Compliance Conversations By Healthicity

Let’s say you’re a Medicare Advantage organization and one day you receive a notification from CMS that you’ve been selected for program audit. What should you do? Recently, I sat down with Scott Robinson, director of compliance at Davis Vision, and former medicare contractor who used to accompany the folks at CMS to conduct effectiveness audits. Robinson gave me the details on what to do and what not to do when and if you receive the news. “The first thing is to not panic,” Robinson said, “All you really need to do is explain yourself. You just need to articulate your usual business practices in a way that CMS will understand and agree with.” But doing this requires you to be ready for it. Tune into this episode to learn how to:Prepare for a CMS Audit Before it HappensStay Calm During a CMS AuditEffectively Explain Yourself to CMS 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 Youtub

Michael Warner, an Osteopathic physician, board certified in family medicine, turned patients’ rights advocate has a lot say about a patient’s rights to access. Warner is passionate about empowering patients to co-author their medical record. Through his research, Warner has found that giving patients the opportunity to take control of their information greatly increases accuracy, efficiency, and patient satisfaction. In a post-study follow-up survey, most patients reported that they “appreciated being given the chance to co-author” their medical records. For any healthcare organization, this is music. Listen to this episode, Patients Empowered: Improving Accuracy Through Co-Authorship, to learn how to: Collect patient data before their visit to maximize efficiency. Share history, exam, and Medical Decision Making with patients for accuracy. How HIPAA’s privacy rule allows patients to amend their records. Thank you for listening! Please share, like, and subscribe. If you'd like to see more compliance and

Everything You Never Knew You Needed to Know About ACO Compliance by CJ Wolf 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.

In this episode of Compliance Conversations, I sat down with Stephani Scott, VP of Audit Services for Healthicity, to chat about her twenty years of experience and pick her brain on important auditing issues. As all of you know, auditing is a crucial component of an effective compliance program. Stephani explains how she approaches post-audit education with difficult providers, “I always tell them to be prepared first and foremost.” Then she adds, “make sure you’ve reviewed the audit and you know where they did well. Sometimes the effectiveness depends on your approach.” Scott provides rules for post-audit education, like how to deal with a physician who inherently distrusts auditors or bad apples who code incorrectly on purpose. Tune in to learn the auditing ropes with expert Stephani Scott and learn how to: • Build Trust with Providers• Effectively Change Behaviors• Approach Post Audit Educations Like a Pro• Deal with Bad Apples Thank you for listening! Please share, like, and subscribe. If you'd like

In this episode of Compliance Conversations: I asked compliance and healthcare law expert Marcie Swenson, “What do you think the hot topics will be for 2018.” And she gave us two answers: “Benchmarking and data breaches and cyber security.” Organizations will be utilizing OIG guidance to create their own benchmarks and rate their own compliance program. I also asked Marci what she hoped to see differently in 2018 and she passionately responded, “more risk assessments. To be proactive in compliance you have to perform a risk assessment.” Tune in to this episode of Compliance Conversations: Benchmarking Your Way to Compliance, for hot topic predictions and tips for 2018 including how to: Use the OIG Guide to Benchmark Your ProgramPrepare for Cyber Threats and Data BreachesUtilize Risk Assessments 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 re

Find out how Culture can Solve Compliance Issues“Compliance professionals were people before they were in compliance,” said Rudy Green in our most recent episode of Compliance Conversations. Green told me about his long and interesting path to compliance from an undergraduate degree in organizational behavior, to being drafted into the NFL, then to law school. He did all of this before taking a position as the compliance officer at the University of Texas in Austin. He added, “life experience is what makes a great compliance officer,” he said. Compliance professionals are critical to a company’s success (especially in healthcare). So, it only makes sense that company culture counts. Could company culture be the answer to solving compliance issues? The data suggests yes but — big surprise — it’s not always that easy.Tune in to this episode of Compliance Conversations to learn how to: Effectively Deal with Complex Issues as They AriseTackle Risk Assessment the Right WayUse Patience as a Compliance Tool Thank yo

