The Compliance Guy

Sean was joined by Terry, Scott, Stephanie, Paul as they took on the biggest issues in healthcare!
Topics Included:
1. RPM and RTM services, the difference between them and the difference between RPM and CCM and why these services are such a high priority target for CMS, OIG and commercial insurance (hint: telehealth!
2. HIPAA - enforcement is on the rise and things you do every day without knowing may be causing you a reportable event...
3. Bio Fire - what are these services, how were they used during the PHE and why are so many insurance companies coming after providers now...
4. What to do with a payer that is jerking you around but they only make up 5% or less of your payer population... and so much more!

Terry and Sean sat down to discuss the impact of prescription drug management and the impact on the overall level of EM Service. Take a listen, you might be surprised by this discussion!

Sean was joined by John Paul Spencer Terry A Fletcher BS CPC CEMC CCC CCS CCSP CMC ACS-CA SCP-CA, QMPM Stephanie Allard, CPC, CEMA, RHIT and Scott Kraft to discuss all of the big events impacting #healthcareoperations!

So much to discuss including:

1. ChatGPT and its impact on #physician documentation

2. Sub-regulatory guidance and the False Claims Act

3. E/M Visits when the patient is not part of the visit

4. Cigna and Claims Rejections

Don't miss this one!!!

Assistant Attorney General and the head of the Criminal Division at the Department of Justice, Kenneth Polite sits down for a candid discussion with Sean to explore a variety of topics including:

This is a discussion you cannot afford to miss!

Terry and Sean discuss the critical importance of completing medical records and closing them within the time requirements established by state and federal requirements. What are the potential penalties for non-compliance and how do you argue technical violations...

In this episode, Sean is joined by Ashley Morgan (Partner) and Robert Liles (Founding Member), of Liles / Parker, LLC to discuss Medicare Suspensions and Revocations, what are they, how are they different and how do you get them reversed. There is a great discussion about UPICs, OIG, DOJ, and Medical Boards. There is so much to unpack in this great issue!

Don't miss this one.

On March 15th Sean put out a blog post on Cigna and their new demand for documentation when an EM and minor procedure is performed on the same day with the modifier 25 appended. Don't miss this one!

In this episode Sean breaks down the False Claims Act and the Health Care Fraud Statute. This is a very detailed breakdown of both laws with some insight to the proposed language change to the Medicare Voluntary Refund (60-Day Rule). 

Terry and Sean sit down to discuss the latest investigation and prosecutions tied to telehealth services performed by providers engaging in contractual arrangements with 3rd party telefraud companies to perform medical necessity reviews for DME prescribed by other providers! You do not want to miss this one! 

In this episode Sean is joined by the all star cast of subject matter experts to discuss topics impacting healthcare operations and compliance!