Best Medicare Appeal Podcasts (2024)

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Ep. 83 - PULSECHECK: Medicare Changes, Supreme Court Appeals, and Kentucky Prior Authorizations 30:00

16d ago30:00

30:00

Today on the FLATLINING Podcast from Fulcrum Strategies, Ron Howrigon and Matthew Handley take a look at some of the latest healthcare news. First, they discuss changes to the Medicare Advantage rates published by the Centers for Medicare and Medicaid Services; they explain why insurers are saying out of pocket expenses will go up for seniors. Ron …

1
NEXT WEEK: John Scagnelli, MD discusses treatment advances for multiple sclerosis 0:34

4h ago0:34

0:34

Next week on the FLATLINING Podcast from Fulcrum Strategies, President and CEO Ron Howrigon and Matthew Handley are joined by John Scagnelli, MD of Raleigh Neurology. They will be discussing multiple sclerosis, a devastating disease with no known cause and no known cure. But there is hope. Recent research has created new advancements in treatment. …

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Ep. 85 - ER docs go on strike in Detroit 28:02

5h ago28:02

28:02

On today’s episode of the FLATLINING Podcast from Fulcrum Strategies, President and CEO Ron Howrigon and Matthew Handley discuss some of the most pressing topics affecting physicians and their patients. In this episode, they discuss: • UnitedHealth Group admits they paid the ransom for the Change Healthcare cyber attack • The Justice Department set…

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Medicare Advantage - Emerging Trends in 2024 Webinar 5:58

1h ago5:58

5:58

In this episode, Olga Barone-Allan, BESLER's Director of Revenue Integrity, provides us with a glimpse into our next webinar, Medicare Advantage: Emerging Trends in 2024, presented live May 1, at 1 PM ET.By Kelly Wisness

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Ep. 84 - Economy watch: UHC loses $1.4 billion in Q1 and California introduces $25/hr minimum healthcare wage 21:24

1d ago21:24

21:24

This week on the FLATLINING Podcast from Fulcrum Strategies, Matthew and Ron discuss the news that UnitedHealth Group posted a $1.4 billion loss in quarter 1 of 2024 following the Change Healthcare cyber attack. They talk about whether or not providers should care about news such as this. Then, they discuss a new law going into effect in California…

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Understanding 340B Webinar 9:25

1d ago9:25

9:25

In this episode, Tim Powell, Sr. Reimbursement Consultant at BESLER, gives us with a glimpse into our next webinar, Understanding 340B, coming live on April 24, at 1 PM ET.By Kelly Wisness

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The Impact of Medication Adherence on Healthcare Economics 11:40

14d ago11:40

11:40

In this episode, Stacey Wasserman, Chief Business Officer at Medisafe, discusses the impact of medication adherence on healthcare economics.By Kelly Wisness

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Season 7 - Episode 24 - #TerryTuesday 28:06

9d ago28:06

28:06

Sean and Terry are back at it with another great episode focusing on the most challenging issues facing healthcare providers and their organizations.

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Season 7 - Episode 23 - Monday Auditing, Coding and Compliance Roundtable 1:01:36

9d ago1:01:36

1:01:36

The all star panel is back together again with an all new episode. 1. Clean Claims 2. Misapplication of Diagnosis Codes 3. Change Healthcare Debacle

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Improving Cash Flow for Physician Organizations 32:14

16d ago32:14

32:14

In this episode, Michael J. McLafferty, CEO/Founder at MJM Advisory & Educational Services LLC, discusses improving cash flow for physician organizations.By Kelly Wisness

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Recap from AHLA 17:20

21d ago17:20

17:20

In this episode, Randi Deckard, BESLER's SVP of Client Engagement & Kristin DeGroat, BESLER's Compliance & General Counsel, provide us with a recap from the recent AHLA show in Baltimore.By Kelly Wisness

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Ep. 82 - Artificial Intelligence in Radiology (with Matthew Stephens, MD) 33:34

22d ago33:34

33:34

Today on the FLATLINING Podcast from Fulcrum Strategies, Matthew Handley and Ron Howrigon have a conversation with Matthew Stephens, MD, a board certified radiologists at Radiology of Indiana. Dr. Stevens, Matthew, and Ron discuss the exciting topic of artificial intelligence in healthcare, particularly AI's influence in radiology. They discuss wha…

