The Compliance Guy

The entire crew (Christine, Terry, Scott, Paul, and Stephanie) is back for an outstanding roundtable discussion that is wide-ranging and full of great content! 1. Orders for tests and how the EMR impacts how specific tests are displayed in a note and the impact given for credit for towards data and MDM. 2. Cyber Security Attacks on healthcare providers (CMS Warning) and how to be diligent in your...

Terry and Sean take on can I do this because the doctor down the street does it... and what happens when you don't stay in your lane!

We had a great line-up of topics on this episode: 1. Orders for tests and how the EMR impacts how specific tests are displayed in a note and the impact given for credit for towards data and MDM. 2. Cyber Security Attacks on healthcare providers (CMS Warning) and how to be diligent in your efforts! 3. The impact of private equity money and the latest claims of price gouging by the government agains...

Sean was joined by Dr. Carolyn Ward, Director of Clinical Strategy for Particle Health to discuss challenges with interoperability and other dynamic challenges facing healthcare professionals... About Dr. Ward: Carolyn Ward is a dynamic and driven internal medicine physician with a passion for physician empowerment and data-driven decision making. With over eight years of experience in healthcare,...

On this episode, Sean was joined by Dr. Brian Fengler of EvidenceCare to discuss the state of healthcare and what he as an Emergency Room Physician has see as opportunities to gain access to evidence based care information to assist in the treatment of patients at bedside faster and more accurately. About Dr. Fengler: (https://evidence.care/) Dr. Brian Fengler is the co-founder and Chief Medical O...

Terry and Sean take on the giant headache of split/shared and incident-to services. This one gets a bit heated for legitimate reasons. You're gonna love this one!

The entire team is back for this episode! There was a lot to discuss with so many issues coming to light in the areas of coding, billing, documentation, and compliance. Don't miss one minute of this one!

What is a compliance plan and how to build one that is effective and meets OIG and DOJ requirements!

This was an epic episode that you do not want to miss. Scott, Terry, Stephanie and Christine joined Sean to discuss the False Claims Act, Anti-Kickback Statute, Template issues, and so much more!

Terry and Sean take on Telehealth access. Clients are getting letters about not having Telehealth available for disabled patients, which is required under the Federal Disabilities Act. Physicians telling patients they don't have in-person options for care, ONLY Telehealth is not okay.

The panel was back at it with a great breakdown of the Medicare Physician Fee Schedule Rule Changes for 2024... as always it was a lively discussion about the proposed rule changes and their impact on providers. Topics Included: 1. Split/shared services – the definition of substantive portion will remain the same as it is now through 12/31/2024... Time will not be the controlling factor. HX, EX, a...

This is a systemic problem facing the industry and the MACs, OIG, DOJ and others who audit and investigate are hyper aggressive when it comes to recoveries! Learn the regulations and your obligations to refund money you are not entitled to!

The panel was back for a great discussion on today's most pressing issues facing healthcare professionals: 1. Providers changing records and documentation after notice of an audit... 2. Denials by CIGNA and other plans for unspecified diagnosis. What is a "valid" diagnoses, vs. "covered" diagnoses... 3. United Healthcare's continued woes...

Sean and Terry take on some spicy issues (literally and figuratively) in this episode. Not knowing the coding rules can land you in some hot water and lead to significant claw backs and/or overpayment demands. Don't miss this outstanding episode with one of the industries foremost coding and billing SMEs!

The all star panel was back for another outstanding episode. There was a lot of debate in this one and the fact is all of the positions laid out were solid and accurate. Providers need to be proactive in their compliance when it comes to accurate coding but when things aren't perfect it takes a team to create a solid defense. Do not miss this one as it was hands-down one of the best debates of...

The one and only Ronald Chapman II of the Chapman Law Group joins Sean to discuss their latest (5 in 12 months) of acquittals for Dr. Loey Kousa. Sean and Ron lay out what went right for the defense and why the prosecution's case failed. If you are a provider charged with a crime in healthcare or an attorney looking for strategies to ensure a level playing field and due process for your client...

Sean and Terry take on the world of Pre-ops and provide clarification of the different types of visits and what is required to satisfy billing of these services.

Sean and Terry are back and taking on Stark from a practical standpoint in this episode of The Compliance Guy.

The panel is back for this outstanding discussion on when it's appropriate to make changes to CPT Code Selection(s) and when it is not!

Just because you go paid doesn't mean you billed it right... just because you got paid doesn't mean you get to keep it... just because you got paid once doesn't mean you will be paid again! Terry and Sean tackle an issue that we know is prevalent in all medical groups.

The all star panel was back live to discuss the latest in healthcare billing, coding, compliance, and documentation issues and strategies. On the topic list for this episode was the impact of cyber-terrorism on healthcare facilities and the false sense of security physicians have by relying on their EMR Templates. Truly a great discussion!

This episode was mind boggling to yours truly! Just when you think you understand a Medicare process you realize you really need brilliant health care attorneys like Ashley Morgan and Robert Liles to help you make sense of things! Don't miss this one

Sean was joined by Hassan Abdallah of ATLAH to take on a wide-range of topics directly impacting healthcare compliance, audits, private equity, and so much more! About Hassan F. Abdallah Hassan F. Abdallah is a proven and recognized professional in the field of organizational compliance with extensive experience in designing and managing compliance based solution systems. Throughout his career he...

Terry is back in the hot seat to discuss facility vs pro-fee coding... lots to unpack in the episode!

The entire gang is back for this one... Terry, Christine, Stephanie, Scott and Paul teamed up with Sean to discuss: 1. AI and the impact on healthcare... 2. Q3014 Site of Service Fee Differential... 3. Patient Centered Care... 4. Statistically Valid Random Sample (SVRS) when and how can it be used...