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).

Heidi McKinnon, PharmD, CHC, a seasoned compliance expert, shares insights from her journey from retail pharmacy to head of compliance at Capital Rx, a leading pharmacy benefit manager.

In this episode, Heidi shares her unique path and extensive experience in the compliance world. We delve into the evolving landscape of digital pharmacy, discussing:

- The true meaning of digital pharmacy and how it differs from telepharmacy and online pharmacies.

- The regulatory challenges faced by digital pharmacies and strategies to stay ahead of ever-changing rules.

- The impact of digital pharmacies on patient care and medication access.

- The intricacies of reimbursement and licensing in the digital pharmacy space.

- Practical tips for compliance officers new to the digital pharmacy sector.

Heidi McKinnon, PharmD, CHC

Heidi McKinnon is a dedicated healthcare professional with a Doctor of Pharmacy (PharmD) degree and a Certified Healthcare Compliance (CHC) credential. With extensive experience in the pharmacy and healthcare industry, Heidi brings a wealth of knowledge and expertise to her role as Head of Compliance at Capital Rx.

About Capital Rx

Capital Rx is a full-service pharmacy benefit manager (PBM) and pharmacy benefit administrator (PBA) dedicated to advancing our nation's healthcare infrastructure to improve drug price visibility and patient outcomes through innovative solutions and cutting-edge technology.

To learn more about Capital Rx and their mission to create a better healthcare experience, visit Capital Rx's website.

Contact Information

For more information or to get in touch with Heidi McKinnon, you can reach out via LinkedIn.

In this episode, we welcome back Hal McCard, Counsel at Spencer Fane, to delve into the complexities of financial relationships with physicians, including essential insights on compliance with STARK and Anti-Kickback statutes.

CJ Wolf, MD, and Hal McCard discuss:

- Hal’s extensive career in healthcare law and his journey to becoming a leading expert in the field.

- Detailed explanations of STARK and Anti-Kickback statutes and their implications for healthcare organizations.

- Practical advice on maintaining compliance in physician contracting, from fair market value documentation to auditing processes.

- The importance of centralized arrangements tracking systems and how they can help mitigate compliance risks.

- Real-world examples and valuable insights from Hal’s experiences as in-house counsel and external advisor.

Check out the episode to gain valuable knowledge and practical tips to enhance your compliance programs and safeguard your organization against potential pitfalls.

Are you intrigued by the rapid evolution of telehealth and its impact across the globe? Then you won’t want to miss our latest podcast episode where Keisha Wilson and CJ Wolf discusses the nuances, challenges, and opportunities in international telehealth services!

In this episode, we discuss:

COVID-19’s Impact on Telehealth: Learn how the pandemic prompted a reevaluation of international telehealth practices and regulations.

Compliance and Legalities: Keisha dives into the intricate details of understanding and navigating international laws and compliance issues, ensuring seamless and legal telehealth services across borders.

Challenges and Solutions: From infrastructure limitations to insurance hurdles, Keisha shares real-world examples and innovative solutions to delivering healthcare to remote and underserved populations.

Global Collaborations: Get insights into how organizations like the International Society for Telemedicine and eHealth (ISfTeH) and the World Health Organization are shaping the future of telehealth.

Regulatory Requirements: Understand the various certifications, permits, and legal considerations necessary for practicing telehealth internationally.

Tune in to our latest episode and join us in exploring the dynamic world of international telehealth.