The Compliance Guy

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!

The team was back and took on when it does and does not make sense to employ remote workers as well as the do's and don'ts. The team also took on AI and the inherent risks associated with EHRs deploying this technology into their systems.

Before you say, "not again" keep in mind these are the problem child of providers and the government. The provisional services continue to create problems and until the ambiguous aspects of these services are more clearly defined we will have to continue threading the needle to keep you compliant.

The entire cast is back this week taking on the most complex and challenging issues tied to medical auditing, coding, and compliance...

In this episode Sean takes on effective leadership and what it takes to lead a team. While Sean is known as "The Compliance Guy" he started his professional career in practice management back in the mid-90s amid all the consolidation and acquisitions by the health systems "Physician Services" Groups. Take a listen... you just may be surprised at what a regulatory compliance professional knows abou...

The one and only Clint Pulver returns to The Compliance Guy to provide an update on his upcoming 2024 speaking tour, his new documentary (Finding Hill on YouTube), The Master Class Program, and so many more unbelievable amazing things Clint and his team are undertaking! Clint Pulver is a professional keynote speaker, author, musician, pilot, and workforce expert. Known as the leading authority on...

In the first Legal with Liles/Parker episode of 2024, Robert and Ashley sit down with Sean to discuss Compliance Risks in 2024! The list is long and distinguished...

Terry and Sean take on Cloning, Cut and Paste and Clinical Plagiarism... It is not as clear cut as you would think it is! Don't miss this one because the end-results could cost you dearly!

The All Star Panel was back taking on the latest in auditing, coding and compliance challenges for healthcare professionals.

Katie Deming, MD sits down with Sean to discuss engaging with those diagnosed with cancer. Dr. Deming, host of the Born to Heal Podcast and a #tedxspeaker , provides insightful and invaluable advice on communication. Don't miss this opportunity to change your outlook on how we engage with those diagnosed with cancer...

There is no doubt the machines are taking over! Terry and Sean explore how AI both helps and hurts providers of medical services and what they need to do to ensure they don't find themselves in a trap!

The All Star Panel is back for the first roundtable discussion of 2024 and what a great discussion it was. Topics Include: 1. G2211 - The New Add-on for Evaluation and Management Codes... The Dos and Don'ts 2. Medical Students - What they can and cannot provide as a services and the PATH Guidelines... 3. Laboratory Compliance - The world of lab services has been absolutely turned on its head o...

David sits down with Sean to discuss avoiding 2024 pitfalls with provider enrollment, credentialing, and contracting in addition to so much more. David is one of the most celebrated healthcare professionals and for good reason. Don't miss this one! Zetter Consulting Website: https://zetter.com/ NSCHBC Website: https://nschbc.org/

In this final episode of season 6 and the overall final episode of 2023 Terry joins sean to take on the critical nature of having a non-retaliation policy for your organization! You can't have a compliance program without one of these!

In this final roundtable discussion of 2023 the all star cast was back to address: 1. CPT Coding Changes for 2024 2. Impact of a transmittal change by CMS for chemo and Rheumatology Infusion Drugs 3. The impact of medical necessity 4. Documentation standards 5. The impact bad behavior has on a case at trial

CMS is at it once again with a new HCPCSII Code that will only lead to confusion and potential long-term audits and claw backs! Take a listen as Sean and Terry break down this one...

Terry, Scott, Paul, and Christine joined Sean for a great discussion... Topics include: 1. Holding on to overpayments when a refund, corrected claim, and/or self-disclosure should be made; 2. How to teach audit results... painting the wrong picture; 3. Wound care; 4. Critical mistakes providers make that lead to charges of healthcare fraud and/or false claims act violations... There is so much to...