The American Health Law Association (AHLA) is the largest nonprofit, nonpartisan educational organization devoted to legal issues in the health care field with nearly 14,000 members. As part of its educational mission, AHLA's Speaking of Health Law podcasts offer thoughtful analysis and insightful commentary on the legal and policy issues affecting the health care system. AHLA is committed to ensuring equitable access to our educational content. We are continually improving the user experien ...
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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 ...
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Allinfoodz covers a variety of food, and foodservice-related topics that aim to answer core questions regarding our food decisions: How, and why we eat food? The process of creating, serving, and eating food can be a personal or social event. Most people think about food frequently during any given day. Furthermore, there are often underlying reasons that might drive how we make our food choices and decisions, whether we are consuming, or offering food to others. Allinfoodz provides a space ...
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How to “Survive and Thrive” in Health Law: Tips for Early Career Professionals
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Alé Dalton, Partner, Bradley Arant Boult Cummings LLP, speaks with Ari Markenson, Partner, Venable LLP, about how early career professionals can use the complexities of the health care industry to their advantage. They discuss why the average health care lawyer is like a “Swiss Army Knife,” how to navigate the sea of acronyms that exist in the heal…
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Meetings & Events are crucial to our travel and hospitality experiences and food is a central element. In this pod we discuss the complexity of managing food waste in this industry and opportunities to solve this crucial aspect of sustainable, and responsible consumption. Our guest, Dr Rick Garlick, shares insights from a recent World Wildlife Fund…
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Health Care Enterprise Risk Management: Issues Related to Cybersecurity
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David Crapo and Bethany Corbin discuss enterprise risk management for health care organizations, with a particular focus on cybersecurity. They cover the sources of cyberattacks on health care organizations, risks involving third-party vendors, strategies for minimizing cybersecurity risks, legal requirements, different stakeholder responsibilities…
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season 8 - Episode 14 - #TerryTuesday - The Final Rule is A Critical Mistake
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Summary In this episode, Sean and Terry discuss the implications of the recent Medicare final rule, particularly focusing on the challenges facing telehealth services. They explore the political dynamics surrounding healthcare access, the importance of equitable access to telehealth, and the need for legislative action to address these issues. The …
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Season 8 - Episode 13 - Navigating Post-Pandemic Audits in Healthcare
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Summary In this episode of the Compliance Guy Podcast, Sean engages with Dean Viskovich, a healthcare attorney with extensive experience in lab-related compliance and reimbursement. They discuss the challenges faced by healthcare providers in the wake of post-pandemic audits, the importance of documentation, and proactive measures that can be taken…
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Drafting Health Care Contracts: Tips from the Trenches
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Jenna Brofsky, Partner, Husch Blackwell LLP, and Thomas Spellman, Associate General Counsel and Vice President, Fresenius Medical Care North America, discuss approaches for drafting health care contracts, focusing on negotiation techniques and strategies and non-compete provisions. Jenna and Thomas are co-authors of AHLA’s Health Care Contracts: A …
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Season 8 - Episode 12 - #TerryTuesday - Navigating The World of Consultants in Healthcare
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Summary In this episode, Sean and Terry discuss the challenges faced by consultants in the healthcare industry, particularly regarding collaboration requests and the importance of maintaining credibility. They share personal experiences with scams and the necessity of due diligence when engaging with potential partners. The conversation also touche…
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AI in Health Care: Patient Safety and Responsible Implementation
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Jiayan Chen, Partner, McDermott Will & Emery, and Lauren Willens, Senior Counsel, Henry Ford Health, discuss how health care organizations can safely and responsibly implement artificial intelligence (AI). They cover the opportunities and risks of AI in health care, the current state of AI regulation, the role that patient safety organizations can …
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Texas’ Reproductive Health Privacy Rule Lawsuit: Potential Federal-State Challenges
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Texas recently filed a lawsuit against the U.S. Department of Health and Human Services challenging both the HIPAA Final Rule to Support Reproductive Health Care Privacy and the HIPAA Privacy Rule, with potential implications for the balance of power between federal health privacy regulations and states’ authority to investigate potential legal vio…
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Season 8 - Episode 11 - Dr. Muhamad Aly Rifai - Lessons Learned from a High-Stakes Trial
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SummaryIn this episode, Sean discusses the complexities of compliance in healthcare with Dr. Muhammad Ali Rafai, who faced a criminal indictment for healthcare fraud. The conversation covers the emotional toll of the indictment, the audit process, trial preparation, expert testimonies, and the eventual acquittal. Dr. Rifai shares insights on the ch…
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In this episode, we explore innovative ways to address food waste and food insecurity through community efforts. The conversation highlights turning surplus food into opportunities, while discussing sustainability, logistics, and the broader impact of these initiatives. Stay tuned for inspiring insights on tackling one of today’s major global chall…
