The Compliance Guy
By Sean M. Weiss
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 advocate, Sean engages with clients to ensure a “level-playing-field” and due process when allegations and/or accusations of impropriety are leveled by a payor or government investigation agency.
When Sean is not engaging in administrative, civil and criminal matters on behalf of more than 30 nationally recognized law firms and clients, he is serving as a third-party compliance officer for a dozen organization across the country ranging in size and specialty to ensure a “Culture of Compliance”!
Sean is a proud member in good-standing with the National Society of Certified Healthcare Business Consultants (NSCHBC), American Health Lawyers Association (AHLA), National Alliance of Medical Auditing Specialists (NAMAS), and the American Academy of Professional Coders (AAPC). Sean holds (CHC, CEMA, CMCO, CPMA, CPC-P, CMPE, CPC, CMC, CMIS, CMOM) national certifications from the Health Care Compliance Association, The National Alliance of Medical Auditing Specialists, The American Academy of Professional Coders and Practice Management Institute.
The Compliance GuyJun 29, 2022
Season 7 - Episode 27 - Non-compete Agreements - "The Road Ahead"
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!
Season 7 - Episode 26 - #TerryTuesday
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!
Season 7 - Episode 25 - Monday Auditing, Coding and Compliance Roundtable
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!
Season 7 - Episode 24 - #TerryTuesday
Sean and Terry are back at it with another great episode focusing on the most challenging issues facing healthcare providers and their organizations.
Season 7 - Episode 23 - Monday Auditing, Coding and Compliance Roundtable
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
Season 7 - Episode 22 - #TerryTuesday - IPPE and AWE (Medicare)
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.
Season 7 - Episode 21 - Monday Auditing, Coding and Compliance Roundtable
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
Season 7 - Episode - 20 - Christine Hall - Coding and Compliance
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!
Season 7 - Episode 19 - #TerryTuesday - OIG Compliance Program Guidance
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!
Season 7 - Episode 18 - Monday Auditing, Coding and Compliance Roundtable
Join Sean, Stephanie, Scott, Christine, and Terry as they take on:
1. Collaboration Agreements
2. CERT Studies and error rate
Season 7 - Episode - 17 - #TerryTuesday - Bad Coding = Bad Business
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!
Season 7 - Episode 16 - Monday Auditing, Coding and Compliance Roundtable
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-proclaimed "experts" in the area are leading providers and others to poor outcomes. Join Terry A Fletcher BS CPC CEMC CCC CCS CCSP CMC ACS-CA SCP-CA, QMPM, Christine Hall CHC, John Paul Spencer, and Scott Kraft, along with me, as we take on these two critical topics.
Season 7 - Episode 15 - Dan Cohen - PainScript
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 engaged in their health, improving treatment plan and medication adherence. Join us for this fascinating discussion with a true pioneer in the industry.
Season 7 - Episode 14 - #TerryTuesday - HIPAA and The Unknown
Terry joined Sean to discuss some of the more obscure aspects of HIPAA and what practices should be doing to cover their assets!
Season 7 - Episode 13 - The AI Modifier and Taking on Medicaid
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 this case.
Season 7 - Episode 12 - #TerryTuesday - When Audit Results Are Ignored
Sean and Terry take on the risks associated with not following audit results whether internal or external results. Don't miss this one!
Season 7 - Episode 11 - Monday Coding and Compliance Roundtable
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.
Season 7 - Episode 10 - #TerryTuesday - Incident-To
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.
Season 7 - Episode - 9 - Monday Auditing, Coding and Compliance Roundtable
The entire cast is back this week taking on the most complex and challenging issues tied to medical auditing, coding, and compliance...
TCG The Best of The Best "Effective Leadership"
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 what a regulatory compliance professional knows about Practice Management.
Season 7 - Episode - 8 The Return of Clint Pulver
The one and only Clint Pulver returns to The Compliance Guy to provide an update on his upcoming 2024 speaking tour, his new documentary (Finding Hill on YouTube), The Master Class Program, and so many more unbelievable amazing things Clint and his team are undertaking!
Clint Pulver is a professional keynote speaker, author, musician, pilot, and workforce expert. Known as the leading authority on employee retention, Clint has transformed how corporations like Keller Williams, AT&T, and Hewlett Packard create lasting loyalty through his work and research as the Undercover Millennial. He has been featured by BusinessQ Magazine as a "Top 40 Under 40," and, as a professional drummer, he has appeared in feature films and on America's Got Talent. In 2020, Clint won an Emmy Award for his short film Be a Mr. Jensen, which tells the story of how a single moment in time-and one particular mentor-can change the course of a life.
Season 7 - Episode 7 - Legal with Liles/Parker
In the first Legal with Liles/Parker episode of 2024, Robert and Ashley sit down with Sean to discuss Compliance Risks in 2024! The list is long and distinguished...
Season 7 - Episode 6 - #TerryTuesday - Cloning and Clinical Plagiarism
Terry and Sean take on Cloning, Cut and Paste and Clinical Plagiarism... It is not as clear cut as you would think it is! Don't miss this one because the end-results could cost you dearly!
