Spotting The Red Flags: Identifying Coding Compliance Risks Within Your Organization Compliance Conversations By Healthicity podcast

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תוכן מסופק על ידי Compliance Conversations by Healthicity and CJ Wolf. כל תוכן הפודקאסטים כולל פרקים, גרפיקה ותיאורי פודקאסטים מועלים ומסופקים ישירות על ידי Compliance Conversations by Healthicity and CJ Wolf או שותף פלטפורמת הפודקאסט שלהם. אם אתה מאמין שמישהו משתמש ביצירה שלך המוגנת בזכויות יוצרים ללא רשותך, אתה יכול לעקוב אחר התהליך המתואר כאן https://he.player.fm/legal.

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Battle Camp S1: Reality Rivalries with Dana Moon & QT 1:00:36

לפני 12 ימים1:00:36

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Do you have fond childhood memories of summer camp? For a chance at $250,000, campers must compete in a series of summer camp-themed challenges to prove that they are unbeatable, unhateable, and unbreakable. Host Chris Burns is joined by the multi-talented comedian Dana Moon to recap the first five episodes of season one of Battle Camp . Plus, Quori-Tyler (aka QT) joins the podcast to dish on the camp gossip, team dynamics, and the Watson to her Sherlock Holmes. Leave us a voice message at www.speakpipe.com/WeHaveTheReceipts Text us at (929) 487-3621 DM Chris @FatCarrieBradshaw on Instagram Follow We Have The Receipts wherever you listen, so you never miss an episode. Listen to more from Netflix Podcasts.…

Compliance Conversations by Healthicity « »
Spotting the Red Flags: Identifying Coding Compliance Risks Within Your Organization

לפני שנה 33:17

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תוכן מסופק על ידי Compliance Conversations by Healthicity and CJ Wolf. כל תוכן הפודקאסטים כולל פרקים, גרפיקה ותיאורי פודקאסטים מועלים ומסופקים ישירות על ידי Compliance Conversations by Healthicity and CJ Wolf או שותף פלטפורמת הפודקאסט שלהם. אם אתה מאמין שמישהו משתמש ביצירה שלך המוגנת בזכויות יוצרים ללא רשותך, אתה יכול לעקוב אחר התהליך המתואר כאן https://he.player.fm/legal.

This Compliance Conversations episode is a must-listen for anyone in healthcare compliance or coding. We invited Leslie Boles, Co-Owner and President of Revu Healthcare, to chat about identifying coding compliance risks within healthcare organizations. Tune in to Leslie and CJ Wolf’s discussion for more on: - The importance of staying curious and adaptable - The significance of regular audits and assessments in proactively identifying compliance risks - Common coding compliance risks and blind spots within organizations - Strategies for mitigating compliance risks, including the role of data analytics and technology They also talk about one of the most important things to keep top-of-mind – staying humble and acknowledging gaps in knowledge to drive continuous improvement.

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113 פרקים

#CJ Wolf #Podcasting Education #Compliance Conversations By Healthicity

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Spotting the Red Flags: Identifying Coding Compliance Risks Within Your Organization

Compliance Conversations by Healthicity

15 subscribers

published לפני שנה

שתפו

MP3•בית הפרקים

תוכן מסופק על ידי Compliance Conversations by Healthicity and CJ Wolf. כל תוכן הפודקאסטים כולל פרקים, גרפיקה ותיאורי פודקאסטים מועלים ומסופקים ישירות על ידי Compliance Conversations by Healthicity and CJ Wolf או שותף פלטפורמת הפודקאסט שלהם. אם אתה מאמין שמישהו משתמש ביצירה שלך המוגנת בזכויות יוצרים ללא רשותך, אתה יכול לעקוב אחר התהליך המתואר כאן https://he.player.fm/legal.

This Compliance Conversations episode is a must-listen for anyone in healthcare compliance or coding. We invited Leslie Boles, Co-Owner and President of Revu Healthcare, to chat about identifying coding compliance risks within healthcare organizations. Tune in to Leslie and CJ Wolf’s discussion for more on: - The importance of staying curious and adaptable - The significance of regular audits and assessments in proactively identifying compliance risks - Common coding compliance risks and blind spots within organizations - Strategies for mitigating compliance risks, including the role of data analytics and technology They also talk about one of the most important things to keep top-of-mind – staying humble and acknowledging gaps in knowledge to drive continuous improvement.

