The Compliance Guy

In this episode Sean and Terry take on HIPAA and OSHA in a Post Pandemic Work World... The do's and don'ts and all the in-betweens. The wheels on the bus while they do go round and round, start to come off in this one and you don't want to miss it! 

In this episode of The Compliance Guy Monday Coding and Compliance Roundtable, you missed an outstanding panel discussion with Christine Hall CHC CPC , CPB, CPMA, CRC, CEMC, CPC-I Stephanie Allard, CPC, CEMA, RHIT John Paul Spencer and Terry A Fletcher BS CPC CEMC CCC CCS CCSP CMC ACS-CA SCP-CA, QMPM! 

Tremendous interaction by the viewers and out standing topics: 

1. Macro statements and their impact on documentation

2. Surgical Package and how it differs payer to payer

3. Adding ancillary services without understanding federal/state guidelines

4. Proper use of Modifier 22

In this 15 minute episode Sean tackles the issues with routine waiver of copays and/or deductibles, professional courtesy, and the potential implications with the FCA, Health Care Fraud Statute, Anti-Kickback Statute, and Stark Law. 

Sean addresses the Special Fraud Alert from OIG on why it's illegal for "charged-based" providers, practitioners and suppliers to Routinely Waive Copayment and Deductibles! 

https://oig.hhs.gov/documents/special-fraud-alerts/876/121994.html 

In 16 minutes Sean breaks down the 2010 Affordable Care Act (ACA) and its mandate on establishing a compliance program (Core Elements). The breakdown includes: 

1. Mandatory Compliance and Enforcement

2. The implementation of the 60-Day Rule and how it actually works

3. The Relator (qui tam) Bar and Effective Changes under ACA

In this episode, Sean and Terry take on questions from listeners and subscribers... 

Topics: 

1. Telehealth 

2. Documentation Requirements for Telehealth 

3. Use of Locum Tenens 

4. Independent Dispute Resolution (IDR - Surprise Bills) 

The Compliance Guy Coding and Compliance Roundtable this week was simply put, Awesome! Guests Stephanie Allard, CPC, CEMA, RHIT Christine Hall CHC CPC , CPB, CPMA, CRC, CEMC, CPC-I John Paul Spencer and Terry A Fletcher BS CPC CEMC CCC CCS CCSP CMC ACS-CA SCP-CA, QMPM provided outstanding insight on a variety of topics and the engagement from the audience was fantastic! 

Topics Include:

1. Laboratory services - the issues between ordering physicians and labs...

2. The use of templates for procedures and how they do not always support the service or drug codes being billed and

3. The use of "smart" EMR's that are intended to code for a provider and why a human (certified coder) still needs to review documentation to determine medical necessity if the providers are not changing what the system auto selects for them...

4. HIPAA and OSHA Compliance in the Remote workspace for Healthcare Professionals. OSHA is now knocking on doors of employees homes and they are being told that their "work space" is not compliant.

5. Internal audits vs. external audits. What is better for medical practices?

Don't miss these subject matter experts as we discuss and debate all that is coding and compliance!

Colin Callahan of Flannery Georgalis, LLC sat down with Sean on Friday, August 12, 2022 to discuss the Ruan ruling by the Supreme Court. This ruling has and will continue to impact the litigation landscape significantly for matters tied to the Substance Control Act (SCA)!

Steve Gallion, CEO of Medtrainer sits down to discuss all things compliance with Sean on this episode! The discussion covers the current landscape, ramped-up enforcement actions, and a bit about economics! Such an outstanding discussion with one of the industry's thought leaders! Don't miss this one! 

About Steve Gallion

Chief Executive Officer

Steve’s passion for people and eye for market opportunities have led him to build several companies over the past 15 years that have brought benefit to healthcare. Today Steve is directly responsible for company vision and empowerment of the executive team to fulfill MedTrainer’s mission. Academically Steve holds multiple degrees from the University of California Riverside in Business Economics as well as his Juris Doctorate from California Southern Law. In his free time, Steve is active with his two children, enjoys outdoors, loves to read, has a passion for cooking, an affection for travel as well as doing his best to limit time in the gym while still being an active doughnut connoisseur. Steve loves building companies, loves technology, loves people, believes in inclusive leadership, and has a passion for enjoying the journey along each path he ventures down. 

Visit their company here: www.medtrainer.com 

Sean sat down with Scott Kraft, Senior Compliance Auditor for DoctorsManagement, LLC to discuss strategic defense litigation services and how those played a key role in the outcome of the United States v. Rajendra Bothra, et. al case on June 28th, 2022! 

Here are some of the headlines in what is one of the Nation's largest heath care fraud cases. 

"How 4 doctors beat the feds in botched $500 million pill mill case" (https://www.freep.com/story/news/local/michigan/macomb/2022/06/30/doctors-opioid-scheme-birmingham-bothra/7778004001/) 

United States v. Bothra: (https://casetext.com/case/united-states-v-bothra-1) 

"Michigan Physician Rajendra Bothra Acquitted in Prescription Drug Fraud Case After More Than 3 Years in Prison" (https://americankahani.com/community/michigan-physician-rajendra-bothra-acquitted-in-prescription-drug-fraud-case-after-more-than-3-years-in-prison/)

Dr. Maheu joins Sean on this episode to discuss telehealth in behavioral health and the impact it is having on patient care. This is such an important episode for so many reasons especially coming out of the pandemic of the past 2 years! Do not miss this episode with one of the industry's leading voices on this topic! 

About Marlene M. Maheu, PhD

Dr. Marlene Maheu started publically addressing telehealth in 1994 when she was invited to Chair a subcommittee at the American Psychological Association (APA) to examine Internet issues. Her early work was based on a self-funded, consumer-based behavioral health magazine dedicated to bringing behavioral information to the consumer public on the World Wide Web. Her interest in the legal and ethical aspects of using technology fueled her research, which led to invitations from no less than 7 established publishers in 1997 after speaking at the APA’s annual meeting. Those invitations launched her subsequent focus on professional writing and training about a legal and ethical risk management related to clinical interventions mediated through technology.

As the Executive Director of Telebehavioral Health Institute, Dr. Maheu has served on a dozen professional association committees to assist with developing telehealth standards, guidelines, and other consensus documents. She has published 43 book chapters and journal articles as well as 5 professional books related to telehealth practice. Dr. Maheu is a consultant, researcher, author, and trainer who has served more than 55,000 professionals from 109+ countries.

Learn more about her organization here: https://telehealth.org/marlenemaheu/