Compliance Conversations By Healthicity

Learn from our compliance expert, CJ Wolf, and Psychiatrist, Dave Paulson, about how to optimize mental health outcomes in this episode. Thank you for listening! Please share, like, and subscribe. If you'd like to see more compliance and auditing content feel free to follow us on social media. LinkedIn Youtube Facebook Instagram Check out our resource center and weekly compliance newsletter for additional compliance and auditing content from our experts.

Our compliance expert, CJ Wold M.D., spoke with two Reiki practitioners, Justin Larsen and Julie Crane R.N., about the history, science, and practical uses of Reiki. Thank you for listening! Please share, like, and subscribe. If you'd like to see more compliance and auditing content feel free to follow us on social media. LinkedIn Youtube Facebook Instagram Check out our resource center and weekly compliance newsletter for additional compliance and auditing content from our experts.

Recently, I sat down with Brian Burton, our new Chief Compliance and Privacy Officer, for an all-new episode of the Compliance Conversations podcast. Given the time of year, and his area of expertise, we focused our discussion on a topic on many people’s minds: Privacy and Security Risk Assessments. I know these assessments can be daunting to approach or, as Brian put it, “I think a lot of organizations struggle with what does that mean, and how can I accomplish this activity with the minimum amount of effort, but still know that it’s accurate, and that your organization is protected from cyber security threats.”Having worked in the healthcare industry for more than 15 years, Brian become an expert in all things project management and technology. He's devoted most of his career to developing, implementing, and providing oversight for Compliance and Privacy program initiatives, working with more than one hundred healthcare facilities. Considering Brian’s vast experience, we discussed the symbiosis between

Around Healthicity, we love nothing more than to provide answers to some of your most pressing questions. And boy, do we get a lot of them. Because of this, we asked you to send us the questions that most perplex you while on the job. We got a ton of great questions (thank you), some of which even had us scratching our heads, too. So, I took a bunch of your questions to our resident auditing experts, Stephani Scott and Lori Cox, and sat down for a little chat. What we Then, we took a handful of those questions and and sat down to discuss them during this episode of Compliance Conversations, titled “Ask an Auditor Anything.” Here’s a sneak peak at some of the questions we discussed, and answered:Can Documentation of a Previous Allergic Reaction be Used Under ROS, or Only PMH?If the physician states "same/unchanged from last visit" to History will they receive credit for reviewing the last visit information? If the Documentation States “NO PFSH," Is This Applicable On a New PT or Consult Visit?

It’s that time of year again, when everyone is either breathing a sigh of relief because they’ve just completed their annual HIPAA risk assessment, or they’re cramming to get it done before year’s end. In the spirit of HIPAA season, we decided to turn the tables on CJ. So in this latest episode of Compliance Conversations, we had our very own SVP, Jeremy Schow, interview our local HIPAA expert, CJ Wolf, MD, to discuss all things HIPAA. And he had a lot to say. “The number one reason we do a risk assessment is it's a requirement. Number two though, it's good practice, right? We're in the business of helping patients, and we want to keep that information private and confidential. So, it's a good business practice,” CJ observed, before going on to answer all sorts of questions around HIPAA, including:Should I Conduct an Assessment Every Year?How Do I Conduct an Effective HIPAA Risk Assessment?What are Some Common HIPAA Mistakes I Should Avoid? Thank you for listening! Please share, like, and

In part two of my conversation with Christopher Chandler, a Technical Manager of Professional Documentation and Coding, at Intermountain Healthcare, we dove into the NCCI policy manual.It’s been a hot topic, as of late. Mostly because, as Chandler put it with a grin, “people hate the NCCI Policy Manual. They see it as a big book of rules that stops them from getting paid for the stuff they are doing.” But as you’ll hear, the manual is so much more. For instance, sometimes you can bill two codes together and, other times, you can’t. And when you need to know the answer, you consult the NCCI manual. Because many commercial payers have adopted these edits as well, it’s become an indispensable resource for any compliance billing department that’s using today’s best practices. But the manual can be daunting, and oftentimes difficult to decipher. Which is why during this episode of Compliance Conversations, "A Deep Dive Into the NCCI Policy Manual," Chandler and I jump right into the ins-and-outs of the

