The Compliance Guy

Sean and Terry take on the world of Pre-ops and provide clarification of the different types of visits and what is required to satisfy billing of these services.

Sean and Terry are back and taking on Stark from a practical standpoint in this episode of The Compliance Guy.

The panel is back for this outstanding discussion on when it's appropriate to make changes to CPT Code Selection(s) and when it is not!

Just because you go paid doesn't mean you billed it right... just because you got paid doesn't mean you get to keep it... just because you got paid once doesn't mean you will be paid again! Terry and Sean tackle an issue that we know is prevalent in all medical groups.

The all star panel was back live to discuss the latest in healthcare billing, coding, compliance, and documentation issues and strategies. On the topic list for this episode was the impact of cyber-terrorism on healthcare facilities and the false sense of security physicians have by relying on their EMR Templates. Truly a great discussion!

This episode was mind boggling to yours truly! Just when you think you understand a Medicare process you realize you really need brilliant health care attorneys like Ashley Morgan and Robert Liles to help you make sense of things! Don't miss this one

Sean was joined by Hassan Abdallah of ATLAH to take on a wide-range of topics directly impacting healthcare compliance, audits, private equity, and so much more! About Hassan F. Abdallah Hassan F. Abdallah is a proven and recognized professional in the field of organizational compliance with extensive experience in designing and managing compliance based solution systems. Throughout his career he...

Terry is back in the hot seat to discuss facility vs pro-fee coding... lots to unpack in the episode!

The entire gang is back for this one... Terry, Christine, Stephanie, Scott and Paul teamed up with Sean to discuss: 1. AI and the impact on healthcare... 2. Q3014 Site of Service Fee Differential... 3. Patient Centered Care... 4. Statistically Valid Random Sample (SVRS) when and how can it be used...

Sean takes on the question "should we fear the “Bots” or should we openly embrace them"? You be the judge. What risk(s) do we face during an audit if it’s determined the documentation is cloned. What potential med-mal issues could be hiding around the corner?

Sean was joined by Ashley Morgan and Robert Liles of Liles/Parker to discuss Medicare Part C Appeals and how different the process is from traditional Medicare Part A and B Appeals... Once again, this was such an incredible episode with two of the best attorneys in the administrative process! About Ashley Morgan: Ashley Morgan is a Partner at Liles Parker. She focuses her practice on regulatory he...

Sean was joined by Elliot Golding of McDermott Will & Emery to discuss all things HIPAA Privacy and Security, Information Blocking, and a few more critical aspects of cybersecurity! This episode is a must for all medical practices, hospitals and health systems to ensure your compliance with the ever-changing landscape! Elliot is Sean's go-to when it comes to Data Privacy and Cybersecurity!...

Terry and Sean take on the question of why... why are auditors, billers, coders, and providers still doing things that expired with the end of the PHE!

Jerrod Bailey is the CEO of Medplace , Joined me to discuss technology in healthcare, advancements in #artificialintelligence and how he and his company are filling a vital gap in the #litigation , #peerreview and #clinicalreview spaces. Bio: Jerrod is the CEO of Medplace, an app built for healthcare, legal, and insurance industries to streamline their case and peer review processes. He holds over...

Terry and Sean take on the new "Graduate Physician Program" and what this means... This is a very interesting topic that we got to explore. The discussion then shifts to DME Audit Targets... Charity of the Month: The Tafida Raqeeb Foundation https://tr-foundation.org/ Around 6000 children are diagnosed with serious brain injury in the UK every year which result in devastating effects on...

In this episode Sean takes on the routine waiver of copayments and/or deductibles and why it's a really bad idea... There are many Administrative, Civil, and/or Criminal issues/penalties one faces for violating the False Claims Act, Health Care Fraud Statute, and/or the Anti-Kickback Statute(s) (Federal and State)... Charity of the Month: The Tafida Raqeeb Foundation https://tr-foundation.org/...

Terry and Sean are back at it in this episode... the focus was on payor contracting vs. credentialing. Lots to unpack in this episode that you are not going to want to miss! Charity of the Month: The Tafida Raqeeb Foundation https://tr-foundation.org/ Around 6000 children are diagnosed with serious brain injury in the UK every year which result in devastating effects on the child and their family....

Hands-down, one of the best Monday Roundtables to-date! The full panel was back for a lively discussion on the following: 1. Mayo Clinic 2. AdQuic Process 3. The end of the PHE and Telehealth Services 4. Cigna and their Modifier 25 Policy, and so much more! Charity of the Month: The Tafida Raqeeb Foundation https://tr-foundation.org/ Around 6000 children are diagnosed with serious brain injury in...

Sean is joined by attorney's Amanda Waesch and Joshua La Bouef of Brennan Manna and Diamond breakdown the latest legislation signed into law by Governor Ron DeSantis on Personal Injury and Auto Accident and what many are calling a pure disgrace! Listen and you determine... Charity of the Month - The Tafida Raqeeb Foundation was formally launched on 22 March 2022 in London, United Kingdom. The...

This episode is hands-down one of Sean's favorites to date... This episode exposes the Medicare Administrative Appeals Process for what it really is... Smoke and mirrors! The fact is, even if you prevail at the ALJ level there is a significant chance you can still lose the case based on an AdQIC referring the case to the Departmental Appeals Board (DAB)! Sean is definitely in a rare and irrita...

For the first time in 25-years the Office of Inspector General is updating the Compliance Program Guidance (CPG) for the entire healthcare industry! No more are the days of searching and reading the Federal Register... What will be the new delivery method? Tune in to find out! Jenna K. Godlewski - Jenna focuses solely on health care law and assists medical practices across the country on reimburse...

In this final episode of Season 5, Terry and Sean sit down to discuss concierge medicine and health coaches... when, where and how these services come into play and the pitfalls with providing them.

The entire  #allstar  panel ( 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   Stephanie Allard, CPC, CEMA, RHIT   Scott Kraft  and  John Paul Spencer ) are back and armed with a ton of new information to discuss and offer solutions for! #coding  and  #compliance  are the focus and the topics will include: 1. A breakdown of ...

Terry joined Sean to discuss all the intricacies and pitfalls of the three-midnight- rule... Didn't know there was one, well there is. The dynamic duo also took on the two-midnight-rule just to cover all of the bases!

Sean was joined by  Colin Callahan  of  Flannery Georgalis, LLC  and  Jeana Singleton  of  Brennan Manna Diamond  to discuss issues impacting  #healthcareprofessionals  in the  #coding ,  #auditing ,  #compliance ,  #documentation , and  #leagal  areas of healthcare! Todays Topics Include: The intersection of prevention and prosecution/enforcement How preventative measures help defense Recent DOJ...