Compliance Conversations by Healthicity

About this podcast

Compliance Conversations is a monthly podcast for healthcare professionals and compliance officers who want to stay on top of the compliance game. Host CJ Wolf has in-depth conversations with industry experts to explore the riddles and complexities of the compliance world. Wolf chats with fellow compliance experts, auditors, physicians and government officials. Compliance Conversations is produced by Healthicity.

Compliance Conversations by Healthicity

Episodes

2020
A Pro’s Guide to Conducting Your Annual Privacy and Security Risk Assessment
Recently, I sat down with Brian Burton, our new Chief Compliance and Privacy Officer, for an all-new episode of the Compliance Conversations podcast. Given the time of year, and his area of expertise, we focused our discussion on a topic on many people’s minds: Privacy and Security Risk Assessments. I know these assessments can be daunting to approach or, as Brian put it, “I think a lot of organizations struggle with what does that mean, and how can I accomplish this activity with the minimum amount of effort, but still know that it’s accurate, and that your organization is protected from cyber security threats.” Having worked in the healthcare industry for more than 15 years, Brian become an expert in all things project management and technology. He's devoted most of his career to developing, implementing, and providing oversight for Compliance and Privacy program initiatives, working with more than one hundred healthcare facilities. Considering Brian’s vast experience, we discussed the symbiosis between project management and risk assessments, and how organizations should “initiate a project, then execute, monitor, control, and close,” in order to successfully identify and mitigate their risks. To hear more of Brian’s advice and best practices, listen to our latest episode of Compliance Conversations, “A Pro’s Guide to Conducting Your Annual Privacy and Security Risk Assessment,” where we cover topics including: • How to Protect Your Organization from Cyber Security Threats • What Tools You Should Use to Conduct Your Annual Security Risk Assessment • Which Cyber Security Framework Your Organization Should Deploy
December 16, 2020
32 min
2019
Ask an Auditor Anything (Dec 2019)
Around Healthicity, we love nothing more than to provide answers to some of your most pressing questions. And boy, do we get a lot of them. Because of this, we asked you to send us the questions that most perplex you while on the job. We got a ton of great questions (thank you), some of which even had us scratching our heads, too. So, I took a bunch of your questions to our resident auditing experts, Stephani Scott and Lori Cox, and sat down for a little chat. What we Then, we took a handful of those questions and and sat down to discuss them during this episode of Compliance Conversations, titled “Ask an Auditor Anything.” Here’s a sneak peak at some of the questions we discussed, and answered: Can Documentation of a Previous Allergic Reaction be Used Under ROS, or Only PMH? If the physician states "same/unchanged from last visit" to History will they receive credit for reviewing the last visit information? If the Documentation States “NO PFSH," Is This Applicable On a New PT or Consult Visit?
December 16, 2019
24 min
What You Must Do to be HIPAA Compliant in 2020
It’s that time of year again, when everyone is either breathing a sigh of relief because they’ve just completed their annual HIPAA risk assessment, or they’re cramming to get it done before year’s end. In the spirit of HIPAA season, we decided to turn the tables on CJ. So in this latest episode of Compliance Conversations, we had our very own SVP, Jeremy Schow, interview our local HIPAA expert, CJ Wolf, MD, to discuss all things HIPAA. And he had a lot to say. “The number one reason we do a risk assessment is it's a requirement. Number two though, it's good practice, right? We're in the business of helping patients, and we want to keep that information private and confidential. So, it's a good business practice,” CJ observed, before going on to answer all sorts of questions around HIPAA, including: Should I Conduct an Assessment Every Year? How Do I Conduct an Effective HIPAA Risk Assessment? What are Some Common HIPAA Mistakes I Should Avoid?
December 11, 2019
21 min
A Deep Dive Into the NCCI Policy Manual
In part two of my conversation with Christopher Chandler, a Technical Manager of Professional Documentation and Coding, at Intermountain Healthcare, we dove into the NCCI policy manual. It’s been a hot topic, as of late. Mostly because, as Chandler put it with a grin, “people hate the NCCI Policy Manual. They see it as a big book of rules that stops them from getting paid for the stuff they are doing.” But as you’ll hear, the manual is so much more. For instance, sometimes you can bill two codes together and, other times, you can’t. And when you need to know the answer, you consult the NCCI manual. Because many commercial payers have adopted these edits as well, it’s become an indispensable resource for any compliance billing department that’s using today’s best practices. But the manual can be daunting, and oftentimes difficult to decipher. Which is why during this episode of Compliance Conversations, "A Deep Dive Into the NCCI Policy Manual," Chandler and I jump right into the ins-and-outs of the manual, and discuss the three main topics of the manual, including: Knowing Exactly What’s Included in a Surgical Package Understanding Multiple Procedure Overlaps Billing Protocols for Inherent Services
October 2, 2019
26 min
Understanding the Nuance of NPP Coding
