The Compliance Guy

In this episode Collin Callahan of Flannery Georgalis joins Sean to discuss what a prosecutor / defense counsel looks for in an expert, why expert reports are so critical, the dos and don’ts of SMEs and their reports, Daubert Motions vs Motion in Limine, and more... There are even some tributes to Runaway Jury and a Few Good Men! Don't miss this outstanding episode with one of Sean's favorite guests! 

In this episode Sean hits on a Daubert Motion, which is a type of motion which seeks to exclude the presentation of an expert's testimony to a jury. Daubert motions are named for the Supreme Court case, Daubert v. Merrell Dow Pharm., Inc. (509 U.S. 579 (1993)). Rules 702 and 703 of the Federal Rules of Evidence govern the admission of scientific evidence in federal court. The rules allow expert witnesses greater leniency in their testimony because it is presumed that the expert will have a reliable basis in knowledge and expertise in their field.  The court in Daubert required that trial judges act as a gatekeeper and determine the scientific validity of scientific evidence before admitting it. 

So much to address in 15 minutes. Don't miss this one if you are or planning to be an expert in a trial. 

Terry joins Sean to discuss Compliance Programs and Obligations for participating with all insurance companies... The difference between compliance plans and compliance programs, why compliance fails in smaller practices and how things like the No Surprise Act impact your efforts! 

There's also a discussion about a pink comfy, Tom doing laundry and making coffee, and so many other things to keep you entertained. 

On this Monday roundtable discussion Sean is joined by Terry Fletcher, Christine Hall, Paul Spencer and Scott Kraft to discuss coding and compliance issues plaguing hospitals and physician practices. The panel addresses providers creating and signing notes prior to ever seeing the patient, cloning, clinical plagiarism, impact of not having a compliance plan, and so much more.   

Dawn Carter, Director of Product Strategy of Centauri Health Solutions joined Sean to discuss Risk Adjustment Audits and the ins and outs of these often times annoying administrative requirements if you participate with an MA Plan... This was such an interesting discussion and we believe you will think so too! 

Links to articles from the show:

Article 1:  Medicare Advantage, Direct Contracting, And The Medicare ‘Money Machine,’ Part 1: The Risk-Score Game - https://www.healthaffairs.org/do/10.1377/forefront.20210927.6239/full/

Article 2: Medicare Advantage, Direct Contracting, And The Medicare ‘Money Machine,’ Part 2: Building On The ACO Model - https://www.healthaffairs.org/do/10.1377/forefront.20210928.795755/full/

Article 3: Halvorsen/Crane rebuttals: https://www.healthaffairs.org/do/10.1377/forefront.20220106.907235and https://www.healthaffairs.org/do/10.1377/forefront.20220203.915914/

Article 4: Gilfillan and Berwick rebuttal to Halvorsen and Crane: The Emperor Still Has No Clothes: A Response To Halvorson And Crane - https://www.healthaffairs.org/do/10.1377/forefront.20220602.413644

Article 5: Kang/Duncan/Hunh response: Making The Right Diagnosis: A Response To Berwick And Gilfillan - https://www.healthaffairs.org/do/10.1377/forefront.20220706.909897/ 

About Dawn Carter: 

Her career in healthcare spans 28 years, which most recently includes extensive experience in developing revenue integrity and quality software solutions, with a focus on encounter management, risk adjustment, and social determinants of health solutions for Medicare Advantage, Medicaid and Commercial health plans, as well as providing risk adjustment strategic advisory services for these markets. Prior to that, her experience spans all domains of health care including health plan and provider systems administration, finance, compliance and healthcare applications development inclusive of EDI and X12 and HL7 development. Her experience also includes multiple teaching engagements in medical administration, billing and coding. Dawn holds a Bachelor’s degree in Business Administration, and she holds the American Association of Professional Coders CPC (Certified Professional Coder), CRC (Certified Risk Adjustment Coder), and CPMA (Certified Professional Medical Auditor) credentials. She is also a Certified Scrum Product Owner (CSPO). Dawn is a passionate and prolific industry speaker, author, blogger and subject matter expert in claims, EDI management, and risk adjustment.

Terry joins Sean to discuss the ins and outs of Medicare Advantage (MA) and what you really need to know about these plans. Why is the OIG investigating MA plans and what are they finding. Don't miss this one!

Sean was joined by an all star panel of guests including Christine Hall, Paul Spencer, Terry Fletcher and Scott Kraft to discuss "Scary Scenarios" they've each dealt with over the past week and what you need to know to avoid the same costly mistakes as others... Don't miss this one as it's an absolute fright! 

In this episode I am joined by Stephen Soloway MD FACP FACR to discuss his new book "Medical Politics" This dynamic book shows you through a Non-Fictional lens health care's landscape and all that is wrong with it!

In this episode of the Daily Dose Sean discusses and reads the Foreword of Dr. Stephen Soloway's new book "Medical Politics" This dynamic book takes you through a Non-Fictional lens of health care's landscape and all that is wrong with it! 

Terry Fletcher joins Sean on this #TerryTuesday Episode of The Compliance Guy to discuss Time Based Coding, Las Vegas, The Steelers and other fun facts! Don't miss this one as Sean and Terry hit their stride!