Compliance Conversations by Healthicity

Are you navigating the complex world of healthcare compliance, particularly when it comes to Medicare and Advanced Beneficiary Notices (ABNs)? We've got you covered in the latest episode of Compliance Conversations, featuring industry expert Keisha Wilson, founder of KW Advanced Consulting. Keisha brings over two decades of healthcare experience to the table, offering invaluable insights into the intricacies of ABNs. This episode delves deep into what ABNs mean for healthcare professionals and patients alike, recent changes to ABN forms, compliance risks, and the importance of proper education and implementation within healthcare settings. Why Tune In? - Uncover the essentials of ABNs: Learn what ABNs are and why they're critical in healthcare from a seasoned expert. - Stay updated: Get the scoop on the latest ABN form changes effective from June 2023 and how they impact practices. - Avoid common pitfalls: Keisha discusses frequent compliance risks and how to navigate them effectively. - Engage in comprehensive learning: From policy implementation to case studies, this episode is packed with actionable advice and best practices. Keisha's journey from aspiring social worker to healthcare compliance consultant adds a unique perspective to understanding patient communication and the nuances of Medicare coverage. Her passion for compliance and patient care shines throughout the conversation, making it a must-listen for anyone in the healthcare sector. You can also read a recent blog post from KW Consulting on ABNs. Keisha Wilson, CCS, CPC, CPCO, CPMA, CRC, CPB, Approved Instructor, is the Founder/CEO of KW Advanced Consulting LLC, Minority Women Own Business Enterprise (M/WBE) Certified, with 20+ years in healthcare specializing in various areas of compliance. Multi-specialty, Telehealth/Telemedicine, Risk Adjustment, provider and coder training. She currently sits on a Board of Directors for an outpatient mental health clinic. Keisha is a licensed PMCC who teaches coders looking to become Certified Risk Adjustment (CRC) and hosts various compliance documentation and coding webinars. She is a published author, having written for AAPC editors on Primary Care Coding Alert, Healthcare Business Monthly, and KW Advanced Consulting coding articles. Keisha can speak at various events this year, including the AAPC Regional Conference on Philidelphia and Cohen's Coding Summit on Telehealth in the U.S. vs Internationally.

In this episode, we're joined by Kandi O'Brien, the Founder of Delegated Credentialing Pro’s and an expert with extensive experience in credentialing and compliance. Kandi shares her fascinating journey in healthcare, from clinical roles to owning urgent cares, and ultimately specializing in compliance and credentialing. We discuss the importance of credentialing, its various aspects, and why it's crucial for patient safety, regulatory compliance, and maintaining organizational reputation. Tune in to our conversation to learn more about: - The significance of credentialing as the first step for providers entering healthcare facilities. - The distinction between facility credentialing and professional (provider) credentialing. - The complexities of enrollment and why it's not synonymous with credentialing. - The concept of delegated credentialing and its benefits for organizations, including improved efficiency and revenue generation. - The primary source verification process and ongoing monitoring for compliance. - The potential challenges and considerations associated with delegated credentialing. Kandi's LinkedIn: https://www.linkedin.com/in/kandio/ Delegated Credentialing Pro's: https://www.linkedin.com/company/delegated-credentialing-pro-s/

This Compliance Conversations episode is a must-listen for anyone in healthcare compliance or coding. We invited Leslie Boles, Co-Owner and President of Revu Healthcare, to chat about identifying coding compliance risks within healthcare organizations. Tune in to Leslie and CJ Wolf’s discussion for more on: - The importance of staying curious and adaptable - The significance of regular audits and assessments in proactively identifying compliance risks - Common coding compliance risks and blind spots within organizations - Strategies for mitigating compliance risks, including the role of data analytics and technology They also talk about one of the most important things to keep top-of-mind – staying humble and acknowledging gaps in knowledge to drive continuous improvement.