Recently, I sat down with Christopher Chandler, a Technical Manager of Professional Documentation and Coding, and we had a lot to cover during our podcast. So much so, that we actually recorded two new podcast episodes. In this first episode, Understanding the Nuance of NPP Coding, we dove into the world of non-physician practitioner (NPP) coding. NPPs, as Medicare calls them, are made up of a number of different provider types. They include nurse practitioners, physician assistants, certified nurse anesthetists, clinical nurse specialists, amongst others. The world of NPPs is ever-changing as hospitals are, in Chandler’s words, “developing new ways of providing care to patients… and help alleviate the burden that physicians are feeling, with the amount of patient load that they have.” If your hospital or clinic has a number of NPPs, it could be a signal to payers to keep an eye on your claim submissions. Which makes it all the more critical that your billing department has the tools to correctly code your NPPs. Listen to our newest episode of Compliance Conversations:, where Chandler and I discussed everything NPP, including: Identifying the Difference Between Shared Services and Incident Two Avoiding Double Billing the Patient and the Payer Following the Intense Guidelines of Shared Services
September 25, 2019
23 min
How to Provide Access to Telehealth, While Maintaining Compliance
For this installment of Compliance Conversations, we interviewed Jake Geertsen, a Technical Manager in the documentation and coding, who specializes in telehealth. It’s a fast-growing segment of healthcare, which has spawned a lot of questions around the field. Not least of which is: What exactly is telehealth? According to Geertsen, telehealth is “a collection of means or methods for enhancing healthcare, public health, and health education delivery and support, using telecommunication technologies.” Just ten years ago, few of us were carrying around the computing power we commonly find in our pockets and purses today. Nor did we know the benefits this technology could have to, as Geertsen puts it, “to the patient, the healthcare organization looking to cut costs, to insurance companies also looking to cut costs. In many scenarios, this is an area of innovation and improvement.” Understand the History and Evolution of Telehealth Implement Proper Coding and Billing Compliance Practices Stay Current with Ever-changing Medicare Regulations and Payer Policie
September 11, 2019
25 min
How to Earn a Huge ROI from Medicare’s IOMs
I sat down with Tyler Griffeth, a Technical Manager of Professional Documentation and Coding at Intermountain Healthcare, to discuss a couple of his favorite Medicare Internet Only Manuals (IOMs), specifically the National Correct Coding Initiative (NCCI) Policy Manual and the Claims Processing Manual. The NCCI Manual, about which he jokingly said, “I’ve got mine laminated, I can read it in the tub with a little bit of bubbly” is just one of his favorites. Meanwhile, the Claims Processing Manual, “Is a really great resource if you’re dealing with things like denials, but also if you’re involved in a RAC audit.” Tune in to my most recent episode of Compliance Conversations, How to Earn a Huge ROI from Medicare’s IOMs, and learn how to: Use the NCCI Policy Manual to Clarify Procedure Codes to Physicians Leverage the Claims Processing Manual to Avoid Denials Apply Situational Modifiers in Conjunction with Codes
August 21, 2019
26 min
Export Controls: The Most Important Compliance Element You Probably Haven’t Heard Of
Whether you’re dealing with medical devices or new drugs–regardless if it’s a product or a service, and whether that product or service ever even leaves the United States, export controls affect every organization in one way or another. That’s why I was so excited to sit down with Export Controls and Compliance expert, Wendy Epley, the president of Epley Consulting, for this episode of Compliance Conversations. As a compliance professional in healthcare, you might hear the word “export” and think ‘I don’t ship anything out of the country, so export controls don’t apply to me.’ But surprisingly it does! Epley explained, “[export controls] is referring to a very complicated network of federal agencies and regulations that are interconnected to regulate or control how things are to be protected in order that they are not used in a way that would cause harm...regardless of where those persons are located, including if they are here within the United States.” Epley also went into detail about the foreign corrupt practices act, an important act for many of you in various healthcare compliance roles. “Just a few years ago, Teva Pharmaceutical Industries paid nearly five hundred and twenty million...for its role in violations with the FCPA.” Said Epley. Find out how export controls apply to all of you healthcare compliance professionals out there. Tune in to my latest episode of Compliance Conversations, Export Controls: The Most Important Compliance Element You Probably Haven’t Heard Of, to learn why: One Doctor Went to Prison For His Research Some Medical Equipment and New Drugs Pose A Risk You Need to Institute Export Protocols and Training in a Research Uni Setting Teva Pharmaceutical Industries Paid Nearly $520 Million in Violations
August 7, 2019
34 min
How to Build a Mutually Beneficial Relationship with Your Compliance Committee
Listen to this most recent episode of Compliance Conversations, How to Build a Mutually Beneficial Relationship with Your Compliance Committee, with special guest, Judith Maber-Fox, to learn how to: Build a Mutually Beneficial Relationship with your Compliance Committee Engage Sr. Leadership to Actively Support the Committee Create Opportunities That Give You a Seat at the Table
July 25, 2019
32 min
The Psychology Behind Why Physicians Undercode
For this Compliance Conversations episode, I’ve got a special treat for you: Dr. Ira Specter. He spent many years as a practicing OBGYN physician and is also a certified coder and medical auditor. After practicing medicine for a few decades he went on to run a large medical management company, where they did billing collection, coding, compliance, and ICC10 courses for sixty-five physicians. Because of his unique perspective, we tackled bridging the gap between coding and auditing and physician documentation. I asked Dr. Specter, “what’s the biggest area for improvement for physician documentation?” After a brief pause, he said, “Let me start by saying, by and large, most physicians are under coding.” It seems, according to Specter, that physicians are “cutting off their own legs,” and also “cherry picking” codes. What does that mean? Listen to this episode to find out what Dr. Specter views as the biggest mistakes physicians are currently making and learn: What Coders/Auditors Should Look Out For in Physicians Documentation Why Physicians Should Never Cherry Pick Codes The Pitfalls of Copying and Cloning.