… continue reading

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#CJ Wolf #Podcasting Education #Compliance Conversations By Healthicity

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Conferences, Coding, and Compliance: What We Learned 38:57

לפני יומיים38:57

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38:57

From artificial intelligence in audit workflows to CMS’s renewed focus on fraud, waste, and abuse, this episode of Compliance Conversations covers the biggest themes that emerged from HEALTHCON and HCCA’s Compliance Institute. Tune in to hear real takeaways from the exhibit hall, speaker sessions, and side conversations—including why quality of care oversight is gaining new attention. CJ Wolf, MD, and Brian Burton, Healthicity Chief Compliance & Privacy Officer, discuss: - Why AI was everywhere—and what it means for your compliance program - The latest OIG and DOJ guidance on effectiveness and enforcement - How CMS is signaling a “war on fraud, waste, and abuse” - What quality of care oversight looks like in the real world…

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What to Do When the Audit Letter Arrives 30:40

לפני 16 ימים30:40

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30:40

Audits are an inevitable part of healthcare. But they don’t have to throw your practice into chaos. In this episode, CJ Wolf talks with regulatory and transactional healthcare attorney Christina Kuta, a Shareholder at Roetzel & Andress, about the essential steps providers should take when facing a third-party audit. You’ll learn: - The first three things to do when you receive an audit notice - How government and commercial audits differ - Why self-auditing matters—and how to do it right - Tips for reducing risk, managing appeals, and avoiding common pitfalls - Whether you're a compliance officer, auditor, or provider, this episode is packed with practical advice and real-world insights. You can reach Christina at CKuta@ralaw.com.…

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Inside IROs: What Compliance Professionals Need to Know 28:13

לפני 30 ימים28:13

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28:13

Independent Review Organizations (IROs) play a crucial role in healthcare compliance, particularly when organizations are under a Corporate Integrity Agreement (CIA). In this episode of Compliance Conversations, CJ Wolf interviews Stephani Scott, VP of Audit Services at AAPC, on what it really means to be an IRO. You’ll discover: - What IROs do and why independence matters - The key components of CIA audit timelines and expectations - How RAT-STATS ensures unbiased sampling…

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From Templates to Time-Savers: EHR Tips for Coders and Clinicians 30:45

לפני 6 weeks30:45

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30:45

In this episode of Compliance Conversations, host CJ Wolf chats with Elizabeth Herbert, an Epic Application Analyst with over 25 years of healthcare experience. Together, they break down the myths around EHR templates, offer practical tips for providers and compliance professionals, and explore underused tools that can streamline your day-to-day work. From proper template design to avoiding compliance risks and improving provider training, this conversation is a must-listen for anyone working in healthcare documentation, coding, or compliance. - Practical examples from real audits - Time-saving tools you might be missing - Compliance pitfalls—and how to avoid them - Smart ways to personalize your EHR workflow…

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Stay Compliant, Stay Connected: Navigating Healthcare Outreach 31:24

לפני 8 weeks31:24

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31:24

In this episode of Compliance Conversations, CJ Wolf and Dan Fox explore the intersection of AI and healthcare compliance. From proactive patient outreach to regulatory risks, they break down how organizations can leverage AI while staying compliant. What You'll Learn: - How AI-driven communication is enhancing patient engagement - The biggest compliance challenges organizations face - Practical examples of AI implementation in healthcare Don’t miss this deep dive into AI, compliance, and the future of patient outreach.…

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Top Enforcement Trends Every Healthcare Compliance Officer Should Watch 33:45

לפני 10 weeks33:45

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33:45

In this episode of Compliance Conversations, host CJ Wolfsits down with returning guest Sean McKenna, a Partner at Nelson Mullins and former Federal Prosecutor, to explore the critical issues at the intersection of healthcare law and compliance. From the challenges posed by the False Claims Act to the innovative use of data analytics in enforcement, Sean offers firsthand insights drawn from years of legal practice. Whether you’re managing a compliance program or navigating regulatory challenges, this episode delivers actionable strategies and expert predictions for the future. What You’ll Learn: - How evolving legal standards impact healthcare providers - The role of whistleblower initiatives in driving compliance - Data analytics as a game-changer in regulatory enforcement - Strategies to build and maintain effective compliance programs - Predictions for upcoming changes in healthcare law and regulation…

