The Compliance Guy

Summary In this episode, Sean Weiss interviews Christina Panos from Wolters Kluwer to discuss the importance of regulatory compliance in healthcare, the capabilities of MediRegs, and how organizations can stay ahead in fraud, waste, and abuse prevention. Key Topics Healthcare fraud, waste, and abuse MediRegs features and benefits Regulatory updates and alerts Customizable compliance tools AI and a...

Summary This episode explores the ethical, legal, and practical implications of virtual critical care in healthcare, highlighting recent cases and regulatory challenges. Hosts Sean and Terry discuss the boundaries of telehealth, the moral dilemmas faced by providers, and the importance of appropriate, compliant virtual care practices. Key Topics Ethical dilemmas in virtual critical care Legal and...

Summary This episode features a detailed discussion on recent healthcare compliance issues, focusing on Medicare Advantage overpayments, the importance of proactive audits, and the evolving role of data analytics in fraud detection. Experts Terry Fletcher and Sean Weiss share insights on regulatory updates, best practices, and the need for strategic compliance in healthcare organizations. Key Topi...

Summary In this episode of The Compliance Guy, Sean Weiss and Terry Fletcher discuss various compliance issues related to audits, medical necessity, and the importance of thorough documentation in healthcare. They engage in a role play to illustrate common pitfalls in audits, emphasizing the need for physicians to conduct appropriate examinations and maintain accurate records. The conversation als...

Summary Join Sean Weiss as he discusses behavioral health coding, billing, and the current challenges faced by providers with expert Sonda Kunzi. Explore topics like reimbursement issues, telehealth, and regulatory complexities in behavioral health care. Key Topics Behavioral health reimbursement challenges Telehealth regulations and compliance Impact of COVID-19 on behavioral health services

Summary This episode explores the complexities of virtual supervision under Medicare, emphasizing compliance, operational best practices, and the potential benefits when implemented correctly. Key Takeaways Virtual supervision is a payment, workflow, and compliance rule, not just a convenience. Real-time audio-video technology is required for virtual direct supervision. Separate telehealth policie...

Summary In this episode, Terry Fletcher discusses common compliance pitfalls in healthcare, billing errors, fraud risks, and the importance of accurate documentation and risk management. He emphasizes the need for healthcare providers to stay informed and vigilant against fraud and billing mistakes. Key Topics Healthcare billing errors and compliance pitfalls Fraud risks and detection in healthcar...

Summary This episode features a comprehensive discussion on healthcare compliance, audits, and payment integrity, with insights from industry experts on recent trends, challenges, and legal considerations in healthcare billing and review processes. Key Topics Prepayment reviews and quality reviews in healthcare Legal considerations and due process in audits CMS restructuring and payment models Sub...

Summary In this episode, Sean Weiss and Terry Fletcher discuss the complexities and pitfalls of billing add-on code G2211 for E&M services, emphasizing the importance of medical necessity, proper documentation, and understanding payer policies. Key Topics G2211 coding and billing Medical necessity and documentation Pediatric billing considerations Payer policies and reimbursement rates Risks o...

Summary In this episode, Sean Weiss and Frank Cohen explore the realities of AI, its limitations, and its implications for healthcare and legal fields. They discuss how AI models work, the importance of human oversight, and the risks of overestimating AI capabilities. Key Topics How AI tokenizes words and predicts next tokens The misconception that AI reasons or learns like humans The importance o...

Summary In this episode of The Compliance Guy, hosts Sean Weiss and Terry Fletcher explore the importance of internal audits, provider documentation, and maintaining objectivity in healthcare compliance. They discuss common pitfalls like over-familiarity with providers, the impact of personality on compliance, and the significance of external reviews to ensure practice integrity. Key Topics Intern...

Summary This episode features a lively panel discussion on critical issues in healthcare compliance, including the use of cell phones for medical communication, prepayment reviews, and critical care documentation. Experts Joe Rivet, ESQ, Scott Kraft, Jordan Johnson, Stephanie Allard, and David Duhaime share insights, practical advice, and regulatory updates to help providers navigate complex compl...

