The Compliance Guy

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. 

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...