Join us for an eye-opening conversation on Compliance Conversations, where CJ Wolf interviews Nick Sahar, founder of Semantic Health and pioneer in AI for medical coding. In this episode, you’ll learn:

- How AI enhances coding accuracy and speeds up workflows.

- Practical use cases for AI in coding, auditing, and clinical documentation.

- What the future holds for AI in healthcare compliance.

Don’t miss this must-listen discussion about how technology is shaping the future of healthcare compliance and coding.

In this episode of Compliance Conversations, CJ Wolf welcomes Dave Cardelle to discuss the payer perspective on payment integrity. From the complexities of DRG claims to the use of AI, this conversation sheds light on how automation and collaboration can transform the healthcare landscape.

What you’ll gain:

- A deep dive into DRG audits and common pitfalls.

- The role of technology in reducing abrasion between payers and providers.

- Real-world solutions to improve payment accuracy and efficiency.

In the latest episode of Compliance Conversations, CJ Wolf welcomes Jay Anstine back to explore the nuances of effective compliance communication.

What You’ll Learn:

- Strategies for delivering tough news to leadership

- How to avoid creating a culture of false urgency

- Practical tips for navigating compliance politics

- The importance of clear communication plans

Jay draws on years of healthcare compliance experience and shares lessons from his book, Navigating the Politics of Healthcare. Whether you’re dealing with audits, overpayments, or building trust, this episode provides actionable insights you can apply today. -

We’re excited to share a new episode of Compliance Conversations where CJ Wolf, MD talks with healthcare compliance expert Nancy Clark, the Senior Manager of Health Care Services at EisnerAmper! In this episode, Nancy brings decades of experience in coding and revenue management to address improper payments—a costly issue for healthcare providers.

Listen in as we dive deep into:

- The most common coding errors and how to avoid them

- How to leverage Medicare’s transparent data to stay compliant

- Steps you can take to safeguard your practice’s revenue and reputation

Whether you’re in compliance, billing, or coding, this episode is packed with actionable insights that could save you time, money, and stress.

We’re thrilled to announce a major milestone for Compliance Conversations – our 100th episode!

Over the years, we’ve had the privilege of hosting industry experts to hear their invaluable perspective on best practices, trends, and real-world scenarios in compliance and auditing. This special episode is a celebration of our journey and the incredible community that’s made it possible!

Join CJ Wolf, MD, Debi Behunin (Healthicity Vice President of Product), Brian Burton (Healthicity Chief Compliance and Privacy Officer), Remo Peshkepia (Healthicity Product Manager), and Sarah Crane (Marketing and Brand Manager) for insider insights on:

- The evolution of compliance and auditing.

- Key milestones for Healthicity, including Audit Manager and Compliance Manager developments.

- Insights from the Healthicity team on where compliance is headed.

Thank you for being part of this journey! Here's to many more episodes of helping you navigate the complex (and interesting!) world of compliance.

In this episode, CJ Wolf, MD, and E/M coding expert Sharisa Freeman discuss her journey and insights into mastering the complexities of E/M coding.

Here's a quick look at what you can expect from this episode:

- The Evolution of E/M Coding: Changes in guidelines that shifted the focus to Medical Decision Making.

- Medical Decision Making Tips: Understanding the three essential sub-elements: number of problems, data reviewed, and risk.

- Documentation Challenges: Common issues with lower-level visit documentation and how to address them.

- Networking and Continuous Learning: The value of staying updated on coding changes and connecting with peers.

- Advice for New Coders: Sharisa’s top tips for those just starting in the field.

Check out their conversation today – and thank you to Sharisa for sharing her time and insights on Compliance Conversations!

Ever wondered what it’s like to testify as an expert witness? We talk about that and more in this episode of Compliance Conversations!

We invited compliance expert Rebecca Busch to explore her incredible journey from trauma nurse to legal expert in healthcare fraud and compliance.

Join us as Rebecca shares:

- Her transition from nursing to healthcare fraud examination

- The key legal challenges in compliance she’s faced as an expert witness

- Practical advice on how to stay ahead of compliance trends

- Tips and insights on depositions

Tune in to this episode of "Compliance Conversations" where we dive deep into the world of innovation and biotech with our special guest, Steve VanNurden!

