 - #TerryTuesday - Independence and Objectivity in Auditing!

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