Podcast appearances and mentions of Sean M Weiss

SummaryIn this episode, Sean M Weiss and Terry Fletcher discuss the complexities surrounding Additional Documentation Requests (ADRs) from Medicare Advantage plans. They emphasize the importance of compliance, the legal obligations of providers, and the potential consequences of ignoring these requests. The conversation also touches on the ongoing investigations into Medicare Advantage fraud and the need for providers to navigate these challenges carefully while maintaining good relationships with payers.TakeawaysResponding to ADRs is a legal obligation for providers.Ignoring ADRs can lead to serious consequences.Providers should negotiate terms if requests are unreasonable.HIPAA allows disclosures for payment-related activities.Payers are permitted to request specific documentation for audits.Maintaining a good relationship with payers is crucial.Providers can ask for clarification on ADR requests.Documentation requests should be fulfilled within narrow parameters.The OIG investigates Medicare Advantage plans for fraud.Providers should utilize electronic means for submitting documentation.

SummaryIn this episode, Sean M Weiss discusses the critical role of compliance officers in healthcare organizations, emphasizing their responsibilities, best practices, and the importance of maintaining objectivity and independence. He outlines the do's and don'ts of compliance, highlights essential resources for compliance officers, and stresses the need for separation between compliance, legal, and operations to ensure effective oversight and ethical conduct.TakeawaysThe compliance officer is pivotal in safeguarding organizational integrity.Compliance officers must adhere to laws like the False Claims Act and HIPAA.Regular risk assessments are crucial for identifying high-risk areas.Establishing anonymous reporting mechanisms encourages whistleblowing.Ignoring red flags can expose organizations to significant risks.Objectivity and independence are essential for effective compliance.Resources from OIG and CMS are vital for compliance programs.Separation of compliance from legal and operations is necessary.Fostering a culture of ethical conduct mitigates potential liabilities.Compliance is a continuous process that requires vigilance and adaptation.

SummaryIn this conversation, Terry Fletcher and Sean M Weiss discuss the recent announcement by ChatGPT regarding its decision to cease providing health and legal advice due to a significant error rate. They explore the implications of this decision, the ongoing debate about the accuracy of AI chatbots, and the potential consequences of AI errors in professional fields.TakeawaysChatGPT announced it will stop providing health or legal advice.The error rate for ChatGPT is reported to be over 40%.Debate exists about the accuracy of AI chatbots.Significant hallucination rates in AI-generated content are concerning.The decision to stop providing advice may be influenced by legal pressures.AI's limitations in professional fields raise ethical questions.Users should be cautious when relying on AI for critical information.The conversation highlights the need for human oversight in AI applications.Misinformation from AI can have serious consequences.The future of AI in professional settings remains uncertain.

SummaryIn this episode of The Compliance Guy podcast, Sean M Weiss engages in a detailed conversation with attorney Summer McKeivier about the complexities of healthcare law, particularly focusing on incident two billing, healthcare fraud prosecutions, and the challenges faced by providers in navigating compliance issues. They discuss the current trends in healthcare fraud, the role of medical directors and Medicare Administrative Contractors (MACs), and the implications of inexperienced prosecutors in healthcare cases. The conversation also highlights the impact of accusations on healthcare professionals and the importance of understanding medical necessity in the context of local coverage determinations. Throughout the discussion, both Sean and Summer share insights from their experiences in the field, emphasizing the need for knowledgeable representation in healthcare law.TakeawaysSummer McKeivier is a leading attorney in healthcare law.Incident two billing is a significant issue in healthcare compliance.Wound care is currently a major focus for healthcare fraud investigations.CMS's definition of medical necessity often differs from providers' perspectives.Local Coverage Determinations (LCDs) do not have the effect of law.Medical directors may lack the necessary expertise in specific healthcare areas.Healthcare providers face challenges due to poorly written LCDs.Overpayment disputes can escalate if not addressed properly.Inexperienced prosecutors can lead to unjust accusations in healthcare cases.Accusations can severely impact healthcare professionals' ability to practice.

