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The Compliance Guy

The Compliance Guy

Veröffentlicht: 2025-06-18
© Sean M. Weiss
The Compliance Guy - QR Code
368 Folgen
Audio
Anhören auf Apple Podcasts
368 Folgen
Audio
Anhören auf Apple Podcasts
Veröffentlicht: 2025-06-18
© Sean M. Weiss
Aktuelle Folge
Episode 367 - Monday Auditing, Coding and Compliance Roundtable

Episode 367 - Monday Auditing, Coding and Compliance Roundtable

Summary In this episode, the hosts discuss various pressing issues in healthcare, including the recent increase in CMS investigations into Medicare risk adjustment data, the challenges faced by providers in complying with insurance requests, and the imp
Länge: 1:00:29
Summary
In this episode, the hosts discuss various pressing issues in healthcare, including the recent increase in CMS investigations into Medicare risk adjustment data, the challenges faced by providers in complying with insurance requests, and the implications of Medicaid eligibility changes. They also delve into the role of GLP-1 medications in weight loss and the importance of patient advocacy in navigating healthcare decisions. The conversation emphasizes the need for healthcare professionals to engage in meaningful dialogue with insurers and to advocate for their patients' needs.
Takeaways
The increase in CMS investigators for Medicare risk adjustment data is significant.Providers have the right to push back against unrealistic insurance requests.Medicaid is a state program designed for low-income individuals and specific groups.Work requirements for Medicaid eligibility are being proposed, affecting millions.GLP-1 medications are becoming popular for weight loss but come with high costs.Patients should advocate for themselves and ask questions about their treatment plans.Insurance companies often request excessive documentation, creating administrative burdens.The healthcare system is facing challenges with compliance and documentation accuracy.Understanding the implications of HCC coding is crucial for providers.The long-term effects of new medications are still largely unknown.
Folgen-ID: 1000713334276
GUID: 4e8cd66a-641a-430c-8555-838fe124005e
Erscheinungs­datum: 18.6.2025, 02:51:26

Beschreibung

Sean is the host of “The Compliance Guy” a live production dedicated to the intersection of regulatory compliance and the business of medicine. The show provides timely, accurate, and easy to digest information to healthcare professionals.
The show features interviews of industry leaders, government officials, and others helping to shape the healthcare landscape.
Sean M. Weiss (AKA – The Compliance Guy) has been an industry respected name for more than 25-years. A physician and health system advocate, Sean engages with clients to ensure a “level-playing-field” and due process when allegations and/or accusations of impropriety are leveled by a payor or government investigation agency.
When Sean is not engaging in administrative, civil and criminal matters on behalf of more than 30 nationally recognized law firms and clients, he is serving as a third-party compliance officer for a dozen organization across the country ranging in size and specialty to ensure a “Culture of Compliance”!
Sean is a proud member in good-standing with the National Society of Certified Healthcare Business Consultants (NSCHBC), American Health Lawyers Association (AHLA), National Alliance of Medical Auditing Specialists (NAMAS), and the American Academy of Professional Coders (AAPC). Sean holds (CHC, CEMA, CMCO, CPMA, CPC-P, CMPE, CPC, CMC, CMIS, CMOM) national certifications from the Health Care Compliance Association, The National Alliance of Medical Auditing Specialists, The American Academy of Professional Coders and Practice Management Institute.

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