The Compliance Guy

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...

In this Episode the entire All-Star Panel is back together to discuss the latest most pressing coding and compliance issues healthcare organizations are facing! The panel takes on Computer Assisted Coding (CAC) and the problems that come with this technology as well as the significant differences between office, inpatient and facility coding when it comes to EM Guidelines.  Such a great episo...

Shay Eskew joins #thecomplianceguy tomorrow at 11am right here on #linkedinlive for an insightful discussion on life, surviving, healthcare and so much more. PLEASE DO NOT MISS THIS ONE!!! Shay is the CSO of CirclesX – a technology company & the Chief People Officer of Shay Eskew – Motivational Speaking and Consulting. He is an All-American & top 1% All World ranked #ironman triathlete, bu...

The all star cast of characters is back as they join Sean to discuss 2023 em services and the impact changes have and will have on your coding and compliance! Christine Hall CHC CPC , CPB, CPMA, CRC, CEMC, CPC-I / Scott Kraft Terry A Fletcher BS CPC CEMC CCC CCS CCSP CMC ACS-CA SCP-CA, QMPM / Stephanie Allard, CPC, CEMA, RHIT / John Paul Spencer will join me to discuss how the AMA has added so muc...

Terry joins Sean to discuss a variety of coding and compliance related topics including the critical importance of following instructions and complying with published guidance. The conversation also addresses the Clean Claims Payment (42 CFR 447.45), Christmas Trees and being a farmer... Enjoy!  For more information on Terry and her service offerings visit her at www.terryfletcher.net 

In this episode Collin Callahan of Flannery Georgalis joins Sean to discuss what a prosecutor / defense counsel looks for in an expert, why expert reports are so critical, the dos and don’ts of SMEs and their reports, Daubert Motions vs Motion in Limine, and more... There are even some tributes to Runaway Jury and a Few Good Men! Don't miss this outstanding episode with one of Sean's favorite gues...

In this episode Sean hits on a Daubert Motion, which is a type of motion which seeks to exclude the presentation of an expert's testimony to a jury. Daubert motions are named for the Supreme Court case, Daubert v. Merrell Dow Pharm., Inc. (509 U.S. 579 (1993)). Rules 702 and 703 of the Federal Rules of Evidence govern the admission of scientific evidence in federal court. The rules allow expert wi...

Terry joins Sean to discuss Compliance Programs and Obligations for participating with all insurance companies... The difference between compliance plans and compliance programs, why compliance fails in smaller practices and how things like the No Surprise Act impact your efforts!  There's also a discussion about a pink comfy, Tom doing laundry and making coffee, and so many other things to k...

On this Monday roundtable discussion Sean is joined by Terry Fletcher, Christine Hall, Paul Spencer and Scott Kraft to discuss coding and compliance issues plaguing hospitals and physician practices. The panel addresses providers creating and signing notes prior to ever seeing the patient, cloning, clinical plagiarism, impact of not having a compliance plan, and so much more.   

Dawn Carter, Director of Product Strategy of Centauri Health Solutions joined Sean to discuss Risk Adjustment Audits and the ins and outs of these often times annoying administrative requirements if you participate with an MA Plan... This was such an interesting discussion and we believe you will think so too!  Links to articles from the show: Article 1:  Medicare Advantage, Direct Contr...