The Compliance Guy

Terry Joins Sean to discuss the Office of Inspector General (OIG) Work Plan! As the new year approaches you need to be prepared to conduct internal audits and the best thing to do is create an audit elements guide and set yourself up for success: Topics of Discussion: 1. Breakdown of the OIG Work Plan 2. Audits of Emergency Room Physician Evaluation and Management Services 3. Audits of Autoimmune...

It is #TerryTuesday and that can only mean my good friend Terry Fletcher is joining me for our special segement! This week we are tackling the UPICs and clearing up misperceptions and misunderstandings for who they are and what they actually do! You do not want to miss this one...

Brianna Santolli, ESQ and Terry Fletcher join Sean to discuss the realse on November 5, 2021 The CMS Interim Final Omnibus Rule followed by the OSHA ETS were released... These have been declared as "Mandates" but since their issuance there have been several legal maneuvers to block these mandates from being carried out. On Thursday November 11, 2021 several states led by Texas file a motion to blo...

In this episode Scott Kraft, Stephanie Allard and J. Paul Spencer join Sean to discuss the 2022 Physician Fee Schedule Final Rule, Evaluation and Management Service pitfalls in 2021 tied to the new guidelines and changes to the Split/Shared Services. Lots of great information that all healthcare professionals need to be aware of! There was also a discussion of Chronic Care Management (CCM) Service...

Karen joined Sean on this episode to discuss the TN Association and their incredible government and legal advocacy, comprehensive education opportunities, and the fact they are pioneers with their partnerships with the biggest insurers and governmental payers. Whether you are in the state of TN or not, you will want to hear what Karen and Sean discuss because it just may help you in your state!

Jared Walker, Founder of Dollar For (www.dollarfor.org) joined me for this critical discussion on the medical debt crisis! Jared inspires me every single day and he should inspire you as well... Nationally, 17.8 percent of people with a credit report as of 2020 had medical debt in collections, and 13 percent had accrued debt in the prior year but were not yet in collections. Of those who had medic...

In this episode of TCG, Terry joins Sean to discuss the re-launch of the TPE Audit Program by The Centers for Medicare and Medicaid Services (CMS)... There have been some significant changes to the process so hang around until the end to make sure you capture all the critical information to ensure when you get "The Letter" you are prepared.

Welcome to season 2 of TCG. In my first episode we lay out how to level the playing field with payers and we did this! Here is what is included in this episode: 1. Ex-post Facto Guidelines and Laws 2. Understanding Payer Participation Agreements 3. Breakdown of Clinical Judgement, Medical Necessity, and The Treating Physician Rule 4. AMA Definition of Risk When Clinical and Non-Clinical Reviews ar...

This was an incredibly special podcast for me as it is not often you get to say, "I got to interview an Emmy Award Winner"! My discussion with Clint Pulver (yes, that Clint Pulver) while short, the impact of his message will linger long after you reach the end!

Terry sits down with Sean for her #TerryTuesday discussion on the many payor audits providers can be subject to with a great breakdown of each!

Sean is joined by Jeanmarie Loria to discuss her evolution in healthcare from CPC to Managing Director (CEO) at Advize Health! The discussion takes an in-depth look into the current and future landscape of our industry. Jeanmarie provides invaluable insights and truly is a breath of fresh air and an inspiration for the younger, aspiring generation of healthcare leaders! She truly is one of the mos...

Dr. Kolinski joins Sean to discuss his latest book Work - Passion - Life Balance - and the process of "Reengineering"! The world we work in doesn't allow for many opportunities to balance the demands of the job and what we seek as fulfillment. Dr. Kolinski talks about what professionals should and can be doing to take the steps necessary to create that perfect work-life balance! Don't miss this in...

If you missed this live episode you can catch the podcast here! I sat down with Ronald Chapman II, Esq. LLM Chapman II to discuss and breakdown the Biden-Harris Executive Order and its impact on approximately 100 million American workers! We address the "work-around" employed by OSHA as well as previous Supreme Court cases that could impact future litigation... This is a comprehensive explanation...

In this special episode Sean is Joined by Nationally Recognized Medical Auditors Stephanie Allard, Scott Kraft and J. Paul Spencer from the National Alliance of Medical Auditing Specialists (NAMAS) to discuss Risk Mitigation, Coding, Billing, Documenation and Audit issues providers, hospitals and health systems face daily!

In this episode Sean takes on The False Claims Act (FCA) and all the ins and outs of these type cases. Sean shares his insights and expertise in this critical area of regulatory compliance and health law. The importance of understanding this Act cannot be overstated.

In this episode Sean sits down with Ron Chapman to discuss Fraud, Waste and Abuse in healthcare, strategic litigation defense services and the never ending battle with the Department of Justice! This dynamic conversation is one you do not want to miss.

In this episode, Sean and Amanda sit down and discuss Information Blocking and the misperceptions and misinformation that exists. Providers (physician practices, hospitals, health systems, etc.) need to understand their obligation(s) to providing patients access to their protected health information in a readable/useable format in a timely manner... Failure to comply can have significant financial...

This is the latest episode of The Compliance Guy... I sat down with Ray McGrogan and Steven Kleinberg, Co-founders of CardChoice International to discuss PCI Compliance and the misunderstandings between this and HIPAA Compliance and other little known facts about this type of compliance that is the responsibility of each entity and not your vendor or bank! The guys did a great job of explaining so...

Today it was a privilege to welcome Terry Fletcher and Brianna Santolli on to the Compliance Guy Podcast to discuss Telehealth misunderstandings! Given the fact there is federal guidance, state guidance and then variances from state to state it's no wonder risk continues to increase while complete understanding for the requirements lags! Don't miss this in-depth discussion with two outstanding pro...

In this episode Sean and Scott Kraft discuss a few of the more pressing sections of the MPFS 2022 Proposed Rule including the Conversion Factor reduction and clinical labor cost reductions (Potential Specialty Financial Losers), Changes to Physical and Occupational Therapy and the use of PTAs and OTAs, and Split/Shared Service propsed rule changes. This is definitely not an episode you want to mis...

In this segment Sean discusses the ins and outs of building an effective compliance program. The seven steps outlined by the OIG are address in addition to step 8 (Risk Assessment). This is not just an introduction to compliance... Sean takes the time to engage in the various components to ensure your complete understanding.

In this segment attorney and former special investigator Matt Lawhon sits down with Sean to discuss the ins and outs of various 3-letter agencies and their contractors processes for conducting provider / health organization investigations and what providers need to understand once "The Letter" arrives or the investigator shows up to your practice/hospital. Matt clears up misperceptions surrounding...

In this segment David Glaser, ESQ sits down with Sean to discuss the misunderstanding between regulation and guideline. This is not a coding session about Incident-to, this is intended for auditor, compliance officers, providers and administrators to understand the operational risk(s) associated with billing Incident-to and how to mitigate your risk accordingly. This podcast is a must for anyone g...

In this segment Scott Kraft sits down with Sean to discuss the ins and outs and dos and don'ts of Incident-to. This overly complex high-risk audit target continues to plague providers and confuse prosecutors and the investigators they rely on. Should you or should you not bill Incident-to... find out in this must listen to segment.

In this segment J.Paul Spencer sits down with Sean to discuss the critical importance of Local Coverage and National Coverage Determinations in addition to Local Coverage Articles when determining payment policy and responding to an audit! Is CMS the "Gold Standard"? A discussion regarding provider generated clinical summaries/rebuttals used during an appeal is addressed.