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The Compliance Guy
By Sean M. WeissBusiness
The Compliance Guy episodes
- The Daily Dose / TCG - Episode 4 - MEDICARE IMPROPERLY PAID PHYSICIANS FOR SPINAL FACET-JOINT DENERVATION SESSIONSIn this episode Sean tackles the 2021 report issued by OIG to address inappropriate billing for and overuse of spinal facet-joint denervation for pain management. In total, Medicare improperly paid physicians $9.5 million during the audit period of January 2019 - August 2020... This is a must for providers performing these procedures.A whole lot to unpack in this one.11 min
- The Daily Dose / TCG - Episode 3 - Cigna Requires Documentation for EM Services and Modifier 25In this episode Sean addresses the policy change being pushed forward by Cigna requiring documentation to be faxed to a dedicated fax line beginning August 13, 2022 for EM Services (99212-99215) when billed with Modifier 25 and a minor procedure on the same day.11 min
- The Daily Dose / TCG - Episode 2 - Timely Claims Payment and Prompt Pay LawsIn this episode we discuss the federal Timely Claims payment Law and State Prompt Pay Laws. In this 10 minute segment a lot is revealed to ensure you're on the right track to getting your claims paid.11 min
- TCG Season 3 Episode 17 #TerryTuesday with Special Guest Brianna J. SantolliBrianna J. Santolli, Esq. of Riker Danzig Scherer Hyland & Perretti LLP joined Terry A Fletcher BS CPC CEMC CCC CCS CCSP CMC ACS-CA SCP-CA, QMPM and Sean on a special episode of TCG / #TerryTuesday to discuss the updates of the #nosurprisesact...There is a ton to unpack in this episode and there's no doubt things get a bit sideways with Sean driving!1 hr 3 min
- The Daily Dose / TCG - Episode 1 - DOJ Settling the First False Claims Act Enforcement Action Since the Launch of the Civil Cyber-Fraud InitiativeWelcome to the “Daily Dose” on The Compliance Guy. Each day you will be caught up with a different event or multiple events in the world of healthcare. This segment is not meant to be a deep dive but rather a breakdown of what significant issue(s) government investigational agencies such as DOJ, OIG, FBI, OCR, CMS, and other healthcare contractors are focused on. Additionally, topics from the world of Auditing, Coding, and Operations will addressed.These are 5–10-minute segments focusing on headlines, with a brief explanation of what you need to know to ensure your organization's operations and compliance initiatives are headed in the right direction.7 min
- TCG Season 3 Episode 16 Karen Weintraub / Healthcare Fraud ShieldKaren Weintraub joins Sean to discuss Special Investigative Units, the state of healthcare, fraud and the what the future holds. It is so critical to understand that not all who work on the payor side are "Out to get you" and that in a lot of cases healthcare professionals like Karen are trying to refute allegations of misconduct. Take a listen and we are sure you're going to agree, this was a fascinating interview with a fascinating healthcare professional!About Karen:Karen Weintraub is the Executive Vice President SIU for Healthcare Fraud Shield. As EVP, Ms. Weintraub is responsible for the design and development of the company's healthcare fraud detection software products and services. She provides subject matter expertise on system design and workflow, business rule development, data mining and fraud outlier algorithms as well as SIU policies and procedures.Prior to joining Healthcare Fraud Shield, Ms. Weintraub was the Senior Manager of SIU Services at GDIT and the Supervisor of Investigations for Health Net, Inc. and managed all northeast healthcare investigations for all commercial, Medicaid and Medicare business and claims of fraudulent activity.Thank you for helping to make The Compliance Guy a 2022 Top 25 Podcast:https://blog.feedspot.com/regulatory_compliance_podcasts/37 min
- TCG Seasons 3 Episode 15 Cloning and Clinical PlagiarismTerry Joins Sean on this episode to discuss Cloning and Clinical Plagiarism including the Do's and Don'ts of Electronic Health Records! A review of OIG's Report on EMRs (CMS and Its Contractors Have Adopted Few Program Integrity Practices to Address Vulnerabilities in EMRs) and what leads to allegations of "Fraud".What is copy-pasting? what is over-documentation? When is it okay to carry-forward information?This is a topic that is not going away and as prevalent today as it was years ago!Thank you for helping to make The Compliance Guy a 2022 Top 25 Podcast:https://blog.feedspot.com/regulatory_compliance_podcasts/37 min
- TCG Season 3 Episode 14 Rozmin Bapat RCM, Auditing, Billing and ComplianceMy special guest will be Rozmin Bapat, Founder of CodeRite Healthcare Consulting. It was a fascinating discussion with a fascinating healthcare professional! Rozmin and I got a chance to discuss a lot of different aspects of healthcare, a bit about her rise through the ranks and what inspires her to keep going!Don't miss this outstanding episode!Thank you for helping to make The Compliance Guy a 2022 Top 25 Podcast:https://blog.feedspot.com/regulatory_compliance_podcasts/58 min
- TCG Seasons 3 Episode 13 U.S. Government Accountability Office (GAO) Medicaid and CMS Telehealth ReportIn this episode Terry and Sean discuss accountability within CMS and more specifically Medicaid Telehealth Services (Quality of Care)... This episode is so important for so many reasons... take a listen and we are sure you will agree.Thank you for helping to make The Compliance Guy a 2022 Top 25 Podcast:https://blog.feedspot.com/regulatory_compliance_podcasts/36 min
- TCG Season 3 Episode 12 Dr. Naveen Sikka - Allergy and ImmunologyRenowned allergist / immunologist Naveen Sikka of US Allergy & Asthma sits down with Sean to discuss the world of Allergey / Immunology and Asthma... After his fellowship in St. Paul, Dr. Sikka was part of North Texas Allergy and Asthma Associates where he spent 8-years.During our discussion Dr. Sikka and I discussed how biologics are impacting patient care, and tackled a bit of controversy; oral immunotherapy treatment (OIT).Dr. Sikka shares his thoughts on payors, targeted audits, and what providers should be doing to sure up their documentation, ensure proper billing /coding and how to deal with medical necessity issues causing claim denials.So much great information whether you are a provider or a patient, you do not want to miss this episode!Thank you for helping to make The Compliance Guy a 2022 Top 25 Podcast:https://blog.feedspot.com/regulatory_compliance_podcasts/57 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.