The Compliance Guy

Terry and Sean take on Time Based Coding... This is a lively discussion about high-risk service and how to mitigate risk! 

The all star cast of characters is back again to discuss bad decisions made by physicians and what can be done to ensure the train doesn't derail! Great discussions and great interaction with the viewers from the live stream!  Don't miss this one! 

Sean and Jordan sit down to discuss the end of the Public Health Emergency (PHE), what that means for the waivers and flexibilities afforded during the PHE and the Good Rx FTC Settlement!  This episode is a little salty so take it with a grain of salt! 

The one and only Clint Pulver sat down with Sean to discuss effective leadership and what it takes to become an effective leader! Clint shares his insights into what makes an effective leader and how to keep your team engaged!  Don't miss this awesome interview with a true leader and a great person! 

Sean and Terry sit down to discuss Addendums, Late Entries, and Corrections... This one is a must listen to since so many, make lots of mistakes on when and how to address these things! 

The all star panel is back for another bite at the apple! Great discussion on incident-to, inference when it comes to medical documentation to support billing of ancillary services, split/shared services, and much more!  

Jared Walker, CEO of Dollar For joins Sean to discuss the world of medical debt and hospital charity care. This is an episode that whether you are a hospital C-Suite or consumer of health care services at a hospital you are not going to want to miss. Jared exposed the dark-side of medical debt and how to detect the schemes and scams some try to get over on the unsuspecting.  Don't miss this o...

Jordan sits down with Sean to discuss some of the more interesting, political and hairbrained issues impacting healthcare operations and compliance efforts!  Topics include:  1. ChatGPT - is this Artificial Intelligence (AI) really here? How is it and will it impact billing, coding, compliance, clinical care, documentation, and operations? Who’s afraid of ChatGPT? AI in healthcare could...

In this episode Sean is joined by the full All Star Panel (Christine Hall, Paul Spencer, Scott Kraft, Stephanie Allard, and Terry Fletcher)! Topics include: 1. Changes to the United Health Care Appeal Process 2. Rendering Telehealth Service over state lines 3. Behavioral Health and the increased interest in auditing these services and why 4. The Reasonable, Necessary Standard established by CMS Su...

Terry joins Sean to discuss Chronic Care Management (CCM) Services, what they are, how they are billed, and what documentation is required to support them. But, what happens when you get it all wrong or don't have documentation to support the billing and reimbursement of these services? 

Jordan Johnson sits down with Sean to discuss the ins and outs of the FTC Proposed Rule on Non-Competes for Employees. This is a full breakdown of the proposed rule. The conversation then shifts to physician shortages by specialty and what should and can be done about it. Below are the 2 links from the show:  Percentage Change in the Number of Active Physicians by Specialty, 2016-2021 | AAMC...

Terry joins Sean to discuss training and education, or lack thereof at the payers and why they are not being held accountable! If you don't like humor skip the first 12 minutes but if you enjoy humor and fun stories listen to the who episode! 

Monday's Roundtable on the compliance guy podcast will be a lively discussion about #payeraudits and what to do when the "letter" arrives! Christine Hall CHC CPC , CPB, CPMA, CRC, CEMC, CPC-I John Paul Spencer Stephanie Allard, CPC, CEMA, RHIT Terry A Fletcher BS CPC CEMC CCC CCS CCSP CMC ACS-CA SCP-CA, QMPM and Scott Kraft will provide insight into why: 1. Having great #yelpreviews won't protect...

In this episode Jordan Johnson sits down with Sean to discuss operational concerns in physician practices driving them to abandon their practice and join large groups, hospital networks, and integrated delivery health systems. The discussion the transitions to the impact of nurse strikes and what it will take to get them aligned with their employers. This episode is a bit charged but hey, someone...

Terry joins Sean for a discussion on what it means to stay in your lane and not create liability situation for your clients or yourself. This episode gets a bit salty so buckle up and enjoy the ride! 

This was one of the best episodes of our Monday Roundtable! Sean was joined by Stephanie Allard, Terry Fletcher, Scott Kraft, and Paul Spencer. Topics included:  1. Dealing with Commercial Payor Demand for Refund of Overpayments, when they say they did a statistically valid random sampling that led to an extrapolated overpayment.  2. The No Surprises Act and the change to how the process...

Salvador Hernandez, Senior Compliance and Ethics Advisor at Husch Blackwell joins Sean to discuss the state of compliance... Topics of discussion include:  The DOJ Corporate Crime and Compliance Initiative:  Where are We Now, One Year Later? (a high-level survey) Disclosure to the Government—the why, how and when (discussion of the DOJ’s expectations, the pros and cons of disclosing) Com...

 Ronald Chapman II, Esq. LLM of Chapman Law Group | Health Care Attorneys sits down with Sean to discuss his full trial acquittal in United States vs. Lesley Pompy, MD. You do not want to miss this one because what happened to Dr. Pompy can happen to you!

This is the very first episode of the newest segment on The Compliance Guy... It is not J2, it's J-Squared with Jordan Johnson, Healthcare Data Analytics Expert! Such a great first episode and the topics will not disappoint:  Omnibus bill includes relief from Medicare cuts, extensions of rural and telehealth programs 1.7 trillion dollar package and what it means for healthcare · Telehealth pr...

Terry Fletcher joins Sean for the very first #TerryTuesday episode of 2023 to discuss the Medicare Fee Schedule Change and What it Really Means! As they say... watch out for the ole bait and switch! While Congress indicates a slight bump was given to the conversion factor the reality is, it was still an overall decrease. Terry and Sean explain it all in this episode.

The All Star Panel was back together for an outstanding first roundtable of the year! Sean was Joined by Terry, Christine, Scott, and Paul to discuss 2023 EM Services for the Inpatient setting, Split/Shared Services, Corporate Compliance Programs, HIPAA, and much more! 

In this episode Sean takes on H.R. 8800 (The Supporting Medicare providers Act of 2022)... Medicare Providers are facing a potential cut in reimbursement of up to 8.4%. However, if your contracts are paid at a % of Medicare your commercial contracts may be taking up to the same 8.4% cut. H.R. 8800 was referred to the Subcommittee on Health back on September 14, 2022, but there’s been crickets ever...

In this final #TerryTuesday episode, Sean and Terry tackle the OIG Report on improper payments for Co-Surgeons and assistants at surgery! Such an important topic to round out the year! 

It is that time of the year where we begin to wrap-up our current efforts and prepare for the year that awaits us! This is the FINAL #thecomplianceguy podcast of 2022 and we are going out in style! Join John Paul Spencer Stephanie Allard, CPC, CEMA, RHIT Terry A Fletcher BS CPC CEMC CCC CCS CCSP CMC ACS-CA SCP-CA, QMPM Christine Hall CHC CPC , CPB, CPMA, CRC, CEMC, CPC-I and Scott Kraft in a #codi...

Sean and Terry take on the HHS-OIG Report on Insights on Telehealth Use and Program Integrity Risks Across Selected Health Care Programs During the Pandemic... The report makes you questions who's on these committees and why we spend so much of the taxpayer money that we do on reports that can be written by an 8-year-old! Since he stayed in a Holiday Inn Express recently, Sean shares with you his...