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Season 8 - Episode 10 - #TerryTuesday - Demystifying Compliance
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Summary In this episode, Sean and Terry discuss the critical importance of compliance in healthcare, focusing on the need for consequences for non-compliance, the implementation of financial penalties, and the role of documentation in ensuring patient safety. They emphasize the necessity of creating a culture of compliance within medical practices …
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Season 8 - Episode 9 - Monday Auditing, Coding and Compliance Roundtable
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Summary The conversation delves into the complexities of Medicare Advantage plans, highlighting concerns about their effectiveness and the implications of recent changes in coding. The panel discusses the challenges faced by patients under these plans, the deceptive marketing tactics used, and the potential shift towards remote patient monitoring a…
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The Provider's Role in Medicare Marketing: An Evolving Concept
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Jennifer Hatchett, Of Counsel, Hall Render Killian Heath & Lyman PC, and Jennifer McGowen, Senior Counsel, Health Plans and Networks, CHRISTUS Health, discuss considerations related to the provider’s role in Medicare Advantage marketing. They cover ways that providers can help their patients select a Medicare Advantage plan, CMS' guidance on “commu…
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Health Care Corporate Governance: Board Oversight of Compliance in Light of DOJ’s New Guidance
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Rob Gerberry, Senior Vice President and Chief Legal Officer, Summa Health, speaks with Michael Peregrine, Partner, McDermott Will & Emery, about the Department of Justice’s (DOJ’s) updated compliance program guidance and its implications for Board oversight of compliance. They discuss the DOJ’s updated Evaluation of Corporate Compliance Programs gu…
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Season 8 - Episode 8 - The Complex World of Qui Tam Cases - Dismissal Dynamics: With and Without Prejudice
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Summary Eric Rubenstein and Ron Chapman join The Compliance Guy to discuss the implications of a recent dismissal of a False Claims Act case based on the appointment clause. The guys explore the historical context of key tam cases, the role of relators, and the complexities surrounding the appointment clause. The conversation delves into the differ…
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AI in Health Care: Case Law and Enforcement Trends
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Nathaniel Mendell, Partner, Morrison Foerster, Kristopher Hult, Principal, Charles River Associates, and Jonathan Porter, Partner, Husch Blackwell, discuss some hot topics related to artificial intelligence in health care and accompanying case law trends. They cover issues related to antitrust, patient facing applications, claims processing and cla…
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C-Suite Roundtable: Latest Trends and Developments in Health IT
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Rob Gerberry, Senior Vice President and Chief Legal Officer, Summa Health, speaks with two health IT leaders, Daniel Clark and Supantha Banerjee, about the current landscape of health IT and some of the biggest challenges they are seeing. They discuss how to drive efficiency and value in health IT systems, how to engage providers in the use of data…
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Autism Spectrum Disorder and Food Preferences
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The impact of Autism Spectrum Disorder on food preferences remains less understood. In this podcast we unpack several of these aspects with Dr. Vinita Berry, from multiple perspectives, including how restaurant and foodservice industries can make spaces more accessible to autistic people.Av Amit Sharma
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Season 8 - Episode 7 - #TerryTuesday - Evaluation Medical Necessity
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Summary In this episode, Sean and Terry discuss the intersection of sports and healthcare, particularly focusing on the implications of sports injuries on mental health. They delve into the nuances of preventative medicine visits, the complexities of evaluation and management services, and the importance of medical necessity in billing practices. T…
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Season 8 - Episode 6 - Monday Auditing, Coding and Compliance Roundtable -
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Summary In this conversation, Sean and his guests discuss various pressing issues in healthcare, focusing on the implications of HIPAA violations, the challenges of patient privacy, and the recent controversies surrounding the Epic EMR system. They delve into the complexities of unauthorized access to patient information, the role of AI in healthca…
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Cutting Edge Developments in Health Insurance
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David E. Kopans, Partner, DLA Piper LLP (US), and Larry Pliskin, Senior Vice President, General Counsel & Chief Compliance Officer, Home Care Delivered, Inc., discuss current trends and developments surrounding the delivery of health insurance coverage in the United States. They cover artificial intelligence in health insurance, marketing health in…
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Navigating Private Equity in Health Care Amid Regulatory Scrutiny
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Leslie C. Overton, Partner, Axinn Veltrop & Harkrider LLP, speaks with Rebekah Goshorn Jurata, General Counsel, American Investment Council, and Dr. Isabel Tecu, Principal, Charles River Associates, about antitrust agencies' increased scrutiny of private equity in health care. They discuss certain aspects associated with the private equity model, w…
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Season 8 - Episode 5 - Nicole Thorne - Understanding the Surge in Healthcare Audits and the Role of AI in Shaping Healthcare Compliance