June 19, 2019
27 min
How the Pros Implement a Compliance Program
There are a lot of barriers in compliance. In this installment of Compliance Conversations, I chat with Eric Dominguez, the chief compliance officer at Emerus, a management company that specializes in healthcare systems. “Part of the services we provide to these joint ventures is a compliance program.” Dominguez explains some of the common hurdles of aligning with partners. “It’s a challenge and at the same time, it’s really a great opportunity for growth.” So how do Dominguez and his group manage compliance on such a big scale? And how can we get better at it ourselves? Listen to this episode to learn how to: Tackle Compliance Like a Large Hospital Group Manage the Unique Challenges of Micro-Hospitals Navigate Policies and Procedures for Hospital Licensing
June 3, 2019
31 min
Taking the Trauma out of Technology
Whether it’s an EMR or a compliance software solution, you want technology to do the work for you, not make you do extra work. Knowing where tech disappoints has helped Healthicity’s president, and my guest on my most recent episode of Compliance Conversations, Barry Johnson, D.D.S., to create software solutions that healthcare organizations really want. And, according to the US Government, solutions that healthcare organizations really need. “Recently at HCCA, we heard government officials telling the people that were at the meeting that compliance has got to move into the digital age and start doing things with software rather than spreadsheets.” It doesn’t matter if you’re an early adopter or tech-adverse, this informative and fun episode will bring you up to speed on all things healthcare technology from the largest challenges to the newest tools and gadgets that save lives or make your workday a whole lot easier. If tech has got you down: Johnson just might have a solution for you. Tune into this episode of Compliance Conversations, Taking the Trauma out of Technology with Barry Johnson, D.D.S., to learn: * Tech Trends (and Failures) in Healthcare * Upcoming Advances in Healthcare to Watch For * How to Make Tech Work For You * What the US Government Has to Say About Technology in Compliance
May 29, 2019
32 min
What You Need to Know About Billing Compliance in Academic Medical Centers
I’ve been getting a lot of requests to do a show about coding and billing and I couldn’t think of a better guest than my friend and former colleague, Jay McVean, an expert in billing and coding compliance with the University of Texas Health Science Center in Houston. Starting out, I had to ask: What’s the biggest coding and billing compliance issues in medical school, with faculty, and academic medical centers? This is where McVean’s expertise really shines and it’s an area that doesn’t get talked about nearly enough. McVean explained, “One of the biggest challenges we face in this ever-growing clinical world is that our teaching physicians really must understand who they’re working with...When various people are touching the notes, documenting portions of the visit, at the end of the day physicians are really confused about if they have a TPA situation, or if this is a shared split visit if I’m in the hospital, and how much of the note to document versus an NP or a PA.” From there, we talked about physician pressures and productivity and how it plays into billing and coding compliance. Listen in to our latest episode, What You Need to Know About Billing Compliance in Academic Medical Centers, with expert Jay McVean. In this episode we chat about: Teaching Physician Traps Documentation Issues The Complexity of the Clinical Environment Education and Training Potential EMR Concerns
April 1, 2019
21 min
Recognizing the Differences Between Medical Necessity and Medical Decision Making
In this episode of Compliance Conversations, I chatted with Charla Prillaman, the Regional Vice President of Audit Services and 30-year compliance veteran, about the crucial differences between Medical Necessity and Medical Decision Making (MDM). Prillaman pointed out that both terms are incorrectly used interchangeably, though they have distinctly different meanings. “Medical Necessity is the foundation for payment for all medical services. We find the original or the beginning statement about medical necessity being the overarching criteria all the way back into the social security act…Now the complexity of medical decision making is that it’s intended to somehow or another quantify a provider’s cognitive work in a specific encounter with the patient.” Said Prillaman. In this highly requested conversation, Prillaman breaks down how to properly document medical necessity and medical decision making and how to quantify something as difficult as “cognitive effort” for MDM. Tune into this episode of Compliance Conversations, “Recognizing the Differences Between Medical Necessity and Medical Decision Making” with me, CJ Wolf, and Charla Prillaman for the full scoop on Medical Necessity and MDM, including: The History of Both Medical Necessity and MDM Key Differences of Medical Necessity and MDM Ways to Properly Quantify and Document MDM
March 20, 2019
26 min
2018
Tips for When You’re the New Kid on the Compliance Block
