Welcome to NACDL's podcast series, "The Criminal Docket," hosted by Ivan J. Dominguez, NACDL's senior director of public affairs & communications. NACDL is the National Association of Criminal Defense Lawyers and is well-known to many as "Liberty's Last Champion." Each episode of "The Criminal Docket" explores important items on the criminal justice agenda, in-depth, with top leaders in the legal practice, public policy, journalism, academia, and others whose lives intersect with the crimina ...
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Sean is the host of “The Compliance Guy” a live production dedicated to the intersection of regulatory compliance and the business of medicine. The show provides timely, accurate, and easy to digest information to healthcare professionals. The show features interviews of industry leaders, government officials, and others helping to shape the healthcare landscape. Sean M. Weiss (AKA – The Compliance Guy) has been an industry respected name for more than 25-years. A physician and health system ...
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National Advocacy Calls on Developing Legislation
National Association of Criminal Defense Lawyers
NACDL’s State Criminal Justice Network (SCJN), has initiated a conference call series entitled National Advocacy Calls on Developing Legislation (NACDL). The teleconferences generally feature an expert on an issue area and are designed to inform criminal defense lawyers and advocates across the country on a variety of criminal justice issues. Key to the calls is informing participants of any legislation or litigation pending that seeks progressive reform on the issue, and serves as a call to ...
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Summary In this episode, Sean and Terry discuss the intersection of sports and healthcare, particularly focusing on the implications of sports injuries on mental health. They delve into the nuances of preventative medicine visits, the complexities of evaluation and management services, and the importance of medical necessity in billing practices. T…
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Season 8 - Episode 6 - Monday Auditing, Coding and Compliance Roundtable -
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Summary In this conversation, Sean and his guests discuss various pressing issues in healthcare, focusing on the implications of HIPAA violations, the challenges of patient privacy, and the recent controversies surrounding the Epic EMR system. They delve into the complexities of unauthorized access to patient information, the role of AI in healthca…
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Season 8 - Episode 5 - Nicole Thorne - Understanding the Surge in Healthcare Audits and the Role of AI in Shaping Healthcare Compliance
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Summary In this conversation, Sean and Nicole Thorn discuss the increasing challenges healthcare providers face regarding compliance, particularly in light of rising audit risks and overpayment demands. They explore the complexities of healthcare law, the role of attorneys in navigating disputes, and the importance of proactive compliance strategie…
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Summary In this episode, Sean and Terry discuss the current state of the healthcare industry, focusing on the business of medicine, the impact of external factors on healthcare operations, and the alarming rise in healthcare bankruptcies. They delve into the role of private equity in healthcare, the importance of compliance, and the need for health…
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Summary In this episode, Sean and David discuss the importance of compliance education in healthcare, highlighting the diverse educational sources available, particularly through the Practice Management Institute (PMI). They explore the various certifications offered by PMI, the significance of personalized education, and the impact of recent chang…
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Summary In this episode, Sean and Terry Fletcher discuss the complexities of prior authorization in healthcare, emphasizing its critical role in the reimbursement process. They explore the misconceptions surrounding prior authorization, the disconnect between healthcare providers and payers, and the challenges posed by Medicare Advantage plans. The…
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Summary In this episode, the panel discusses the critical importance of honesty in healthcare compliance, the challenges posed by audits, and the responsibilities of providers in navigating vendor relationships. They explore the implications of using AI in clinical documentation, the escalation of compliance issues to law enforcement, and the risks…
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Summary In this conversation, Sean and Terry discuss the critical importance of conducting audits in healthcare practices, emphasizing the need for both internal and external reviews to ensure compliance and accuracy in coding and billing. They highlight real-world examples of practices that have suffered due to a lack of audits and the biases that…
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Summary In this episode, Sean and Terry discuss various topics related to healthcare compliance. They start by sharing their recent experiences, including Sean's trip to Alaska. Then, they dive into the theme of the episode, which is when things are as clear as mud in the healthcare community. They discuss the challenges of finding clear guidelines…
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Season 7 - Episode 48 - Monday Auditing, Coding and Compliance Roundtable
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Summary The conversation revolves around the topic of padding medical bills and the importance of clear communication with patients regarding their financial responsibilities. The speakers discuss instances where unnecessary charges are added to the bill, such as billing for lifestyle medicine codes during a visit for a finger fracture or adding ch…
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Season 7 - Episode 47 - #TerryTuesday - Navigating the Challenges of Telehealth Services and Billing
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In this episode, Sean and Terry discuss the recent incident where Sean accidentally went live with colorful language during a recording. They also dive into the proposed changes to the telehealth services and fee structure for 2025. Terry explains the challenges and limitations of telehealth services, especially when it comes to billing and coding.…
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This is a controversial topic depending on which side of the yellow line you stand on... The question is does all work with a consultant require attorney client privilege... This is a great discussion for those of you looking to engage in coding and billing audits.
