Compliance Conversations by Healthicity

From artificial intelligence in audit workflows to CMS's renewed focus on fraud, waste, and abuse, this episode of Compliance Conversations covers the biggest themes that emerged from HEALTHCON and HCCA's Compliance Institute. Tune in to hear real takeaways from the exhibit hall, speaker sessions, and side conversations—including why quality of care oversight is gaining new attention. CJ Wolf, MD, and Brian Burton, Healthicity Chief Compliance & Privacy Officer, discuss: - Why AI was everywhere—and what it means for your compliance program - The latest OIG and DOJ guidance on effectiveness and enforcement - How CMS is signaling a “war on fraud, waste, and abuse” - What quality of care oversight looks like in the real world

Audits are an inevitable part of healthcare. But they don't have to throw your practice into chaos. In this episode, CJ Wolf talks with regulatory and transactional healthcare attorney Christina Kuta, a Shareholder at Roetzel & Andress, about the essential steps providers should take when facing a third-party audit. You'll learn: - The first three things to do when you receive an audit notice - How government and commercial audits differ - Why self-auditing matters—and how to do it right - Tips for reducing risk, managing appeals, and avoiding common pitfalls - Whether you're a compliance officer, auditor, or provider, this episode is packed with practical advice and real-world insights. You can reach Christina at CKuta@ralaw.com.

Independent Review Organizations (IROs) play a crucial role in healthcare compliance, particularly when organizations are under a Corporate Integrity Agreement (CIA). In this episode of Compliance Conversations, CJ Wolf interviews Stephani Scott, VP of Audit Services at AAPC, on what it really means to be an IRO. You'll discover: - What IROs do and why independence matters - The key components of CIA audit timelines and expectations - How RAT-STATS ensures unbiased sampling

In this episode of Compliance Conversations, host CJ Wolf chats with Elizabeth Herbert, an Epic Application Analyst with over 25 years of healthcare experience. Together, they break down the myths around EHR templates, offer practical tips for providers and compliance professionals, and explore underused tools that can streamline your day-to-day work. From proper template design to avoiding compliance risks and improving provider training, this conversation is a must-listen for anyone working in healthcare documentation, coding, or compliance. - Practical examples from real audits - Time-saving tools you might be missing - Compliance pitfalls—and how to avoid them - Smart ways to personalize your EHR workflow

In this episode of Compliance Conversations, CJ Wolf and Dan Fox explore the intersection of AI and healthcare compliance. From proactive patient outreach to regulatory risks, they break down how organizations can leverage AI while staying compliant. What You'll Learn: - How AI-driven communication is enhancing patient engagement - The biggest compliance challenges organizations face - Practical examples of AI implementation in healthcare Don't miss this deep dive into AI, compliance, and the future of patient outreach.

In this episode of Compliance Conversations, host CJ Wolfsits down with returning guest Sean McKenna, a Partner at Nelson Mullins and former Federal Prosecutor, to explore the critical issues at the intersection of healthcare law and compliance. From the challenges posed by the False Claims Act to the innovative use of data analytics in enforcement, Sean offers firsthand insights drawn from years of legal practice. Whether you're managing a compliance program or navigating regulatory challenges, this episode delivers actionable strategies and expert predictions for the future. What You'll Learn: - How evolving legal standards impact healthcare providers - The role of whistleblower initiatives in driving compliance - Data analytics as a game-changer in regulatory enforcement - Strategies to build and maintain effective compliance programs - Predictions for upcoming changes in healthcare law and regulation

Telehealth is revolutionizing healthcare, but with new opportunities come new risks. In this latest episode of Compliance Conversations, host CJ Wolf welcomes healthcare attorney Susan Walberg to discuss: - Common telehealth fraud schemes—and how to spot them - Compliance pitfalls that could cost your organization - The latest regulatory updates from the FTC, FDA, and HHS - The role of AI in healthcare risk management - Stay ahead of compliance risks and protect your practice.