Biometric technology can sometimes feel like sci-fi – which is why it raises so many great compliance questions. That’s why we invited Dr. Mohamed Lazzouni, the Chief Technology Officer at Aware, a leading company in the field of biometrics, to join us for our latest episode of Compliance Conversations. In this episode, Dr. Lazzouni shares insights into the exciting developments in biometrics and its pivotal role in healthcare. From access control to fraud prevention, Dr. Lazzouni and I discuss the impact on compliance and security in the healthcare industry. Listen now to gain a deeper understanding of: - How biometrics enhance healthcare access control - Real-world applications of biometrics in preventing fraud - The intersection of biometrics and compliance in healthcare - The future of wearables and AI in biometric healthcare interventions

Ready for a crash course into regulatory considerations in health tech? In this episode of Compliance Conversations featuring Susan Walberg, a seasoned regulatory and compliance professional and published author of fiction and non-fiction In this interesting interview, Susan shares her journey from novels to HIPAA, offering a behind-the-scenes look at the challenges and triumphs of navigating compliance in the rapidly evolving health tech landscape. Tune in to the episode to discover: - Some surprising realities of health tech compliance - Real-word intriguing cases (like the Jelly Bean dilemma!) - Key lessons for startups and small organizations as they navigate compliance concerns Thanks to Susan for joining us for this episode – we hope you enjoy! Susan Walberg has worked in health care for nearly 30 years, from working as a fraud investigator at a health plan, to a regulatory attorney and privacy officer for a very large health system. She has worked as a compliance officer, and a subcontractor working with CMS on Part C and D Medicare fraud and abuse. Susan has also worked as an interim compliance officer for a range of healthcare organizations, designing and building compliance programs unique to the needs of those organizations. Her specific experiences include helping clients manage a Corporate Integrity Agreement and developing programs for new organizations or those going through an organizational transition. Susan has trained and mentored many new compliance professionals, and strives to help those new to compliance to succeed in their roles. As a consultant, Susan uses her passion for building, creating, and organizing compliance programs along with a true understanding of the needs of healthcare organizations to help create programs that really fit within the each client’s unique culture and environment.

Tune in to this episode of Compliance Conversations interview with Maya Turner, a seasoned expert in the healthcare industry with close to 30 years of experience in auditing, coding, billing, compliance – you name it. Maya shares her perspective on the evolution of telehealth, especially in the context of recent changes and challenges brought by the COVID-19 pandemic. Maya and CJ also discuss: - Significant changes in telehealth regulations from its early days to the present - Telehealth’s crucial role in addressing healthcare disparities - The importance of proper documentation in telehealth visits - Compliance issues and risks that auditors and coders should be aware of We welcomed an unexpected guest during the episode – Maya's dog! See if you can hear the friendly canine interruption. Maya is a seasoned certified coder and auditor, boasting nearly 30 years of experience and subject matter expertise to many coding compliance subjects; she especially is sought after for her in-depth knowledge base of pro fee multi-specialty practice, primary care, hospitalists, telehealth, in-patient and SNF billing. She is also a published author, having written articles for AAPC and HCCA, and currently is a part of the ACDIS Leadership Council. She showcases her unmatched three-dimensional thinking in complex subject matters, Mayas’ success is marked by her clear and well received presentation style, reflecting her profound understanding and expertise. Maya also has a consulting company, Turner Expert Consulting Services, LLC.

Dr. Adam Robinson, an internal medicine physician and founder of Aimedica, joined CJ Wolf, MD to explore the promises and pitfalls presented by AI in the healthcare landscape. Dr. Robinson provides valuable insights into the current state of electronic medical records, the impact of the 21st Century Cures Act, and the potential for AI to revolutionize patient care. Tune in to our latest episode, “Beyond the Buzzwords: Understanding AI's Role in Healthcare,” to hear CJ and Adam's discussion on: - Existing challenges with electronic medical records, such as data interoperability issues and the siloed nature of patient information. - The implications of the 21st Century Cures Act and its role in making healthcare data more transparent and interoperable. - Successful applications of AI in imaging specialties, highlighting the potential for improved diagnostics. - The current lack of comprehensive regulations for AI in healthcare and predictions around the emergence of potential FDA regulations in the future.