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Summary In this conversation, Sean and Nicole Thorn discuss the increasing challenges healthcare providers face regarding compliance, particularly in light of rising audit risks and overpayment demands. They explore the complexities of healthcare law, the role of attorneys in navigating disputes, and the importance of proactive compliance strategie…
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Season 8 - Episode 4 - #TerryTuesday
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Summary In this episode, Sean and Terry discuss the current state of the healthcare industry, focusing on the business of medicine, the impact of external factors on healthcare operations, and the alarming rise in healthcare bankruptcies. They delve into the role of private equity in healthcare, the importance of compliance, and the need for health…
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AI in Health Care: Managing Algorithmic Bias and Fairness
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Brad M. Thompson, Partner, Epstein Becker & Green PC, Chris Provan, Managing Director & Senior Principal Data Scientist, Mosaic Data Science, and Sam Tyner-Monroe, Ph.D., Managing Director of Responsible AI, DLA Piper LLP (US), discuss how to analyze and mitigate the risk of bias in artificial intelligence through the lens of data science. They cov…
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Season 8 - Episode 3 - David Womack of Practice Management Institute
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Summary In this episode, Sean and David discuss the importance of compliance education in healthcare, highlighting the diverse educational sources available, particularly through the Practice Management Institute (PMI). They explore the various certifications offered by PMI, the significance of personalized education, and the impact of recent chang…
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Recent Trends Related to Behavioral Health Transactions
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Jordan Zoeller, Senior Vice President, Stout, speaks with Julie Sullivan, Shareholder, Greenberg Traurig LLP, about recent trends in the regulation of transactions related to behavioral health providers. They discuss current federal and state oversight trends, state laws impacting behavioral health providers both at the hospital and outpatient leve…
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Articulating Sustainability in Foodservice
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In this podcast we speak with Mr. Alan Horowitz, Vice President of Sustainability at Aramark, and Walter J. Conti Professor at Penn State University, on his perspectives of sustainability in the foodservice industry, and beyond. The quiz question is aligned with our discussion topic.Av Amit Sharma
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Season 8 - Episode - 2 - #TerryTuesday
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Summary In this episode, Sean and Terry Fletcher discuss the complexities of prior authorization in healthcare, emphasizing its critical role in the reimbursement process. They explore the misconceptions surrounding prior authorization, the disconnect between healthcare providers and payers, and the challenges posed by Medicare Advantage plans. The…
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Season 8 - Episode 1 - Monday Auditing, Coding and Compliance Roundtable
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Summary In this episode, the panel discusses the critical importance of honesty in healthcare compliance, the challenges posed by audits, and the responsibilities of providers in navigating vendor relationships. They explore the implications of using AI in clinical documentation, the escalation of compliance issues to law enforcement, and the risks…
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Federal Preemption of State Health Care Laws
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Andrew London, Partner, Foley Hoag LLP, and Peter Fjelstad, Assistant Vice President, State Regulatory and Legal Affairs, Pharmaceutical Care Management Association, discuss the evolution of federal preemption of state health care laws, mainly pertaining to ERISA and Medicare, and the corresponding increase in state efforts to regulate the structur…
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Health Care Corporate Governance: Implications of Corporate Officerships
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Rob Gerberry, Senior Vice President and Chief Legal Officer, Summa Health, speaks with Michael Peregrine, Partner, McDermott Will & Emery, about the nature, role, and purpose of corporate officerships. They discuss general principles related to the roles and fiduciary duties of officers and the specific duties of the Chairman of the Board, CEO, sec…
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Season 7 - Episode 50 - #TerryTuesday - Independence and Objectivity in Auditing!
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Summary In this conversation, Sean and Terry discuss the critical importance of conducting audits in healthcare practices, emphasizing the need for both internal and external reviews to ensure compliance and accuracy in coding and billing. They highlight real-world examples of practices that have suffered due to a lack of audits and the biases that…
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Site-Neutral Payment Policy Considerations in Health Care Transactions
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Caroline Reignley, Partner, McDermott Will & Emery LLP, and Travis Lloyd, Member, Bass Berry & Sims PLC, discuss site-neutral payment policy, an issue that is top of mind for many hospitals and health systems given the shifting legal landscape and congressional interest. They cover the history of site-neutral payments; issues related to relocation,…
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Trends and Developments Related to Health Care Fraud Settlements
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Joe Wolfe, Attorney, Hall Render Killian Heath & Lyman PC, speaks with Marissel Descalzo, Partner, Tache Bronis and Descalzo PA, about the current landscape of health care fraud settlements and enforcement activity. They discuss what triggers a false claim and accompanying investigation, what drives whistleblowers, patterns with respect to false cl…
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Season 7 - Episode 49 - #TerryTuesday - When It's Clear As Mud!
