Regulatory Compliance - DoctorsManagement Regulatory Compliance - DoctorsManagement

Caveat Emptor

By | 2019, Regulatory Compliance, Sean Weiss
Caveat Emptor “The Truth About Evaluation and Management Services & Proprietary Algorithms” by Sean Weiss, Partner & VP of Compliance We have, and will remain in, an industry dominated by fancy terms like predictive analytics and artificial intelligence and words such as proprietary determined by marketing teams at various vendors trying to get their piece...
Read More

Business Associate Agreement

By | 2019, Regulatory Compliance, Sean Weiss
Business Associate Agreement “Make Sure You Have Them on File” by Sean Weiss, Partner & VP of Compliance The Health Insurance Portability and Accountability Act of 1996 (HIPAA), also referred to as Public Law 104-191, has been around for more than two decades now. For the first 15 years or so, there was not much...
Read More

Co-Management Agreements

By | 2019, Regulatory Compliance, Sean Weiss
Co-Management Agreements “Aligning Hospitals and Providers” by Sean Weiss, Partner & VP of Compliance While the industry is split between physician practices remaining independent versus being acquired and thus being employed, there are other type arrangements that are taking place which have been around for quite a while (mid-00’s); I am referring to Co-management Agreements....
Read More

Cigna, UnitedHealth to stop paying for consults in October

By | 2019, Regulatory Compliance
Cigna, UnitedHealth to stop paying for consults in October Grant Huang, CPC, CPMA Director of Content Two major commercial payers will stop reimbursing consultation E/M services (CPT codes 99241-99255) in October, finally joining CMS in ditching the high-paying but sometimes confusing code set. UnitedHealth made its announcement in its March 2019 newsletter, stating that it...
Read More

OIG Compliance 101

By | 2019, Regulatory Compliance, Sean Weiss

Each day our industry gains new members who are eager to learn and make a difference in the organizations in which they work. However, many times there is a gap in what they know versus what they should know. Honestly, experience is the best teacher but if along the way we, who have either picked…

Read More

Oh HIPAA!

By | 2019, Regulatory Compliance, Sean Weiss
Oh HIPAA! “The Compliant and The Negligent” by Sean Weiss, Partner & VP of Compliance In the words of Edward Porter Humphry “True wisdom is to know what is best worth knowing, and to do what is best worth doing.” When it comes to compliance, and especially Public Law 104-191 Part 160 better known as...
Read More

Bad Actors

By | 2019, Regulatory Compliance, Sean Weiss
Bad Actors “Financial Remedies When All Else Fails” by Sean Weiss, Partner & VP of Compliance Today I am going to keep things short and sweet and not because I cannot come up with oodles of things to say. I am keeping it to a minimum today to focus on implementing remedies when you have...
Read More

The Civil Investigative Demand

By | 2019, Regulatory Compliance, Sean Weiss
The Civil Investigative Demand “Justice's Aggressive Investigative Tool” by Sean Weiss, Partner & VP of Compliance Prior to any litigation by the Department of Justice (DOJ), a Civil Investigative Demand (CID) will be sent to the party(s) of interest that allows for an investigation of potential allegations of False Claims Act (FCA) liability. These investigative...
Read More