Join CJ Wolf as he sits down with Clint Narver, a former DOJ prosecutor and healthcare compliance expert, to explore best practices, emerging trends, and real-world strategies for avoiding legal pitfalls. Highlights: - Learn how to safeguard your organization against research fraud. - Insights into the DOJ's perspective on compliance programs. - Real-life examples of compliance missteps and how to avoid them. - The role of training, monitoring, and proactive measures in compliance success. Ready to strengthen your compliance program? Listen to the full episode and gain the tools to navigate the complexities of healthcare compliance.

Selling or acquiring a healthcare practice is no small feat. Regulatory compliance challenges, from Stark Law violations to billing audits, can derail even the best-planned transactions. In this insightful episode of Compliance Conversations, CJ Wolf interviews Ericka Adler, a leading healthcare attorney and Shareholder at Roetzel & Andress, to uncover: - The most common compliance pitfalls in healthcare transactions - Strategies for preparing your practice for sale to ensure a smoother process - Key steps buyers must take to mitigate compliance risks during due diligence - Tune in to the episode and gain actionable strategies from an expert with over 28 years of experience in healthcare law. About Ericka Adler: Ericka has over 25 years representing individual providers, physician groups, and other health care entities, such as home health care agencies, DME companies, hospices, MRI facilities, and surgery centers. She focuses her practice on regulatory and transactional health care law, in compliance counseling, structuring, and implementing complex joint ventures to comply with state and federal laws and regulations. Ericka spends a significant amount of time helping physicians to negotiate their employment agreements with various types of physician employers. She handles mergers, sales and acquisitions of healthcare entities and has extensive experience in completing transactions with private equity, hospitals and other third parties. Ericka also has deep experience dealing with Stark, Anti-Kickback Statute, fee-splitting concerns, the corporate practice of medicine, and other challenges facing healthcare providers. Ericka works closely with her clients on their day-to-day legal health care needs and strives to be available so that her clients always feel like they are her top priority. She serves as general counsel to her practice clients. Ericka keeps clients up-to-date on her weekly podcast, “Roetzel HealthLaw HotSpot®. The podcasts have addressed timely topics, including private equity acquisitions, Stark Law compliance, employment and HR issues, and other matters of importance and interest to her clients. In addition, Ericka contributes to the Law & Malpractice section of the online magazine Physicians Practice and to the Business section of the online blog site Medscape, where she addresses legal and management issues facing independent physician practices. She devotes a large part of her practice to advising professionals and practices on their employment agreements, helping them to negotiate their contractual arrangements, and assisting her clients in acquiring and selling health care entities. She also works with providers in HIPAA, fraud and abuse, billing audits, government investigations, licensure matters, and contract disputes. Ericka can be reached via email at EAdler@ralaw.com.

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).

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

In this episode, our host CJ Wolf sits down with Laidy Diana Martinez, a coding supervisor, to discuss the world of GI coding and compliance. Episode Highlights: - Introduction to GI Coding Challenges: Understand the common hurdles and how to overcome them. - Screening vs. Diagnostic Colonoscopies: Learn the critical differences and their coding implications. - Essential Modifiers: Find out which modifiers to use and when. - Documentation Best Practices: Discover what's needed for accurate and compliant GI procedure billing. - Medicare and Payer Policies: Stay up to date with the latest changes and requirements. Laidy Diana Martinez, with her extensive experience as a coding supervisor, brings valuable insights and practical advice that can help enhance your coding accuracy and compliance efforts.

Our latest episode of Compliance Conversations features Johanna Brown, the recipient of Healthicity's 2023 Compliance Officer of the Year Award! Join our host, CJ Wolf, as he delves into Johanna's journey in compliance, her leadership philosophy, and the qualities that make her an outstanding compliance officer. Here's what you can expect: - Career Journey: Learn about Johanna's path from journalism to compliance. - Leadership Insights: Discover her secrets to fostering teamwork, maintaining work-life balance, and navigating the complex world of healthcare compliance. - Heartfelt Recognition: Hear the glowing recommendations from her colleagues and what they appreciate most about her approach to compliance.

