The Compliance Guy

Summary In this episode of The Compliance Guy podcast, Sean M Weiss interviews Steven Adler, co-chair of litigation at Mandelbaum Barrett PC, focusing on non-compete agreements and restrictive covenants in healthcare. They discuss the complexities of these agreements, the rights of patients, and the implications of a recent case involving Dr. Timothy Vogel, a pediatric neurosurgeon. The conversati...

Summary In this engaging conversation, Sean M Weiss and Terry Fletcher explore the evolving landscape of healthcare in 2025, emphasizing the importance of reflection on career paths, the integration of AI in healthcare, and the vast opportunities available within the industry. They discuss the significance of passion in one's career and the need for continuous learning and adaptation in a rapi...

Summary In this episode, Sean M Weiss and Terry Fletcher discuss the current state of telehealth services amidst the ongoing government shutdown. They explore the changes in telehealth regulations since the public health emergency, the challenges faced by Medicare in reimbursing telehealth services, and the implications of the False Claims Act for healthcare providers. The conversation emphasizes...

Summary In this episode, Sean M Weiss and Terry Fletcher discuss the critical aspects of Clinical Documentation Integrity (CDI) in healthcare. They explore the importance of compliance, the implications of audits, and the responsibilities of providers in maintaining accurate medical records. The conversation highlights the need for integrity in documentation before any improvements can be made, em...

I was joined by Terry, Stephanie, Scott, Paul and Christine for this all new episode to discuss a variety of issues including tied to Auditing, Coding, Compliance, and Documentation. I was so good to be back after a 3-week break to spend time with the panel and with all of our listeners/viewers and friends!

Summary In this conversation, Sean M Weiss and Walter Haydock discuss the implications of ISO IEC 42001 in the healthcare sector, focusing on AI governance, regulatory compliance, and the management of bias in AI systems. They explore the challenges faced by multi-site healthcare organizations, the importance of leadership in ethical AI use, and real-world examples of organizations implementing IS...

Summary In this episode, Sean M Weiss and Terry Fletcher discuss various trends and issues in healthcare auditing, coding, and documentation. They reflect on their recent experiences and the importance of accurate coding practices to avoid risks associated with incomplete documentation. The conversation also touches on behavioral change interventions and the challenges providers face in maintainin...

Summary In this episode, Sean and Terry discuss the critical role of hospitalists in patient care, emphasizing the importance of understanding their responsibilities and the challenges posed by overutilization and compliance issues. They highlight the necessity of medical necessity in documentation and the potential risks associated with billing practices that may violate regulations. The conversa...

Summary In this episode of the Compliance Guide podcast, Sean Weiss speaks with Jonathan Porter, a former prosecutor turned defense attorney, about the complexities of healthcare compliance and the legal landscape surrounding it. They discuss the transition from prosecution to defense, the power dynamics in legal practice, and the challenges faced by healthcare providers in navigating compliance i...

Summary In this episode, Sean and Terry discuss the alarming prevalence of embezzlement in medical practices, particularly focusing on the role of family dynamics and the importance of compliance and auditing. Terry shares a recent experience where she uncovered significant embezzlement in a client's practice, emphasizing the need for vigilance and proper oversight in financial practices. The...

Summary In this episode, the panel discusses the evolving landscape of telehealth, the implications of AI-driven ambient scribes in medical documentation, and the challenges posed by payer downcoding of evaluation and management services. The conversation emphasizes the importance of compliance, understanding payer contracts, and the need for proactive measures to ensure quality patient care amids...

Summary In this conversation, Sean and Terry discuss the latest updates in telehealth regulations, focusing on new Medicare codes, changes in billing practices, and the implications for healthcare providers. They emphasize the importance of understanding these changes to ensure compliance and effective patient care. Takeaways Telehealth services will revert to pre-COVID regulations after 2025. New...