In this episode, compliance expert CJ Wolf sits down with product development expert Jeff Young to discuss tools that can simplify compliance and make you so much more effective as a compliance officer. Young explains how tools are changing healthcare organizations, “with the tools that are out there today you can gather data consistently in one location, identify risks based on data trends and decide what to do. Maybe you need to put a new policy in place, or you need to introduce training to your organization. The idea is that it gives you the power to get away from some of this manual work by utilizing technology to help automate and optimize what you’re doing as a compliance officer.” Regarding random audits, Young asks, “if you’re looking at just ten random records, how do you know those are representative of what the physicians doing, and how does it really help you to understand where you need to focus for that physician?” Listen to this episode to learn how to utilize technology to decrease manual lab

For this episode of Compliance Conversations, I sat down with Chad Peterson, a senior consultant at a large hospital, in their professional coding and reimbursement group. He educates physicians, mid-level providers/ advanced practice providers and even ancillary staff about E/M coding. Peterson explained some of the most common E/M coding mistakes. For example, in 2013 they came out with the status of 3 chronic conditions in addition to the already set guidelines. There’s often confusion around when to use regular HPI elements or when to use the status of 3 chronic conditions. “This is something really useful for your physicians,” Peterson added. Tune in to this episode of Compliance Conversations, “E/M Coding Tips and Risks,” to learn: How to navigate the gray areas of medical necessity When to use the chronic conditions statusWhy the risks of EMR upcoding and auto-populating are so grave Thank you for listening! Please share, like, and subscribe. If you'd like to see more compliance and auditing con

I recently talked with Christopher Chandler, a senior consultant at a large medical group in the professional coding and reimbursements department. Christopher explained a whole slew of common misunderstandings of surgical coding. We soon realized that at the end of the day, many people just don’t understand the coding system. There’s so much confusion about how the coding system works, how ICD coding works with CPT coding, and even more confusion when multiple procedures overlap. It’s cause for a lot of mistakes–and a ton of stress. But, when you really understand the system, you can navigate surgical coding in a way that will accurately reflect what the physician’s doing, regardless of complexity. Rid your life of added stress by becoming a surgical coding expert by listening to our newest podcast, Common Misunderstandings of Surgical Coding, where you’ll learn how to:Ensure reimbursement through accurate codingCode separate procedures Avoid over-coding, coding post-op work, and more! Thank you for listenin

In this episode of Compliance Conversations, I sat down with Senior Consultant, Brenden O’Neil, who works in Intermountain’s professional coding and reimbursement department. O’Neil and I had a fascinating discussion on CPT codes and the complicated gray area of coding a laminectomy. The code has changed, physicians are in limbo, and revenue is being lost. And, there are a number of compliance issues that might arise. If you’re a compliance officer in an organization with neurosurgeons, you should perform an audit and run some data analytics for the code 22633 or that range of codes that represent fusions anytime a 63047 or laminectomy is reported. Otherwise, there could be trouble on the horizon. If you’re in healthcare, you won’t want to miss this. Listen to our newest podcast, Complex Coding, Complicated Compliance, to brush up on: Laminectomy and Potential Compliance IssuesSpecific Updates to Code 63047Payers, Medicaid, and more! Thank you for listening! Please share, like, and subscribe. If you'd li

In this episode, Sean McKenna, Shareholder at Greenberg Traurig, and I discussed the ins-and-outs DOJ and OIG investigations, and how the federal government is determining who–and how–they prosecute. While we all know the importance of having a robust, effective compliance plan, Sean also stresses the importance of having an independent and empowered compliance committee. One which refuses to bury it’s head in the sand when compliance issues surface. In his experience, organizations that operate routine, transparent compliance programs will be equipped with the best line of defense. Tune in to our Compliance Conversations podcast, Proactive Compliance is Your Best Defense, to listen to Sean and CJ dive into: Why incident reporting and documentation needs to be taken seriously What the OIG constitutes as an illegal kickbackHow to protect your organization from false claims investigations Thank you for listening! Please share, like, and subscribe. If you'd like to see more compliance and auditing content

In this episode, compliance expert CJ Wolf M.D., and Auditor Superstar Charla Prillaman, spend twenty-five exciting minutes (perfect for your short commute) chatting about how to overcome communication hurdles between auditing and compliance departments.Tune in to their conversation about potential ways compliance professionals can make auditors’ jobs easier, how both departments can leverage each other's expertise, and much, much more. And, be sure to subscribe to the Compliance Conversations Podcast for your regular dose of compliance education. 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.

