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The Compliance Guy
By Sean M. WeissBusiness
The Compliance Guy episodes
- TCG Season 3 Episode 3 with Christine HallChristine Hall joins Sean on The Compliance Guy Live to discuss the state of healthcare compliance, and the role auditors, coders, and billers play to ensure clean and accurate claims. What is CMS focused on with audits and what are some of the OIG hot targets providers need to be aware of...1 hr 7 min
- TCG Season 3 Episode 2 Medicare's 60-Day RuleAttorneys Jesse Whitten and Steve Lokensgard of Faegre, Drinker, Biddle & Reath, LLP join The Compliance Guy (TCG) to discuss Medicare's 60-Day Rule and its impact on Medicare Advantage and Medicaid Managed Care Plans.50 min
- TCG Season 3 Episode 1 Eric Rubenstein - Ret OIG Special AgentThe one, the only Eric Rubenstein joined Sean on the first episode of season 3 to ensure we came out of the gate swinging. The episode focused on all things OIG Compliance!Topics:1. UPICS2. Telehealth3. DoJ Prosecutions4. Updates on Fraud, Waste and Abuse5. Investigations by the OIG - How they start and how they escalate1 hr
- TCG Episode 26 with Terry Fletcher The Buck Stops HereIn this final Episode of season 2 Terry and Sean discuss who bares the ultimate responsibility for the claims sent out the door to payors. What benefit if any does coder liability insurance have, what is required from an ethics and responsibility standpoint by the associations that credential or license a healthcare professional. What happens in a False Claims Act case, who is the likely target and who faces exclusion?Do not miss this final episode of season 2 of The Compliance Guy!48 min
- TCG Episode 25 Live with Ronald Chapman, II / Fight The FedsRonald Chapman, II joins Sean to discuss his new book Fight the Feds, "Unraveling Federal Criminal Investigations".Do not miss this episode... there is so much to unpack. Whether you are a student of the law or you are an experienced attorney this book is a must for your shelf and this episode is a must for your here and now knowledge!56 min
- Episode 24 TCG with Terry Fletcher - Revenue Cycle Management and Its Impact on ComplianceIn this episode Terry joins Sean for their weekly #TerryTuesday on The Compliance Guy Podcast to discuss Revenue Cycle Management (RCM) and its impact on compliance efforts in physician practices, hospitals, and health systems. Additionally, Sean discusses how he uses RCM when investigating matters for administrative actions and/or trial.This episode is packed with steps to take to ensure a thorough analysis of the revenue cycle as well as do's and dont's.55 min
- Episode 23 with Terry Fletcher Part II of The Medicare Appeals ProcessTerry Fletcher joins Sean for their #TerryTuesday episode and take on Levels III through V (ALJ, DAB and Judicial Review) of the Medicare Appeals Process to ensure listeners have a firm understanding for how to file an appeal at each level and what all is involved to ensure success. Don't miss Part II!59 min
- Episode 22 TCG with Ashley Morgan of Liles Parker - Administrative Proceedings and Provider RevocationsIn this episode Sean sits down with Ashley Morgan of Liles Parker to discuss the Administrative Appeals Process within CMS and the recoupments after level II and recent rulings by the 5th Circuit Court of Appeals and other courts. Sean and Ashley provide insights for who's reviewing your claim(s), what the program integrity manual sets as Medical Record (MR) Scope of Work (SOW) for claims reviewers and how to ensure due process.The episode also focuses on what leads to a provider's revocation of billing privileges with CMS and the steps that can be taken to reverse the revocation. Revocations are happening at a frenzied pace and before it happens to you, get the facts!This is such a critical discussion for those who are responsible for filing appeals at a medical practice, hospital, health system, suppliers, or other types of medical organization.51 min
- Episode 21 TCG #TerryTuesday Medicare Appeals Part 1In Part I of a II part series on appeals Sean and Terry tackle the Redetermination and Reconsideration in extreme detail.What's Covered in Part I:Terms to be familiar withAreas of focus to determine if you should appealPitfalls to avoidRequired timelines and forms to file your appealIf you struggle with appeals this no nonsense, straightforward approach will set you on the path to filing winning appeals.40 min
- Episode 20 TCG with Jose "Joe" Vela, Jr. of Clark HillJose "Joe" Vela Jr., J.D., LL.M. joins #thecomplianceguy podcast tomorrow (Friday / February 4th) to discuss Civil Investigative Demands (CID) issued by the Department of Justice (DOJ) and how the Office of Inspector General (OIG) is used to carry out the subpoena.We will be discussing the False Claims Act (FCA), Health Care Fraud Statute, the significance of a compliance plan and creating a culture of compliance within your organization.Recently transitioned from the Assistant U.S. Attorney's (AUSA) Office to private practice "Joe" discusses recent cases he prosecuted how cases turned from civil to criminal and what got culprits caught in the first case.This is a fascinating discussion you will not want to miss especially when we lay out a roadmap for healthcare professionals and physicians to follow to ensure compliance.You can find the podcast here on linkedin facebook youtube apple podcast spotify podcasts amazon iheart radio and more than 80 podcast platforms...1 hr 17 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.