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Telehealth Fraud, AI, and Cybersecurity: The Compliance Landscape in 2025 35:34

לפני 12 weeks35:34

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35:34

Telehealth is revolutionizing healthcare, but with new opportunities come new risks. In this latest episode of Compliance Conversations, host CJ Wolf welcomes healthcare attorney Susan Walberg to discuss: - Common telehealth fraud schemes—and how to spot them - Compliance pitfalls that could cost your organization - The latest regulatory updates from the FTC, FDA, and HHS - The role of AI in healthcare risk management - Stay ahead of compliance risks and protect your practice.…

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What DOJ and FDA Are Looking For in Compliance Programs 39:07

לפני 14 weeks39:07

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39:07

Join CJ Wolf as he sits down with Clint Narver, a former DOJ prosecutor and healthcare compliance expert, to explore best practices, emerging trends, and real-world strategies for avoiding legal pitfalls. Highlights: - Learn how to safeguard your organization against research fraud. - Insights into the DOJ’s perspective on compliance programs. - Real-life examples of compliance missteps and how to avoid them. - The role of training, monitoring, and proactive measures in compliance success. Ready to strengthen your compliance program? Listen to the full episode and gain the tools to navigate the complexities of healthcare compliance.…

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Beyond the Deal: Compliance Lessons for Healthcare Transactions 32:49

לפני 16 weeks32:49

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32:49

Selling or acquiring a healthcare practice is no small feat. Regulatory compliance challenges, from Stark Law violations to billing audits, can derail even the best-planned transactions. In this insightful episode of Compliance Conversations, CJ Wolf interviews Ericka Adler, a leading healthcare attorney and Shareholder at Roetzel & Andress, to uncover: - The most common compliance pitfalls in healthcare transactions - Strategies for preparing your practice for sale to ensure a smoother process - Key steps buyers must take to mitigate compliance risks during due diligence - Tune in to the episode and gain actionable strategies from an expert with over 28 years of experience in healthcare law. About Ericka Adler: Ericka has over 25 years representing individual providers, physician groups, and other health care entities, such as home health care agencies, DME companies, hospices, MRI facilities, and surgery centers. She focuses her practice on regulatory and transactional health care law, in compliance counseling, structuring, and implementing complex joint ventures to comply with state and federal laws and regulations. Ericka spends a significant amount of time helping physicians to negotiate their employment agreements with various types of physician employers. She handles mergers, sales and acquisitions of healthcare entities and has extensive experience in completing transactions with private equity, hospitals and other third parties. Ericka also has deep experience dealing with Stark, Anti-Kickback Statute, fee-splitting concerns, the corporate practice of medicine, and other challenges facing healthcare providers. Ericka works closely with her clients on their day-to-day legal health care needs and strives to be available so that her clients always feel like they are her top priority. She serves as general counsel to her practice clients. Ericka keeps clients up-to-date on her weekly podcast, “Roetzel HealthLaw HotSpot®. The podcasts have addressed timely topics, including private equity acquisitions, Stark Law compliance, employment and HR issues, and other matters of importance and interest to her clients. In addition, Ericka contributes to the Law & Malpractice section of the online magazine Physicians Practice and to the Business section of the online blog site Medscape, where she addresses legal and management issues facing independent physician practices. She devotes a large part of her practice to advising professionals and practices on their employment agreements, helping them to negotiate their contractual arrangements, and assisting her clients in acquiring and selling health care entities. She also works with providers in HIPAA, fraud and abuse, billing audits, government investigations, licensure matters, and contract disputes. Ericka can be reached via email at EAdler@ralaw.com.…

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The Next Big Shift: AI in Healthcare Compliance and Coding 28:25

לפני 20 weeks28:25

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28:25

Join us for an eye-opening conversation on Compliance Conversations, where CJ Wolf interviews Nick Sahar, founder of Semantic Health and pioneer in AI for medical coding. In this episode, you’ll learn: - How AI enhances coding accuracy and speeds up workflows. - Practical use cases for AI in coding, auditing, and clinical documentation. - What the future holds for AI in healthcare compliance. Don’t miss this must-listen discussion about how technology is shaping the future of healthcare compliance and coding.…

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Inside Payment Integrity: Key Insights from a Payer’s Lens 33:10

