The Compliance Guy

Sean takes on the question "should we fear the “Bots” or should we openly embrace them"? You be the judge. What risk(s) do we face during an audit if it’s determined the documentation is cloned. What potential med-mal issues could be hiding around the corner?

Sean was joined by Ashley Morgan and Robert Liles of Liles/Parker to discuss Medicare Part C Appeals and how different the process is from traditional Medicare Part A and B Appeals... Once again, this was such an incredible episode with two of the best attorneys in the administrative process! About Ashley Morgan: Ashley Morgan is a Partner at Liles Parker. She focuses her practice on regulatory he...

Sean was joined by Elliot Golding of McDermott Will & Emery to discuss all things HIPAA Privacy and Security, Information Blocking, and a few more critical aspects of cybersecurity! This episode is a must for all medical practices, hospitals and health systems to ensure your compliance with the ever-changing landscape! Elliot is Sean's go-to when it comes to Data Privacy and Cybersecurity!...

Terry and Sean take on the question of why... why are auditors, billers, coders, and providers still doing things that expired with the end of the PHE!

Jerrod Bailey is the CEO of Medplace , Joined me to discuss technology in healthcare, advancements in #artificialintelligence and how he and his company are filling a vital gap in the #litigation , #peerreview and #clinicalreview spaces. Bio: Jerrod is the CEO of Medplace, an app built for healthcare, legal, and insurance industries to streamline their case and peer review processes. He holds over...

Terry and Sean take on the new "Graduate Physician Program" and what this means... This is a very interesting topic that we got to explore. The discussion then shifts to DME Audit Targets... Charity of the Month: The Tafida Raqeeb Foundation https://tr-foundation.org/ Around 6000 children are diagnosed with serious brain injury in the UK every year which result in devastating effects on...

In this episode Sean takes on the routine waiver of copayments and/or deductibles and why it's a really bad idea... There are many Administrative, Civil, and/or Criminal issues/penalties one faces for violating the False Claims Act, Health Care Fraud Statute, and/or the Anti-Kickback Statute(s) (Federal and State)... Charity of the Month: The Tafida Raqeeb Foundation https://tr-foundation.org/...

Terry and Sean are back at it in this episode... the focus was on payor contracting vs. credentialing. Lots to unpack in this episode that you are not going to want to miss! Charity of the Month: The Tafida Raqeeb Foundation https://tr-foundation.org/ Around 6000 children are diagnosed with serious brain injury in the UK every year which result in devastating effects on the child and their family....

Hands-down, one of the best Monday Roundtables to-date! The full panel was back for a lively discussion on the following: 1. Mayo Clinic 2. AdQuic Process 3. The end of the PHE and Telehealth Services 4. Cigna and their Modifier 25 Policy, and so much more! Charity of the Month: The Tafida Raqeeb Foundation https://tr-foundation.org/ Around 6000 children are diagnosed with serious brain injury in...

Sean is joined by attorney's Amanda Waesch and Joshua La Bouef of Brennan Manna and Diamond breakdown the latest legislation signed into law by Governor Ron DeSantis on Personal Injury and Auto Accident and what many are calling a pure disgrace! Listen and you determine... Charity of the Month - The Tafida Raqeeb Foundation was formally launched on 22 March 2022 in London, United Kingdom. The...

This episode is hands-down one of Sean's favorites to date... This episode exposes the Medicare Administrative Appeals Process for what it really is... Smoke and mirrors! The fact is, even if you prevail at the ALJ level there is a significant chance you can still lose the case based on an AdQIC referring the case to the Departmental Appeals Board (DAB)! Sean is definitely in a rare and irrita...

For the first time in 25-years the Office of Inspector General is updating the Compliance Program Guidance (CPG) for the entire healthcare industry! No more are the days of searching and reading the Federal Register... What will be the new delivery method? Tune in to find out! Jenna K. Godlewski - Jenna focuses solely on health care law and assists medical practices across the country on reimburse...

In this final episode of Season 5, Terry and Sean sit down to discuss concierge medicine and health coaches... when, where and how these services come into play and the pitfalls with providing them.

The entire  #allstar  panel ( Terry A Fletcher BS CPC CEMC CCC CCS CCSP CMC ACS-CA SCP-CA, QMPM   Christine Hall CHC CPC , CPB, CPMA, CRC, CEMC, CPC-I   Stephanie Allard, CPC, CEMA, RHIT   Scott Kraft  and  John Paul Spencer ) are back and armed with a ton of new information to discuss and offer solutions for! #coding  and  #compliance  are the focus and the topics will include: 1. A breakdown of ...

Terry joined Sean to discuss all the intricacies and pitfalls of the three-midnight- rule... Didn't know there was one, well there is. The dynamic duo also took on the two-midnight-rule just to cover all of the bases!

Sean was joined by  Colin Callahan  of  Flannery Georgalis, LLC  and  Jeana Singleton  of  Brennan Manna Diamond  to discuss issues impacting  #healthcareprofessionals  in the  #coding ,  #auditing ,  #compliance ,  #documentation , and  #leagal  areas of healthcare! Todays Topics Include: The intersection of prevention and prosecution/enforcement How preventative measures help defense Recent DOJ...

Terry and Sean take on the coding and compliance surrounding Urgent Care Centers and Retail Clinics and all of the "gotchas"... There are a lot of hidden gems in this one.

The all star panel of Terry Fletcher, Stephanie Allard, Scott Kraft and Paul Spencer are back to take on Auditor vs. Coder! Sounds contentious but the fact is, this was a dynamic discussion with a ton of thoughtful dialogue!

Robert Liles and Ashley Morgan join Sean to discuss the power of UPICs and their reach and affirmative actions! This was a brilliant discussion. Don't miss this one!

Terry and Sean are at it again with another hard-hitting topic impacting health care operations... identifying a problem but not wanting to issue a refund! This one gets interesting.

Sean was joined by Terry, Scott, Stephanie, Paul as they took on the biggest issues in healthcare! Topics Included: 1.  RPM  and  RTM  services, the difference between them and the difference between RPM and  CCM  and why these services are such a high priority target for  CMS ,  OIG  and  commercial insurance  (hint: telehealth! 2. HIPAA - enforcement is on the rise and things you do every day wi...

Terry and Sean sat down to discuss the impact of prescription drug management and the impact on the overall level of EM Service. Take a listen, you might be surprised by this discussion!

Sean was joined by John Paul Spencer Terry A Fletcher BS CPC CEMC CCC CCS CCSP CMC ACS-CA SCP-CA, QMPM Stephanie Allard, CPC, CEMA, RHIT and Scott Kraft to discuss all of the big events impacting #healthcareoperations! So much to discuss including: 1. ChatGPT and its impact on #physician documentation 2. Sub-regulatory guidance and the False Claims Act 3. E/M Visits when the patient is not part of...

Assistant Attorney General and the head of the Criminal Division at the Department of Justice, Kenneth Polite sits down for a candid discussion with Sean to explore a variety of topics including: Why compliance programs are so important to DOJ... The benefit of Compliance Certifications Proffers where corporate attorneys are driving the responses vs the compliance officer of the organization... Re...

Terry and Sean discuss the critical importance of completing medical records and closing them within the time requirements established by state and federal requirements. What are the potential penalties for non-compliance and how do you argue technical violations...