We're excited to announce a new episode of Compliance Conversations! Join CJ Wolf and special guest Kimberly Jolivette Williams as they explore the complexities of anesthesia coding and billing. In this episode: - Kimberly's journey from unit secretary to compliance expert. - Unique aspects of anesthesia coding and essential resources. - The importance of modifiers in compliance and billing. - Tips for accurate documentation and minimizing compliance risks. Don't miss out on Kimberly's expert advice and passion for lifelong learning. Here are some additional resources around this important topic: Centers for Medicare & Medicaid Services Anesthesiologists Center - https://www.cms.gov/medicare/payment/fee-schedules/physician/anesthesiologists-center Certified Anesthesiologist Assistants Now Authorized to Practice in Washington State - https://www.asahq.org/about-asa/newsroom/news-releases/2024/03/certified-anesthesiologist-assistants-now-authorized-to-practice-in-washington-state#:~:text=SEATTLE%20%E2%80%93%20Washington%20state%20Gov

Our latest episode of Compliance Conversations features CJ Wolf, MD, and Brian Burton, our Chief Compliance and Privacy Officer, sharing their key takeaways from two of the most prominent industry conferences: HCCA's Compliance Institute and AAPC's HEALTHCON. Find out what they had to say about insights on the OIG's new General Compliance Program Guidance, industry-specific updates, and so much more. From discussions on artificial intelligence in compliance to the latest developments in Medicare Advantage and risk adjustment, this episode offers valuable insights for professionals across the healthcare spectrum. We also wanted to share a few resources CJ and Brian mentioned during their chat: - Our webinar on Leveraging Data Analytics for Proactive Compliance Management (https://www.healthicity.com/resources/leveraging-data-analytics-proactive-compliance-management-webinar) - The section of our Resource Center dedicated to the OIG's General Compliance Program Guidance (https://www.healthicity.com/resources/topic/oig-gcpg)

We're thrilled to share the latest episode of Compliance Conversations featuring a Jeni Colarusso, a seasoned nurse and an expert in telehealth and Tele-ICU systems. In this episode, Jeni dives deep into the transformative power of telehealth, particularly in critical care environments. Episode Highlights: - Jeni's extensive experience in surgical and cardiac ICU settings. - An in-depth look at Tele-ICU and its role in expanding access to specialist care in remote areas. - The impact of technology on patient outcomes and hospital efficiency. - Insightful discussion on overcoming healthcare disparities through innovative telehealth solutions. Jeni shares not only her professional journey but also gives us a peek into the future of healthcare where geography no longer limits access to top-notch medical expertise.

Are you navigating the complex world of healthcare compliance, particularly when it comes to Medicare and Advanced Beneficiary Notices (ABNs)? We've got you covered in the latest episode of Compliance Conversations, featuring industry expert Keisha Wilson, founder of KW Advanced Consulting. Keisha brings over two decades of healthcare experience to the table, offering invaluable insights into the intricacies of ABNs. This episode delves deep into what ABNs mean for healthcare professionals and patients alike, recent changes to ABN forms, compliance risks, and the importance of proper education and implementation within healthcare settings. Why Tune In? - Uncover the essentials of ABNs: Learn what ABNs are and why they're critical in healthcare from a seasoned expert. - Stay updated: Get the scoop on the latest ABN form changes effective from June 2023 and how they impact practices. - Avoid common pitfalls: Keisha discusses frequent compliance risks and how to navigate them effectively. - Engage in comprehensive learning: From policy implementation to case studies, this episode is packed with actionable advice and best practices. Keisha's journey from aspiring social worker to healthcare compliance consultant adds a unique perspective to understanding patient communication and the nuances of Medicare coverage. Her passion for compliance and patient care shines throughout the conversation, making it a must-listen for anyone in the healthcare sector. You can also read a recent blog post from KW Consulting on ABNs. Keisha Wilson, CCS, CPC, CPCO, CPMA, CRC, CPB, Approved Instructor, is the Founder/CEO of KW Advanced Consulting LLC, Minority Women Own Business Enterprise (M/WBE) Certified, with 20+ years in healthcare specializing in various areas of compliance. Multi-specialty, Telehealth/Telemedicine, Risk Adjustment, provider and coder training. She currently sits on a Board of Directors for an outpatient mental health clinic. Keisha is a licensed PMCC who teaches coders looking to become Certified Risk Adjustment (CRC) and hosts various compliance documentation and coding webinars. She is a published author, having written for AAPC editors on Primary Care Coding Alert, Healthcare Business Monthly, and KW Advanced Consulting coding articles. Keisha can speak at various events this year, including the AAPC Regional Conference on Philidelphia and Cohen's Coding Summit on Telehealth in the U.S. vs Internationally.