SummaryIn this episode of the Compliance Guy podcast, Sean M Weiss welcomes Don Self, a veteran in the medical billing industry, to discuss his extensive experience and insights. They explore Don's two recent books, touching on topics such as medical office management, evaluation and management services, and the importance of understanding ERISA. The conversation highlights the challenges faced by healthcare providers in documentation and billing, as well as the need for better practices in the industry. Personal anecdotes and reflections on mentorship add depth to the discussion, making it both informative and engaging.TakeawaysDon Self has over 40 years of experience in the medical billing industry.The importance of mentorship in professional growth is emphasized.Don's books are accessible and filled with practical advice.Evaluation and management services continue to challenge providers.Documentation practices have become more complex and subjective.Healthcare systems in other countries can offer valuable lessons.Local coverage determinations are crucial for understanding payment policies.ERISA provides significant protections for employees and providers.Many providers are unaware of their rights under ERISA.The conversation encourages proactive engagement with insurance carriers.

SummaryIn this episode of The Compliance Guy podcast, Sean M Weiss interviews Steven Adler, co-chair of litigation at Mandelbaum Barrett PC, focusing on non-compete agreements and restrictive covenants in healthcare. They discuss the complexities of these agreements, the rights of patients, and the implications of a recent case involving Dr. Timothy Vogel, a pediatric neurosurgeon. The conversation highlights the importance of legal counsel in navigating employment agreements and the enforceability of non-compete clauses.TakeawaysNon-competes are often negotiated and rarely go to trial.Restrictive covenants can include non-solicitation and confidentiality clauses.Patients have the right to choose their treating physician, even if a non-compete exists.Courts generally respect the doctor-patient relationship in these cases.The enforceability of non-compete agreements varies by state and circumstance.Legal counsel is crucial when signing employment agreements in healthcare.Many physicians mistakenly believe non-compete agreements are unenforceable.The geographic scope of non-compete agreements must be reasonable.Blue penciling allows courts to modify overly broad agreements.The credibility of witnesses can significantly impact trial outcomes.

SummaryIn this engaging conversation, Sean M Weiss and Terry Fletcher explore the evolving landscape of healthcare in 2025, emphasizing the importance of reflection on career paths, the integration of AI in healthcare, and the vast opportunities available within the industry. They discuss the significance of passion in one's career and the need for continuous learning and adaptation in a rapidly changing environment.TakeawaysThis is an interesting year for healthcare professionals.The AMBA conference highlighted the importance of in-person networking.Reflecting on career goals is essential, especially at year-end.AI is a powerful tool but requires human oversight.Healthcare offers diverse career paths beyond traditional roles.Collaboration between billing and coding professionals is crucial.Understanding compliance is vital for all healthcare roles.Passion for the job can lead to greater job satisfaction.Continuous learning is necessary to stay relevant in healthcare.There are many resources available for career development in healthcare.

SummaryIn this episode, Sean M Weiss and Terry Fletcher discuss the current state of telehealth services amidst the ongoing government shutdown. They explore the changes in telehealth regulations since the public health emergency, the challenges faced by Medicare in reimbursing telehealth services, and the implications of the False Claims Act for healthcare providers. The conversation emphasizes the importance of compliance and the need for practices to adapt to the evolving landscape of telehealth.TakeawaysTerry Fletcher celebrated her birthday during the episode.The government shutdown has significant implications for telehealth services.Telehealth regulations have changed since the public health emergency.Only specific diagnoses are currently covered for telehealth under Medicare.Practices must ensure compliance to avoid false claims.The importance of having a telehealth facilitator in healthcare practices.The future of telehealth services remains uncertain post-shutdown.Providers must be transparent with patients regarding telehealth services.The conversation highlights the risks of submitting false claims.Sean M Weiss emphasizes the need for ethical practices in healthcare.

SummaryIn this episode, Sean M Weiss and Terry Fletcher discuss the critical aspects of Clinical Documentation Integrity (CDI) in healthcare. They explore the importance of compliance, the implications of audits, and the responsibilities of providers in maintaining accurate medical records. The conversation highlights the need for integrity in documentation before any improvements can be made, emphasizing that compliance is essential for both legal and ethical practice in healthcare.TakeawaysClinical Documentation Integrity (CDI) is crucial for accurate medical records.Compliance must be prioritized before any improvements can be made.Providers often overlook legal and compliance issues in documentation.Audits reveal significant gaps in healthcare practices.Education and training are essential for healthcare staff.Providers must be aware of changing regulations and adapt accordingly.Documentation should reflect the true nature of patient care.Telehealth practices must comply with HIPAA regulations.Ignoring compliance can lead to severe consequences for providers.Healthcare professionals need to take accountability for their documentation.