Recently, I sat down with Christopher Chandler, a Technical Manager of Professional Documentation and Coding, and we had a lot to cover during our podcast. So much so, that we actually recorded two new podcast episodes. In this first episode, Understanding the Nuance of NPP Coding, we dove into the world of non-physician practitioner (NPP) coding. NPPs, as Medicare calls them, are made up of a number of different provider types. They include nurse practitioners, physician assistants, certified nurse anesthetists, clinical nurse specialists, amongst others. The world of NPPs is ever-changing as hospitals are, in Chandler’s words, “developing new ways of providing care to patients… and help alleviate the burden that physicians are feeling, with the amount of patient load that they have.”If your hospital or clinic has a number of NPPs, it could be a signal to payers to keep an eye on your claim submissions. Which makes it all the more critical that your billing department has the tools to correctly code your NPP

For this installment of Compliance Conversations, we interviewed Jake Geertsen, a Technical Manager in the documentation and coding, who specializes in telehealth. It’s a fast-growing segment of healthcare, which has spawned a lot of questions around the field. Not least of which is: What exactly is telehealth? According to Geertsen, telehealth is “a collection of means or methods for enhancing healthcare, public health, and health education delivery and support, using telecommunication technologies.”Just ten years ago, few of us were carrying around the computing power we commonly find in our pockets and purses today. Nor did we know the benefits this technology could have to, as Geertsen puts it, “to the patient, the healthcare organization looking to cut costs, to insurance companies also looking to cut costs. In many scenarios, this is an area of innovation and improvement.” Understand the History and Evolution of TelehealthImplement Proper Coding and Billing Compliance PracticesStay Current with Ever-cha

I sat down with Tyler Griffeth, a Technical Manager of Professional Documentation and Coding at Intermountain Healthcare, to discuss a couple of his favorite Medicare Internet Only Manuals (IOMs), specifically the National Correct Coding Initiative (NCCI) Policy Manual and the Claims Processing Manual. The NCCI Manual, about which he jokingly said, “I’ve got mine laminated, I can read it in the tub with a little bit of bubbly” is just one of his favorites. Meanwhile, the Claims Processing Manual, “Is a really great resource if you’re dealing with things like denials, but also if you’re involved in a RAC audit.” Tune in to my most recent episode of Compliance Conversations, How to Earn a Huge ROI from Medicare’s IOMs, and learn how to:Use the NCCI Policy Manual to Clarify Procedure Codes to PhysiciansLeverage the Claims Processing Manual to Avoid DenialsApply Situational Modifiers in Conjunction with Codes Thank you for listening! Please share, like, and subscribe. If you'd like to see more compliance and

Whether you’re dealing with medical devices or new drugs–regardless if it’s a product or a service, and whether that product or service ever even leaves the United States, export controls affect every organization in one way or another. That’s why I was so excited to sit down with Export Controls and Compliance expert, Wendy Epley, the president of Epley Consulting, for this episode of Compliance Conversations. As a compliance professional in healthcare, you might hear the word “export” and think ‘I don’t ship anything out of the country, so export controls don’t apply to me.’ But surprisingly it does! Epley explained, “[export controls] is referring to a very complicated network of federal agencies and regulations that are interconnected to regulate or control how things are to be protected in order that they are not used in a way that would cause harm...regardless of where those persons are located, including if they are here within the United States.” Epley also went into detail about the foreign corrupt p

Listen to this most recent episode of Compliance Conversations, How to Build a Mutually Beneficial Relationship with Your Compliance Committee, with special guest, Judith Maber-Fox, to learn how to:Build a Mutually Beneficial Relationship with your Compliance CommitteeEngage Sr. Leadership to Actively Support the CommitteeCreate Opportunities That Give You a Seat at the Table Thank you for listening! Please share, like, and subscribe. If you'd like to see more compliance and auditing content feel free to follow us on social media. LinkedIn Youtube Facebook Instagram Check out our resource center and weekly compliance newsletter for additional compliance and auditing content from our experts.