In this episode, we're joined by Kandi O'Brien, the Founder of Delegated Credentialing Pro's and an expert with extensive experience in credentialing and compliance. Kandi shares her fascinating journey in healthcare, from clinical roles to owning urgent cares, and ultimately specializing in compliance and credentialing. We discuss the importance of credentialing, its various aspects, and why it's crucial for patient safety, regulatory compliance, and maintaining organizational reputation. Tune in to our conversation to learn more about: - The significance of credentialing as the first step for providers entering healthcare facilities. - The distinction between facility credentialing and professional (provider) credentialing. - The complexities of enrollment and why it's not synonymous with credentialing. - The concept of delegated credentialing and its benefits for organizations, including improved efficiency and revenue generation. - The primary source verification process and ongoing monitoring for compliance. - The potential challenges and considerations associated with delegated credentialing. Kandi's LinkedIn: https://www.linkedin.com/in/kandio/ Delegated Credentialing Pro's: https://www.linkedin.com/company/delegated-credentialing-pro-s/

This Compliance Conversations episode is a must-listen for anyone in healthcare compliance or coding. We invited Leslie Boles, Co-Owner and President of Revu Healthcare, to chat about identifying coding compliance risks within healthcare organizations. Tune in to Leslie and CJ Wolf's discussion for more on: - The importance of staying curious and adaptable - The significance of regular audits and assessments in proactively identifying compliance risks - Common coding compliance risks and blind spots within organizations - Strategies for mitigating compliance risks, including the role of data analytics and technology They also talk about one of the most important things to keep top-of-mind – staying humble and acknowledging gaps in knowledge to drive continuous improvement.

Biometric technology can sometimes feel like sci-fi – which is why it raises so many great compliance questions. That's why we invited Dr. Mohamed Lazzouni, the Chief Technology Officer at Aware, a leading company in the field of biometrics, to join us for our latest episode of Compliance Conversations. In this episode, Dr. Lazzouni shares insights into the exciting developments in biometrics and its pivotal role in healthcare. From access control to fraud prevention, Dr. Lazzouni and I discuss the impact on compliance and security in the healthcare industry. Listen now to gain a deeper understanding of: - How biometrics enhance healthcare access control - Real-world applications of biometrics in preventing fraud - The intersection of biometrics and compliance in healthcare - The future of wearables and AI in biometric healthcare interventions

Ready for a crash course into regulatory considerations in health tech? In this episode of Compliance Conversations featuring Susan Walberg, a seasoned regulatory and compliance professional and published author of fiction and non-fiction In this interesting interview, Susan shares her journey from novels to HIPAA, offering a behind-the-scenes look at the challenges and triumphs of navigating compliance in the rapidly evolving health tech landscape. Tune in to the episode to discover: - Some surprising realities of health tech compliance - Real-word intriguing cases (like the Jelly Bean dilemma!) - Key lessons for startups and small organizations as they navigate compliance concerns Thanks to Susan for joining us for this episode – we hope you enjoy! Susan Walberg has worked in health care for nearly 30 years, from working as a fraud investigator at a health plan, to a regulatory attorney and privacy officer for a very large health system. She has worked as a compliance officer, and a subcontractor working with CMS on Part C and D Medicare fraud and abuse. Susan has also worked as an interim compliance officer for a range of healthcare organizations, designing and building compliance programs unique to the needs of those organizations. Her specific experiences include helping clients manage a Corporate Integrity Agreement and developing programs for new organizations or those going through an organizational transition. Susan has trained and mentored many new compliance professionals, and strives to help those new to compliance to succeed in their roles. As a consultant, Susan uses her passion for building, creating, and organizing compliance programs along with a true understanding of the needs of healthcare organizations to help create programs that really fit within the each client's unique culture and environment.

