The Compliance Guy

In this episode Sean tackles the 2021 report issued by OIG to address inappropriate billing for and overuse of spinal facet-joint denervation for pain management. In total, Medicare improperly paid physicians $9.5 million during the audit period of January 2019 - August 2020... This is a must for providers performing these procedures. A whole lot to unpack in this one.

In this episode Sean addresses the policy change being pushed forward by Cigna requiring documentation to be faxed to a dedicated fax line beginning August 13, 2022 for EM Services (99212-99215) when billed with Modifier 25 and a minor procedure on the same day.

In this episode we discuss the federal Timely Claims payment Law and State Prompt Pay Laws. In this 10 minute segment a lot is revealed to ensure you're on the right track to getting your claims paid.

Brianna J. Santolli, Esq. of Riker Danzig Scherer Hyland & Perretti LLP joined Terry A Fletcher BS CPC CEMC CCC CCS CCSP CMC ACS-CA SCP-CA, QMPM and Sean on a special episode of TCG / #TerryTuesday to discuss the updates of the #nosurprisesact...There is a ton to unpack in this episode and there's no doubt things get a bit sideways with Sean driving!

Welcome to the “Daily Dose” on The Compliance Guy. Each day you will be caught up with a different event or multiple events in the world of healthcare. This segment is not meant to be a deep dive but rather a breakdown of what significant issue(s) government investigational agencies such as DOJ, OIG, FBI, OCR, CMS, and other healthcare contractors are focused on. Additionally, topics f...

Karen Weintraub joins Sean to discuss Special Investigative Units, the state of healthcare, fraud and the what the future holds. It is so critical to understand that not all who work on the payor side are "Out to get you" and that in a lot of cases healthcare professionals like Karen are trying to refute allegations of misconduct. Take a listen and we are sure you're going to agree, this was a fas...

Terry Joins Sean on this episode to discuss Cloning and Clinical Plagiarism including the Do's and Don'ts of Electronic Health Records! A review of OIG's Report on EMRs (CMS and Its Contractors Have Adopted Few Program Integrity Practices to Address Vulnerabilities in EMRs) and what leads to allegations of "Fraud". What is copy-pasting? what is over-documentation? When is it okay to carry-forward...

My special guest will be Rozmin Bapat, Founder of CodeRite Healthcare Consulting. It was a fascinating discussion with a fascinating healthcare professional! Rozmin and I got a chance to discuss a lot of different aspects of healthcare, a bit about her rise through the ranks and what inspires her to keep going! Don't miss this outstanding episode! Thank you for helping to make The Compliance Guy a...

In this episode Terry and Sean discuss accountability within CMS and more specifically Medicaid Telehealth Services (Quality of Care)... This episode is so important for so many reasons... take a listen and we are sure you will agree. Thank you for helping to make The Compliance Guy a 2022 Top 25 Podcast: https://blog.feedspot.com/regulatory_compliance_podcasts/

Renowned allergist / immunologist Naveen Sikka of US Allergy & Asthma sits down with Sean to discuss the world of Allergey / Immunology and Asthma... After his fellowship in St. Paul, Dr. Sikka was part of North Texas Allergy and Asthma Associates where he spent 8-years. During our discussion Dr. Sikka and I discussed how biologics are impacting patient care, and tackled a bit of controversy;...

In this episode Terry Joins Sean to discuss the ins and outs of Locum Tenens and Reciprocal Agreements for Medicare. Lots to unpack in this episode including covered visit services, continuous services and the exception to the 60-days, global surgery package, modifiers and how physical therapists play into all this... Don't miss this one! Thank you for helping to make The Compliance Guy a 2022 Top...

Terry joins Sean to discuss whether to refund or not to refund on a variety of topics including Offshoring (CCM, TCM, etc.), Bundled Services, Durable Medical Equipment, and Amended Medical Records (Addendums, Late Entries, Corrections)... Gray areas area addressed as well: Internal or External Audit of E/M services finds level 5's are auditing at level 3 or 4. Office Visits w/minor procedures not...