SummaryIn this episode, Sean M Weiss and Terry Fletcher discuss various trends and issues in healthcare auditing, coding, and documentation. They reflect on their recent experiences and the importance of accurate coding practices to avoid risks associated with incomplete documentation. The conversation also touches on behavioral change interventions and the challenges providers face in maintaining compliance with evolving regulations. The episode concludes with a teaser for the next discussion on shared visits.TakeawaysTime flies, and boy, they were not kidding.An abundance of macros and smart phrases can lead to issues.Providers should only code for services actively managed during encounters.Incomplete documentation invites risk and potential legal issues.Behavioral change interventions require proper documentation and patient agreement.It's not the volume of documentation, but the quality that matters.Smart phrases and macros can lead to compliance problems if misused.The current administration is intensifying scrutiny on healthcare practices.Providers need to be aware of the risks associated with coding for unrelated diagnoses.Next episode will focus on the complexities of shared visits.

SummaryIn this conversation, Sean M Weiss and Walter Haydock discuss the implications of ISO IEC 42001 in the healthcare sector, focusing on AI governance, regulatory compliance, and the management of bias in AI systems. They explore the challenges faced by multi-site healthcare organizations, the importance of leadership in ethical AI use, and real-world examples of organizations implementing ISO 42001. The discussion also touches on the legislative landscape surrounding AI and the need for clear policies in healthcare AI applications.TakeawaysISO 42001 is a blueprint for managing AI risk.Bias in AI is unavoidable but can be managed.Leadership commitment is essential for effective AI governance.ISO 42001 aids in compliance with regulations like HIPAA.Multi-site healthcare systems face unique challenges in AI implementation.Ethical AI use is crucial in telemedicine applications.Real-world examples show the benefits of ISO 42001 certification.Behavioral health can greatly benefit from AI governance.Integrating ISO standards enhances overall AI governance.Legislators need to improve their understanding of AI issues.

Corrective Action Plans (CAPS) are critical to ensure providers are able to resolve allegations of wrong-doing. This episode addresses a lot of the nuacned aspects to building a successful CAP as part of an SDP or settlement agreement. Don't miss this critical episode. If you would like a copy of the modle CAP created by Sean M. Weiss, email him at sstpierreweiss@drsmgmt.com

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Sean M. Weiss Partner, Vice President of Compliance CHC, CEMA, CMCO, CPMA, CPC-P, CMPE, CPC Sean has dedicated his more than 25 – year career to helping healthcare facilities reduce the risk of noncompliance and achieve measurable financial results. An accomplished compliance and management professional, Sean has extensive knowledge of the inner workings of government agencies at both the federal and state level, including the Office of Inspector General, Department of Justice and The United States Attorney's Office. Sean has earned and maintains numerous certifications including Certified in Healthcare Compliance (CHC), Certified Evaluation & Management Auditor (CEMA), Certified Medical Compliance Officer (CMCO), Certified Professional Medical Auditor (CPMA), Certified Professional Coder (CPC), Certified Medical Practice Executive (CMPE) and Certified Professional Coder-Payer (CPC-P). Sean is an active member in good standing with The American Health Lawyers Association, Health Care Compliance Association, The American Academy of Professional Coders and the National Society of Certified Healthcare Business Consultants. Sean Weiss on LinkedIn: https://www.linkedin.com/in/seanmweissakathecomplianceguy/ The Compliance Guy Podcast on YouTube: https://www.youtube.com/channel/UCIwYgrkkU7urrnmFJ1_V6cg/featured The National Society of Certified Healthcare Business Consultants (NSCHBC): https://nschbc.org/ Brian Cui on LinkedIn: https://linkedin.com/in/briancui/ Check out our supporting Medical Coding Geek Partners: https://medicalcodinggeek.com/partners Medical Coding Geek and NEC Podcast on Social Media https://facebook.com/medcodinggeek https://facebook.com/necpodcast https://instagram.com/medcodinggeek https://instagram.com/necpodcast https://tiktok.com/@medcodinggeek Watch this episode on the NEC Podcast YouTube Channel: https://www.youtube.com/channel/UCKh_A91__rieaSSPIRm4gBw Subscribe to Medical Coding Geek on YouTube: https://youtube.com/MedicalCodingGeekVideos Medical Coding Geek Facebook Groups: https://facebook.com/medcodinggeek/groups