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This was a great live show! Sean was joined by Terry, Christine, and Paul to discuss Medical Decision-Making for levels of EM service when Rx Management is involved. There was a lot to unpack in this episode so don't miss this one!
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Terry and Sean take on the importance of words in the medical record. There is no slowing of the audit trend so providers better buckle up!
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In this episode Terry and Sean take on what it means to flat-line with your coding and how to avoid unnecessary scrutiny!
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This one is a head-scratcher for The Compliance Guy for so many reasons... Not going to give it away but this is a really good episode you are gonna want to catch!
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We had a great program on Monday with Terry Fletcher CPC CEMC CCC CCS CCS-P CMC ACS-CA SCP-CA PACS QMPM Christine Hall Stephanie Allard, CPC, CEMA, RHIT Scott Kraft and John Paul Spencer and their take on some hard-hitting issues: 1. Practices wanting to use RNs or MAs to do post of visits after 90-global surgery 2. Medical necessity for E/M servic…
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Terry Fletcher CPC CEMC CCC CCS CCS-P CMC ACS-CA SCP-CA PACS QMPM and #TheComplianceGuy, addressed critical issues in the latest #TerryTuesday episode. In this episode, we delved into current events affecting our country, marking a significant departure from our usual content. Listeners can fast forward to the 15-minute mark for an insightful discu…
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Sean sat down with Dana McMahon, Chief Compliance Officer for Stryker to discuss all the great things she and her team are doing to ensure a culture of compliance and to lead Stryker into the future. Beyond that Dana is the Global President for Stryker Women's Network (see bio below)! This is one great discussion you do not want to miss! Bio Dana s…
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Terry and Sean sat down to discuss credentialing vs contracting. What are the main differences, how do you handle various aspects of each and the pitfalls to avoid.
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Season 7 - Episode 37 - Monday Auditing, Coding and Compliance Roundtable
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The full panel was back this week taking on an array of topics impacting healthcare organizations across the country! Join Stephanie, Paul, Scott, Christine and Terry as they discuss and debate HCC Coding Issues, No Charging Physicians and others who refer to the practice and so much more...
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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!
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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!
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Season 7 - Episode 34 - Monday Auditing, Coding and Compliance Roundtable
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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.
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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.
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Season 7 - Episode 32 - Monday Auditing, Coding and Compliance Roundtable
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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...
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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 Commerci…
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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.
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Sean and Terry are back with an all new #TerryTuesday episode that you are not going to want to miss!
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Season 7 - Episode 28 - Monday Auditing, Coding, and Compliance Roundtable
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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 code…
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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!
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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!
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Season 7 - Episode 25 - Monday Auditing, Coding and Compliance Roundtable
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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!
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Sean and Terry are back at it with another great episode focusing on the most challenging issues facing healthcare providers and their organizations.
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Season 7 - Episode 23 - Monday Auditing, Coding and Compliance Roundtable
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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
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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.
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Season 7 - Episode 21 - Monday Auditing, Coding and Compliance Roundtable
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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
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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!
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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!
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Season 7 - Episode 18 - Monday Auditing, Coding and Compliance Roundtable
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Join Sean, Stephanie, Scott, Christine, and Terry as they take on: 1. Collaboration Agreements 2. CERT Studies and error rate
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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!
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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-proc…
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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…
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Terry joined Sean to discuss some of the more obscure aspects of HIPAA and what practices should be doing to cover their assets!
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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 thi…
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Sean and Terry take on the risks associated with not following audit results whether internal or external results. Don't miss this one!
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Season 7 - Episode 11 - Monday Coding and Compliance Roundtable
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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.
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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.
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Season 7 - Episode - 9 - Monday Auditing, Coding and Compliance Roundtable
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1:00:32
The entire cast is back this week taking on the most complex and challenging issues tied to medical auditing, coding, and compliance...
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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 wh…
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