לפני 22 weeks33:10

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In this episode of Compliance Conversations, CJ Wolf welcomes Dave Cardelle to discuss the payer perspective on payment integrity. From the complexities of DRG claims to the use of AI, this conversation sheds light on how automation and collaboration can transform the healthcare landscape. What you’ll gain: - A deep dive into DRG audits and common pitfalls. - The role of technology in reducing abrasion between payers and providers. - Real-world solutions to improve payment accuracy and efficiency.…

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Lessons on Compliance Communication and Leadership 34:11

לפני 24 weeks34:11

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In the latest episode of Compliance Conversations, CJ Wolf welcomes Jay Anstine back to explore the nuances of effective compliance communication. What You’ll Learn: - Strategies for delivering tough news to leadership - How to avoid creating a culture of false urgency - Practical tips for navigating compliance politics - The importance of clear communication plans Jay draws on years of healthcare compliance experience and shares lessons from his book, Navigating the Politics of Healthcare. Whether you’re dealing with audits, overpayments, or building trust, this episode provides actionable insights you can apply today. -…

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Improper Payments Explained: Tips from the Field 33:24

לפני 26 weeks33:24

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33:24

We’re excited to share a new episode of Compliance Conversations where CJ Wolf, MD talks with healthcare compliance expert Nancy Clark, the Senior Manager of Health Care Services at EisnerAmper! In this episode, Nancy brings decades of experience in coding and revenue management to address improper payments—a costly issue for healthcare providers. Listen in as we dive deep into: - The most common coding errors and how to avoid them - How to leverage Medicare’s transparent data to stay compliant - Steps you can take to safeguard your practice’s revenue and reputation Whether you’re in compliance, billing, or coding, this episode is packed with actionable insights that could save you time, money, and stress.…

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Behind the Mic: 100 Episodes of Compliance and Auditing Insights 47:42

לפני 28 weeks47:42

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We’re thrilled to announce a major milestone for Compliance Conversations – our 100th episode! Over the years, we’ve had the privilege of hosting industry experts to hear their invaluable perspective on best practices, trends, and real-world scenarios in compliance and auditing. This special episode is a celebration of our journey and the incredible community that’s made it possible! Join CJ Wolf, MD, Debi Behunin (Healthicity Vice President of Product), Brian Burton (Healthicity Chief Compliance and Privacy Officer), Remo Peshkepia (Healthicity Product Manager), and Sarah Crane (Marketing and Brand Manager) for insider insights on: - The evolution of compliance and auditing. - Key milestones for Healthicity, including Audit Manager and Compliance Manager developments. - Insights from the Healthicity team on where compliance is headed. Thank you for being part of this journey! Here's to many more episodes of helping you navigate the complex (and interesting!) world of compliance.…

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Expert Insights on E/M Coding 29:02

לפני 30 weeks29:02

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29:02

In this episode, CJ Wolf, MD, and E/M coding expert Sharisa Freeman discuss her journey and insights into mastering the complexities of E/M coding. Here's a quick look at what you can expect from this episode: - The Evolution of E/M Coding: Changes in guidelines that shifted the focus to Medical Decision Making. - Medical Decision Making Tips: Understanding the three essential sub-elements: number of problems, data reviewed, and risk. - Documentation Challenges: Common issues with lower-level visit documentation and how to address them. - Networking and Continuous Learning: The value of staying updated on coding changes and connecting with peers. - Advice for New Coders: Sharisa’s top tips for those just starting in the field. Check out their conversation today – and thank you to Sharisa for sharing her time and insights on Compliance Conversations!…

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Healthcare Fraud, Compliance, and Expert Testimony 30:59

לפני 32 weeks30:59

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30:59

Ever wondered what it’s like to testify as an expert witness? We talk about that and more in this episode of Compliance Conversations! We invited compliance expert Rebecca Busch to explore her incredible journey from trauma nurse to legal expert in healthcare fraud and compliance. Join us as Rebecca shares: - Her transition from nursing to healthcare fraud examination - The key legal challenges in compliance she’s faced as an expert witness - Practical advice on how to stay ahead of compliance trends - Tips and insights on depositions…

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Innovation at the Intersection of Healthcare, Science, and Startups 23:32