Tune in to this episode of Compliance Conversations interview with Maya Turner, a seasoned expert in the healthcare industry with close to 30 years of experience in auditing, coding, billing, compliance – you name it. Maya shares her perspective on the evolution of telehealth, especially in the context of recent changes and challenges brought by the COVID-19 pandemic. Maya and CJ also discuss: - Significant changes in telehealth regulations from its early days to the present - Telehealth's crucial role in addressing healthcare disparities - The importance of proper documentation in telehealth visits - Compliance issues and risks that auditors and coders should be aware of We welcomed an unexpected guest during the episode – Maya's dog! See if you can hear the friendly canine interruption. Maya is a seasoned certified coder and auditor, boasting nearly 30 years of experience and subject matter expertise to many coding compliance subjects; she especially is sought after for her in-depth knowledge base of pro fee multi-specialty practice, primary care, hospitalists, telehealth, in-patient and SNF billing. She is also a published author, having written articles for AAPC and HCCA, and currently is a part of the ACDIS Leadership Council. She showcases her unmatched three-dimensional thinking in complex subject matters, Mayas' success is marked by her clear and well received presentation style, reflecting her profound understanding and expertise. Maya also has a consulting company, Turner Expert Consulting Services, LLC.

Dr. Adam Robinson, an internal medicine physician and founder of Aimedica, joined CJ Wolf, MD to explore the promises and pitfalls presented by AI in the healthcare landscape. Dr. Robinson provides valuable insights into the current state of electronic medical records, the impact of the 21st Century Cures Act, and the potential for AI to revolutionize patient care. Tune in to our latest episode, “Beyond the Buzzwords: Understanding AI's Role in Healthcare,” to hear CJ and Adam's discussion on: - Existing challenges with electronic medical records, such as data interoperability issues and the siloed nature of patient information. - The implications of the 21st Century Cures Act and its role in making healthcare data more transparent and interoperable. - Successful applications of AI in imaging specialties, highlighting the potential for improved diagnostics. - The current lack of comprehensive regulations for AI in healthcare and predictions around the emergence of potential FDA regulations in the future.

In this episode, Jenny Hamilton the Clinical Project Research Manager at Barrow Neurologic Institute, joins CJ Wolf, MD for an in-depth discussion on compliance considerations for clinical trials. From the complexities of protocol deviations to the vital role of Institutional Review Boards, they cover a wide range of topics. Tune in for valuable insights into the compliance landscape of clinical trials and learn more about the crucial role patients play in advancing medical research. Jenny and CJ also cover: - The importance of informed consent in clinical trials - Insights into FDA audits and the role of Clinical Research Associates - The fascinating and diverse landscape of global clinical trials You can also learn more about Jenny's work here. https://www.barrowneuro.org/centers-programs/als-neuromuscular-disease/

If you haven't had the time yet to read all 90+ pages of the OIG's New Compliance Program Guidance, we've got a great place for you to start. We invited Sarah Couture, a nurse turned compliance consultant, to discuss the new guidance with us in our latest episode of Compliance Conversations. Join Sarah and CJ Wolf, MD as they break down the essential elements and updates, including: - The evolving role of Chief Compliance Officers - The significance of incentives in compliance programs - Collaborative risk management approaches - Emphasizing medical necessity in billing audits Sarah is the Principal of Couture Compliance, an organization dedicated to elevating compliance program effectiveness through tailored compliance solutions. You can reach her at sarah@couturecompliance.co.