Nick Merkin, CEO of Compliagent, chatted with me from his home in sunny California about compliance from an attorney’s perspective. Merkin is a lawyer by training and spent the first ten years of his career in healthcare law, primarily in litigation defense. Merkin explained why it’s so important for organizations to see compliance from an attorney’s perspective. And how his unique point of view provides an additional layer of protection from compliance violations. In this compelling interview, Merkin explains how organizing compliance functions is, “worth it’s weight in gold.” Tune in to this podcast, An Attorney Talks Compliance, to find out how to: Focus Compliance on Processes and InfrastructureOrganize Compliance Functions to Protect Against LitigationMitigate Legal Liabilities That Might Arise in Healthcare 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

Back in the 1980’s, Larry Plutko started his career in Healthcare. By the 90’s he found himself fascinated by compliance. And in 2008, he accepted a position of compliance officer in Austin, Texas, where he became an important career mentor to our very own compliance expert, CJ Wolf. Now, Plutko is a compliance consultant who currently sees clients across the country. In this episode of Compliance Conversations, Wolf interviews Plutko on the compliance career path and how to to become a compliance officer. “I believe in diversity and organizations benefit from having compliance Officers from a number of different backgrounds. Compliance Officers come from all sorts of backgrounds from legal to clinical, ethics and auditing,” said Plutko. Plutko and Wolf discuss the ways in which compliance is growing rapidly and why it was named one of the hottest career tracks in an article in the Wall Street Journal in 2014. Then, they dive into what it means to be a good compliance officer and how to develop the unique ski

In this episode of our podcast, Compliance Conversations, Wolf and Dunnick tackle documentation, what to do, what not to do, and what you definitely didn’t learn in medical school. Wolf is a compliance expert who went to medical school but found a passion for the compliance side of things. Dunnick is not only a physician with years of practice experience, he’s also a full-time consultant who educates physicians on coding and documentation best practices. Documentation dream team, if we’ve ever seen one. In this detailed, thought-provoking interview, Dunnick and Wolf dive deep into compliance, coding, and audit risks. Particularly, how to use EHRs effectively and efficiently. Including, why you should be weary of copy and pasting in EHRs, and documentation best practices that every physician should know. Listen to our Podcast, A Physician Explains Documentation Best Practices, to learn: How to Document CorrectlyWays to Reduce Audit Risk Exposure Rules You Didn’t Learn in Medical School Thank you for listening

In our newest episode of Compliance Conversations, CJ Wolf sits down with Security and Privacy expert, Steve Spearman, for an enthusiastic chat about how healthcare practices can protect themselves from imminent threats.In just a few seconds, Wolf and Spearman launch into a dynamic back and forth exchange about why privacy and security matters, how OCR audits have been a gift that keeps on giving and why more organizations need to have a list of their Business Associates on hand. Plus, a little banter about why some companies are forced to negotiate with terrorists. Listen to our newest podcast, Episode 2 of Compliance Conversations, So Now You Take Security And Privacy Seriously, to learn: Why OCR Audits Have Been A Gift To Security ExpertsHow To Protect Your Organization When Working With Business AssociatesThe Real Reason Your Organization Needs to Backup Your Data Thank you for listening! Please share, like, and subscribe. If you'd like to see more compliance and auditing content feel free to follow

In this episode, compliance expert CJ Wolf M.D., and Auditor Mastermind, Lamon Willis, spend twenty-five captivating minutes (perfect length for your lunch break) chatting about the many ways that auditing best practices support your organization’s compliance. They’ll be bantering about common CCI Audit Errors, Modifier 59 Best Practices and much, much more. Tune in for your weekly dose of compliance and audit education. 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.