The Compliance Guy

Split/Shared Services is the theme of this episode and you do not want to miss this in-depth discussion!

The Allstar team was back together to discuss the latest changes to the AMA CPT Manual, Risk to Providers who Clone medical records, and so much more!

Terry and Sean take on 2024 changes from AMA/CMS regarding telehealth!

This episode is all about compliance... So much to unpack in so little time!

Terry, Christine, and Stephanie joined Sean to discuss a variety of pressing topics impacting compliance and operations. Topics for Discussion: - Billing for bundled or non-covered services “hoping” to get paid and then writing it off if you don’t. - trying to bill to insurance an injection code when it’s on the list of “likely self administered” because the patient doesn’t want to self Inject. -...

This is a very special episode of The Compliance Guy #TerryTuesday... There is some signing, and somethings that we refer to as "Don't Do That... It's Stupid!

Join Stephanie, Terry, Christine, Scott, and Paul as they sit down with Sean to discuss a variety of coding and compliance topics including: 1. Traveling overseas and needing medical attention... who is going to pay for it? 2. Modifier 25 CMS/AMA Joint Definitional Change...

In this episode, Sean and Terry take on Revenue Cycle Management and the role of compliance in operations.

You favorite dynamic duo is back and at it again! In this episode Sean and Terry take on the different types of audits... This episode is a must for every type of healthcare organization!

The entire crew (Christine, Terry, Scott, Paul, and Stephanie) is back for an outstanding roundtable discussion that is wide-ranging and full of great content! 1. Orders for tests and how the EMR impacts how specific tests are displayed in a note and the impact given for credit for towards data and MDM. 2. Cyber Security Attacks on healthcare providers (CMS Warning) and how to be diligent in your...

Terry and Sean take on can I do this because the doctor down the street does it... and what happens when you don't stay in your lane!

We had a great line-up of topics on this episode: 1. Orders for tests and how the EMR impacts how specific tests are displayed in a note and the impact given for credit for towards data and MDM. 2. Cyber Security Attacks on healthcare providers (CMS Warning) and how to be diligent in your efforts! 3. The impact of private equity money and the latest claims of price gouging by the government agains...

Sean was joined by Dr. Carolyn Ward, Director of Clinical Strategy for Particle Health to discuss challenges with interoperability and other dynamic challenges facing healthcare professionals... About Dr. Ward: Carolyn Ward is a dynamic and driven internal medicine physician with a passion for physician empowerment and data-driven decision making. With over eight years of experience in healthcare,...

On this episode, Sean was joined by Dr. Brian Fengler of EvidenceCare to discuss the state of healthcare and what he as an Emergency Room Physician has see as opportunities to gain access to evidence based care information to assist in the treatment of patients at bedside faster and more accurately. About Dr. Fengler: (https://evidence.care/) Dr. Brian Fengler is the co-founder and Chief Medical O...

Terry and Sean take on the giant headache of split/shared and incident-to services. This one gets a bit heated for legitimate reasons. You're gonna love this one!

The entire team is back for this episode! There was a lot to discuss with so many issues coming to light in the areas of coding, billing, documentation, and compliance. Don't miss one minute of this one!

What is a compliance plan and how to build one that is effective and meets OIG and DOJ requirements!

This was an epic episode that you do not want to miss. Scott, Terry, Stephanie and Christine joined Sean to discuss the False Claims Act, Anti-Kickback Statute, Template issues, and so much more!

Terry and Sean take on Telehealth access. Clients are getting letters about not having Telehealth available for disabled patients, which is required under the Federal Disabilities Act. Physicians telling patients they don't have in-person options for care, ONLY Telehealth is not okay.

The panel was back at it with a great breakdown of the Medicare Physician Fee Schedule Rule Changes for 2024... as always it was a lively discussion about the proposed rule changes and their impact on providers. Topics Included: 1. Split/shared services – the definition of substantive portion will remain the same as it is now through 12/31/2024... Time will not be the controlling factor. HX, EX, a...

This is a systemic problem facing the industry and the MACs, OIG, DOJ and others who audit and investigate are hyper aggressive when it comes to recoveries! Learn the regulations and your obligations to refund money you are not entitled to!

The panel was back for a great discussion on today's most pressing issues facing healthcare professionals: 1. Providers changing records and documentation after notice of an audit... 2. Denials by CIGNA and other plans for unspecified diagnosis. What is a "valid" diagnoses, vs. "covered" diagnoses... 3. United Healthcare's continued woes...

Sean and Terry take on some spicy issues (literally and figuratively) in this episode. Not knowing the coding rules can land you in some hot water and lead to significant claw backs and/or overpayment demands. Don't miss this outstanding episode with one of the industries foremost coding and billing SMEs!

The all star panel was back for another outstanding episode. There was a lot of debate in this one and the fact is all of the positions laid out were solid and accurate. Providers need to be proactive in their compliance when it comes to accurate coding but when things aren't perfect it takes a team to create a solid defense. Do not miss this one as it was hands-down one of the best debates of...

The one and only Ronald Chapman II of the Chapman Law Group joins Sean to discuss their latest (5 in 12 months) of acquittals for Dr. Loey Kousa. Sean and Ron lay out what went right for the defense and why the prosecution's case failed. If you are a provider charged with a crime in healthcare or an attorney looking for strategies to ensure a level playing field and due process for your client...