
Hosted by Sean M. Weiss · EN
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.

SummaryIn this episode of The Compliance Guy, Sean Weiss and Terry Fletcher discuss various compliance issues related to audits, medical necessity, and the importance of thorough documentation in healthcare. They engage in a role play to illustrate common pitfalls in audits, emphasizing the need for physicians to conduct appropriate examinations and maintain accurate records. The conversation also touches on the impact of electronic medical records (EMR) and artificial intelligence (AI) on healthcare practices, highlighting the risks of relying on outdated or incorrect information. The episode concludes with a call for healthcare providers to take responsibility for their documentation and patient care.TakeawaysAudits often reveal common sense oversights in healthcare practices.Physicians must understand the difference between hospital-based and private practice standards.Medical necessity is crucial for justifying patient evaluations and management services.Technicalities in documentation should not overshadow clinical responsibilities.Inaccurate or outdated information in EMRs can lead to significant risks in patient care.Providers should not rely on loopholes in guidelines to justify their actions.The importance of a medically appropriate history and examination cannot be overstated.Documentation should reflect current patient status, not historical data.AI and EMR systems can exacerbate existing documentation issues if not managed properly.Healthcare providers must prioritize accuracy and thoroughness in patient evaluations.

SummaryJoin Sean Weiss as he discusses behavioral health coding, billing, and the current challenges faced by providers with expert Sonda Kunzi. Explore topics like reimbursement issues, telehealth, and regulatory complexities in behavioral health care.Key TopicsBehavioral health reimbursement challengesTelehealth regulations and complianceImpact of COVID-19 on behavioral health services

SummaryThis episode explores the complexities of virtual supervision under Medicare, emphasizing compliance, operational best practices, and the potential benefits when implemented correctly.Key TakeawaysVirtual supervision is a payment, workflow, and compliance rule, not just a convenience.Real-time audio-video technology is required for virtual direct supervision.Separate telehealth policies from supervision policies to avoid confusion.Organizations must verify service eligibility and supervision compliance before billing.Immediate availability of the supervisor is a critical operational and documentation requirement.Global surgery exclusions and state law overlays are key considerations.Proper training, documentation, and auditing are essential for compliance.When done right, virtual supervision enhances access, efficiency, and workforce flexibility.

SummaryIn this episode, Terry Fletcher discusses common compliance pitfalls in healthcare, billing errors, fraud risks, and the importance of accurate documentation and risk management. He emphasizes the need for healthcare providers to stay informed and vigilant against fraud and billing mistakes.Key TopicsHealthcare billing errors and compliance pitfallsFraud risks and detection in healthcareCMS guidelines and billing codesThe impact of AI and data analysis on fraud prevention

SummaryThis episode features a comprehensive discussion on healthcare compliance, audits, and payment integrity, with insights from industry experts on recent trends, challenges, and legal considerations in healthcare billing and review processes.Key TopicsPrepayment reviews and quality reviews in healthcareLegal considerations and due process in auditsCMS restructuring and payment modelsSubjectivity and AI in healthcare reviewsALJ hearings and LCD misapplications

SummaryIn this episode, Sean Weiss and Terry Fletcher discuss the complexities and pitfalls of billing add-on code G2211 for E&M services, emphasizing the importance of medical necessity, proper documentation, and understanding payer policies.Key TopicsG2211 coding and billingMedical necessity and documentationPediatric billing considerationsPayer policies and reimbursement ratesRisks of improper billing and fraud

SummaryIn this episode, Sean Weiss and Frank Cohen explore the realities of AI, its limitations, and its implications for healthcare and legal fields. They discuss how AI models work, the importance of human oversight, and the risks of overestimating AI capabilities.Key TopicsHow AI tokenizes words and predicts next tokensThe misconception that AI reasons or learns like humansThe importance of human oversight in AI applicationsRisks of hallucinations and fake citations in AI outputsThe role of bias and subjectivity in AI decision-making

SummaryIn this episode of The Compliance Guy, hosts Sean Weiss and Terry Fletcher explore the importance of internal audits, provider documentation, and maintaining objectivity in healthcare compliance. They discuss common pitfalls like over-familiarity with providers, the impact of personality on compliance, and the significance of external reviews to ensure practice integrity.Key TopicsInternal audits and their role in healthcare complianceThe phenomenon of spousal concordance and over-familiarityCommon documentation errors and their legal implicationsThe importance of objective external reviewsThe influence of personality and relationships on compliance behavior

SummaryThis episode features a lively panel discussion on critical issues in healthcare compliance, including the use of cell phones for medical communication, prepayment reviews, and critical care documentation. Experts Joe Rivet, ESQ, Scott Kraft, Jordan Johnson, Stephanie Allard, and David Duhaime share insights, practical advice, and regulatory updates to help providers navigate complex compliance challenges.Key TopicsUse of cell phones and texting in healthcarePrepayment review processes and challengesDocumentation and billing for critical care services

SummaryIn this episode of the Compliance Guy podcast, host Sean Weiss interviews healthcare compliance expert Susan Wahlberg. They discuss the evolving landscape of healthcare regulation, focusing on the roles of the FTC, FDA, and OCR, and explore how compliance professionals can stay ahead in a rapidly changing environment.Key TopicsRole of the FTC in healthcare data privacy and enforcementEmerging FDA regulations on AI and medical devicesThe importance of data mapping and vendor vetting in complianceThe impact of government enforcement on healthcare organizationsHere is a link to Susan's Website: www.susanwalberg.com Here is a link to Susan's LinkedIn Profile: https://www.linkedin.com/in/susanwalbergjd/