Season 7 - Episode 5 - Monday Coding and Compliance Roundtable
The All Star Panel was back taking on the latest in auditing, coding and compliance challenges for healthcare professionals.
Season 7 - Episode 4 - Dr. Katie Deming
Katie Deming, MD sits down with Sean to discuss engaging with those diagnosed with cancer. Dr. Deming, host of the Born to Heal Podcast and a #tedxspeaker, provides insightful and invaluable advice on communication. Don't miss this opportunity to change your outlook on how we engage with those diagnosed with cancer...
Season 7 - Episode 3 - #TerryTuesday - Artificial Intelligence in Healthcare
There is no doubt the machines are taking over! Terry and Sean explore how AI both helps and hurts providers of medical services and what they need to do to ensure they don't find themselves in a trap!
Season 7 - Episode 2 - Monday Coding and Compliance Roundtable
The All Star Panel is back for the first roundtable discussion of 2024 and what a great discussion it was.
Topics Include:
1. G2211 - The New Add-on for Evaluation and Management Codes... The Dos and Don'ts
2. Medical Students - What they can and cannot provide as a services and the PATH Guidelines...
3. Laboratory Compliance - The world of lab services has been absolutely turned on its head over the past 24 months and there is no end in sight...
Season 7 - Episode 1 - David J Zetter
David sits down with Sean to discuss avoiding 2024 pitfalls with provider enrollment, credentialing, and contracting in addition to so much more.
David is one of the most celebrated healthcare professionals and for good reason. Don't miss this one!
Zetter Consulting Website: https://zetter.com/
NSCHBC Website: https://nschbc.org/
Season 6 - Episode 50 - #TerryTuesday - Non-retaliation
In this final episode of season 6 and the overall final episode of 2023 Terry joins sean to take on the critical nature of having a non-retaliation policy for your organization! You can't have a compliance program without one of these!
Season 6 - Episode 49 - Monday Coding and Compliance Roundtable
In this final roundtable discussion of 2023 the all star cast was back to address:
1. CPT Coding Changes for 2024
2. Impact of a transmittal change by CMS for chemo and Rheumatology Infusion Drugs
3. The impact of medical necessity
4. Documentation standards
5. The impact bad behavior has on a case at trial
Season 6 - Episode 48 - #TerryTuesday - G2211 Add-on Code
CMS is at it once again with a new HCPCSII Code that will only lead to confusion and potential long-term audits and claw backs! Take a listen as Sean and Terry break down this one...
Season 6 - Episode 47 - Monday Coding and Compliance Roundtable
Terry, Scott, Paul, and Christine joined Sean for a great discussion...
Topics include: 1. Holding on to overpayments when a refund, corrected claim, and/or self-disclosure should be made; 2. How to teach audit results... painting the wrong picture; 3. Wound care; 4. Critical mistakes providers make that lead to charges of healthcare fraud and/or false claims act violations... There is so much to explore!
Season 6 - Episode 46 - Monday Coding and Compliance Roundtable
Split/Shared Services is the theme of this episode and you do not want to miss this in-depth discussion!
Season 6 - Episode 45 - Monday Coding and Compliance Roundtable
The Allstar team was back together to discuss the latest changes to the AMA CPT Manual, Risk to Providers who Clone medical records, and so much more!
Season 6 - Episode 44 - #TerryTuesday - AMA/CMS 2024 Changes to Telehealth
Terry and Sean take on 2024 changes from AMA/CMS regarding telehealth!
Season 6 - Episode 43 - #TerryTuesday - Compliance as a Culture
This episode is all about compliance... So much to unpack in so little time!
Eason 6 - Episode 42 - Monday Coding and Compliance Roundtable
Terry, Christine, and Stephanie joined Sean to discuss a variety of pressing topics impacting compliance and operations.
Topics for Discussion:
- Billing for bundled or non-covered services “hoping” to get paid and then writing it off if you don’t.
- trying to bill to insurance an injection code when it’s on the list of “likely self administered” because the patient doesn’t want to self Inject.
- not verifying patient's insurance coverage, getting denials and then billing the patient-
So much to discuss!
Season 6 - Episode 41 - #TerryTuesday - Don't Do That... It's Stupid!
This is a very special episode of The Compliance Guy #TerryTuesday... There is some signing, and somethings that we refer to as "Don't Do That... It's Stupid!
Season 6 - Episode 40 - Monday Coding and Compliance Roundtable
Join Stephanie, Terry, Christine, Scott, and Paul as they sit down with Sean to discuss a variety of coding and compliance topics including:
1. Traveling overseas and needing medical attention... who is going to pay for it?
2. Modifier 25 CMS/AMA Joint Definitional Change...
Season 6 - Episode 39 - #TerryTuesday - RCM
In this episode, Sean and Terry take on Revenue Cycle Management and the role of compliance in operations.
