The Compliance Guy

Terry joins Sean to discuss Chronic Care Management (CCM) Services, what they are, how they are billed, and what documentation is required to support them. But, what happens when you get it all wrong or don't have documentation to support the billing and reimbursement of these services? 

Jordan Johnson sits down with Sean to discuss the ins and outs of the FTC Proposed Rule on Non-Competes for Employees. This is a full breakdown of the proposed rule. The conversation then shifts to physician shortages by specialty and what should and can be done about it.

Below are the 2 links from the show: 

Percentage Change in the Number of Active Physicians by Specialty, 2016-2021 | AAMC 

Non-Compete Clause Rulemaking | Federal Trade Commission (ftc.gov)

Terry joins Sean to discuss training and education, or lack thereof at the payers and why they are not being held accountable! If you don't like humor skip the first 12 minutes but if you enjoy humor and fun stories listen to the who episode! 

Monday's Roundtable on the compliance guy podcast will be a lively discussion about #payeraudits and what to do when the "letter" arrives!

Christine Hall CHC CPC , CPB, CPMA, CRC, CEMC, CPC-I John Paul Spencer Stephanie Allard, CPC, CEMA, RHIT Terry A Fletcher BS CPC CEMC CCC CCS CCSP CMC ACS-CA SCP-CA, QMPM and Scott Kraft will provide insight into why:

1. Having great #yelpreviews won't protect you against being audited...

2. Steps to take when #adr letter, audit #letters are received...

3. Missing #deadlines and why that leads to #recoupments...

4. Why size doesn't matter...

There is so much to unpack in this one!!! Don't miss this #allstar panel at 12pm EDT / Monday, January 16, 2023!

In this episode Jordan Johnson sits down with Sean to discuss operational concerns in physician practices driving them to abandon their practice and join large groups, hospital networks, and integrated delivery health systems. The discussion the transitions to the impact of nurse strikes and what it will take to get them aligned with their employers. This episode is a bit charged but hey, someone has to stand-up for America's Elite! 

Terry joins Sean for a discussion on what it means to stay in your lane and not create liability situation for your clients or yourself. This episode gets a bit salty so buckle up and enjoy the ride! 

This was one of the best episodes of our Monday Roundtable! Sean was joined by Stephanie Allard, Terry Fletcher, Scott Kraft, and Paul Spencer. Topics included: 

1. Dealing with Commercial Payor Demand for Refund of Overpayments, when they say they did a statistically valid random sampling that led to an extrapolated overpayment. 

2. The No Surprises Act and the change to how the process works based on CMS sneaking in a change prior to Christmas after making promises they would not change. 

3. How to deal with "clinical plagiarism" in 2023 with the changes to EM Guidelines. 

4. The impact of terms like Fraud, Waste, Abuse when speaking to providers. 

You Do Not Want To Miss This One! 

Salvador Hernandez, Senior Compliance and Ethics Advisor at Husch Blackwell joins Sean to discuss the state of compliance... Topics of discussion include: 

As a former senior executive with the Federal Bureau of Investigation (FBI)

Sal began his career inside government with 25 years at the FBI, where he rose through the ranks, via numerous assignments, from Special Agent to executive-level positions at FBI Headquarters in Washington, DC, the U.S. Embassy in Mexico City, and the FBI’s Los Angeles Field Office. At FBI Headquarters, as Deputy Assistant Director in the Criminal Investigative Division, he had oversight responsibility for the FBI’s Financial Crimes and Public Corruption Programs. In Los Angeles, he held the title of Assistant Director and served as the office’s chief executive, with responsibility for the work of more than 1,300 FBI employees charged with carrying out the FBI’s criminal, counterterrorism and national foreign-intelligence responsibilities in Southern California. Sal followed his FBI career with a career in the private sector where, first as Security Director, and then as Vice President of Compliance and Ethics, he expanded the security and investigations programs and established and led the legal and regulatory compliance efforts at Enterprise Holdings, Inc., the world’s largest vehicle rental, leasing and sales company.

Sal is uniquely suited to collaborate closely with attorney teams and clients to strategize at all stages of investigative and compliance-program work. He has experience building compliance structures for clients and is equally adept at program review, risk assessment, crisis response and mitigation.

phone: 314.345.6193

email: [email protected]

 Ronald Chapman II, Esq. LLM of Chapman Law Group | Health Care Attorneys sits down with Sean to discuss his full trial acquittal in United States vs. Lesley Pompy, MD.

You do not want to miss this one because what happened to Dr. Pompy can happen to you!

This is the very first episode of the newest segment on The Compliance Guy... It is not J2, it's J-Squared with Jordan Johnson, Healthcare Data Analytics Expert! Such a great first episode and the topics will not disappoint: 

Omnibus bill includes relief from Medicare cuts, extensions of rural and telehealth programs

1.7 trillion dollar package and what it means for healthcare

· Telehealth provisions

· Medicaid coverage

· No mention of prior auth

Prior auth bill

· Go live January 2026

· API utilization

Access to care and what will need to be tackled

· Fewer physicians in specialties

· Fellows and residency going to urban areas

Hospital closures

631 rural hospitals at risk of closure by state (beckershospitalreview.com)

More rural hospitals will close in 2023 - Poynter

Rural hospital closures affect operations of surrounding hospitals (medicalxpress.com)