In this episode, Jenny Hamilton the Clinical Project Research Manager at Barrow Neurologic Institute, joins CJ Wolf, MD for an in-depth discussion on compliance considerations for clinical trials. From the complexities of protocol deviations to the vital role of Institutional Review Boards, they cover a wide range of topics. Tune in for valuable insights into the compliance landscape of clinical trials and learn more about the crucial role patients play in advancing medical research. Jenny and CJ also cover: - The importance of informed consent in clinical trials - Insights into FDA audits and the role of Clinical Research Associates - The fascinating and diverse landscape of global clinical trials You can also learn more about Jenny’s work here. https://www.barrowneuro.org/centers-programs/als-neuromuscular-disease/

If you haven’t had the time yet to read all 90+ pages of the OIG’s New Compliance Program Guidance, we’ve got a great place for you to start. We invited Sarah Couture, a nurse turned compliance consultant, to discuss the new guidance with us in our latest episode of Compliance Conversations. Join Sarah and CJ Wolf, MD as they break down the essential elements and updates, including: - The evolving role of Chief Compliance Officers - The significance of incentives in compliance programs - Collaborative risk management approaches - Emphasizing medical necessity in billing audits Sarah is the Principal of Couture Compliance, an organization dedicated to elevating compliance program effectiveness through tailored compliance solutions. You can reach her at sarah@couturecompliance.co.

In the age of technology, data, and artificial intelligence, there’s one often-overlooked workplace tool: soft skills. That’s why we invited Jay Anstine, the founder of Bluebird Healthlaw partners, to chat with CJ Wolf, MD about communication and navigating work environments. In our new episode of Compliance Conversations, “From the Boardroom to the Exam Room: Diplomatic Communication in Healthcare,” Jay and CJ discuss: - Real-world, complex scenarios with patients and clinicians - How to adapt your communication style for different audiences - Learning various communication tactics so you can effectively interact with physicians, leaders, and executives - Addressing compliance concerns in a group setting Jay Anstine is the founder of Bluebird Healthlaw Partners, a consulting firm with a mission to help compliance officers change the perception of compliance in their organizations. For over 20 years, he has worked on the provider and payer side of the healthcare market, consulting to leaders and clinicians about compliance program matters. He routinely writes and speaks about compliance program requirements and is a faculty member at the University of Southern California’s Gould School of Law, teaching courses on healthcare compliance. Jay recently wrote a book entitled, Navigating the Politics of Healthcare: A Compliance Officer’s Guide to Communication, Relationships, and Gaining Buy-in, which is available on Amazon or at Barnes and Noble. In his book, he talks about how there are two worlds within healthcare-the world the general public experiences in receiving care, and the world industry workers experience in providing that care. Jay’s theorizes it is the second world where the politics of healthcare lives, which impacts the effectiveness of a compliance program. His book then provides strategies to improve the compliance officer’s ability to communicate effectively with their healthcare leaders in order to gain buy-in to the compliance program. You can find Jay at www.bluebirdhealthlaw.com. He has a blog dedicated to communication strategies for compliance officers. You can also find him on LinkedIn.

In this episode of Compliance Conversations, we’re taking an in-depth look at the revenue cycle and coding. We’re joined by Stephanie Perry, the outpatient medical supervisor for e4health, as she shares insights from her 12 years of experience in coding, auditing, training, and leadership roles within the healthcare industry. Tune in to our episode, “Coding Strategies for Successful Revenue Cycle Management,” to understand modifiers, status indicators, and their significance in the reimbursement process. Stephanie sheds light on how coding decisions can either facilitate or hinder the smooth progress of claims through the revenue cycle.

In this episode, we welcomed Stacey Crudup, Chief Compliance Officer at The SEES Group, to share her insights on why building relationships with team members on the front lines of healthcare is essential in driving strong compliance programs. Stacey's experience and practical advice shed light on the benefits of understanding the business, spending time with your internal teams, and creating value through compliance efforts. Tune in to our new episode, “How Compliance Teams Can Build Trust to Accelerate Success,” to hear more about: - Stacey's journey into compliance from an IT background - The importance of building relationships in the world of compliance - Practical tips for embedding compliance into operations - Overcoming obstacles in the process - How to add value to your organization through compliance Stacey has unique expertise in recognizing the role of compliance in daily health care operations and communicating effectively with staff at all levels about the practical application of compliance principles. She is experienced in developing and executing organizational policies and procedures related to legal questions in the health care environment, compliance, and risk management.