לפני 34 weeks23:32

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Tune in to this episode of "Compliance Conversations" where we dive deep into the world of innovation and biotech with our special guest, Steve VanNurden! In this episode, CJ Wolf, MD, talks with Steve VanNurden, CEO of Fitzsimons Innovation Community and Associate Vice Chancellor of Biotechnology at the University of Colorado Anschutz Medical Campus. Listen in as they explore the unique integration of academic and entrepreneurial ecosystems, discuss the reinvention of tech transfer, and reveal the keys to building a thriving biotech community. You'll hear: The vision behind Fitzsimons Innovation Community and its role in advancing healthcare innovation. - The unique benefits of integrating academic medical centers and biotech communities. - Real-life examples of startups and research breakthroughs happening in Colorado – and why it’s a powerful hub for healthcare innovation. - How the Community addresses regulatory and funding challenges to accelerate innovation. - Whether you're in healthcare, compliance, biotech, or simply passionate about innovation, this episode offers valuable insights and inspiration.…

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Behavioral Health Compliance: Insights and Challenges 25:35

לפני 36 weeks25:35

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25:35

In this episode, Maeve O'Neill, MEd, LPC-S, CHC, CDTLF, the National Compliance Director for Circa Behavioral Healthcare Solutions, joins us to share insights from her three decades of experience in mental health and addiction services as she provides valuable insights into the unique challenges and best practices for compliance in this field. Tune in as we discuss: - The complex web of regulations: The intricate layers of compliance in behavioral health, from state regulations to accreditation standards, and how organizations can effectively navigate them. - Building effective compliance programs: The importance of simplifying compliance processes and aligning them with organizational goals to create robust and practical programs. - The role of compliance in patient care: The critical connection between compliance and quality care, highlighting how a strong compliance program can support staff well-being and ultimately benefit patient outcomes. We appreciate Maeve’s time and expertise in talking about this vital topic!…

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Navigating Medicare Audits and Appeals 34:30

לפני 38 weeks34:30

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34:30

Medicare audits can be a daunting challenge for any healthcare provider. With a maze of regulations, different types of audits, and a complex appeal process, it’s easy to feel overwhelmed. That’s why we invited Alicia Shickle, AHFI, CHC, CPC, CPCO, CPMA, CRC, the President and CEO of ProCode Compliance Solutions LLC, to share the knowledge and strategies you need to navigate this tricky terrain. Tune in to the episode as we discuss: - The top issues that trigger Medicare audits - How to prepare your practice and avoid common pitfalls - The five levels of Medicare appeals and how to effectively manage them - Why proactive compliance programs are crucial for your practice Thank you, Alicia, for sharing your time and expertise with us! About Alicia Shickle Alicia has decades of clinical and administrative healthcare experience. Her areas of expertise include revenue cycle integrity, documentation, coding and billing compliance, Medicare, MSP, and Medicaid regulations, practice workflow and operations, compliance program assessments, development, and implementation. Alicia provides advisory services to attorneys, healthcare administrators, providers, and organizations. She frequently works with business litigation and health law practices on fraud and abuse intervention and providing independent and objective assessments for both plaintiff’s and defense teams. She works closely with clients on both routine and complex documentation and coding reviews. She provides in-depth coding and claims data analysis, education, and assists providers with navigating complex regulatory and policy requirements, identifying and mitigating potential FCA risks while optimizing revenue. She has extensive experience developing and implementing effective compliance programs including all seven elements. Alicia served as the Director of Compliance for the American Academy of Professional Coders (AAPC). She has worked with some of the top consulting and health law practices and, was a Family Practice Administrator for over a decade. Alicia has presented educational training boot camps and seminars nationally on compliance, documentation and coding, and practice management. She was a medical billing and coding instructor at a community college. She is a frequent author for online physician blogs, and journals. Alicia is an Accredited Health Care Fraud Investigator (AHFI) with the National Health Care Anti-Fraud Association (NHCAA), and is certified in Healthcare Compliance (CHC, CPCO) through the Health Care Compliance Association (HCCA), and AAPC. She is a Certified Professional Coder (CPC), Certified Professional Medical Auditor (CPMA), and certified in Risk Adjustment Coding (CRC). She is also a Certified Physician Practice Manager (CPPM). Alicia is an active member of the American Academy of Professional Coders (AAPC) and served as the President of AAPC’s Manhattan Local Chapter for two years. She is a member of the Health Care Compliance Association (HCCA), and the National Health Care Anti-Fraud Association (NHCAA), and American Health Lawyers Association (AHLA). She is a member of American Health Information Management Association (AHIMA), the National Alliance of Medical Auditing Specialists (NAMAS), and a member of Medical Group Management Association (MGMA).…