In this episode, CJ Wolf, MD, talks with Steve VanNurden, CEO of Fitzsimons Innovation Community and Associate Vice Chancellor of Biotechnology at the University of Colorado Anschutz Medical Campus. Listen in as they explore the unique integration of academic and entrepreneurial ecosystems, discuss the reinvention of tech transfer, and reveal the keys to building a thriving biotech community.

You'll hear:

The vision behind Fitzsimons Innovation Community and its role in advancing healthcare innovation.

- The unique benefits of integrating academic medical centers and biotech communities.

- Real-life examples of startups and research breakthroughs happening in Colorado – and why it’s a powerful hub for healthcare innovation.

- How the Community addresses regulatory and funding challenges to accelerate innovation.

- Whether you're in healthcare, compliance, biotech, or simply passionate about innovation, this episode offers valuable insights and inspiration.

In this episode, Maeve O'Neill, MEd, LPC-S, CHC, CDTLF, the National Compliance Director for Circa Behavioral Healthcare Solutions, joins us to share insights from her three decades of experience in mental health and addiction services as she provides valuable insights into the unique challenges and best practices for compliance in this field.

Tune in as we discuss:

- The complex web of regulations: The intricate layers of compliance in behavioral health, from state regulations to accreditation standards, and how organizations can effectively navigate them.

- Building effective compliance programs: The importance of simplifying compliance processes and aligning them with organizational goals to create robust and practical programs.

- The role of compliance in patient care: The critical connection between compliance and quality care, highlighting how a strong compliance program can support staff well-being and ultimately benefit patient outcomes.

We appreciate Maeve’s time and expertise in talking about this vital topic!

Medicare audits can be a daunting challenge for any healthcare provider. With a maze of regulations, different types of audits, and a complex appeal process, it’s easy to feel overwhelmed.

That’s why we invited Alicia Shickle, AHFI, CHC, CPC, CPCO, CPMA, CRC, the President and CEO of ProCode Compliance Solutions LLC, to share the knowledge and strategies you need to navigate this tricky terrain.

Tune in to the episode as we discuss:

- The top issues that trigger Medicare audits

- How to prepare your practice and avoid common pitfalls

- The five levels of Medicare appeals and how to effectively manage them

- Why proactive compliance programs are crucial for your practice

Thank you, Alicia, for sharing your time and expertise with us!

About Alicia Shickle

Alicia has decades of clinical and administrative healthcare experience. Her areas of expertise include revenue cycle integrity, documentation, coding and billing compliance, Medicare, MSP, and Medicaid regulations, practice workflow and operations, compliance program assessments, development, and implementation.

Alicia provides advisory services to attorneys, healthcare administrators, providers, and organizations. She frequently works with business litigation and health law practices on fraud and abuse intervention and providing independent and objective assessments for both plaintiff’s and defense teams.

She works closely with clients on both routine and complex documentation and coding reviews. She provides in-depth coding and claims data analysis, education, and assists providers with navigating complex regulatory and policy requirements, identifying and mitigating potential FCA risks while optimizing revenue. She has extensive experience developing and implementing effective compliance programs including all seven elements.

Alicia served as the Director of Compliance for the American Academy of Professional Coders (AAPC). She has worked with some of the top consulting and health law practices and, was a Family Practice Administrator for over a decade.

Alicia has presented educational training boot camps and seminars nationally on compliance, documentation and coding, and practice management. She was a medical billing and coding instructor at a community college. She is a frequent author for online physician blogs, and journals. Alicia is an Accredited Health Care Fraud Investigator (AHFI) with the National Health Care Anti-Fraud Association (NHCAA), and is certified in Healthcare Compliance (CHC, CPCO) through the Health Care Compliance Association (HCCA), and AAPC. She is a Certified Professional Coder (CPC), Certified Professional Medical Auditor (CPMA), and certified in Risk Adjustment Coding (CRC). She is also a Certified Physician Practice Manager (CPPM).

Alicia is an active member of the American Academy of Professional Coders (AAPC) and served as the President of AAPC’s Manhattan Local Chapter for two years. She is a member of the Health Care Compliance Association (HCCA), and the National Health Care Anti-Fraud Association (NHCAA), and American Health Lawyers Association (AHLA). She is a member of American Health Information Management Association (AHIMA), the National Alliance of Medical Auditing Specialists (NAMAS), and a member of Medical Group Management Association (MGMA).