Sean M. Weiss Partner, Vice President of Compliance CHC, CEMA, CMCO, CPMA, CPC-P, CMPE, CPC Sean has dedicated his more than 25 – year career to helping healthcare facilities reduce the risk of noncompliance and achieve measurable financial results. An accomplished compliance and management professional, Sean has extensive knowledge of the inner workings of government agencies at both the federal and state level, including the Office of Inspector General, Department of Justice and The United States Attorney's Office. Sean has earned and maintains numerous certifications including Certified in Healthcare Compliance (CHC), Certified Evaluation & Management Auditor (CEMA), Certified Medical Compliance Officer (CMCO), Certified Professional Medical Auditor (CPMA), Certified Professional Coder (CPC), Certified Medical Practice Executive (CMPE) and Certified Professional Coder-Payer (CPC-P). Sean is an active member in good standing with The American Health Lawyers Association, Health Care Compliance Association, The American Academy of Professional Coders and the National Society of Certified Healthcare Business Consultants. Sean Weiss on LinkedIn: https://www.linkedin.com/in/seanmweissakathecomplianceguy/ The Compliance Guy Podcast on YouTube: https://www.youtube.com/channel/UCIwYgrkkU7urrnmFJ1_V6cg/featured The National Society of Certified Healthcare Business Consultants (NSCHBC): https://nschbc.org/ Brian Cui on LinkedIn: https://linkedin.com/in/briancui/ Check out our supporting Medical Coding Geek Partners: https://medicalcodinggeek.com/partners Medical Coding Geek and NEC Podcast on Social Media https://facebook.com/medcodinggeek https://facebook.com/necpodcast https://instagram.com/medcodinggeek https://instagram.com/necpodcast https://tiktok.com/@medcodinggeek Watch this episode on the NEC Podcast YouTube Channel: https://www.youtube.com/channel/UCKh_A91__rieaSSPIRm4gBw Subscribe to Medical Coding Geek on YouTube: https://youtube.com/MedicalCodingGeekVideos Medical Coding Geek Facebook Groups: https://facebook.com/medcodinggeek/groups

Episode 7 Return of the Agent! In this episode Eric Rubenstein, Jordan Johnson and Sean M. Weiss take on the facts, the fallacies and the far-fetched when it comes to search warrants, subpoenas and raids at medical practices, hospitals and health systems! Then the guys turn their attention to Price Transparency, the Proposed Rule (2022 MPFS and OPPS) regarding Inpatient only procedures vs ASC Procedures and the misperceptions that exist...

Providers that received payments from the federal Provider Relief Fund will be required to file reports demonstrating their compliance with the terms and conditions of those payments.Reporting on this, our lead story during the next live edition of Monitor Mondays, will be healthcare attorney Andrew Wachler, managing partner of Wachler & Associates. Mr. Wachler will report on anticipated “hot spots” in the auditing of the use of these payments, including healthcare-related costs and lost revenue attributable to the coronavirus and expenses that have been reimbursed from other sources.Other segments to be featured during the live broadcast include the following:Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds with another installment of his popular segment.RAC Report: Healthcare attorney Knicole Emanuel, a partner at the law firm of Practus, will file the Monitor Mondays RAC Report.Audit Report: Sean M. Weiss of DoctorsManagement will return to the broadcast with an update on comparative billing reports (CBRs), reporting that providers need to change their billing patterns to avoid financial losses.Legislative Update: Former Centers for Medicare & Medicaid Services (CMS) official Matthew Albright, now chief legislative affairs officer for Zelis, will report on the status of healthcare legislation associated with the current COVID-19 pandemic.SDoH Report: Ellen Fink-Samnick, a nationally recognized expert on the social determinants of health (SDoH), will report on the news that’s happening at the intersection of COVID-19 and the SDoH. Ellen will also conduct the Monitor Mondays Listeners Survey.