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Pharmacy in the Digital Age: Challenges and Innovations 27:39

לפני 40 weeks27:39

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Heidi McKinnon, PharmD, CHC, a seasoned compliance expert, shares insights from her journey from retail pharmacy to head of compliance at Capital Rx, a leading pharmacy benefit manager. In this episode, Heidi shares her unique path and extensive experience in the compliance world. We delve into the evolving landscape of digital pharmacy, discussing: - The true meaning of digital pharmacy and how it differs from telepharmacy and online pharmacies. - The regulatory challenges faced by digital pharmacies and strategies to stay ahead of ever-changing rules. - The impact of digital pharmacies on patient care and medication access. - The intricacies of reimbursement and licensing in the digital pharmacy space. - Practical tips for compliance officers new to the digital pharmacy sector. Heidi McKinnon, PharmD, CHC Heidi McKinnon is a dedicated healthcare professional with a Doctor of Pharmacy (PharmD) degree and a Certified Healthcare Compliance (CHC) credential. With extensive experience in the pharmacy and healthcare industry, Heidi brings a wealth of knowledge and expertise to her role as Head of Compliance at Capital Rx. About Capital Rx Capital Rx is a full-service pharmacy benefit manager (PBM) and pharmacy benefit administrator (PBA) dedicated to advancing our nation's healthcare infrastructure to improve drug price visibility and patient outcomes through innovative solutions and cutting-edge technology. To learn more about Capital Rx and their mission to create a better healthcare experience, visit Capital Rx's website. Contact Information For more information or to get in touch with Heidi McKinnon, you can reach out via LinkedIn.…

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Healthcare's Legal Tightrope: Navigating Physician Contracts 31:32

לפני 42 weeks31:32

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31:32

In this episode, we welcome back Hal McCard, Counsel at Spencer Fane, to delve into the complexities of financial relationships with physicians, including essential insights on compliance with STARK and Anti-Kickback statutes. CJ Wolf, MD, and Hal McCard discuss: - Hal’s extensive career in healthcare law and his journey to becoming a leading expert in the field. - Detailed explanations of STARK and Anti-Kickback statutes and their implications for healthcare organizations. - Practical advice on maintaining compliance in physician contracting, from fair market value documentation to auditing processes. - The importance of centralized arrangements tracking systems and how they can help mitigate compliance risks. - Real-world examples and valuable insights from Hal’s experiences as in-house counsel and external advisor. Check out the episode to gain valuable knowledge and practical tips to enhance your compliance programs and safeguard your organization against potential pitfalls.…

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Telehealth Beyond Borders: Legalities and Logistics 36:40

לפני 45 weeks36:40

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36:40

Are you intrigued by the rapid evolution of telehealth and its impact across the globe? Then you won’t want to miss our latest podcast episode where Keisha Wilson and CJ Wolf discusses the nuances, challenges, and opportunities in international telehealth services! In this episode, we discuss: COVID-19’s Impact on Telehealth: Learn how the pandemic prompted a reevaluation of international telehealth practices and regulations. Compliance and Legalities: Keisha dives into the intricate details of understanding and navigating international laws and compliance issues, ensuring seamless and legal telehealth services across borders. Challenges and Solutions: From infrastructure limitations to insurance hurdles, Keisha shares real-world examples and innovative solutions to delivering healthcare to remote and underserved populations. Global Collaborations: Get insights into how organizations like the International Society for Telemedicine and eHealth (ISfTeH) and the World Health Organization are shaping the future of telehealth. Regulatory Requirements: Understand the various certifications, permits, and legal considerations necessary for practicing telehealth internationally. Tune in to our latest episode and join us in exploring the dynamic world of international telehealth.…

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Expert Tips on Gastrointestinal Coding and Billing 27:13