For this Compliance Conversations episode, I’ve got a special treat for you: Dr. Ira Specter. He spent many years as a practicing OBGYN physician and is also a certified coder and medical auditor. After practicing medicine for a few decades he went on to run a large medical management company, where they did billing collection, coding, compliance, and ICC10 courses for sixty-five physicians. Because of his unique perspective, we tackled bridging the gap between coding and auditing and physician documentation. I asked Dr. Specter, “what’s the biggest area for improvement for physician documentation?” After a brief pause, he said, “Let me start by saying, by and large, most physicians are under coding.” It seems, according to Specter, that physicians are “cutting off their own legs,” and also “cherry picking” codes. What does that mean?Listen to this episode to find out what Dr. Specter views as the biggest mistakes physicians are currently making and learn: What Coders/Auditors Should Look Out For in Physician

There are a lot of barriers in compliance. In this installment of Compliance Conversations, I chat with Eric Dominguez, the chief compliance officer at Emerus, a management company that specializes in healthcare systems. “Part of the services we provide to these joint ventures is a compliance program.” Dominguez explains some of the common hurdles of aligning with partners. “It’s a challenge and at the same time, it’s really a great opportunity for growth.” So how do Dominguez and his group manage compliance on such a big scale? And how can we get better at it ourselves? Listen to this episode to learn how to: Tackle Compliance Like a Large Hospital GroupManage the Unique Challenges of Micro-Hospitals Navigate Policies and Procedures for Hospital Licensing Thank you for listening! Please share, like, and subscribe. If you'd like to see more compliance and auditing content feel free to follow us on social media. LinkedIn Youtube Facebook Instagram Check out our resource center and weekly compliance news

Whether it’s an EMR or a compliance software solution, you want technology to do the work for you, not make you do extra work. Knowing where tech disappoints has helped Healthicity’s president, and my guest on my most recent episode of Compliance Conversations, Barry Johnson, D.D.S., to create software solutions that healthcare organizations really want. And, according to the US Government, solutions that healthcare organizations really need. “Recently at HCCA, we heard government officials telling the people that were at the meeting that compliance has got to move into the digital age and start doing things with software rather than spreadsheets.”It doesn’t matter if you’re an early adopter or tech-adverse, this informative and fun episode will bring you up to speed on all things healthcare technology from the largest challenges to the newest tools and gadgets that save lives or make your workday a whole lot easier. If tech has got you down: Johnson just might have a solution for you. Tune into this episode

I’ve been getting a lot of requests to do a show about coding and billing and I couldn’t think of a better guest than my friend and former colleague, Jay McVean, an expert in billing and coding compliance with the University of Texas Health Science Center in Houston. Starting out, I had to ask: What’s the biggest coding and billing compliance issues in medical school, with faculty, and academic medical centers? This is where McVean’s expertise really shines and it’s an area that doesn’t get talked about nearly enough. McVean explained, “One of the biggest challenges we face in this ever-growing clinical world is that our teaching physicians really must understand who they’re working with...When various people are touching the notes, documenting portions of the visit, at the end of the day physicians are really confused about if they have a TPA situation, or if this is a shared split visit if I’m in the hospital, and how much of the note to document versus an NP or a PA.” From there, we talked about physician