I recently spoke with Brooklyn Trumpy on what it’s like to be new to compliance. Trumpy graduated in 2009 with a degree in Operations Management and ended up in compliance five years ago when she took a role at Community Health Systems and worked her way into a compliance role. Trumpy found that being new to compliance was a challenge. She explained how it can be intimidating to learn all of the new rules and regulations and how to piece together the puzzle that is compliance. She initially struggled to make connections and find her tribe within Compliance and it took some time to learn how to stay organized. Trumpy had some expert advice for new compliance professionals that will help them have an easier transition into the world of compliance. Listen to this episode of Compliance Conversations, "Tips for When You’re the New Kid on the Compliance Block," to learn: * Which Personality Types are Drawn to Compliance in the First Place * How to Set Expectations as a New Compliance Professional * Why It's Okay not to Know Everything Right Out of the Gate
October 24, 2018
28 min
The Teaching Physician Rule: A Blessing or a Curse
Back in February, CMS announced changes that seem to allow medical students a lot more freedom to document a patient’s medical record. Which could sound like a dream to physicians who might be thinking that the students will help ease the heavy burden of bureaucracy, but auditors are a little worried. Auditors are going, “Wait, hold on, we’ve got to really look at this before we jump the gun.” I spoke with expert compliance auditor, Charla Prillaman, who’s lived and breathed auditing for decades. The hard part, it turns out, isn’t understanding the new rule; the hard part is re-educating doctors. Tune into our latest episode of Compliance Conversations, The Teaching Physician Rule: A Blessing or a Curse, to learn the: New Specifics of Student Documentation for E/M Services and HPI, Dangers of Improper Documentation Teaching Physician’s Responsibility to Verify and Attest to Student Documentation.
August 23, 2018
27 min
Smart Strategies to Holistically Tackle Your Organization's Risks
We kicked off this episode of Compliance Conversations with a guest host, our very own compliance expert, Marcie Swenson, and her special guest, Emily Haley, who has worked as a Chief Privacy Officer and Compliance Director at Intermountain healthcare and is currently working in Care Transformation. In the first half of the show, Haley gave us a full fledged rundown on gap analysis, risk analysis and risk management plans. In the second half of the show, we dove unapologetically into the OCR’s phase 2 desk audits and what we can all learn from them. “Everybody is familiar with OCR’s phase 2 desk audits, where they audited 63 covered entities, and I think 40 something business associates. They used a scale 1 through 5, 1 being the very best risk analysis or risk management plan, and 5 being the very worst...more than half both business associates and the covered entities had scored a 4 and a 5. That’s shocking. That means most of us are not doing the right things.” Tune into our latest episode of Compliance Conversations, Smart Strategies to Holistically Tackle Your Organization’s Risks, with guest host Marcie Swenson. In this podcast we’ll cover how: Every Department Must Work Together to Reduce Risks Risk Analysis is Dependent on Gap Analysis and Management Plans To Mitigate the Lack of Updated Risk Analysis Information From the OCR
July 11, 2018
24 min
How to Avoid the Compliance Dangers of Medical Marijuana
Weed. Pot. Ganja. Marijuana goes by many names and has been a part of the global counterculture scene for decades. But now it’s quickly becoming a part of healthcare, as medical marijuana continues to be legalized across the nation. In my latest episode of Compliance Conversations, I talked with Judy Cassel, JD, MBA, an expert legal advisor on all things medical marijuana. I asked her how medical marijuana will impact physicians, compliance officers, and hospitals. There are dangers in prescribing it even if it’s legal. While each state is able to decide on whether or not to legalize medical marijuana, it’s still illegal at a federal level–this is where things get complicated. Cassel explained the dangers of physicians, or a practice, prescribing medical marijuana and how you and your organization can recommend it while still remaining compliant. Listen to this episode to learn how to: Reduce Opioid Deaths and Addiction Avoid Violating the Federal Law with Medical Marijuana Recommend Medical Marijuana and Stay Compliant
June 6, 2018
28 min
What Not to Do When CMS Audits You
Let’s say you’re a Medicare Advantage organization and one day you receive a notification from CMS that you’ve been selected for program audit. What should you do? Recently, I sat down with Scott Robinson, director of compliance at Davis Vision, and former medicare contractor who used to accompany the folks at CMS to conduct effectiveness audits. Robinson gave me the details on what to do and what not to do when and if you receive the news. “The first thing is to not panic,” Robinson said, “All you really need to do is explain yourself. You just need to articulate your usual business practices in a way that CMS will understand and agree with.” But doing this requires you to be ready for it. Tune into this episode to learn how to: Prepare for a CMS Audit Before it Happens Stay Calm During a CMS Audit Effectively Explain Yourself to CMS
May 30, 2018
26 min
Patients Empowered: Improving Accuracy Through Co-Authorship
Michael Warner, an Osteopathic physician, board certified in family medicine, turned patients’ rights advocate has a lot say about a patient’s rights to access. Warner is passionate about empowering patients to co-author their medical record. Through his research, Warner has found that giving patients the opportunity to take control of their information greatly increases accuracy, efficiency, and patient satisfaction. In a post-study follow-up survey, most patients reported that they “appreciated being given the chance to co-author” their medical records. For any healthcare organization, this is music. Listen to this episode, Patients Empowered: Improving Accuracy Through Co-Authorship, to learn how to: Collect patient data before their visit to maximize efficiency. Share history, exam, and Medical Decision Making with patients for accuracy. How HIPAA’s privacy rule allows patients to amend their records.
April 18, 2018
27 min

