October 14, 2022 | By Sean Weiss, CHC, CEMA, CMCO, CPMA, CPC-P, CMPE, CPC Why is it that payors often, can’t or won’t comply with their own reimbursement rules or guidelines for processing/adjudicating claims? Some (who are contracted to The Centers for Medicare and Medicaid Services (CMS)) may view this blog in a negative…
September 16, 2022 | By Sean Weiss, CHC, CEMA, CMCO, CPMA, CPC-P, CMPE, CPC Audits are nothing new but the requirements tied to them are in a lot of cases. For years I have talked about and encouraged clients to create Corrective Action Plans (CAPS) when they uncover something that requires adjustments and possibly…
Strategic Litigation Services | CEMA Certification | Audit Services Details of the Case From Expert Witness Sean M. Weiss Recently, Sean M. Weiss with NAMAS’ parent company DoctorsManagement testified as an expert witness in a federal court case against four healthcare providers in one of the largest Medicare/Medicaid fraud cases in U.S. history. Read below as Sean recaps…
August 12, 2022 | By Sean Weiss, CHC, CEMA, CMCO, CPMA, CPC-P, CMPE, CPC Self-audits are critical. They demonstrate compliance, or at least a “good-faith effort” to be compliant; they minimize refunds of overpayments to “actuals” and also mitigate the potential for a multiple being added. Most importantly, they prevent an auditor, agent, or…
June 17, 2022 | By Sean Weiss, CHC, CEMA, CMCO, CPMA, CPC-P, CMPE, CPC I am constantly being asked what can be done when government and commercial payors are slow-walking claims for payment. The simple answer is to know your state and federal law. First, let’s tackle the federal law which is 42 CFR…
November 5, 2021 | By Sean Weiss, CHC, CEMA, CMCO, CPMA, CPC-P, CMPE, CPC Terry Fletcher sits down with our very own Sean M. Weiss to discuss how physicians become audit targets. Terry joins Sean monthly on the compliance guy for her #TerryTuesday segment. We know you’ll enjoy it! Listen Now
April 8, 2022 | By Sean Weiss, CHC, CEMA, CMCO, CPMA, CPC-P, CMPE, CPC Four months into 2022 and the question is: How far along is your audit of high, medium, and low-risk services? If you are like most practices or health systems, something always gets in the way and causes audits to take…
February 1, 2022 | By Sean Weiss, CHC, CEMA, CMCO, CPMA, CPC-P, CMPE, CPC As 2022 kicks into full gear one of the biggest areas providers (*rendering services in hospitals) face a change is tied to the 2022 CMS Split/Shared Visit Rules and what the anticipated impact(s) will be (here is a link…
January 21, 2022 | By Sean Weiss, CHC, CEMA, CMCO, CPMA, CPC-P, CMPE, CPC While I am sure you have heard it several dozen times by now, I want to welcome you to 2022 because that is where the pleasantries end. 2022 will see Medical Necessity put front & center not only in audits…
September 24, 2021 | By Sean Weiss, CHC, CEMA, CMCO, CPMA, CPC-P, CMPE, CPC Sean Weiss, DoctorsManagement Partner and Vice President of Compliance recently sat down with Ronald Chapman II, Esq. LLM of The Chapman Law Group to discuss and break down the Biden-Harris Executive Order and its impact on approximately 100 million American…