Summary In this engaging conversation, Sean and Terry discuss the challenges and importance of audits in medical practices, the resistance to change within healthcare, and the critical role of compliance and implementation of recommendations. They share personal anecdotes and insights from their experiences, emphasizing the need for meaningful change and the consequences of ignoring audit findings...

Summary In this conversation, the panel discusses various challenges in the healthcare industry, focusing on the roles of students in medical practices, the complexities of Medicaid, and the implications of proposed CMS regulations on skin substitutes. They emphasize the importance of compliance, accurate documentation, and the need for providers to be aware of the evolving landscape of healthcare...

Summary In this episode, Sean and Terry discuss the critical importance of accurate and specific documentation in healthcare, particularly in the context of E&M services and audits. They explore the challenges faced by providers in maintaining detailed records, the implications of using generic phrases, and the role of defense operatives in ensuring compliance. The conversation emphasizes the...

Summary In this episode of Terry Tuesday, Sean and Terry discuss the challenges and insights from recent audits in emergency rooms, focusing on overutilization of services, critical care documentation, and the importance of accurate medical records. They highlight the need for compliance in healthcare practices and the implications of poor documentation on patient care and billing. Takeaways Terry...

Summary In this episode, Sean and Terry discuss the complexities surrounding the G2211 add-on code in healthcare billing. They reflect on personal experiences, the importance of understanding coding regulations, and the implications of team-based care. The conversation highlights the challenges faced by healthcare providers in navigating compliance and the potential misuse of coding practices. The...

You Don't Want To Miss This One! Summary In this episode, Sean and Terry discuss the critical importance of proper documentation in healthcare, particularly focusing on the discrepancies that arise when dealing with cash patients versus insured patients. They emphasize that documentation should be consistent and thorough, regardless of the patient's financial status, to mitigate compliance...

Summary The conversation delves into the recent healthcare cuts, particularly focusing on the $1.1 trillion in cuts to Medicaid, which are expected to have significant impacts on both rural and urban healthcare systems. The panel discusses the implications of these cuts, including the potential closure of rural hospitals, the challenges faced by urban healthcare facilities, and the ongoing issues...

Summary In this conversation, Sean Weiss and Terry Fletcher discuss the complexities of accountability in healthcare billing and coding. They explore the challenges providers face in ensuring compliance, the role of coders, and the importance of accurate documentation. The discussion highlights the need for clear communication and responsibility among all parties involved in the billing process, e...

Summary In this episode, the hosts discuss various pressing issues in healthcare, including the recent increase in CMS investigations into Medicare risk adjustment data, the challenges faced by providers in complying with insurance requests, and the implications of Medicaid eligibility changes. They also delve into the role of GLP-1 medications in weight loss and the importance of patient advocacy...

Summary In this episode of the Compliance Guy podcast, Sean and Terry discuss the critical importance of medical necessity in healthcare, particularly in relation to patient preparation and documentation. They explore the challenges faced by providers and support staff in ensuring that patient records are complete and accurate, emphasizing the legal and ethical implications of inadequate documenta...

Summary In this episode of the Compliance Guy podcast, Sean interviews attorney Andrew Feldman, who specializes in federal healthcare fraud cases. They discuss Andrew's recent trial victory, the impact of COVID-19 on healthcare fraud, and the legal challenges surrounding COVID testing and medical necessity. The conversation also touches on prosecutorial challenges, ethical considerations in health...

Summary In this episode, Sean and Terry discuss various challenges in healthcare compliance, including the importance of networking, the role of third-party auditors, and the necessity of due diligence in verifying information. They delve into Medicare and Medicaid regulations, telehealth compliance, and the consequences of ignoring audit findings. The episode concludes with a celebration of their...

Summary In this episode of the Compliance Guy Podcast, the hosts discuss various compliance issues in healthcare, including coding practices, the implications of audits, and the evolving role of artificial intelligence in documentation. They emphasize the importance of proper coding, the risks associated with unauthorized alterations, and the need for a robust compliance culture. Insights from the...