לפני 46 weeks27:13

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27:13

In this episode, our host CJ Wolf sits down with Laidy Diana Martinez, a coding supervisor, to discuss the world of GI coding and compliance. Episode Highlights: - Introduction to GI Coding Challenges: Understand the common hurdles and how to overcome them. - Screening vs. Diagnostic Colonoscopies: Learn the critical differences and their coding implications. - Essential Modifiers: Find out which modifiers to use and when. - Documentation Best Practices: Discover what’s needed for accurate and compliant GI procedure billing. - Medicare and Payer Policies: Stay up to date with the latest changes and requirements. Laidy Diana Martinez, with her extensive experience as a coding supervisor, brings valuable insights and practical advice that can help enhance your coding accuracy and compliance efforts.…

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Meet Healthicity's Inaugural Compliance Officer of the Year Award Recipient 26:52

לפני 48 weeks26:52

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26:52

Our latest episode of Compliance Conversations features Johanna Brown, the recipient of Healthicity's 2023 Compliance Officer of the Year Award! Join our host, CJ Wolf, as he delves into Johanna’s journey in compliance, her leadership philosophy, and the qualities that make her an outstanding compliance officer. Here’s what you can expect: - Career Journey: Learn about Johanna’s path from journalism to compliance. - Leadership Insights: Discover her secrets to fostering teamwork, maintaining work-life balance, and navigating the complex world of healthcare compliance. - Heartfelt Recognition: Hear the glowing recommendations from her colleagues and what they appreciate most about her approach to compliance.…

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Compliance Conversations by Healthicity

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Demystifying Anesthesia Coding and Billing 31:32

לפני 50 weeks31:32

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31:32

We’re excited to announce a new episode of Compliance Conversations! Join CJ Wolf and special guest Kimberly Jolivette Williams as they explore the complexities of anesthesia coding and billing. In this episode: - Kimberly’s journey from unit secretary to compliance expert. - Unique aspects of anesthesia coding and essential resources. - The importance of modifiers in compliance and billing. - Tips for accurate documentation and minimizing compliance risks. Don't miss out on Kimberly's expert advice and passion for lifelong learning. Here are some additional resources around this important topic: Centers for Medicare & Medicaid Services Anesthesiologists Center - https://www.cms.gov/medicare/payment/fee-schedules/physician/anesthesiologists-center Certified Anesthesiologist Assistants Now Authorized to Practice in Washington State - https://www.asahq.org/about-asa/newsroom/news-releases/2024/03/certified-anesthesiologist-assistants-now-authorized-to-practice-in-washington-state#:~:text=SEATTLE%20%E2%80%93%20Washington%20state%20Gov…

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Compliance Conversations by Healthicity

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Insider Insights: HCCA & HEALTHCON Recap 31:19

לפני 1 year31:19

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הפעל מאוחר יותר

31:19

Our latest episode of Compliance Conversations features CJ Wolf, MD, and Brian Burton, our Chief Compliance and Privacy Officer, sharing their key takeaways from two of the most prominent industry conferences: HCCA's Compliance Institute and AAPC's HEALTHCON. Find out what they had to say about insights on the OIG’s new General Compliance Program Guidance, industry-specific updates, and so much more. From discussions on artificial intelligence in compliance to the latest developments in Medicare Advantage and risk adjustment, this episode offers valuable insights for professionals across the healthcare spectrum. We also wanted to share a few resources CJ and Brian mentioned during their chat: - Our webinar on Leveraging Data Analytics for Proactive Compliance Management (https://www.healthicity.com/resources/leveraging-data-analytics-proactive-compliance-management-webinar) - The section of our Resource Center dedicated to the OIG’s General Compliance Program Guidance (https://www.healthicity.com/resources/topic/oig-gcpg)…

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Compliance Conversations by Healthicity

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Critical Care Anywhere: Exploring Tele-ICU's Impact 28:18

לפני 1 year28:18

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28:18

We're thrilled to share the latest episode of Compliance Conversations featuring a Jeni Colarusso, a seasoned nurse and an expert in telehealth and Tele-ICU systems. In this episode, Jeni dives deep into the transformative power of telehealth, particularly in critical care environments. Episode Highlights: - Jeni’s extensive experience in surgical and cardiac ICU settings. - An in-depth look at Tele-ICU and its role in expanding access to specialist care in remote areas. - The impact of technology on patient outcomes and hospital efficiency. - Insightful discussion on overcoming healthcare disparities through innovative telehealth solutions. Jeni shares not only her professional journey but also gives us a peek into the future of healthcare where geography no longer limits access to top-notch medical expertise.…