In this episode of Compliance Conversations, I chatted with Charla Prillaman, the Regional Vice President of Audit Services and 30-year compliance veteran, about the crucial differences between Medical Necessity and Medical Decision Making (MDM). Prillaman pointed out that both terms are incorrectly used interchangeably, though they have distinctly different meanings. “Medical Necessity is the foundation for payment for all medical services. We find the original or the beginning statement about medical necessity being the overarching criteria all the way back into the social security act…Now the complexity of medical decision making is that it’s intended to somehow or another quantify a provider’s cognitive work in a specific encounter with the patient.” Said Prillaman. In this highly requested conversation, Prillaman breaks down how to properly document medical necessity and medical decision making and how to quantify something as difficult as “cognitive effort” for MDM. Tune into this episode of Compliance

I recently spoke with Brooklyn Trumpy on what it’s like to be new to compliance. Trumpy graduated in 2009 with a degree in Operations Management and ended up in compliance five years ago when she took a role at Community Health Systems and worked her way into a compliance role. Trumpy found that being new to compliance was a challenge. She explained how it can be intimidating to learn all of the new rules and regulations and how to piece together the puzzle that is compliance. She initially struggled to make connections and find her tribe within Compliance and it took some time to learn how to stay organized. Trumpy had some expert advice for new compliance professionals that will help them have an easier transition into the world of compliance. Listen to this episode of Compliance Conversations, "Tips for When You’re the New Kid on the Compliance Block," to learn: * Which Personality Types are Drawn to Compliance in the First Place * How to Set Expectations as a New Compliance Professional* Why

Back in February, CMS announced changes that seem to allow medical students a lot more freedom to document a patient’s medical record. Which could sound like a dream to physicians who might be thinking that the students will help ease the heavy burden of bureaucracy, but auditors are a little worried. Auditors are going, “Wait, hold on, we’ve got to really look at this before we jump the gun.” I spoke with expert compliance auditor, Charla Prillaman, who’s lived and breathed auditing for decades. The hard part, it turns out, isn’t understanding the new rule; the hard part is re-educating doctors. Tune into our latest episode of Compliance Conversations, The Teaching Physician Rule: A Blessing or a Curse, to learn the:New Specifics of Student Documentation for E/M Services and HPI, Dangers of Improper Documentation Teaching Physician’s Responsibility to Verify and Attest to Student Documentation. Thank you for listening! Please share, like, and subscribe. If you'd like to see more compliance and auditing

We kicked off this episode of Compliance Conversations with a guest host, our very own compliance expert, Marcie Swenson, and her special guest, Emily Haley, who has worked as a Chief Privacy Officer and Compliance Director at Intermountain healthcare and is currently working in Care Transformation. In the first half of the show, Haley gave us a full fledged rundown on gap analysis, risk analysis and risk management plans. In the second half of the show, we dove unapologetically into the OCR’s phase 2 desk audits and what we can all learn from them. “Everybody is familiar with OCR’s phase 2 desk audits, where they audited 63 covered entities, and I think 40 something business associates. They used a scale 1 through 5, 1 being the very best risk analysis or risk management plan, and 5 being the very worst...more than half both business associates and the covered entities had scored a 4 and a 5. That’s shocking. That means most of us are not doing the right things.” Tune into our latest episode of Compliance Co

Weed. Pot. Ganja. Marijuana goes by many names and has been a part of the global counterculture scene for decades. But now it’s quickly becoming a part of healthcare, as medical marijuana continues to be legalized across the nation. In my latest episode of Compliance Conversations, I talked with Judy Cassel, JD, MBA, an expert legal advisor on all things medical marijuana. I asked her how medical marijuana will impact physicians, compliance officers, and hospitals. There are dangers in prescribing it even if it’s legal. While each state is able to decide on whether or not to legalize medical marijuana, it’s still illegal at a federal level–this is where things get complicated. Cassel explained the dangers of physicians, or a practice, prescribing medical marijuana and how you and your organization can recommend it while still remaining compliant. Listen to this episode to learn how to: Reduce Opioid Deaths and Addiction Avoid Violating the Federal Law with Medical MarijuanaRecommend Medical Marijuana and Stay