The Compliance Guy

In this episode Sean and Terry take on HIPAA and OSHA in a Post Pandemic Work World... The do's and don'ts and all the in-betweens. The wheels on the bus while they do go round and round, start to come off in this one and you don't want to miss it! 

In this episode of The Compliance Guy Monday Coding and Compliance Roundtable, you missed an outstanding panel discussion with Christine Hall CHC CPC , CPB, CPMA, CRC, CEMC, CPC-I Stephanie Allard, CPC, CEMA, RHIT John Paul Spencer and Terry A Fletcher BS CPC CEMC CCC CCS CCSP CMC ACS-CA SCP-CA, QMPM!  Tremendous interaction by the viewers and out standing topics:  1. Macro statements an...

In this 15 minute episode Sean tackles the issues with routine waiver of copays and/or deductibles, professional courtesy, and the potential implications with the FCA, Health Care Fraud Statute, Anti-Kickback Statute, and Stark Law.  Sean addresses the Special Fraud Alert from OIG on why it's illegal for "charged-based" providers, practitioners and suppliers to Routinely Waive Copayment and D...

In 16 minutes Sean breaks down the 2010 Affordable Care Act (ACA) and its mandate on establishing a compliance program (Core Elements). The breakdown includes:  1. Mandatory Compliance and Enforcement 2. The implementation of the 60-Day Rule and how it actually works 3. The Relator (qui tam) Bar and Effective Changes under ACA

In this episode, Sean and Terry take on questions from listeners and subscribers...  Topics:  1. Telehealth  2. Documentation Requirements for Telehealth  3. Use of Locum Tenens  4. Independent Dispute Resolution (IDR - Surprise Bills) 

The Compliance Guy Coding and Compliance Roundtable this week was simply put, Awesome! Guests Stephanie Allard, CPC, CEMA, RHIT Christine Hall CHC CPC , CPB, CPMA, CRC, CEMC, CPC-I John Paul Spencer and Terry A Fletcher BS CPC CEMC CCC CCS CCSP CMC ACS-CA SCP-CA, QMPM provided outstanding insight on a variety of topics and the engagement from the audience was fantastic!  Topics Include: 1. La...

Colin Callahan of Flannery Georgalis, LLC sat down with Sean on Friday, August 12, 2022 to discuss the R uan ruling by the Supreme Court. This ruling has and will continue to impact the litigation landscape significantly for matters tied to the Substance Control Act (SCA)! High profile cases have already been impacted and several that are pending decisions by Prosecutors to dismiss or move forward...

Steve Gallion, CEO of Medtrainer sits down to discuss all things compliance with Sean on this episode! The discussion covers the current landscape, ramped-up enforcement actions, and a bit about economics! Such an outstanding discussion with one of the industry's thought leaders! Don't miss this one!  About Steve Gallion Chief Executive Officer Steve’s passion for people and eye for market op...

Sean sat down with Scott Kraft, Senior Compliance Auditor for DoctorsManagement, LLC to discuss strategic defense litigation services and how those played a key role in the outcome of the United States v. Rajendra Bothra, et. al case on June 28th, 2022!  Here are some of the headlines in what is one of the Nation's largest heath care fraud cases.  "How 4 doctors beat the feds in botched...

Dr. Maheu joins Sean on this episode to discuss telehealth in behavioral health and the impact it is having on patient care. This is such an important episode for so many reasons especially coming out of the pandemic of the past 2 years! Do not miss this episode with one of the industry's leading voices on this topic!  About Marlene M. Maheu, PhD Dr. Marlene Maheu started publically addressin...

On this episode of TCG - The #TerryTuesday episode Karen N. George of Buchalter Law Firm joins Sean and Terry Fletcher to discuss payer contracting and all the ins and outs to ensure success!  Such a great episode!  About Karen N. George: Karen George is an attorney at Buchalter in the Los Angeles office and is a member of firm’s Health Care Practice group. Karen specializes in managed c...

On this episode Terry Fletcher, Scott Kraft and Paul Spencer join Sean for their Monday Coding and Compliance Roundtable to discuss Cloning and Clinical Plagiarism and who is actually accountable for compliance within an organization.  This was a live stream with great audience participation and outstanding interaction between the panelists!  

Alice Harris and Jenna Godlewski of Nexsen Pruet - Health Law Team join Sean to discuss The 2022 Strategic Plan also known as the "CMS Framework. The ladies identify Six Trends to Follow for the remainder of 2022 and well beyond, but they only scratched the surface! Here is the link to their article: Understanding the CMS 2022 Strategic Plan:  Six Trends to Follow (nexsenpruet.com) The Six Tr...

