The Compliance Guy

Terry joins Sean to discuss the ins and outs of Medicare Advantage (MA) and what you really need to know about these plans. Why is the OIG investigating MA plans and what are they finding. Don't miss this one!

Sean was joined by an all star panel of guests including Christine Hall, Paul Spencer, Terry Fletcher and Scott Kraft to discuss "Scary Scenarios" they've each dealt with over the past week and what you need to know to avoid the same costly mistakes as others... Don't miss this one as it's an absolute fright! 

In this episode I am joined by Stephen Soloway MD FACP FACR to discuss his new book "Medical Politics" This dynamic book shows you through a Non-Fictional lens health care's landscape and all that is wrong with it! You can find the book on Amazon ( https://lnkd.in/gP4UrfWh ), at Target or at Barns & Nobel Book Store or wherever books are sold!

In this episode of the Daily Dose Sean discusses and reads the Foreword of Dr. Stephen Soloway's new book "Medical Politics" This dynamic book takes you through a Non-Fictional lens of health care's landscape and all that is wrong with it! 

Terry Fletcher joins Sean on this #TerryTuesday Episode of The Compliance Guy to discuss Time Based Coding, Las Vegas, The Steelers and other fun facts! Don't miss this one as Sean and Terry hit their stride! 

Terry Fletcher joins Sean to discuss the PHE and its impact on the healthcare industry! No matter what side of the isle you sit on this should not be a political issue but rather a business and compliance issue and that is what Sean and Terry focus on!  Don't miss this one! 

On this roundtable Sean is joined by Terry Fletcher, Karen George, Stephanie Allard, Christine Hall, and Paul spencer for a discussion on the following:  1. Information Blocking Rule 2. No Surprises Act / Independent Dispute Resolution 3. Preparing for a Payor and/or Contractor Audit  4. MDD Audits and their impact on HCCs

This is part 2 of the series on using the Gap Analysis to develop and implement an effective compliance program in your organization... Do not miss this episode because Sean delivers the punchline! 

In this episode Sean takes on the critical aspects tied to GAP analysis and what they are, how to perform one and how it impacts your ability to build an effective compliance program, which leads to demonstrating a "Culture of Compliance"!  Don't miss this one! 

This is an awesome episode with my very good friend Terry Fletcher. Take a listen as our answer(s) may shock you! 

After a week of being off for Conferences Sean is back with an all new episode... Today's focus is delivering audit results to providers in the most effective and efficient way! 

Terry joins Sean to discuss a variety of topics including ablations, bilateral services and other nuanced issues impacting health care organizations. Don't miss this one!  

Terry Fletcher, Christine Hall, Scott Kraft and Paul Spencer joined the Coding and Compliance Roundtable to discuss a host of critical topics including:  1. Evaluation and Management Services - What does it mean to take a clinically relevant history and examination 2. Telehealth Services - The Challenge Continues  3. Incident-to Services - Can a Physician bill Incident to another physici...

Sean was joined by Scott Kraft, Christine Hall, Paul Spencer, Stephanie Allard and Terry Fletcher to discuss all of the latest in the world of coding and compliance. 

In this episode Sean and Terry tackle "Split Visits" not to be confused with "Split-shared Visits"... E/M Services on the same date as a preventive service have and continue to cause a lot of confusion for coders and billers. Hangout with us for a bit and let us clear up the confusion.

In this episode Sean takes on Templated Compliance Plans and the Do's and Don'ts! Taking the time to understand how compliance templates work for and against you is critical to establishing an effective program. The key takeaway from this podcast should be, “Don’t Be Lazy” if using a template… spend the time and effort on the front end to save you money, and your sanity on the back end.

What do you do when you receive "The Letter"? Everyone gets at least one from a payer/investigator/contractor that makes your belly gurgle and sends you searching for the Imodium AD! Take a listen to this episode for the Do's and Don'ts and how best to respond to the dreaded letter! 

In this episode I take on the lack of auditing standards in healthcare and push for standardization... There is no doubt we work in one of the most regulated and complex industries and at times it leads to a misinterpretation of Acts, Guidelines, Laws, Regulations and Statutes, and because of the complexities we deal with, it also leads to folks to taking shortcuts that in the long-run lead to cri...

In this episode Sean and Terry provide a comprehensive list of acronyms in healthcare from the obvious to the obscure. There is also talk of The Show Friends, Sean's beard, and much more. There is also, a complete list of Sean and Terry's Acronyms available on LinkedIn on Sean's feed. 

In this 20 minute episode I discuss the dos and don'ts of handling an onsite investigation/audit and steps to take prior to something like that ever happening. 

In this episode I take on provider legibility. I know you are on an EMR but take a listen to this 13 minute episode to find out how a technical violation results in significant demands for refund by payors. I break down how payors try to use sampling and extrapolation without actually using the words but findings other synonyms to try to make it look less like they are doing something they should...

In this episode Sean and Terry take on non-compliant providers and the liability it creates for "anyone" who knowingly submits claims in violation of the False Claims Act... Sean also gets to practice his Latin, which is quite entertaining! 

In this quick 15 minute episode Sean discusses the 2022 FCA increases for penalties and discusses the False Claims act and qui tam lawsuits. 

Joining Sean is special guests Attorney Colin Callahan of Flannery / Georgalis and Eric Rubenstein, Ret. OIG Agent of Advize Healthcare. The roundtable discussion will be Private Equity (PE) and the pitfalls of engaging both as the investor and as the portfolio company.  There is ton to explore and we are sure you will walk away with a better understanding of how best to engage with PE! ...

In this episode Sean takes on the Eliminating Kickbacks in Recovery Act of 2018 (EKRA), the little known law passed in 2018... Congress enacted EKRA, a law to fight patient brokering and recovery profiteering. The law prohibits accepting or paying kickbacks for referrals to recovery homes, clinical treatment facilities, or laboratories. EKRA combats opioid related fraud. Give me 20 minutes and I w...