Podcast
The Compliance Guy
Hosted by Sean M. Weiss · EN
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.
42episodes
Episodes
Newest firstAll episodes
Episode 350 - The Ethics of Compliance in Healthcare
Feb 11, 202500:59:49Tap to summarizeSummaryIn this conversation, the panel discusses the complexities and challenges faced by external auditors in the healthcare industry. They explore the importance of maintaining integrity and ethical standards while navigating client relationships, compliance issues, and the business side of medicine. The discussion highlights the need for clear communication and understanding between auditors and healthcare providers to ensure proper documentation and adherence to regulations. The conversation delves into various aspects of healthcare compliance, focusing on HCC chart reviews, the integrity of medical records, and the complexities of transitional care management (TCM). The participants discuss the importance of understanding medical necessity, the role of digital e-visits, and the risks associated with vendor relationships in healthcare. They emphasize the need for accurate documentation, the challenges faced by providers, and the importance of compliance in billing practices.TakeawaysExternal auditors play a crucial role in healthcare compliance.Clients often want validation rather than objective feedback.Maintaining integrity is essential in consulting roles.Documentation must support billing to avoid compliance issues.Providers need to understand the business side of medicine.Ethical standards should not be compromised for profit.Communication is key in client-auditor relationships.Preventative services should not incur out-of-pocket costs for patients.Auditors must navigate gray areas in compliance guidance.The importance of philosophical alignment in consulting engagements. HCC chart reviews are crucial for identifying missing information.Metadata manipulation in medical records can lead to compliance issues.Transitional Care Management (TCM) is essential for patient support post-discharge.Providers often misunderstand the billing process for TCM services.Medical necessity must be clearly documented and justified.Digital e-visits offer a new avenue for patient-provider communication.Vendors can create compliance risks if not properly vetted.Healthcare providers need to be aware of the implications of coding errors.Consultants play a vital role in ensuring compliance and proper documentation.Coders must actively correct and verify the accuracy of medical records.
Transcribe →Episode 349 - #TerryTuesday - Decoding Imaging Services
Feb 6, 202500:23:22Tap to summarizeSummary In this episode, Sean and Terry discuss the complexities of billing for imaging services, focusing on the distinctions between professional and technical components. They explore compliance issues, the importance of proper documentation, and the challenges faced by healthcare providers in navigating billing practices. The conversation also touches on patient interactions and the ethical considerations in medical billing, emphasizing the need for transparency and accuracy in reporting services rendered. Takeaways Understanding the difference between professional and technical components is crucial for accurate billing. Billing globally means including both technical and professional components in the fee. Documentation must reflect formal interpretations to justify billing for imaging services. Modifiers like 26 and TC are essential for distinguishing between professional and technical billing. Certain imaging services require specific certifications for billing. Billing practices can vary significantly between different specialties and settings. Providers must be cautious not to double bill for services rendered by other providers. Patient interactions can complicate billing, especially when documentation is unclear. It's important to engage in constructive dialogue about billing practices and compliance. Healthcare billing often operates in shades of gray, requiring careful consideration of regulations.
Transcribe →