The upheaval in healthcare resulting from the pandemic along with changes to the 2021 EM Documentation Guidelines is ripe territory for audit scrutiny. Regulatory compliance and audit defense expert Sean M. Weiss predicts problems will continue for providers and health system based on the surge in telehealth services and COVID-19 waivers extended during the Public Health Emergency (PHE) to help providers operate more efficiently. But it's not too late to get things straight. It all comes down to establishing a Culture of Compliance!
 |
Sean Weiss
|
Sean serves as Chief Compliance Officer for numerous nationally recognized health care organizations; engaged in the development of customized Corporate Compliance Programs including Standard Operating Procedures (SOPs), Policies, Corrective Action Plans, Investigations and maintaining their Culture of Compliance. He is a Partner, DoctorsManagement, where he has been recognized by clients for successfully protecting their organization from unwarranted penalties and ensuring they receive due process. He has protected thousands of physicians, medical practice groups, and hospitals from undue penalties. In his medical audit appeal defense work, Sean and his team of auditing and compliance experts have a proven record of having claims dismissed that had been brought against large and small healthcare organizations targeted by federal (Medicare), state (Medicaid), and commercial insurance payors.
The instructor will explain how you can perform a self-audit or bring a professional auditor onsite to guide the process before it becomes a red flag. Sean will also help you to understand how to build a solid defense.
Participants in this program will learn how to:
- Distinguish the difference between disclosure and refund processes
- Research, locate specific payer policies, utilization guidelines, participation agreements, contracts or any other published guidance documents when you perform audits
- Secure authoritative guidance from peer-reviewed papers, specialty society publications, and guidance from the AMA, CMS, etc.
- Challenge payers that try to argue your lack of knowledge or obligation thereof
- Request that they produce the binding guidance documents that place the responsibility on you or your providers.
Comments from past participants:
“Good content about dealing with Insurance providers and what to ask auditors.”
“Excellent program. Provides good insight if you every have this come up in your own practice reviews or audits.”
“Speaker was passionate and offers great information.”
“The information was precise and real time - things we can use.”
“It was very informational and this person knows his stuff!”
Prod ID: 332