In this episode Sean takes on Modifier 25 and all the problems that comes with it. Critical explanations for how to properly define the modifier (significant and separately identifiable), NCCI Edit changes for 2022, OIG Report on Modifier 25, and how CMS and other payers are scrutinizing your claims!  Thank you for making us a Top 25 Podcast: https://blog.feedspot.com/regulatory_compliance_po...

In this episode Terry joins Sean to discuss Transitional Care Management and Chronic Care Management and all of the auditing, billing, coding, and compliance information you need to get it right!  These are not profit centers, at least how they are structured so be careful and avoid the pitfalls associated with these services!  Thank you for making us a Top 25 Podcast: https://blog.feeds...

On this episode Terry A Fletcher BS CPC CEMC CCC CCS CCSP CMC ACS-CA SCP-CA, QMPM, Scott Kraft, Stephanie Allard, CPC, CEMA, RHIT Christine Hall CHC CPC , CPB, CPMA, CRC, CEMC, CPC-I and John Paul Spencer join Sean live to discuss a variety of coding and compliance issues being uncovered in their daily auditing, coding and compliance activities on behalf of clients all across the United States!&nb...

In this episode Sean sits down with Maggie Perritt - Medicare Compliance Officer for Mass Advantage (MA Plan) to discuss her role as a compliance officer for the plan, prior authorization, claims processing, claims adjudication, engagement with law enforcement and so much more!  Was a great discussion you will not want to miss!  Thank you for making us a Top 25 Podcast: https://blog.feed...

In this 20 minute episode Sean covers specific sections of the Medicare Program Integrity Manual (Chapter 3) as it relates to the Medicare Medical Record Review Standards and Requirements for MACs, RACs, UPICs, SMRCs, and CERTs... Don't miss this one especially if you are responsible for the appeals and adjudication of claims!  Thank you for making us a Top 25 Podcast: https://blog.feedspot.c...

Telehealth is the number 1 audit target for commercial and government payors. Whether it's originating site, place of services, interactive v audio only, requirements for documentation, etc. providers all over the country are struggling. Give us less than 50 minutes and we will make it all make sense!  Thank you for making us a Top 25 Podcast: https://blog.feedspot.com/regulatory_compliance_p...

This Monday round table discussion was outstanding, with an amazing panel! I was joined by Christine Hall CHC CPC , CPB, CPMA, CRC, CEMC, CPC-I Terry A Fletcher BS CPC CEMC CCC CCS CCSP CMC ACS-CA SCP-CA, QMPM John Paul Spencer, COC, CPC and Scott Kraft, CPMA, CPC! We focused on the most pressing auditing billing compliance and coding challenges! Don't miss this outstanding panel discussion and re...

Jordan Johnson, MSHA, iMPaCT of Oncospark joined Sean for an in-depth discussion! We focused on the major disconnects between operations and finance leading to the true dysfunction with patients.      Topics Include:  4. Private Equity and the impact on healthcare, and so much more!    This was a brilliant discussion with my good friend that if you miss you could...

In this quick 15-minute episode Sean hits all the critical aspects of Modifier 59 and the more specific X-Modifiers. Think you know how and when to apply these modifiers and the potential risk(s) you face take a listen just to make sure!  Thank you for making us a Top 25 Podcast: https://blog.feedspot.com/regulatory_compliance_podcasts/ The Compliance Guy has been Nominated in 2 categories (A...

"Salty" Sean M. Weiss sits down with Terry Fletcher for their weekly #TerryTuesday to discuss telehealth place of service confusion, policies and procedures for split/shared services and a host of other issues creating "noise" and chaos in healthcare organizations! You definitely do not want to miss this one!  Thank you for making us a Top 25 Podcast: https://blog.feedspot.com/regulatory_comp...

Terry Fletcher, Christine Hall, Stephanie Allard, and Scott Kraft Join Sean to discuss Auditing, Billing, Coding and Compliance in this 45-minute roundtable!    Topics Include:   1. Modifier 25 Audits (what is Cigna, Aetna and BCBS doing?)  2. Taking credit for interpretations (Impact on Medical Decision-Making)  3. Rheumatology Insights - Who do you need to listen to on i...

In this daily dose Sean tackles CMS's guidance on Coding Determinations when there are no coverage guidelines. The reasonable and necessary standards and limitations of liability are broken down in detail.