The Compliance Guy

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.

In this segment Sean discusses the steps and provides insight to the various regulations and other critical information to ensure you get your investigation right. Taking the time to do a bona fide investigation whereby every I is dotted and T is crossed is paramount to avoiding problems.

In this episode Sean and Jenna Godlewski, Special Counsel for Nexsen Pruet sit down to discuss CMS' Supplemental Medical Review Contractor (SMRC) and the impact they're having on providers, hospitals and health systems.

In this episode Sean sits down with Amanda Waesch of Brennan Manna and Diamond (BMD) to discuss Stark Law and the enfocement changes in 2021 and those coming in 2022...

In this episode Sean sits down with Jenna Godlewski, Special Counsel for Nexsen Pruet to discuss the Supplemental Medical Review Contracto (SMRC) and the disruption they are causing in the health space for providers, hospitals and health systems. Noridian is the SMRC for The Centers for Medicare and Medicaid Services and their reach is quite broad as you will come to learn during this segment.

In this segment Sean sits down with Amanda L. Waesch of Brennan Manna and Diamond (BMD) to discuss the November of 2020 Final Rule on Stark Law and Profit/Gain Sharing. This segment is a must for all provider groups, hospitals and health systems!

In this segment Sean discusses the DOJ Criminal Division's Evaluation of Corporate Compliance Programs. Sean breaks down various aspects of what most consider a prosecutors playbook. A discussion of conducting internal audits and developing corrective actions to ensure listeners are intune with what is required ensures risk mitigation.

In this session Sean discusses appeal strategies with a central focus on Medicare. Appeals are technical in nature but are a lost art and this podcast you'll understand how and when to appeal to the different levels. Specific terms are defined, forms are addressed, and processes for the 5-levels are broken down. A full explanation of the structural changes put forth in the 2017 final rule that wer...

Fraud, Waste and Abuse continue to plague the healthcare system and drive consumer prices and medical practice costs sky-high. In this episode Sean discusses the ins and outs of conducting a fraud investigation in addition to various laws, statutes, regulations and Acts as well as requirements for a corrective action plan.

In this session Sean discusses how to determine whether a self-disclosure protocol through the OIG is the right decision for your medical practice/organization. This is an in-depth look into a complex process to ensure you make the right decision.