More payment cuts are being proposed by the Centers for Medicare & Medicaid Services (CMS) for next year, a move sure to impact the many hospitals participating in the 340B drug discount program, as described in the 2021 Medicare Outpatient Prospective Payment System (OPPS) Proposed Rule.Such proposed cuts are expected to reduce Medicare Part B drug payments to levels lower than in 2018, when the last round of cuts were made. Reporting our lead story during the next edition of Monitor Mondays will be Maureen Testoni, CEO for 340B Health. Also participating in the broadcast will be ICD10monitor national correspondent Timothy Powell, CPA, who will report on the expected financial impact of those proposed cuts to critical access hospitals (CAHs).Other segments to be featured during the live broadcast include the following:RAC Report: Healthcare attorney Knicole Emanuel, a partner at the law firm of Practus, will file the Monitor Mondays RAC Report.Special Report: Even though length of stay (LOS) continues to generate buzz, there might be an alternative to the long-heralded metric. John Zelem, board-certified-surgeon-turned healthcare consultant, will report on another set of criteria that could be gaining traction. Audit Report: Sean M. Weiss of DoctorsManagement will return to the broadcast with an update on the increase in auditing activity by federal contractors.Legislative Update: Former CMS official Matthew Albright, now chief legislative affairs officer for Zelis, will report on the status of healthcare legislation associated with the current COVID-19 pandemic.IFR Report: Angela Phillips, PT, president and chief executive officer for Image and Associates, considered by many to be one of the nation’s foremost authorities on inpatient rehabilitation facility compliance, returns to the broadcast to report on how the issue of “medical necessity” for IFR stays is prompting concerns about audits and denials. Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Bryon, will join the broadcast with his trademark segment, reporting on legal implications that have the potential to put providers at risk.Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds with another installment of his popular segment.

The recent announcement by the Centers for Medicare & Medicaid Services (CMS) that it will be “ramping up” audits are quickly becoming a reality for providers across the country. Medicare Administrative Contractor (MAC), Comprehensive Error Rate Testing (CERT), Recovery Audit Contractor (RAC), and Unified Program Integrity Contractor (UPIC) auditors are going full steam ahead, using data and analytics to assess overpayments via automated reviews – and new language in UPIC letters paints an ominous picture for providers they deem non-compliant.Reporting the lead story during this edition of Monitor Mondays is Sean M. Weiss of DoctorsManagement, who addresses these issues and the steps necessary to ensure a level playing field.Other segments to be featured during the live broadcast include the following:RAC Report: Healthcare attorney Knicole Emanuel, a partner at the law firm of Practus, files the Monitor Mondays RAC Report.SDoH Report: Ellen Fink-Samnick, a nationally recognized expert on the social determinants of health (SDoH), reports on the news that’s happening at the intersection of COVID-19 and the SDoH. Ellen also conducts the Monitor Mondays Listeners Survey.Legislative Update: Former CMS official Matthew Albright, now chief legislative affairs officer for Zelis, reports on the status of healthcare legislation associated with the current COVID-19 pandemic.Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Bryon, joins with his trademark segment, reporting on legal implications during the pandemic.Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, makes his Monday Rounds with another installment of his popular segment.

Waivers from regulations, dire shortages of ICU beds, and scarce personal protective equipment (PPE), including gloves, gowns, and masks, are all part of the new normal as the coronavirus (COVID-19) continues to generate global headlines, especially in the United States.Amid a cacophony of misinformation, providers and patients are searching for clarity in this fog of war. That time has come. Next Monday, the long-running and authoritive voice of healthcare regulation, Monitor Mondays, will broadcast a live, 60-minute town hall, during which its panelists will answer your questions and those of your colleagues.The broadcast rundown will include updates from the following, and then segue to the town hall. Participating in the special news update will be the following:Rural Health Crisis: The global pandemic that is the coronavirus is spreading to the wide-open spaces of rural America, threatening the very existence of hospitals, caregivers, and patients. Reporting on this crisis will be the vice president of government affairs and policy for the National Association of Rural Health, Brock Slabach.RAC Report: Healthcare attorney Knicole Emanuel, a partner in the Potomac Law Group, will file the Monitor Mondays RAC Report. Emanuel is expected to report on auditing activities by third-party auditors during COVID-19.Audit Report: Sean M. Weiss, partner and chief compliance officer for DoctorsManagement, will report on contingency planning during the pandemic.SDoH Report: Ellen Fink-Samnick, a nationally recognized expert on the social determinants of health (SDoH), will report on how hospitals should respond to the homeless population presenting in emergency departments during the COVID-19 crisis. Ellen will also conduct the Monitor Mondays Listener Survey.Legislative Update: Former Centers for Medicare & Medicaid Services (CMS) official Matthew Albright, now chief legislative affairs officer for Zelis, will report on the $2 trillion COVID-19 economic stimulus deal passed by the Senate on Wednesday and expected to be voted on by the House on Friday.Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrickson & Bryon, will join the broadcast with his trademark segment, in which he reports on problematic issues facing providers during the global pandemic, which has now resulted in more than 1,000 U.S, deaths.Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds with another installment of his popular segment.

