The Compliance Guy

Terry and Sean take on the coding and compliance surrounding Urgent Care Centers and Retail Clinics and all of the "gotchas"... There are a lot of hidden gems in this one.

The all star panel of Terry Fletcher, Stephanie Allard, Scott Kraft and Paul Spencer are back to take on Auditor vs. Coder! Sounds contentious but the fact is, this was a dynamic discussion with a ton of thoughtful dialogue!

Robert Liles and Ashley Morgan join Sean to discuss the power of UPICs and their reach and affirmative actions! This was a brilliant discussion. Don't miss this one!

Terry and Sean are at it again with another hard-hitting topic impacting health care operations... identifying a problem but not wanting to issue a refund! This one gets interesting.

Sean was joined by Terry, Scott, Stephanie, Paul as they took on the biggest issues in healthcare! Topics Included: 1.  RPM  and  RTM  services, the difference between them and the difference between RPM and  CCM  and why these services are such a high priority target for  CMS ,  OIG  and  commercial insurance  (hint: telehealth! 2. HIPAA - enforcement is on the rise and things you do every day wi...

Terry and Sean sat down to discuss the impact of prescription drug management and the impact on the overall level of EM Service. Take a listen, you might be surprised by this discussion!

Sean was joined by John Paul Spencer Terry A Fletcher BS CPC CEMC CCC CCS CCSP CMC ACS-CA SCP-CA, QMPM Stephanie Allard, CPC, CEMA, RHIT and Scott Kraft to discuss all of the big events impacting #healthcareoperations! So much to discuss including: 1. ChatGPT and its impact on #physician documentation 2. Sub-regulatory guidance and the False Claims Act 3. E/M Visits when the patient is not part of...

Assistant Attorney General and the head of the Criminal Division at the Department of Justice, Kenneth Polite sits down for a candid discussion with Sean to explore a variety of topics including: Why compliance programs are so important to DOJ... The benefit of Compliance Certifications Proffers where corporate attorneys are driving the responses vs the compliance officer of the organization... Re...

Terry and Sean discuss the critical importance of completing medical records and closing them within the time requirements established by state and federal requirements. What are the potential penalties for non-compliance and how do you argue technical violations...

In this episode, Sean is joined by Ashley Morgan (Partner) and Robert Liles (Founding Member), of Liles / Parker, LLC to discuss Medicare Suspensions and Revocations, what are they, how are they different and how do you get them reversed. There is a great discussion about UPICs, OIG, DOJ, and Medical Boards. There is so much to unpack in this great issue! Don't miss this one.

On March 15th Sean put out a blog post on Cigna and their new demand for documentation when an EM and minor procedure is performed on the same day with the modifier 25 appended. Don't miss this one!

In this episode Sean breaks down the False Claims Act and the Health Care Fraud Statute. This is a very detailed breakdown of both laws with some insight to the proposed language change to the Medicare Voluntary Refund (60-Day Rule). 

Terry and Sean sit down to discuss the latest investigation and prosecutions tied to telehealth services performed by providers engaging in contractual arrangements with 3rd party telefraud companies to perform medical necessity reviews for DME prescribed by other providers! You do not want to miss this one! 

In this episode Sean is joined by the all star cast of subject matter experts to discuss topics impacting healthcare operations and compliance! 

It's all about under-coding. 

The full cast of # characters is back for another #allstart panel discussion on #thecomplianceguy ! This is a show you are not going to want to miss: 1. Computer Assisted Coding (CAC) - What is it and the reasons why providers are facing potential #falseclaimsact allegations! 2. The routine waiver of co-payments and/or deductibles - What the OIG and DOJ have to say about it, and why it's illegal!...

Robert Liles, ESQ. sat down with Sean to discuss an array of topics impacting and potentially impacting health care providers and professionals in the near future! There is so much to unpack in this episode... 

Jordan Johnson sits down with Sean to discuss the FTC proposal regarding Noncompete Agreements, Hospital CEO Salaries vs. Nurses and so much more!  

Terry joins Sean to discuss Incident-to and all the headaches that comes with billing this provisional service. 

Once again the all star panel of subject matter experts (Terry, Christine, Scott, Paul, and Stephanie) join Sean to discuss some of the most pressing issues impacting the healthcare industry! 1. Medicare ABN vs. Commercial Payer Waiver of Liability  2. EM Services - How and when time drives pre 2021 services 3. The ins and outs of psych services 4. Mergers and take-overs in healthcare and the...

Terry joins Sean to discuss the end of the PHE and the little known gotchas waiting on the other side. Don't miss this vital information to ensure you are in compliance come May, 2023! 

Sean was joined by his all star cast of characters to discuss HIPAA Breaches and OIG Compliance. There is also a discuss about catching a hacker who recently tried to pull a scam on Sean! A great episode you do not want to miss. 

Terry and Sean discuss the audio only telehealth services and the implications for getting it wrong if you do not document these time based services correctly. 

Sean was joined by the all star cast of characters (Terry, Stephanie, Scott, and Paul) to discuss the latest in coding and compliance headaches impacting health care providers! Topics included:  1. CMS conference call on the end of the public health emergency.  2. What is a medically appropriate history and examination for EM Services...  3. Coding for Psychotherapy Services and the...

Jordan and Sean explore the intersection of compliance and the business of medicine. Lots going on in this episode regarding the end of the pandemic and its impact on operations, the continued issues with the independent dispute resolution and much more.