The Compliance Guy

This episode Terry and Sean take on adding services to your revenue mix and the costs for doing so if "Medical Necessity" is not met. There is a ton to unpack in the episode. Sean also blogged about this topic on LinkedIn Monday, July 1, 2024... take a look at that blog!

Terry and Sean are back at it once again taking on the big issues impacting healthcare providers! It's all about risk mitigation and creating a culture of compliance!

The Monday Roundtable is back with all new segments and compliance centered topics. Join Sean, Terry, Christine, Scott, Paul and Stephanie as they tackle the biggest issues in healthcare.

Don't let the title fool you... this is not just another incident-to podcast. This episode focuses on the employee/employment requirement(s) and how organizations continue to make significant mistakes.

Terry, Christine, Stephanie, Paul, and Scott were all back for this new episode of the Monday Roundtable. It was quite the discussion on various payor guidelines regarding G2211, The Anatomy of CPT Codes, Split/Shared Services, EMR as a Tool, and so much more...

Brian Lobley brings over 20 years of experience leading healthcare businesses, operations, and strategy. Prior to joining tango, he served as the executive vice president, chief operating officer, and president of Health Markets at Independence Health Group, the parent company of Independence Blue Cross, LLC. He was responsible for leading Commercial, Consumer, and Medicare lines of business and t...

In this episode Sean and Terry take on Addendums, Corrections, and Late Entries, and when you can make them, when you shouldn't, and when clinical summaries are a better options.

Sean and Terry are back with an all new #TerryTuesday episode that you are not going to want to miss!

 The full panel! Scott Kraft , John Paul Spencer , Terry Fletcher CPC CEMC CCC CCS CCS-P CMC ACS-CA SCP-CA PACS QMPM , Stephanie Allard, CPC, CEMA, RHIT and Christine Hall CHC was back with all new topics! 1. Weight loss drugs and all the confusion on medical necessity 2. Physician disclaimers and the misnomers 3. Developing the next generation of coders, and the difficulties practices are having...

Bryan Meek of Brennan, Manna, and Diamond joins Sean to discuss last weeks final rule issued by the Federal Trade Commission and what it means at this point, where things are headed and how to navigate through all the noise. Don't miss this episode!

Sean and Terry are at it again, taking on the most perplexing and head-scratching auditing, coding and compliance topics and bringing a sense of sanity to insane situations!

Most of the all star team was back for this one and it was an outstanding discussion of the G2211, Medical Necessity vs. Correct Coding, SNF Visits and Medical Necessity, and so much more!

Sean and Terry are back at it with another great episode focusing on the most challenging issues facing healthcare providers and their organizations.

The all star panel is back together again with an all new episode. 1. Clean Claims 2. Misapplication of Diagnosis Codes 3. Change Healthcare Debacle

Terry and Sean take on Medicare's IPPE and AWV and all the misinformation and dos and don'ts! Hear directly from a Medicare Auditor on her thoughts and opinions on direct supervision / incident-to regarding these services.

The Panel takes on the most pressing issues facing healthcare providers today! 1. Medicare Physician Fee Schedule Update 2. G0136 - SD0H HCPCSII Code Dos and Don'ts 3. TPE Targeting Level II and IV EM Services

It was such a treat to have Christine Hall of Stirling Global Solutions (https://www.stirlingglobalsolutions.com/) join The Compliance Guy Podcast to discuss compliance and coding issues surrounding Chronic Care Management (CCM), Providers Failing to Issue Voluntary Refunds, and so much more!

In this episode Terry and Sean take on the updated Compliance Program Guidance from the OIG and more specifically the section dealing with quality and substandard care leading to prosecution. Don't miss this one!

Join Sean, Stephanie, Scott, Christine, and Terry as they take on: 1. Collaboration Agreements 2. CERT Studies and error rate

Terry and Sean take on providers who render services but choose to bill for a higher level of service than what was actually performed or what they are able to support with their documentation. Oh, but there is more... so much more!

The panel is back for a much-needed discussion on two critical topics that are generating a ton of issues for providers. We'll be addressing G2211, a code that requires specific requirements and documentation components to support it, and Incident-to, a provisional billing service that continues to wreak havoc on providers. Unfortunately, self-proclaimed "experts" in the area are lea...

Dan Cohen of PainScript joined Sean to discuss their innovative solution for managing opioid prescriptions. As the focus on prescriber compliance intensifies, Dan and his team have developed a HIPAA-compliant app that connects physicians with their chronic pain and SUD patients daily. Through real-time data and daily digital care, patients are more engaged in their health, improving treatment plan...

Terry joined Sean to discuss some of the more obscure aspects of HIPAA and what practices should be doing to cover their assets!

What do you do when a State Medicaid program and their contractor fail to comply with their own published guidance... you call The Compliance Guy! Listen to this episode and hear an unbelievable story of incompetence and what happens when folks dig their heels in to deep and lose in the end. Paul Spencer Joins Sean to discuss all the details of this case.

Sean and Terry take on the risks associated with not following audit results whether internal or external results. Don't miss this one!