Season 8 - Episode 5 - Nicole Thorne - Understanding the Surge in Healthcare Audits and the Role of AI in Shaping Healthcare Compliance

The Compliance Guy

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 strategies. The discussion also touches on the impact of AI in healthcare and the necessity for providers to adapt to these changes while maintaining a culture of compliance.

Takeaways

• Healthcare providers are facing a significant increase in audit risks.
• The complexity of healthcare law requires specialized legal expertise.
• Overpayment demands from payers are becoming more aggressive and frequent.
• Proactive compliance strategies can mitigate risks and improve outcomes.
• AI is being increasingly utilized by payers to identify potential issues.
• Effective communication with payers is crucial for dispute resolution.
• Providers must be prepared to defend their billing practices against audits.
• The cost of compliance is rising due to increased regulatory scrutiny.
• Understanding the nuances of payer agreements is essential for providers.
• A culture of compliance can help providers navigate the challenging healthcare landscape.