In the age of technology, data, and artificial intelligence, there's one often-overlooked workplace tool: soft skills. That's why we invited Jay Anstine, the founder of Bluebird Healthlaw partners, to chat with CJ Wolf, MD about communication and navigating work environments. In our new episode of Compliance Conversations, “From the Boardroom to the Exam Room: Diplomatic Communication in Healthcare,” Jay and CJ discuss: - Real-world, complex scenarios with patients and clinicians - How to adapt your communication style for different audiences - Learning various communication tactics so you can effectively interact with physicians, leaders, and executives - Addressing compliance concerns in a group setting Jay Anstine is the founder of Bluebird Healthlaw Partners, a consulting firm with a mission to help compliance officers change the perception of compliance in their organizations. For over 20 years, he has worked on the provider and payer side of the healthcare market, consulting to leaders and clinicians about compliance program matters. He routinely writes and speaks about compliance program requirements and is a faculty member at the University of Southern California's Gould School of Law, teaching courses on healthcare compliance. Jay recently wrote a book entitled, Navigating the Politics of Healthcare: A Compliance Officer's Guide to Communication, Relationships, and Gaining Buy-in, which is available on Amazon or at Barnes and Noble. In his book, he talks about how there are two worlds within healthcare-the world the general public experiences in receiving care, and the world industry workers experience in providing that care. Jay's theorizes it is the second world where the politics of healthcare lives, which impacts the effectiveness of a compliance program. His book then provides strategies to improve the compliance officer's ability to communicate effectively with their healthcare leaders in order to gain buy-in to the compliance program. You can find Jay at www.bluebirdhealthlaw.com. He has a blog dedicated to communication strategies for compliance officers. You can also find him on LinkedIn.

In this episode of Compliance Conversations, we're taking an in-depth look at the revenue cycle and coding. We're joined by Stephanie Perry, the outpatient medical supervisor for e4health, as she shares insights from her 12 years of experience in coding, auditing, training, and leadership roles within the healthcare industry. Tune in to our episode, “Coding Strategies for Successful Revenue Cycle Management,” to understand modifiers, status indicators, and their significance in the reimbursement process. Stephanie sheds light on how coding decisions can either facilitate or hinder the smooth progress of claims through the revenue cycle.

In this episode, we welcomed Stacey Crudup, Chief Compliance Officer at The SEES Group, to share her insights on why building relationships with team members on the front lines of healthcare is essential in driving strong compliance programs. Stacey's experience and practical advice shed light on the benefits of understanding the business, spending time with your internal teams, and creating value through compliance efforts. Tune in to our new episode, “How Compliance Teams Can Build Trust to Accelerate Success,” to hear more about: - Stacey's journey into compliance from an IT background - The importance of building relationships in the world of compliance - Practical tips for embedding compliance into operations - Overcoming obstacles in the process - How to add value to your organization through compliance Stacey has unique expertise in recognizing the role of compliance in daily health care operations and communicating effectively with staff at all levels about the practical application of compliance principles. She is experienced in developing and executing organizational policies and procedures related to legal questions in the health care environment, compliance, and risk management.

We're excited to introduce a thought-provoking podcast episode that dives into the world of compliance in healthcare and explores the ever-evolving challenges compliance professionals face in their careers. In this episode, “A Candid Conversation on Challenges and Balance in a Compliance Career,” Dieter Lehnortt and CJ Wolf share their insights on the complexities of the healthcare compliance landscape. From dealing with government regulations to navigating the uncharted territory of Artificial Intelligence, they cover it all. Key takeaways from the podcast: - Explore the potential of AI in compliance and the importance of using it appropriately to enhance efficiency. - The significance of establishing boundaries, delegating tasks, and prioritizing for a better work-life balance. - How to make compliance approachable more approachable for colleagues who find it intimidating

Join us for a deep dive into healthcare and nursing facility compliance during this episode. Discover the ever-evolving landscape and common challenges faced by providers as CJ Wolf and Paige Pennington share their expert insights.

Whether you're a compliance professional, an HR specialist, or simply interested in the evolving landscape of workplace culture, our latest Compliance Conversations episode offers valuable takeaways for everyone. We invited Kyle Manwaring, a DEI professional, for a great conversation about the possibilities at the intersection of DEI initiatives, compliance, and organizational culture. Tune in to our new episode, “Exploring Diversity, Equity, and Inclusion in Compliance,” to learn more about: - The fundamentals of DEI and its various components. - The importance of DEI for organizations, both ethically and financially. - Strategies for fostering a more inclusive and equitable work environment. - The role of executives in championing DEI efforts.