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Guide to Appeals Webinar 6:05

23d ago6:05

6:05

In this episode, Kristin DeGroat, BESLER's Compliance & General Counsel Officer, & Christina Brown, BESLER's Director of Reimbursement Services, gives us a glimpse into our upcoming webinar, Guide to Appeals, coming April 3, at 1 PM ET.By Kelly Wisness

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Season 7 - Episode 22 - #TerryTuesday - IPPE and AWE (Medicare) 43:59

24d ago43:59

43:59

Terry and Sean take on Medicare's IPPE and AWV and all the misinformation and dos and don'ts! Hear directly from a Medicare Auditor on her thoughts and opinions on direct supervision / incident-to regarding these services.

1
Season 7 - Episode 21 - Monday Auditing, Coding and Compliance Roundtable 1:03:55

24d ago1:03:55

1:03:55

The Panel takes on the most pressing issues facing healthcare providers today! 1. Medicare Physician Fee Schedule Update 2. G0136 - SD0H HCPCSII Code Dos and Don'ts 3. TPE Targeting Level II and IV EM Services

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Ep. 81 - Congress acts on Medicare cuts & Aledade allegedly commits Medicare fraud 25:50

1M ago25:50

25:50

In this episode of the FLATLINING Podcast from Fulcrum Strategies, Ron Howrigon and Matthew Handley discuss Congress’ late fix to eliminate part of the cut to Medicare physician fee schedule. They also discuss a recent report about a whistleblower case that alleges major accountable care organization Aledade engaged in serious Medicare fraud. -- Fo…

1
How Integrated Specialty Pharmacy Improves Health System Economics & Patient Outcomes 11:02

30d ago11:02

11:02

In this episode, David Filstein, Sr. Dir. of Corp. Strategy at Shields Health Solutions, discusses how integrated specialty pharmacy improves health system economics & patient outcomes.By Kelly Wisness

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Season 7 - Episode - 20 - Christine Hall - Coding and Compliance 45:01

1M ago45:01

45:01

It was such a treat to have Christine Hall of Stirling Global Solutions (https://www.stirlingglobalsolutions.com/) join The Compliance Guy Podcast to discuss compliance and coding issues surrounding Chronic Care Management (CCM), Providers Failing to Issue Voluntary Refunds, and so much more!

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Mark Cuban, Data Hacks, and How To Protect Yourself 29:05

1M ago29:05

29:05

A lot of news came out in the pharmacy industry recently. Mark Cuban was at a White House round table speaking his truth about PBMs, and then there was the data hack of Change Healthcare affecting thousands of people, which led us to discuss best practices when protecting the data for your small business.…

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HCC Best Practices Webinar 5:32

1M ago5:32

5:32

In this episode, Victoria Hernandez, Sr. Coding Analyst at BESLER, gives us a glimpse into our upcoming webinar, HCC Best Practices on March 20, 1 PM ET.By Kelly Wisness

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Season 7 - Episode 19 - #TerryTuesday - OIG Compliance Program Guidance 36:32

1M ago36:32

36:32

In this episode Terry and Sean take on the updated Compliance Program Guidance from the OIG and more specifically the section dealing with quality and substandard care leading to prosecution. Don't miss this one!

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Season 7 - Episode 18 - Monday Auditing, Coding and Compliance Roundtable 1:03:52

1M ago1:03:52

1:03:52

Join Sean, Stephanie, Scott, Christine, and Terry as they take on: 1. Collaboration Agreements 2. CERT Studies and error rate

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Realistic Advice from The HR Lady 13:07

1M ago13:07

13:07

In this episode, Wendy Sellers, Author, Speaker, Trainer & Consultant, also known as "The HR Lady", provides us with some realistic HR advice.By Kelly Wisness

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Ep. 79 - Medicare Advantage payers tell CMS they need more money 26:58

2M ago26:58

26:58

Medicare Advantage continues to be one of the most profitable sectors of the health insurance industry, yet a lobby group backed by the nation's largest payers has claimed the federal government isn't paying them enough. Fulcrum Strategies President and CEO Ron Howirgon and Matthew Handley discuss this. Plus, Elevance-owned Anthem BlueCross BlueShi…