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Compliance Conversations by Healthicity

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The ABCs of ABNs 33:26

לפני 1 year33:26

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33:26

Are you navigating the complex world of healthcare compliance, particularly when it comes to Medicare and Advanced Beneficiary Notices (ABNs)? We've got you covered in the latest episode of Compliance Conversations, featuring industry expert Keisha Wilson, founder of KW Advanced Consulting. Keisha brings over two decades of healthcare experience to the table, offering invaluable insights into the intricacies of ABNs. This episode delves deep into what ABNs mean for healthcare professionals and patients alike, recent changes to ABN forms, compliance risks, and the importance of proper education and implementation within healthcare settings. Why Tune In? - Uncover the essentials of ABNs: Learn what ABNs are and why they're critical in healthcare from a seasoned expert. - Stay updated: Get the scoop on the latest ABN form changes effective from June 2023 and how they impact practices. - Avoid common pitfalls: Keisha discusses frequent compliance risks and how to navigate them effectively. - Engage in comprehensive learning: From policy implementation to case studies, this episode is packed with actionable advice and best practices. Keisha's journey from aspiring social worker to healthcare compliance consultant adds a unique perspective to understanding patient communication and the nuances of Medicare coverage. Her passion for compliance and patient care shines throughout the conversation, making it a must-listen for anyone in the healthcare sector. You can also read a recent blog post from KW Consulting on ABNs. Keisha Wilson, CCS, CPC, CPCO, CPMA, CRC, CPB, Approved Instructor, is the Founder/CEO of KW Advanced Consulting LLC, Minority Women Own Business Enterprise (M/WBE) Certified, with 20+ years in healthcare specializing in various areas of compliance. Multi-specialty, Telehealth/Telemedicine, Risk Adjustment, provider and coder training. She currently sits on a Board of Directors for an outpatient mental health clinic. Keisha is a licensed PMCC who teaches coders looking to become Certified Risk Adjustment (CRC) and hosts various compliance documentation and coding webinars. She is a published author, having written for AAPC editors on Primary Care Coding Alert, Healthcare Business Monthly, and KW Advanced Consulting coding articles. Keisha can speak at various events this year, including the AAPC Regional Conference on Philidelphia and Cohen's Coding Summit on Telehealth in the U.S. vs Internationally.…

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Compliance Conversations by Healthicity

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The Credentialing Conundrum: Challenges and Solutions Explored 31:09

לפני 1 year31:09

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הפעל מאוחר יותר

31:09

In this episode, we're joined by Kandi O'Brien, the Founder of Delegated Credentialing Pro’s and an expert with extensive experience in credentialing and compliance. Kandi shares her fascinating journey in healthcare, from clinical roles to owning urgent cares, and ultimately specializing in compliance and credentialing. We discuss the importance of credentialing, its various aspects, and why it's crucial for patient safety, regulatory compliance, and maintaining organizational reputation. Tune in to our conversation to learn more about: - The significance of credentialing as the first step for providers entering healthcare facilities. - The distinction between facility credentialing and professional (provider) credentialing. - The complexities of enrollment and why it's not synonymous with credentialing. - The concept of delegated credentialing and its benefits for organizations, including improved efficiency and revenue generation. - The primary source verification process and ongoing monitoring for compliance. - The potential challenges and considerations associated with delegated credentialing. Kandi's LinkedIn: https://www.linkedin.com/in/kandio/ Delegated Credentialing Pro's: https://www.linkedin.com/company/delegated-credentialing-pro-s/…

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Compliance Conversations by Healthicity

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Spotting the Red Flags: Identifying Coding Compliance Risks Within Your Organization 33:17

לפני 1 year33:17

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הפעל מאוחר יותר

33:17

This Compliance Conversations episode is a must-listen for anyone in healthcare compliance or coding. We invited Leslie Boles, Co-Owner and President of Revu Healthcare, to chat about identifying coding compliance risks within healthcare organizations. Tune in to Leslie and CJ Wolf’s discussion for more on: - The importance of staying curious and adaptable - The significance of regular audits and assessments in proactively identifying compliance risks - Common coding compliance risks and blind spots within organizations - Strategies for mitigating compliance risks, including the role of data analytics and technology They also talk about one of the most important things to keep top-of-mind – staying humble and acknowledging gaps in knowledge to drive continuous improvement.…

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