Compliance Conversations by Healthicity

About this podcast

Categories

About this podcast

Categories

Compliance Conversations by Healthicity

Episodes

A Pro’s Guide to Conducting Your Annual Privacy and Security Risk Assessment

Ask an Auditor Anything (Dec 2019)

What You Must Do to be HIPAA Compliant in 2020

A Deep Dive Into the NCCI Policy Manual

Understanding the Nuance of NPP Coding

How to Provide Access to Telehealth, While Maintaining Compliance

How to Earn a Huge ROI from Medicare’s IOMs

Export Controls: The Most Important Compliance Element You Probably Haven’t Heard Of

How to Build a Mutually Beneficial Relationship with Your Compliance Committee

The Psychology Behind Why Physicians Undercode

How the Pros Implement a Compliance Program

Taking the Trauma out of Technology

What You Need to Know About Billing Compliance in Academic Medical Centers

Recognizing the Differences Between Medical Necessity and Medical Decision Making

Tips for When You’re the New Kid on the Compliance Block

The Teaching Physician Rule: A Blessing or a Curse

Smart Strategies to Holistically Tackle Your Organization's Risks

How to Avoid the Compliance Dangers of Medical Marijuana

What Not to Do When CMS Audits You

Patients Empowered: Improving Accuracy Through Co-Authorship