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Summary In this episode, Sean and Terry discuss various topics related to healthcare compliance. They start by sharing their recent experiences, including Sean's trip to Alaska. Then, they dive into the theme of the episode, which is when things are as clear as mud in the healthcare community. They discuss the challenges of finding clear guidelines…
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Season 7 - Episode 48 - Monday Auditing, Coding and Compliance Roundtable
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Summary The conversation revolves around the topic of padding medical bills and the importance of clear communication with patients regarding their financial responsibilities. The speakers discuss instances where unnecessary charges are added to the bill, such as billing for lifestyle medicine codes during a visit for a finger fracture or adding ch…
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Form 990: What Health Care Organizations Need to Know
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Nicholas Kump, Senior Associate, King & Spalding LLP, speaks with Kim Baltz, Director of Tax, Bon Secours Mercy Health, and Zack Fortsch, RSM US LLP (retired), about how health care organizations can navigate the Form 990. They discuss why the Form 990 is important, logistics for completing and submitting the Form 990, key parts and schedules in th…
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Digital Health Care for the Cognitively Impaired
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Tara Sklar, Faculty Director, Health Law & Policy Program, University of Arizona James E. Rogers College of Law, and Kathryn Huber, MD, Kaiser Permanente, discuss the prevalence of cognitive impairments as the U.S. population ages and the implications this has for the future of digital health care. They cover the legal and regulatory landscape and …
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Fraud and Abuse Investigations: Tips from the Trenches
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Ritu Cooper, Shareholder, Hall Render Killian Heath & Lyman PC, Greg Demske, Partner, Goodwin Procter LLP, and Melissa Wong, Partner, Holland & Knight, discuss strategies that health care organizations can employ when dealing with fraud and abuse investigations. They cover the full life cycle of an investigation, sharing their own insights and expe…
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Bridging the Gap: Early Career Professionals in the Health Law Industry
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Alé Dalton, Partner, Bradley Arant Boult Cummings LLP, speaks with Mara Smith-Kouba, Counsel, Bristol Myers Squibb, and Avery Schumacher, Associate, Epstein Becker & Green PC, about the experiences and challenges of Millennial and Gen Z health law professionals. They discuss the takeaways from a survey of early career professionals by Major, Lindse…
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Health AI Governance: Navigating the Complexities and Risks
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Jon Moore, Head of Consulting Services and Client Success and Chief Risk Officer, Clearwater, speaks with Leah Voigt, Chief Compliance Officer, Corewell Health, and Dr. Mark Sendak, Population Health and Data Science Lead, Duke Institute for Health Innovation, about the policies, procedures, and structures that guide the application of artificial i…
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Hospitals and House Slippers: Shifting Care to the Patient’s Home
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Hope Levy-Biehl, Partner, Davis Wright Tremaine LLP, and Ryan Thurber, Shareholder, Polsinelli PC, discuss the growing trend of shifting patient care for acute illnesses into the home. They cover the federal hospital at-home waiver, state-level developments, special considerations related to the at-home care model, factors driving the growth of the…
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Season 7 - Episode 47 - #TerryTuesday - Navigating the Challenges of Telehealth Services and Billing
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In this episode, Sean and Terry discuss the recent incident where Sean accidentally went live with colorful language during a recording. They also dive into the proposed changes to the telehealth services and fee structure for 2025. Terry explains the challenges and limitations of telehealth services, especially when it comes to billing and coding.…
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Medical Marijuana: Legal and Practical Considerations for Long Term Care Providers
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Ashlee Gray, General Counsel, Transforming Age, and Aleah Schutze, Of Counsel, Steptoe & Johnson PLLC, discuss how long term care providers can navigate the legal and practical considerations of medical marijuana. They cover the current legal and regulatory landscape, legal and compliance risks for providers, and best practices for providers regard…
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Value-Based Care Arrangements and How to Operate Within the Stark and AKS Safe Harbors
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James L. Burke, Hall Render Killian Heath & Lyman PC, and Carmen Johnson discuss how to use value-based enterprise (VBE) within the Stark and Anti-Kickback safe harbors to advance health systems’ needs. They cover the four components of VBE, the Stark and Anti-Kickback VBE rules, and how creating a VBE can be a good strategy and significantly reduc…
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Season 7 - Episode 46 - #TerryTuesday - Privilege or No Privilege "That is the Question"
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This is a controversial topic depending on which side of the yellow line you stand on... The question is does all work with a consultant require attorney client privilege... This is a great discussion for those of you looking to engage in coding and billing audits.
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Season 7 - Episode 45 - Monday Auditing, Coding, and Compliance Roundtable
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This was a great live show! Sean was joined by Terry, Christine, and Paul to discuss Medical Decision-Making for levels of EM service when Rx Management is involved. There was a lot to unpack in this episode so don't miss this one!
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Season 7 - Episode 44 - #TerryTuesday - Words Matter
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Terry and Sean take on the importance of words in the medical record. There is no slowing of the audit trend so providers better buckle up!
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