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Reimbursement Roundtable Webinar 5:58

2M ago5:58

5:58

In this episode, Randi Deckard, BESLER's SVP of Client Engagement, gives us a glimpse into our upcoming webinar, Executive Reimbursement Roundtable, live on March 6, 1 PM ET.By Kelly Wisness

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Season 7 - Episode - 17 - #TerryTuesday - Bad Coding = Bad Business 25:39

2M ago25:39

25:39

Terry and Sean take on providers who render services but choose to bill for a higher level of service than what was actually performed or what they are able to support with their documentation. Oh, but there is more... so much more!

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Season 7 - Episode 16 - Monday Auditing, Coding and Compliance Roundtable 56:22

2M ago56:22

56:22

The panel is back for a much-needed discussion on two critical topics that are generating a ton of issues for providers. We'll be addressing G2211, a code that requires specific requirements and documentation components to support it, and Incident-to, a provisional billing service that continues to wreak havoc on providers. Unfortunately, self-proc…

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Understanding Who You Are and How That Impacts the Bottom Line 12:38

2M ago12:38

12:38

In this episode, Olivia Smith, Transformation Expert & Founder of Write a New Story, discusses understanding who you are & how that impacts the bottom line.By Kelly Wisness

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Season 7 - Episode 15 - Dan Cohen - PainScript 50:27

2M ago50:27

50:27

Dan Cohen of PainScript joined Sean to discuss their innovative solution for managing opioid prescriptions. As the focus on prescriber compliance intensifies, Dan and his team have developed a HIPAA-compliant app that connects physicians with their chronic pain and SUD patients daily. Through real-time data and daily digital care, patients are more…

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Ep. 78 - Lawmakers look to remove site of service differences 21:41

2M ago21:41

21:41

This week on the FLATLINING Podcast from Fulcrum Strategies, Ron Howrigon and Matthew Handley discuss a proposal in Washington to remove the site of service differential. Removing that change would pay doctors the same regardless if a procedure is performed at a hospital or an office. Ron and Matthew also discuss if the Medicare fee schedule is goi…

1
The Cost Report Domino Effect 2024 Webinar 6:41

2M ago6:41

6:41

In this episode, Christina Brown, BESLER's Director of Reimbursement Services, gives us a glimpse into her upcoming webinar, The Cost Report Domino Effect 2024, Feb. 21, 2024, at 1 PM ET.By Kelly Wisness

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Season 7 - Episode 14 - #TerryTuesday - HIPAA and The Unknown 22:48

2M ago22:48

22:48

Terry joined Sean to discuss some of the more obscure aspects of HIPAA and what practices should be doing to cover their assets!

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Season 7 - Episode 13 - The AI Modifier and Taking on Medicaid 39:09

2M ago39:09

39:09

What do you do when a State Medicaid program and their contractor fail to comply with their own published guidance... you call The Compliance Guy! Listen to this episode and hear an unbelievable story of incompetence and what happens when folks dig their heels in to deep and lose in the end. Paul Spencer Joins Sean to discuss all the details of thi…

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Retail Pharmacy Trends Heading Into 2024 29:57

3M ago29:57

29:57

2024 could be a crazy year for the independent pharmacist. While we are optimistic about new legislation that could help the fight against PBMs we are also looking at rising labor challenges. With so many big retailers shutting their doors can we take advantage? This week Anthony looks at the biggest trends in retail pharmacy at the beginning of th…

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Ep. 77 - Will a SCOTUS decision on COVID-19 misinformation affect the ability to practice medcine? 22:46

2M ago22:46

22:46

On today's episode of the FLATLINING Podcast from Fulcrum Strategies, Ron Howrigon and Matthew Handley discuss a current US Supreme Court case that is looking at COVID-19 misinformation and free speech. Namely, the justices are evaluating if misinformation is protected speech. Matthew and Ron discuss what this could mean for physicians who think th…

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The Finance Side of Academics - An Opportunity for Your Health System 16:30

2M ago16:30

16:30

In this episode, John Ballentine, Exec. Dir. for Academics Finance Administration at Prisma Health, discusses the finance side of academics & the opportunities.By Kelly Wisness

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Season 7 - Episode 12 - #TerryTuesday - When Audit Results Are Ignored 37:47

2M ago37:47

37:47

Sean and Terry take on the risks associated with not following audit results whether internal or external results. Don't miss this one!

