Regulatory Compliance Archives

May 23 2019

Compliance Program Guidelines for Third-Party Medical Billing Companies

By Karen | 2019, Regulatory Compliance, Sean Weiss

Compliance Program Guidelines for Third-Party medical Billing Companies “Yes, You Have to Comply as Well” by Sean Weiss, Partner & VP of Compliance A couple of weeks ago, I had the privilege to speak for a Medical Billing Association and without a doubt there were some very sharp people there. What impressed me most was...

May 21 2019

I Know What We’re Doing is Wrong

By Karen | 2019, Regulatory Compliance, Sean Weiss

I Know What We're Doing is Wrong “I Need My Paycheck” by Sean Weiss, Partner & VP of Compliance I know I have said this in numerous Blog Posts in the past, but I really love my job because every day promises to be something new and challenges me to learn things I didn’t know...

May 16 2019

Medicare MACs, SMRC, UPIC/ZPIC, and RACs

By Karen | 2019, Regulatory Compliance, Sean Weiss

Medicare MACs, SMRC, UPIC/ZPIC, and RACs “Why Can't You Just Comply?” by Sean Weiss, Partner & VP of Compliance Yup, I am going to vent about Medicare Contractors - doesn’t mean I don’t love you; it just means I don’t like when you expect providers and health systems to follow the rules of the Program...

May 14 2019

Waiving Privilege and Its Impact

By Karen | 2019, Regulatory Compliance, Sean Weiss

Waiving Privilege and Its Impact “Wish They Made Imodium for the Mouth” by Sean Weiss, Partner & VP of Compliance Dialogue: Good Morning, I am Special Agent Johnson and this is Jane Doe of the U.S. Attorney’s Office and we are here to ask you questions about your organization. Office Manager: Good Morning, come on...

May 09 2019

2019 legislative agenda: Medicare for all?

By RHONDA CASTEEL | 2019, Regulatory Compliance

2019 legislative agenda: Medicare for all? The idea of expanding the Medicare program to cover Americans younger than the age of 65 has been around for a long time – it was referred to as the “single payer option” during the run-up to passage of the Affordable Care Act in 2010 and proved to be...

May 09 2019

CMS proposes using international pricing to slash U.S. drug prices

By RHONDA CASTEEL | 2019, Regulatory Compliance, Sean Weiss

CMS proposes using international pricing to slash U.S. drug prices The Trump administration is trying another approach in its efforts to lower prescription drug prices in the U.S., this time in the form of a proposed rule from CMS that would base Medicare payments for drugs on international prices. Citing data that shows the U.S....

May 09 2019

CMS ramps up ‘Targeted Probe and Educate’ audits

By RHONDA CASTEEL | 2019, Regulatory Compliance

CMS ramps up ‘Targeted Probe and Educate’ audits The Targeted Probe and Educate (TPE) program was launched by CMS nationwide in late 2017 to focus specifically on Medicare providers with high denial rates, the agency says in its fact sheet on the program. Originally a pilot program localized to a few Medicare Administrative Contractor (MAC)...

May 08 2019

DOJ and Corporate Compliance Program Risk Assessment

By RHONDA CASTEEL | 2019, Regulatory Compliance, Sean Weiss

DOJ and Corporate Compliance Program Risk Assessment “Forget the ABCs and Focus on the LBD” by Sean Weiss, Partner & VP of Compliance Mitigating Risk as a Practice Executive means lots of things… financial loss, threats of competitors, threats of audits from payors, and the ever-growing threat of government investigations for compliance violations. While we...

May 08 2019

MIPS survival guide 2019: Doing the bare minimum for a 0% update

By RHONDA CASTEEL | 2019, Regulatory Compliance

MIPS survival guide 2019: Doing the bare minimum for a 0% update The third year of Medicare’s Merit-based Incentive Payment System (MIPS) is now well underway, and it’s gotten tougher to skate through the year doing the bare minimum to avoid a Part B pay cut in 2021. This is by design, as MIPS was...

May 08 2019

E/M changes: The future of medical necessity in 2021 and beyond

By RHONDA CASTEEL | 2019, Regulatory Compliance

E/M changes: The future of medical necessity in 2021 and beyond by Sean Weiss, Partner & VP of Compliance You’ve probably heard that 2021 will be the year that E/M coding and documentation changes forever. Predictions of what will actually happen as a result of Medicare’s 2021 E/M revisions – which have gotten the AMA’s...

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Compliance Program Guidelines for Third-Party Medical Billing Companies

I Know What We’re Doing is Wrong

Medicare MACs, SMRC, UPIC/ZPIC, and RACs

Waiving Privilege and Its Impact

2019 legislative agenda: Medicare for all?

CMS proposes using international pricing to slash U.S. drug prices

CMS ramps up ‘Targeted Probe and Educate’ audits

DOJ and Corporate Compliance Program Risk Assessment

MIPS survival guide 2019: Doing the bare minimum for a 0% update

E/M changes: The future of medical necessity in 2021 and beyond

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