During this of Monitor Mondays, senior healthcare analyst Frank Cohen, a computational statistician, reports on how anecdotal thinking is not evidence-based thinking, and it is difficult to draw conclusions without having all of the information – noting that’s exactly what is happening right now, as America grapples with the coronavirus (COVID-19).Other segments to be featured during the live broadcast include the following:RAC Report: Healthcare attorney Knicole Emanuel files her Monitor Mondays RAC Report.Audit Report: Sean M. Weiss, reports on the next audits you can expect to encounter.SDoH Report: Ellen Fink-Samnick, has the latest news on this trending topic that is attracting significant media attention. Ellen will also conduct the Monitor Mondays Listener Survey.Legislative Update: Matthew Albright reports on current healthcare legislation – proposed, pending, or passed – and its intended consequences.Risky Business: Healthcare attorney David Glaser, joins the broadcast with his trademark segment, in which he reports on problematic issues facing providers.Monday Rounds: Ronald Hirsch, MD, makes his Monday Rounds with another installment of his popular segment which he discusses swing beds, Telehealth and billing under COVID19.

Seldom does a week pass without news about a pharmaceutical giant engaged in corporate wrongdoing. This week, the feds announced that they had filed a complaint under the False Claims Act (FCA) against Mallinckrodt ARD LLC. The complaint alleges that the pharmaceutical company “avoided paying hundreds of millions of dollars in Medicaid rebates due to significant drug price increases” as a result of “large increases in the price” of its drug H.P. Acthar Gel.Recently, pharmaceutical company Sanofi-Aventis U.S., LLC, agreed to pay $11.85 million to resolve allegations that it violated the False Claims Act by paying kickbacks to Medicare patients through a purportedly independent charitable foundation, The Assistance Fund. And earlier, as reported by RACmonitor, electronic health records provider Practice Fusion Inc. agreed to pay a total of $145 million to resolve criminal charges and civil claims that it solicited and accepted unlawful kickbacks from pharmaceutical companies.During this edition of Monitor Mondays, famed whistleblower attorney Mary Inman continues her reporting on the misdeeds of big pharma, with an update on the aforementioned Sanofi-Aventis FCA case.Other segments to be featured during the live broadcast include the following:RAC Report: Healthcare attorney Knicole Emanuel, a partner in the Potomac Law Group, files the Monitor Mondays RAC Report.Audit Report: Sean M. Weiss, partner and chief compliance officer for DoctorsManagement, reports on the next audits you can expect to encounter.Legislative Update: Matthew Albright, chief legislative affairs officer for Zelis reports on current healthcare legislation – proposed, pending, or passed, and its intended consequences.Risky Business: Healthcare attorney David Glaser, joins the broadcast with his trademark segment, in which he reports on problematic issues facing providers.Monday Rounds: Ronald Hirsch, MD makes his Monday Rounds with another installment of his popular segment.

