by Sean M. Weiss
<p>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.</p> <p>The show features interviews of industry leaders, government officials, and others helping to shape the healthcare landscape.</p> <p>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.</p> <p>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”!</p> <p>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.</p>
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Publishing Since
5/10/2021
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April 20, 2025
<p><strong>Summary</strong></p><p>In this episode, Sean and Terry discuss the complexities and challenges surrounding annual well visits in healthcare compliance. They emphasize the importance of physician involvement and the risks associated with allowing non-physician providers to conduct these visits without adequate supervision. The conversation highlights the potential consequences of inadequate patient assessments and the need for proper workflows to ensure quality care. They also touch on the role of medical assistants and the implications of billing practices in the context of compliance and patient safety.</p><p><strong>Takeaways</strong></p><p>Just because you can, doesn't mean you should.</p><p>Annual well visits require thorough physician review.</p><p>Inadequate assessments can lead to serious patient risks.</p><p>Medical assistants should not make clinical determinations.</p><p>Physician involvement is crucial in patient care workflows.</p><p>Quality control is essential for healthcare compliance.</p><p>Audits and inquiries are increasing in healthcare.</p><p>Preventive services must be properly documented and reviewed.</p><p>Common sense should guide healthcare practices.</p><p>Healthcare providers must take responsibility for patient outcomes.</p>
April 20, 2025
<p><strong>Summary</strong></p><p>In this episode, Sean and Terry discuss the critical importance of accurate claims submission in healthcare, particularly regarding the representation of patient identity and biological information. They explore the implications of inaccurate documentation on medical necessity, reimbursement, and patient safety, while also addressing the sensitivity surrounding these topics. The conversation emphasizes the need for providers to balance empathy with the responsibility of maintaining accurate medical records to avoid legal and financial repercussions.</p><p><strong>Takeaways</strong></p><ul><li>Accurate claims submission is essential for reimbursement.</li><li>Sensitivity in documentation must not compromise accuracy.</li><li>Medical necessity is determined by biological information.</li><li>Inaccurate records can lead to healthcare fraud charges.</li><li>Providers must adhere to legal and regulatory standards.</li><li>Patient safety relies on complete and accurate medical records.</li><li>Insurance companies require precise diagnoses for reimbursement.</li><li>The healthcare system is affected by statistical inaccuracies.</li><li>Providers face financial consequences for inaccurate claims.</li><li>Open discussions about sensitive topics are necessary for progress.</li></ul>
March 26, 2025
<p><strong>Summary</strong></p><p>In this episode, Sean and Terry discuss the importance of maintaining high standards of medical record documentation, regardless of whether patients are cash pay or insured. They emphasize that documentation integrity is crucial for all patients and should not be compromised based on financial status. The conversation also touches on recent telehealth updates and the implications of documentation in legal contexts.</p><p><strong>Takeaways</strong></p><ul><li>Medical record compliance is essential for all patients, regardless of payment method.</li><li>Telehealth services have been extended, highlighting ongoing changes in healthcare delivery.</li><li>Documentation integrity is critical in avoiding legal issues and ensuring patient safety.</li><li>Providers should not differentiate the quality of care based on a patient's insurance status.</li><li>Federal standards exist for documentation that apply universally to all patients.</li><li>Medical records must support diagnosis and treatment justification, irrespective of payment type.</li><li>Providers should treat every document as a potential legal document.</li><li>The integrity of medical records is vital for continuity of care among providers.</li><li>Documentation should be accurate, complete, and timely to avoid confusion.</li><li>Healthcare professionals must prioritize patient care over financial considerations.</li></ul>
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