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Season 7 - Episode 11 - Monday Coding and Compliance Roundtable 1:01:19

2M ago1:01:19

1:01:19

The team was back and took on when it does and does not make sense to employ remote workers as well as the do's and don'ts. The team also took on AI and the inherent risks associated with EHRs deploying this technology into their systems.

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Season 7 - Episode 10 - #TerryTuesday - Incident-To 38:30

3M ago38:30

38:30

Before you say, "not again" keep in mind these are the problem child of providers and the government. The provisional services continue to create problems and until the ambiguous aspects of these services are more clearly defined we will have to continue threading the needle to keep you compliant.

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Season 7 - Episode - 9 - Monday Auditing, Coding and Compliance Roundtable 1:00:32

3M ago1:00:32

1:00:32

The entire cast is back this week taking on the most complex and challenging issues tied to medical auditing, coding, and compliance...

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Recap from 2024 Carnival HFMA Western Symposium 14:43

3M ago14:43

14:43

In this episode, Randi Deckard, VP, Client Engagement at BESLER, gives us a recap from the recent HFMA Western Symposium 2024 Carnival.By Kelly Wisness

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Ep. 76 - In NJ only like specialty doctors can now deny your prior authorization requests 19:53

3M ago19:53

19:53

In our continuing series on prior authorization, Ron Howirgon and Matthew Handley discuss a press release from Cigna detailing all the "good" reasons big insurers like it use prior authorizations. They claim it is to save patients money but ultimately, it saves patients' lives. But a new law in New Jersey seems to fly in the face of that saying in …

1
IME-GME Revenue Recovery Strategies Webinar 9:44

3M ago9:44

9:44

In this episode, Olga Barone-Allan, Director of Revenue Integrity at BESLER, gives us a glimpse into our upcoming webinar, IME/GME Revenue Recovery Strategies on Feb. 7, 2024.By Kelly Wisness

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TCG The Best of The Best "Effective Leadership" 43:00

3M ago43:00

43:00

In this episode Sean takes on effective leadership and what it takes to lead a team. While Sean is known as "The Compliance Guy" he started his professional career in practice management back in the mid-90s amid all the consolidation and acquisitions by the health systems "Physician Services" Groups. Take a listen... you just may be surprised at wh…

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Season 7 - Episode - 8 The Return of Clint Pulver 45:08

3M ago45:08

45:08

The one and only Clint Pulver returns to The Compliance Guy to provide an update on his upcoming 2024 speaking tour, his new documentary (Finding Hill on YouTube), The Master Class Program, and so many more unbelievable amazing things Clint and his team are undertaking! Clint Pulver is a professional keynote speaker, author, musician, pilot, and wo…

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Season 7 - Episode 7 - Legal with Liles/Parker 57:49

3M ago57:49

57:49

In the first Legal with Liles/Parker episode of 2024, Robert and Ashley sit down with Sean to discuss Compliance Risks in 2024! The list is long and distinguished...

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Ep. 75 - CMS goes after lengthy prior authorizations 16:10

3M ago16:10

16:10

This week on the FLATLINING Podcast, Matthew and Ron talk about a new Centers for Medicare and Medicaid Services rule that requires insurance companies to respond to prior authorization requests for certain products within seventy-two hours. Those products include Medicare, Medicaid, CHIP, and Obamacare plans. Unfortunately, commercially insured pa…

1
The True Cost of Secure Healthcare Communications 19:47

3M ago19:47

19:47

In this episode, we're pleased to welcome Anurag Lal, President & CEO of NetSfere, to discuss the true cost of secure healthcare communications.By Kelly Wisness

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Season 7 - Episode 6 - #TerryTuesday - Cloning and Clinical Plagiarism 30:38

3M ago30:38

30:38

Terry and Sean take on Cloning, Cut and Paste and Clinical Plagiarism... It is not as clear cut as you would think it is! Don't miss this one because the end-results could cost you dearly!