We're excited to introduce a thought-provoking podcast episode that dives into the world of compliance in healthcare and explores the ever-evolving challenges compliance professionals face in their careers. In this episode, “A Candid Conversation on Challenges and Balance in a Compliance Career,” Dieter Lehnortt and CJ Wolf share their insights on the complexities of the healthcare compliance landscape. From dealing with government regulations to navigating the uncharted territory of Artificial Intelligence, they cover it all. Key takeaways from the podcast: - Explore the potential of AI in compliance and the importance of using it appropriately to enhance efficiency. - The significance of establishing boundaries, delegating tasks, and prioritizing for a better work-life balance. - How to make compliance approachable more approachable for colleagues who find it intimidating

Join us for a deep dive into healthcare and nursing facility compliance during this episode. Discover the ever-evolving landscape and common challenges faced by providers as CJ Wolf and Paige Pennington share their expert insights.

Whether you're a compliance professional, an HR specialist, or simply interested in the evolving landscape of workplace culture, our latest Compliance Conversations episode offers valuable takeaways for everyone. We invited Kyle Manwaring, a DEI professional, for a great conversation about the possibilities at the intersection of DEI initiatives, compliance, and organizational culture. Tune in to our new episode, “Exploring Diversity, Equity, and Inclusion in Compliance,” to learn more about: - The fundamentals of DEI and its various components. - The importance of DEI for organizations, both ethically and financially. - Strategies for fostering a more inclusive and equitable work environment. - The role of executives in championing DEI efforts.

We’re joined by Sara Richards, a newly certified coder, as she shares insights into the intricacies of medical coding and how it aligns with compliance in the healthcare industry. Sara and CJ Wolf, MD, discuss: - The certification process and how Sara prepped for the exam - What the coding exam is really like – and what’s changed (and hasn’t changed) over the last few decades - Career opportunities in the coding industry

Assembling the ideal compliance team is no small task – and that’s why it can be such a puzzle. We invited Sarah Couture, a former nurse turned compliance executive, to share her insights on structuring effective compliance teams. Tune in to our new episode, “The Art of Building a Successful Compliance People Strategy,” as we discuss: - Important considerations for building a strong compliance team - Why compliance liaisons can boost your program’s effectiveness - Real-life examples of compliance staffing done right (and not so right) - Strategies for compliance officers to approach succession planning and mentorship Sarah currently serves as a Senior Managing Director at Ankura, and she is also a faculty member for the Health Care Compliance Association (HCCA). She started her career as a nurse and made the transition to compliance when she saw an opportunity to support and strengthen health care compliance. If you’d like to hear more from Sarah, you can sign up for her upcoming HCCA webinar!

If you’ve been in the Healthicity community for a while, you might know that we conduct annual surveys every year for compliance and auditing professionals. We know there’s no shortage of surveys in this world, but here’s why you should take ours – it's designed to gather vital information to benefit you and your organization, and because you’ll get a handy dandy report after we analyze the responses. Get a look behind the survey scenes on our latest episode of Compliance Conversations, “The Marketing Team: What We Do in the Shadows,” where Healthicity’s Sr. Director of Marketing, Kyle Brogdon, steps from the editing booth into the recording booth to talk about what makes our survey different. Take the compliance survey here: https://www.healthicity.com/en/resources/2023-annual-compliance-survey Take the auditing survey here: https://www.healthicity.com/resources/2023-annual-auditing-survey

Investigations are a natural part of any compliance professional’s career – but that doesn’t make them any less intimidating. We invited Eric Allen, a highly regarded compliance professional with experience spanning academia, hospital institutions, and more, to join us for an episode of Compliance Conversations! In this episode, “Compliance Investigations 101,” Eric and I discuss the nuances of investigations, including: - How to set investigations up for success from the get-go - Navigating the emotional side of interviews and ongoing investigations - Why mannerisms and body language are crucial in the age of remote interviews

“Think like a lawyer, talk like a human, and start with your audience." Those three key principles drive Kirsten Liston’s innovative approach to compliance training, and it’s why we invited her to join us on our latest episode of Compliance Conversations! Kirsten is the CEO of Rethink Compliance and a two-time author. We’re grateful she shared her time and expertise with us on our latest episode!