Like a destructive earthquake, recent news from The Chartis Center for Rural, documenting the accelerated rate of closures among rural hospitals, is sending shock waves through rural communities.As with the Richter scale, the closure of one rural hospital is likely to have an exponential impact on all rural health. And the stark reality is that, as of January 2020, a total of 120 rural health facilities have closed their doors.Leslie Marsh, the chief executive of Lexington Regional Health Center in Lincoln, Neb., returns to Monitor Mondays and reports on precipitous peril for rural hospitals, which is now rising to a national disaster.Other segments featured on the podcast are:RAC Report: Senior healthcare analyst Frank Cohen returns to the broadcast to report on why Recovery Audit Contractors (RACs) can’t be considered unbiased in a court of law.Audit Report: Sean M. Weiss, partner and chief compliance officer for DoctorsManagement, reports Artificial Intelligence (AI) and its impact on compliance and auditing.Risky Business: Healthcare attorney David Glaser, a shareholder in the law offices of Fredrickson & Bryon, will join the broadcast with his trademark segment Risky Business.Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, makes his Monday Rounds with another installment of his popular segment.

With a 30,000-foot view of rural healthcare policies and regulations emanating from Washington, D.C., Leslie Marsh still recognizes the importance of having boots on the ground, serving as the chief executive of Lexington Regional Health Center in Lincoln, Neb.Marsh, who also serves as vice president of board of directors for the ruralMED Health Network, addresses the ubiquitous Z codes and their impact on the rural population, among other serious issues facing rural healthcare providers, during this edition of Monitor Mondays.Other segments to be featured during the podcast includes:RAC Report: Healthcare attorney Knicole Emanuel reports on the latest audits by Recovery Audit Contractors (RACs) and other third-party auditors.Audit Report: Sean M. Weiss, partner, and chief compliance officer for DoctorsManagement, reports the latest on Target Probe Educate.SDoH Report: Ellen Fink-Samnick has the latest news on rural health and also conducts the Monitor Mondays Listener Survey.Risky Business: Healthcare attorney David Glaser has his trademark segment, in which he reports on problematic issues facing providers. Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, makes his Monday Rounds with another installment of his popular segment.

The artificial intelligence (AI) arms race is heating up. The use of AI by healthcare providers responding to a wave of audits initiated by AI systems is an escalation. As the government continues to deploy AI systems in Medicare audits, providers will respond with their own counter-measures, also using AI. Reporting our lead story during the next edition of Monitor Mondays will be RACmonitor investigative reporter Edward Roche, who continues to monitor the intensifying showdown. Other segments to be featured on the podcast include:RAC Report: Healthcare attorney Knicole Emanuel reports on the latest audits by Recovery Audit Contractors (RACs) and other third-party auditors. Emanuel, a member of the RACmonitor editorial board, is a partner in the Potomac Law Group.Audit Report: Sean M. Weiss, partner, and chief compliance officer for DoctorsManagement, reports on the latest audits you can expect to encounter.SDoH Report: Ellen Fink-Samnick, a nationally recognized expert on the social determinants of health (SDoH), has the latest news on this trending topic that is attracting significant media attention. Ellen also conducts the Monitor Mondays Listener Survey.Risky Business: Healthcare attorney David Glaser, a shareholder in the law offices of Fredrickson & Bryon, joins the broadcast with his trademark segment, which he reports on problematic issues facing providers.Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, makes his Monday Rounds with another installment of his popular segment.

What once appeared to be a legislative slam dunk is now mired in controversy, this time fueled by the recently formed coalition dead-set against the proposed use benchmark payments.The Coalition Against Rate-Setting considers the practice tantamount to price-fixing. What will happen next to the compromise legislation, which was hammered out with bipartisan congressional support? Matthew Albright, chief legislative affairs officer for Zelis, reports our lead story during this edition of Monitor Mondays.Other segments to be featured on the broadcast include the following:RAC Report: Healthcare attorney Knicole Emanuel reports on the latest audits by Recovery Audit Contractors (RACs) and other third-party auditors. Emanuel, a member of the RACmonitor editorial board, is a partner in the Potomac Law Group. Audit Report: Sean M. Weiss, partner and chief compliance officer for DoctorsManagement, reports on the latest audits you can expect to encounter. Weiss joins the broadcast as a regular panelist, reporting on the ever-changing audit landscape.SDoH Report: Ellen Fink-Samnick, a nationally recognized expert on the social determinants of health (SDoH), has the latest news on this trending topic that is attracting significant media attention. Ellen also conducted the Monitor Mondays Listener Survey.Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrickson & Bryon, joins the broadcast with his trademark segment, in which he reports on problematic issues facing providers. Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, makes his Monday Rounds with another installment of his popular segment.