Season 6 - Episode 38 - #Terry Tuesday
You favorite dynamic duo is back and at it again! In this episode Sean and Terry take on the different types of audits... This episode is a must for every type of healthcare organization!
Season 6 - Episode 37 - Monday Coding and Compliance Roundtable
The entire crew (Christine, Terry, Scott, Paul, and Stephanie) is back for an outstanding roundtable discussion that is wide-ranging and full of great content!
1. Orders for tests and how the EMR impacts how specific tests are displayed in a note and the impact given for credit for towards data and MDM.
2. Cyber Security Attacks on healthcare providers (CMS Warning) and how to be diligent in your efforts!
3. The impact of private equity money and the latest claims of price gouging by the government against anesthesia groups!
4. What it means to be the subject of an investigation, the impact on your professional and personal life and that of the people surrounding you!
5. Being convicted of a healthcare crime and whether it leads to OIG Exclusion even if you are cooperating with the DOJ.
Don't miss this one!
Season 6 - Episode 36 - #Terry Tuesday
Terry and Sean take on can I do this because the doctor down the street does it... and what happens when you don't stay in your lane!
Season 6 - Episode 35 - Monday Coding and Compliance Roundtable
We had a great line-up of topics on this episode:
1. Orders for tests and how the EMR impacts how specific tests are displayed in a note and the impact given for credit for towards data and MDM.
2. Cyber Security Attacks on healthcare providers (CMS Warning) and how to be diligent in your efforts!
3. The impact of private equity money and the latest claims of price gouging by the government against anesthesia groups!
4. What it means to be the subject of an investigation, the impact on your professional and personal life and that of the people surrounding you!
5. Being convicted of a healthcare crime and whether it leads to OIG Exclusion even if you are cooperating with the DOJ.
Season 6 - Episode 34 - Dr. Carolyn Ward / Particle Health
Sean was joined by Dr. Carolyn Ward, Director of Clinical Strategy for Particle Health to discuss challenges with interoperability and other dynamic challenges facing healthcare professionals...
About Dr. Ward:
Carolyn Ward is a dynamic and driven internal medicine physician with a passion for physician empowerment and data-driven decision making. With over eight years of experience in healthcare, including as Chief Resident at Rutgers Robert Wood Johnson Medical School, she has established herself as a leader in the field. As the Director of Clinical Strategy at Particle Health, Carolyn has taken her experience to the next level. She is responsible for developing the clinical product roadmap for the organization, ensuring that providers and patients are represented throughout the research and development process.
Carolyn's mission is to enable simple and secure access to actionable patient data through Particle's modern API platform. She believes that the health data system must be more cohesive to prevent digital friction and to promote positive patient outcomes. Carolyn is an ideal fit for podcasts targeting audiences of C-suite executives and founders for health tech companies, physicians, and women in tech. She can offer unique insights on topics such as healthcare interoperability, AI in health data management, digital health innovation, and value based care innovation. Her knowledge, experience, and her passion make her an outstanding guest for any podcast looking to explore the challenges facing the industry and the opportunities for innovation.
Season 6 - Episode 33 - Dr. Brian Fengler of EvidenceCare
On this episode, Sean was joined by Dr. Brian Fengler of EvidenceCare to discuss the state of healthcare and what he as an Emergency Room Physician has see as opportunities to gain access to evidence based care information to assist in the treatment of patients at bedside faster and more accurately.
About Dr. Fengler: (https://evidence.care/)
Dr. Brian Fengler is the co-founder and Chief Medical Officer of EvidenceCare. During his career as an emergency medicine physician, Brian saw and experienced a provider struggle to access evidence-based content quickly and at the bedside. Looking to fill this gap, Brian founded EvidenceCare in 2014.
After finishing his residency at the University of Virginia Health System in 2008, Brian moved to Nashville where he began his practice in the emergency department of St. Thomas Health System. He was also a founding physician and managing director of Physicians Urgent Care and a partner-owner of Middle Tennessee Emergency Partners physician group. During these ventures, he served as an assistant professor of emergency medicine for the University of Tennessee/St. Thomas residency program. In 2016, Dr. Fengler left the daily practice of medicine to focus full-time on his work at EvidenceCare.
Season 6 - Episode 32 - #TerryTuesday - Split/Shared and Incident-to Services
Terry and Sean take on the giant headache of split/shared and incident-to services. This one gets a bit heated for legitimate reasons.
You're gonna love this one!
Season 6 - Episode 31 - Monday Coding and Compliance Roundtable
The entire team is back for this episode! There was a lot to discuss with so many issues coming to light in the areas of coding, billing, documentation, and compliance. Don't miss one minute of this one!
Season 6 - Episode 30 - #TerryTuesday
What is a compliance plan and how to build one that is effective and meets OIG and DOJ requirements!
Season 6 - Episode 29 - Monday Coding and Compliance Roundtable
This was an epic episode that you do not want to miss. Scott, Terry, Stephanie and Christine joined Sean to discuss the False Claims Act, Anti-Kickback Statute, Template issues, and so much more!