Healthcare Inspired

By: Jennifer McNamara
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  • Summary

  • Welcome to Season 4 of Healthcare Inspired! This season, we’re focusing on Compliance Connection, exploring the vital role compliance plays in the healthcare industry. From establishing a compliance culture to navigating complex regulations, we’ll share practical insights, real-world stories, and expert interviews that help you stay informed and inspired. Whether you're in leadership, coding, billing, or patient care, this season will offer tools and strategies for creating a stronger, more compliant healthcare environment. Stay tuned for exciting episodes and don’t forget to subscribe, like, and share!
    Jennifer McNamara
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Economics Hygiene & Healthy Living Management Physical Illness & Disease
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Episodes
  • Primary Care Compliance: Balancing Preventive and Chronic Care Billing

    Primary Care Compliance: Balancing Preventive and Chronic Care Billing
    Dec 21 2024
    In this enlightening episode of Compliance Connection, hosts Jennifer McNamara and Maya Turner dive deep into the pivotal role of primary care physicians and the critical importance of accurate documentation. Primary care is the cornerstone of healthcare, but without precise and compliant documentation, even the most diligent care can lead to revenue loss, audits, or severe penalties. Join us as we explore: The Multifaceted Role of Primary Care: Preventive Care: Routine check-ups, screenings, vaccinations, and patient education. Diagnosis and Treatment: Managing a wide range of symptoms and acute issues. Chronic Disease Management: Ongoing care for chronic illnesses, monitoring treatment plans, and lifestyle changes. Coordination of Care: Acting as the central hub between specialists and ensuring continuity of care. Key Services Demanding Strict Documentation: Evaluation and Management (E/M) Visits: Capturing history, exams, and medical decision-making to match service levels. Chronic Care Management (CCM): Documenting care plans, patient consent, and non-face-to-face care time. Preventive Services: Differentiating between preventive and problem-oriented services to avoid denials. Telehealth Services: Meeting current policies by documenting platforms used, patient location, consent, and service timing. Procedures: Detailing procedure specifics, consent, laterality, and any complications. Practical Documentation Tips: Implementing the 'Who, What, When, Where, and Why' of every patient encounter. Double-checking templates and staying updated on payer-specific requirements. Real-World Consequences: A case study where primary care physicians paid $1.5 million to resolve False Claims Act liability due to unsupported diagnoses submitted to Medicare Advantage. Tactical Takeaway: Solid documentation isn't just about compliance—it's about providing quality patient care and safeguarding your practice. This week, take a moment to review your documentation for one of the services discussed and ensure it tells the complete story. Next Episode Preview: Don't miss our next episode, “Ophthalmology Compliance: Eye Codes, E/M, and Surgical Precision,” where we'll uncover the unique compliance challenges in ophthalmology. Resources & Links Case Reference: Primary Care Physicians Pay $1.5 Million to Resolve False Claims Act Liability Sponsor & Production Sponsored by: Healthcare Inspired LLC Produced by: Highland Production Subscribe & Leave a Review If you enjoyed this episode, please subscribe and leave us a review on your favorite podcast platform. Your feedback helps us improve and reach more listeners interested in healthcare compliance.
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    19 mins
  • Orthopedic Documentation: Prepare for Improved Compliance in 2025

    Orthopedic Documentation: Prepare for Improved Compliance in 2025
    Dec 21 2024
    In this episode, hosts Jennifer McNamara and Maya Turner discuss strategies to enhance orthopedic spine documentation in anticipation of 2025 compliance requirements. They cover key areas such as Evaluation and Management (E/M) documentation, office-based injection services, and the correct application of Modifier 25, providing actionable insights to streamline processes and avoid common compliance pitfalls. Main Topics: * Evaluation and Management (E/M) Documentation * Key elements for comprehensive E/M documentation. * Emphasis on detailed patient history, exam findings, and medical decision-making. * Common pitfalls and tips for streamlining notes. * Injection Services Documentation * Guidance on proper documentation of office-based injections. * Essential elements for compliance, including medical necessity and anatomical details. * Avoiding common errors and a real-world case study. * Modifier 25: Correct Usage * Understanding when and how to apply Modifier 25. * Clarification of “significant and separately identifiable” E/M services. * Common errors and tips for proper application. * Streamlining Physician Documentation * Aligning with payer requirements and conducting internal audits. * Recommended tools and templates for accuracy. * Training and collaboration best practices. Call to Action: * Download the Orthopedic Spine Documentation Checklist. * Share this episode with colleagues involved in orthopedic compliance. * Subscribe to the podcast for more compliance tips and best practices. Resources: * Medicare NCCI 2023 Coding Policy Manual – Chapter 4 (https://www.cms.gov/files/document/medicare-ncci-policy-manual-2024-chapter-4.pdf) * Setting the Record Straight on Proper Use of Modifier 25 (https://www.ama-assn.org/practice-management/cpt/setting-record-straight-proper-use-modifier-25) * Orthopedic Spine Coding and Documentation (https://www.healthcareinspiredllc.com/orthopedic-spine-coding-and-documentation)
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    19 mins
  • Correct and Protect: Enforcing Standards with Impact

    Correct and Protect: Enforcing Standards with Impact
    Dec 9 2024
    In this episode, Jennifer McNamara and Maya Turner break down compliance plan elements 5 (Enforcing Standards with Consequences and Incentives) and 7 (Responding to Offenses). They share simple, practical ways to improve financial stability, keep operations running smoothly, and build trust across your team. With real-world advice, role-playing, and actionable tips, they make compliance strategies easy to understand and even easier to use. Who Should Listen? If you’re a healthcare administrator, practice manager, compliance officer, coder, or biller, this episode is for you. What You’ll Learn Jennifer and Maya talk about using accountability and incentives to enforce compliance without overwhelming your team. They also dig into how tools like dashboards and automation make staying compliant less stressful, and why strong leadership and open communication matter in building trust and keeping everyone on the same page. Think about how your team handles compliance today. Are you setting clear expectations? Do you have the right tools in place? This week, schedule time to review your enforcement and response strategies. Coming up: Orthopedic Compliance: Navigating Surgical and Post-Operative Documentation. We’ll talk about how strong documentation keeps you audit-ready and your practice running smoothly. Produced by Highland Production.
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    19 mins

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