AmerisourceBergen, one of the nation’s largest pharmaceutical wholesalers, must turn over records to pension fund shareholders probing to determine wrongdoing by the drug distributor’s board for the company’s multi-billion-dollar legal exposure from the nationwide opioid crisis.AmerisourceBergen was already facing two congressional investigations, plus a Drug Enforcement Administration (DEA) probe. Reporting on this developing story is famed whistleblower attorney Mary Inman, a partner in the London law office of Constantine Cannon.Other segments to be featured on the broadcast include the following:RAC Report: Healthcare attorney Knicole Emanuel reports on the latest audits by Recovery Audit Contractors (RACs) and other third-party auditors.Audit Report: Sean M. Weiss, partner, and chief compliance officer for DoctorsManagement, reports on the latest audits you can expect to encounter.SDoH Report: Ellen Fink-Samnick has the latest news on a report from NPR about life experience and income inequality in the USA. Ellen will also conduct the Monitor Mondays Listener Survey. Risky Business: Healthcare attorney David Glaser joins the broadcast with his trademark segment, in which he reports on problematic issues facing providers. Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds with another installment of his popular segment where he will discuss the new Important Message from Medicare.

It’s been a rough year for home health and hospice providers, especially in light of the fact that the Centers for Medicare & Medicaid Services (CMS) included a reduction in the base payment rate of 8.01 percent in the Patient-Driven Groupings Model (PDGM) of the 2020 Home Health Prospective Payment System Rate Update.Returning to Monitor Mondays is William Dombi, president of the National Association for Home Care and Hospice, who will provide a regulatory update for his association as its members prepare for another year of audits.Other segments to be featured on the broadcast include the following:Monday Focus: What are likely to be three major audit issues in 2020? Sean M. Weiss, partner and chief compliance officer for DoctorsManagement, reveals his pick of the top challenges you and your team will face in 2020.RAC Report: Healthcare attorney Knicole Emanuel reports on the latest activities by the Recovery Audit Contractors (RACs) and other third-party Medicare claims auditors. Emanuel, a member of the RACmonitor editorial board, is a partner in the Potomac Law Group.SDoH Report: Ellen Fink-Samnick, a nationally recognized expert on the social determinants of health (SDoH), has the latest news on this trending topic that is attracting significant media attention. Ellen also conducts the Monitor Mondays Listener Survey.Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Bryon, joins the broadcast with his trademark segment, in which he reports on problematic issues facing providers. Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, unveils his 2019 Hirsch’s Heroes: individuals who, in his judgment, made outstanding contributions in the world of healthcare over the last year.

Long awaited and hotly debated, the 2019 Medicare Physician Fee Schedule (MPFS) and Outpatient Prospective Payment System (OPPS) final rules have been on the minds of healthcare shareholders since late July, when the Centers for Medicare & Medicaid Services (CMS) released proposed rules for both. Tucked into the MPFS were the controversial revisions to the regulations governing evaluation and management (E&M) services.For an in-depth analysis of both the MPFS and the OPPS newly released final rules, Monitor Monday has brought together a pair of industry experts for this edition of the broadcast: Duane Abbey, president of Abbey and Abbey Consultants, and Sean M. Weiss, partner and vice president of compliance for DoctorsManagement.The broadcast rundown also will include:OIG Report: In a recent study, the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) reported that Medicare Advantage Organizations (MAOs) overturned 75 percent of their own prior authorization and claim denials from 2014 to 2016. Healthcare attorney Knicole Emanuel, a partner in the Potomac Law Group, provides details on this latest developments.Risky Business: Healthcare attorney David Glaser with Fredrikson & Byron will report on another example of a potentially troublesome issue that could pose a risk to your facility.TPE: Targeted probe-and-educate (TPE) audits are taking place in a variety of settings, from physical therapy providers to skilled nursing facilities (SNFs), including acute-care facilities. Reporting on TPE audits is Cindy Griffith, director of compliance and audits for ATI Physical Therapy.Monday Rounds: Ronald Hirsch, MD, vice president of R1 Physician Advisory Services, makes his Monday Rounds with another installment of his popular segment.