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The Compliance Guy
By Sean M. WeissBusiness
The Compliance Guy episodes
- TCG Season 3 Episode 11 Locums and Reciprocal AgreementsIn this episode Terry Joins Sean to discuss the ins and outs of Locum Tenens and Reciprocal Agreements for Medicare. Lots to unpack in this episode including covered visit services, continuous services and the exception to the 60-days, global surgery package, modifiers and how physical therapists play into all this...Don't miss this one!Thank you for helping to make The Compliance Guy a 2022 Top 25 Podcast:https://blog.feedspot.com/regulatory_compliance_podcasts/53 min
- TCG Season 3 Episode 10 #TerryTuesday To Refund or Not To Refund...Terry joins Sean to discuss whether to refund or not to refund on a variety of topics including Offshoring (CCM, TCM, etc.), Bundled Services, Durable Medical Equipment, and Amended Medical Records (Addendums, Late Entries, Corrections)...Gray areas area addressed as well:Internal or External Audit of E/M services finds level 5's are auditing at level 3 or 4.Office Visits w/minor procedures not supported on same date.99211 vs 93792 for Protimes (INR testing) when CMS strongly recommends the 93792 and discourages the 99211, but no published rules.Thank you for helping to make The Compliance Guy a 2022 Top 25 Podcast:https://blog.feedspot.com/regulatory_compliance_podcasts/53 min
- TCG Season 3 Episode 9 Opioid Crisis and Increase ProsecutionsIn this critical episode Sean is joined by Robert Liles, ESQ, and renowned opioid expert Dr. James Shear to discuss the ongoing crisis in America, increases in regulatory oversight, and prosecutors' focus on criminal prosecutions... Prescribers of narcotics need to be on-guard to ensure they are taking all necessary precautions to ensure patient compliance as well as their own.It's no longer just a matter of determining what's in a patients' system but what isn't... diversion is a significant problem and providers have an obligation to ensure total compliance. The episode also covers how and when to discharge non-compliant patients and what providers need to do to cover their assets!The increase in data-driven and "medical necessity" audits by government investigators and commercial payor special investigative units for billing presumptive and definitive urine drug tests and urine drug screens continue to plague practices, laboratories, and health systems across the country.Thank you for helping to make The Compliance Guy a 2022 Top 25 Podcast:https://blog.feedspot.com/regulatory_compliance_podcasts/Don't miss a moment of this critical podcast!58 min
- TCG Season 3 Episode 8 #TerryTuesday - PHE ExtensionIn this episode Terry joins Sean to discuss the latest PHE Extension and what that means to the healthcare industry. What does this mean for the "Blanket Waivers" (1135) including physician services, telehealth services, dietary services, and more...53 min
- TCG Season 3 Episode 7 Self Disclosure Protocol vs. Medicare Voluntary Refund ProcessIn this episode I taken on the SDP vs MVRP and provide a detailed breakdown of each as well as when to use each and when to avoid them... Elements covered in this episode include but are not limited to:Fraud and Abuse Laws OverviewOIG Agency BreakdownAnti-Kickback Statute, Stark Law, False Claims Act, Exclusion StatuteDuty to Refund, GenerallyDiscovery; Investigation process; Document retentionOIG Self Disclosure ProtocolCMS Self Referral Disclosure ProtocolMAC Voluntary Refund Processes49 min
- TCG Season 3 Episode 6 #TerryTuesdayIn this episode Terry joins Sean to breakdown OIG Self-Disclosure Protocol vs. Medicare's Voluntary Refund and what each means to your medical practice, hospital, health system, or organization. Things are off to a fast start right out of the gate. This is one of the best episodes yet for our dynamic duo!55 min
- TCG Season 3 Episode 5 with Terry FletcherIt's #TerryTuesday on TCG and we are stoked to bring you this episode! Terry joins Sean to discuss Recovery Audit Contractor Audits (RACs) and their impact on healthcare operations... Sean and Terry have a whole lot of baggage to unpack on this episode regarding Local Coverage Determinations (LCDs), Local Coverage Articles (LCA) and National Coverage Determinations (NCDs)!46 min
- TCG Episode 4 with Chandler MartinChandler joins Sean to discuss the No Surprise Bill Act / Good Faith Estimate (GFE) on this episode! There is a ton to unpack as well as clear up.Chandler works in the Nexsen Pruet's Columbia office and practices in the areas of healthcare and general business/corporate law. He focuses the bulk of his practice on assisting healthcare clients with regulatory, contractual, and transactional matters and has represented a wide variety of health care systems, hospitals, physicians, physician practices, and other healthcare providers and healthcare-related businesses.48 min
- TCG Episode 4 with Chandler MartinChandler joins Sean to discuss the No Surprise Bill Act / Good Faith Estimate (GFE) on this episode! There is a ton to unpack as well as clear up.Chandler works in the Nexsen Pruet's Columbia office and practices in the areas of healthcare and general business/corporate law. He focuses the bulk of his practice on assisting healthcare clients with regulatory, contractual, and transactional matters and has represented a wide variety of health care systems, hospitals, physicians, physician practices, and other healthcare providers and healthcare-related businesses.48 min
- TCG Episode 4 with Chandler MartinChandler joins Sean to discuss the No Surprise Bill Act / Good Faith Estimate (GFE) on this episode! There is a ton to unpack as well as clear up.Chandler works in the Nexsen Pruet's Columbia office and practices in the areas of healthcare and general business/corporate law. He focuses the bulk of his practice on assisting healthcare clients with regulatory, contractual, and transactional matters and has represented a wide variety of health care systems, hospitals, physicians, physician practices, and other healthcare providers and healthcare-related businesses.48 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.