In this critical episode Sean is joined by Robert Liles, ESQ, and renowned opioid expert Dr. James Shear to discuss the ongoing crisis in America, increases in regulatory oversight, and prosecutors' focus on criminal prosecutions... Prescribers of narcotics need to be on-guard to ensure they are taking all necessary precautions to ensure patient compliance as well as their own. It's no longer just...

In this episode Terry joins Sean to discuss the latest PHE Extension and what that means to the healthcare industry. What does this mean for the "Blanket Waivers" (1135) including physician services, telehealth services, dietary services, and more...

In this episode I taken on the SDP vs MVRP and provide a detailed breakdown of each as well as when to use each and when to avoid them... Elements covered in this episode include but are not limited to: Fraud and Abuse Laws Overview OIG Agency Breakdown Anti-Kickback Statute, Stark Law, False Claims Act, Exclusion Statute Duty to Refund, Generally Discovery; Investigation process; Document retenti...

In this episode Terry joins Sean to breakdown OIG Self-Disclosure Protocol vs. Medicare's Voluntary Refund and what each means to your medical practice, hospital, health system, or organization. Things are off to a fast start right out of the gate. This is one of the best episodes yet for our dynamic duo!

It's #TerryTuesday on TCG and we are stoked to bring you this episode! Terry joins Sean to discuss Recovery Audit Contractor Audits (RACs) and their impact on healthcare operations... Sean and Terry have a whole lot of baggage to unpack on this episode regarding Local Coverage Determinations (LCDs), Local Coverage Articles (LCA) and National Coverage Determinations (NCDs)!

Chandler joins Sean to discuss the No Surprise Bill Act / Good Faith Estimate (GFE) on this episode! There is a ton to unpack as well as clear up. Chandler works in the Nexsen Pruet's Columbia office and practices in the areas of healthcare and general business/corporate law. He focuses the bulk of his practice on assisting healthcare clients with regulatory, contractual, and transactional matters...

Chandler joins Sean to discuss the No Surprise Bill Act / Good Faith Estimate (GFE) on this episode! There is a ton to unpack as well as clear up. Chandler works in the Nexsen Pruet's Columbia office and practices in the areas of healthcare and general business/corporate law. He focuses the bulk of his practice on assisting healthcare clients with regulatory, contractual, and transactional matters...

Chandler joins Sean to discuss the No Surprise Bill Act / Good Faith Estimate (GFE) on this episode! There is a ton to unpack as well as clear up. Chandler works in the Nexsen Pruet's Columbia office and practices in the areas of healthcare and general business/corporate law. He focuses the bulk of his practice on assisting healthcare clients with regulatory, contractual, and transactional matters...

Christine Hall joins Sean on The Compliance Guy Live to discuss the state of healthcare compliance, and the role auditors, coders, and billers play to ensure clean and accurate claims. What is CMS focused on with audits and what are some of the OIG hot targets providers need to be aware of...

Attorneys Jesse Whitten and Steve Lokensgard of Faegre, Drinker, Biddle & Reath, LLP join The Compliance Guy (TCG) to discuss Medicare's 60-Day Rule and its impact on Medicare Advantage and Medicaid Managed Care Plans.

The one, the only Eric Rubenstein joined Sean on the first episode of season 3 to ensure we came out of the gate swinging. The episode focused on all things OIG Compliance! Topics: 1. UPICS 2. Telehealth 3. DoJ Prosecutions 4. Updates on Fraud, Waste and Abuse 5. Investigations by the OIG - How they start and how they escalate

In this final Episode of season 2 Terry and Sean discuss who bares the ultimate responsibility for the claims sent out the door to payors. What benefit if any does coder liability insurance have, what is required from an ethics and responsibility standpoint by the associations that credential or license a healthcare professional. What happens in a False Claims Act case, who is the likely target an...

Ronald Chapman, II joins Sean to discuss his new book Fight the Feds, "Unraveling Federal Criminal Investigations". Do not miss this episode... there is so much to unpack. Whether you are a student of the law or you are an experienced attorney this book is a must for your shelf and this episode is a must for your here and now knowledge!