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The Compliance Guy
By Sean M. WeissBusiness
The Compliance Guy episodes
- The Daily Dose / TCG - Episode 10 - Medicare Integrity ProgramToday I tackled the Medicare Integrity Program and more specifically the UPICs and their actual role and clearing up routine misperceptions of what a UPIC actually does, how they do it and who they collaborate with.This episode went a bit longer 18 minutes as there was just so much to unpack to ensure we didn't leave any stone unturned.19 min
- The Daily Dose / TCG - Episode 9 - Medical Record Review DeterminationsIn this episode we look at one of the most critical aspects of Chapter 3 (Section 3.3.1.1) of the #Medicare Program Integrity Manual. This section speaks to #Clinical Review #Judgment and #Medical #Necessity. This section applies to the MACs, CERT, MRAC, SMRC, and UPICs and should be used by all #healthcareprofessionals to stand your ground against payers and their contractors!So much to unpack in such a short period of time!13 min
- TCG Season 3 Episode 21 - #TerryTuesdayThe #Modifier25 is leading to chaos and confusion... Tune in as we debunk the myths and set the record straight on what the payors are actually doing!44 min
- TCG Season 3 Episode 20 - Monday Compliance RoundtableWhat an awesome panel discussion with Scott Kraft, Stephanie Allard, and Paul Spencer of DoctorsManagement! Show topics included:1. CIGNA Policy Change on Modifier 25 (EM Services with Separate Service/Procedure on same date)2. Urine Drug Testing - Screening vs. Definitive, when can a provider go straight to definitive testing, medical necessity, and the laboratory's responsibility3. Coming out of the Pandemic and the biggest Audit Targets (Testing, EM Services, Telehealth, etc.)Such a brilliant discussion with an outstanding panel!55 min
- The Daily Dose / TCG - Episode 8 - Targeted, Probe and Educate (TPE)CMS' Targeted Probe and Educate (TPE) is a critical process to understand since things can and do vary by MAC. Understanding the process is critical to ensure release from the program. In this episode Sean addresses all the critical aspects of the program, how a TPE Audit is initiated, and what is considered an acceptable error rate.Don't miss this Friday episode!13 min
- The Daily Dose / TCG - Episode 7 - LCD Inconsistency / Sub Regulatory Guidance and Allina Health SystemThis is such an important episode for those involved in FCA cases, OIG settlement discussions, and CMS Appeals... In this 13 minute episode we unpack the 2014 OIG Report "LOCAL COVERAGE DETERMINATIONS CREATE INCONSISTENCY IN MEDICARE COVERAGE", The 2019 Supreme Court ruling on Azar v Allina Health System and the difference between regulation(s) and guidance document(s)!14 min
- The Daily Dose / TCG - Episode 6 - Additional Documentation Requests (ADRs)A lot of questions are asked about what to submit when an ADR is recevied for claims and what are the timeframes for submission of pre and post payment reviews. Take a listen to this insightful 10 minute segment on when and how to respond to an ADR12 min
- TCG Season 3 Episode 19 - #TerryTuesdayThis episode was a ton of fun as we got to discuss #cms and #commercialinsurance surveys and the difference between patient experience and patient satisfaction since they are inherently different! A little bit about MACRA and MIPS but overall how your reimbursement is impacted!I am going to say this up front... I was struggling with allergies today so there are approximately 6 times you will get to hear me cough/clear my throat ... I was going to have it clean/scrubbed but it would not have been ready today so, I am sorry for that (Terry don't kill me!) but, do not let it detract from the quality of the content!!!40 min
- The Daily Dose / TCG - Episode 5 - Corrective Action PlansCorrective Action Plans (CAPS) are critical to ensure providers are able to resolve allegations of wrong-doing. This episode addresses a lot of the nuacned aspects to building a successful CAP as part of an SDP or settlement agreement. Don't miss this critical episode.If you would like a copy of the modle CAP created by Sean M. Weiss, email him at [email protected]12 min
- TCG Season 3 Episode 18 Taxpayers Against Fraud - Candid Discussion About the False Claims ActThis is an awesome episode for so many reasons... Jacklyn DeMar joined Sean to discuss the role for TAF Education Fund to discuss whistleblower claims and the False Claims Act. It is so critical to understand all sides of healthcare compliance and how the law works so please do not miss this candid discussion!Jacklyn DeMar is the Director of Legal Education at Taxpayers Against Fraud Education Fund, where she began as the staff attorney in August of 2014. In her capacity as Director of Legal Education, Jacklyn works with whistleblowers, their counsel, and government attorneys on various False Claims Act matters, as well as matters involving the IRS, SEC, and CFTC whistleblower programs. She files amicus curiae briefs in federal courts across the country – including the U.S. Supreme Court – and serves as editor-in-chief of TAFEF's legal periodical, the False Claims Act & Qui Tam Quarterly Review. She is also responsible for coordinating the TAFEF Annual Conference, the nation's largest annual False Claims Act conference.Jacklyn has focused on False Claims Act and other fraud practice for most of her career, since graduating cum laude from American University's Washington College of Law in 2009. She has experience practicing at large Washington D.C. firms, as well as ample experience in the e-Discovery field from her experience working for one of the largest e-Discovery providers in the United States. She is a member of the Maryland and D.C. bars.Thank you for helping to make The Compliance Guy a 2022 Top 25 Podcast:https://blog.feedspot.com/regulatory_compliance_podcasts/43 min
About The Compliance Guy
From the publisher's feed
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.