We're joined by Sara Richards, a newly certified coder, as she shares insights into the intricacies of medical coding and how it aligns with compliance in the healthcare industry. Sara and CJ Wolf, MD, discuss: - The certification process and how Sara prepped for the exam - What the coding exam is really like – and what's changed (and hasn't changed) over the last few decades - Career opportunities in the coding industry

Assembling the ideal compliance team is no small task – and that's why it can be such a puzzle. We invited Sarah Couture, a former nurse turned compliance executive, to share her insights on structuring effective compliance teams. Tune in to our new episode, “The Art of Building a Successful Compliance People Strategy,” as we discuss: - Important considerations for building a strong compliance team - Why compliance liaisons can boost your program's effectiveness - Real-life examples of compliance staffing done right (and not so right) - Strategies for compliance officers to approach succession planning and mentorship Sarah currently serves as a Senior Managing Director at Ankura, and she is also a faculty member for the Health Care Compliance Association (HCCA). She started her career as a nurse and made the transition to compliance when she saw an opportunity to support and strengthen health care compliance. If you'd like to hear more from Sarah, you can sign up for her upcoming HCCA webinar!

If you've been in the Healthicity community for a while, you might know that we conduct annual surveys every year for compliance and auditing professionals. We know there's no shortage of surveys in this world, but here's why you should take ours – it's designed to gather vital information to benefit you and your organization, and because you'll get a handy dandy report after we analyze the responses. Get a look behind the survey scenes on our latest episode of Compliance Conversations, “The Marketing Team: What We Do in the Shadows,” where Healthicity's Sr. Director of Marketing, Kyle Brogdon, steps from the editing booth into the recording booth to talk about what makes our survey different. Take the compliance survey here: https://www.healthicity.com/en/resources/2023-annual-compliance-survey Take the auditing survey here: https://www.healthicity.com/resources/2023-annual-auditing-survey

Investigations are a natural part of any compliance professional's career – but that doesn't make them any less intimidating. We invited Eric Allen, a highly regarded compliance professional with experience spanning academia, hospital institutions, and more, to join us for an episode of Compliance Conversations! In this episode, “Compliance Investigations 101,” Eric and I discuss the nuances of investigations, including: - How to set investigations up for success from the get-go - Navigating the emotional side of interviews and ongoing investigations - Why mannerisms and body language are crucial in the age of remote interviews

“Think like a lawyer, talk like a human, and start with your audience." Those three key principles drive Kirsten Liston's innovative approach to compliance training, and it's why we invited her to join us on our latest episode of Compliance Conversations! Kirsten is the CEO of Rethink Compliance and a two-time author. We're grateful she shared her time and expertise with us on our latest episode!

Technology is integrated into everything we do – including healthcare. But what are the regulatory implications of new software platforms in the medical industry? We invited Ali Aga, the Founder and CEO of Flowbit®, to share his insights on our latest episode of Compliance Conversations. Ali is a digital innovator, software developer, and healthcare insider with a unique perspective on the regulatory processes behind healthcare software.

“The scene can't begin until we start paying attention to each other.” -- David Pasquesi If you think improv comedy and healthcare compliance and coding require opposite skillsets, you might be surprised by our latest podcast episode... We invited Dr. Mike Smith, a multi-talented physician and improv aficionado, to join us for our latest episode of Compliance Conversations. Dr. Smith is currently an Attending Physician at the University of Nebraska Medical Center and a Consultant for Healthcare Improv.

Doctor, firefighter, marine biologist, compliance officer? We're not sure the last one makes many kids' list of their dream careers, but here we all are! We love learning about how people got into compliance and how they continue advancing their own knowledge in the field. That's why we invited Steve Naughton to join us for this episode of Compliance Conversations.

It's no secret that private equity is playing an accelerating role in the healthcare industry – but what does that mean for compliance professionals? This Compliance Conversations features a conversation about why private equity can work with – not against – healthcare organizations.