Summary In this episode of the Compliance Guy podcast, host Sean Weiss interviews healthcare compliance expert Susan Wahlberg. They discuss the evolving landscape of healthcare regulation, focusing on the roles of the FTC, FDA, and OCR, and explore how compliance professionals can stay ahead in a rapidly changing environment. Key Topics Role of the FTC in healthcare data privacy and enforcement Em...

Summary In this episode, healthcare attorney and expert Dean Viskovich discusses the complexities of telehealth, medical necessity, and laboratory compliance, providing practical guidance for labs and billing companies navigating CMS and payer requirements. Key Topics Medical necessity and legal standards Impact of recent court decisions on labs Best practices for compliance and documentation Here...

Summary In this episode, Sean and Terry Fletcher discuss the latest issues in healthcare compliance, focusing on problematic billing practices, the risks of retrospective diagnosis coding, and the influence of third-party payers like Optum. They explore how these practices threaten provider integrity and patient care, offering insights and advice for healthcare professionals navigating these chall...

Summary In this engaging discussion, Sean Weiss and Terry Fletcher explore the recent CMS final rule that bans fax machines and snail mail in healthcare transactions. They analyze the implications for revenue cycle management, the move towards digital documentation, and the broader impact on healthcare modernization and value-based care. Topics CMS final rule banning fax and snail mail Impact on r...

Summary This episode features a comprehensive discussion on current issues in healthcare compliance, including RadV audits, auto down coding, medical necessity, and the impact of AI in billing practices. Experts share insights on regulatory challenges, provider strategies, and the future of healthcare billing integrity Topics RadV audits and their impact on providers Auto down coding and its impli...

Summary This episode features Sean Weiss and Terry Fletcher discussing recent issues with insurance payers, down coding policies, and the impact on healthcare providers. They analyze the implications of AI-driven denials, the importance of proper documentation, and advocate for provider advocacy and education. Key Topics Insurance payer policies and down coding Impact of AI and algorithms on medic...

Summary In this episode, Sean Weiss and Terry Fletcher explore the complexities of healthcare compliance, focusing on workflows, documentation, and audits in medical practices. They discuss real-world scenarios involving frequency audits, documentation cloning, and the importance of proactive compliance strategies to avoid regulatory risks. Key Topics Impact of workflow failures on compliance Risk...

Summary This episode features a lively panel discussion on healthcare documentation, compliance risks, and best practices. The experts share insights on managing documentation delays, metadata analysis, contract oversight, and the impact of AI in healthcare record-keeping. key topics Risks of documentation modification Metadata analysis in audits Contract oversight and compliance AI in healthcare...

Summary This episode features a lively discussion on Olympic hockey, healthcare compliance, and the pitfalls of diagnostic coding. The hosts share insights on how practices often manipulate diagnoses for payment, the importance of proper documentation, and the impact of payer policies on clinical decisions. Topics Diagnostic coding manipulation Healthcare audits and compliance Impact of payer poli...

Summary This episode features a deep discussion on HIPAA compliance, recent enforcement updates, and the implications of AI and third-party tools on patient data security. Experts Terry Fletcher and Sean Weiss explore how healthcare providers can stay compliant amidst evolving regulations and technological advancements. Key Topics HIPAA enforcement updates and penalties Impact of AI and ambient sc...

Here is the latest episode of The Compliance Guy! Summary In this episode of The Compliance Guy, Sean M Weiss and Terry Fletcher discuss various topics related to compliance, telehealth, and revenue cycle management. They emphasize the importance of accurate documentation in medical records, the impact of government shutdowns on telehealth services, and the responsibilities of EMR companies in ens...

Summary The 2026 Compliance Roundtable discusses critical issues in healthcare compliance, focusing on prior authorizations, telehealth, clinical laboratories, and incident two billing provisions. Experts (Joe Rivet, Terry Fletcher, Scott Kraft, Stephanie Allard, Jordan Johnson, and David Duhaime) share insights on the challenges faced by providers, the impact of legislation, and the evolving land...

Summary In this episode, Sean M Weiss and Terry Fletcher discuss the implications of AI in healthcare, particularly focusing on AI scribes and the importance of patient consent. They explore the challenges and responsibilities healthcare providers face in ensuring patient privacy and compliance with regulations. The conversation highlights the need for transparency in AI usage and the potential ri...