Compliance Conversations by Healthicity

What changes — and what stays the same — in healthcare revenue cycle over a 30-year career? In this episode of Compliance Conversations, CJ Wolf speaks with Vanessa Moldovan, Head of RCM Strategy at Magical, about her career journey through physician revenue cycle operations, coding, auditing, education, consulting, and health technology leadership. Vanessa shares firsthand perspective on the operational challenges healthcare organizations continue to face, why education remains one of the biggest gaps in revenue cycle, and how emerging technologies like agentic AI are beginning to reshape workflows across the industry. Topics discussed include: Why many denial and reimbursement challenges still persist today The growing intersection between revenue cycle and health technology How AI can support — not replace — experienced professionals The importance of compliance oversight in automation initiatives Career growth opportunities for coding, billing, and auditing professionals Why healthcare expertise is becoming essential for health tech companies This conversation offers valuable insight for compliance leaders, coders, auditors, revenue cycle professionals, healthcare executives, and anyone navigating the evolving healthcare reimbursement landscape. You can also check out the For the Love of Revenue Cycle Podcast here.  Thank you for listening! Please share, like, and subscribe.If you'd like to see more compliance and auditing content feel free to follow us on social media.LinkedInYoutubeFacebookInstagramCheck out our resource center and weekly compliance newsletter for additional compliance and auditing content from our experts.

Healthcare organizations are navigating a rapidly changing privacy landscape, and many compliance teams are being asked to manage new risks faster than ever before. Between evolving 42 CFR Part 2 requirements, increasing OCR enforcement expectations, and the rapid adoption of AI tools across healthcare operations, organizations are facing growing pressure to ensure privacy, compliance, and operational teams are aligned. In this episode of Compliance Conversations, CJ Wolf sits down with healthcare attorney Debbie Cmielewski to discuss: Recent 42 CFR Part 2 updates and implementation deadlines  How enforcement expectations may evolve moving forward  Why AI vendor agreements deserve closer scrutiny  Common privacy and compliance gaps organizations overlook  Practical advice for organizations that feel overwhelmed or understaffed  The conversation also explores the real-world operational challenges providers face when implementing privacy requirements, training staff, managing vendor relationships, and balancing innovation with compliance oversight. Whether your organization is highly mature or just beginning to strengthen its privacy and compliance infrastructure, this episode offers practical insights healthcare leaders can apply immediately. Listen now to hear how compliance, legal, IT, and operational teams can work together to reduce risk in an increasingly complex healthcare environment.  ABOUT DEBBIE A. CMIELEWSKI: Debbie A. Cmielewski is a member of the Health Care Law and Corporate Practice Groups and co-chair of the Firm's Pharmaceutical Industry and Pharmacy Practice Group. Debbie has also served as a member of the Firm's Management Committee. Debbie advises and counsels health care providers, including hospital systems; physicians; providers of services to the intellectually and developmentally disabled; mental health and substance use disorder facilities; long term care facilities and home care agencies. She also advises pharmaceutical manufacturers and myriad vendors in the healthcare space. Debbie has significant experience in the representation of regulated professionals before administrative agencies in both health and non-health related professions. She also lectures frequently on health care and human resources topics and provides workplace compliance training in a variety of areas, including HIPAA and 42 CFR Part 2. Debbie previously served as Vice President, General Counsel of Armada Health Care LLC (n/k/a Asembia), where she also oversaw the compliance and human resources functions in the organization. She has over 20 years' experience as a practicing attorney, holding key positions in health care corporate law and commercial/bankruptcy litigation. Early in her legal career, Debbie served as Chief of Regulatory Affairs for the New Jersey State Division of Consumer Affairs. Debbie holds a B.B.A in Finance from Pace University, and a J.D from Seton Hall University.   ABOUT SCHENCK, PRICE, SMITH & KING: Schenck, Price, Smith & King is a full-service law firm with offices in Northern New Jersey and Manhattan, serving closely held, growing companies. For 112 years, Schenck Price has represented commercial businesses, individuals, public institutions and charitable organizations with excellence and integrity. We are proud that, in addition to their expertise and experience as legal practitioners, our attorneys have served in positions of leadership in public institutions, as well as community and charitable organizations. Founded in 1912 as a two-person law firm in Morristown, Schenck Price has entered its second century of service as a firm of 80+ attorneys, serving virtually all legal needs of businesses and individuals. Our Firm’s long history of legal excellence in the areas of health care, education, construction, trust and estate planning, corporate law, real estate, insurance defense, banking and commercial litigation, has expanded as the Firm has grown. Our areas of practice also include telecommunications, technology, environmental law, corporate governance, labor and employment law, and family law. Many of our attorneys have been recognized as leaders in their respective practice areas.  Thank you for listening! Please share, like, and subscribe.If you'd like to see more compliance and auditing content feel free to follow us on social media.LinkedInYoutubeFacebookInstagramCheck out our resource center and weekly compliance newsletter for additional compliance and auditing content from our experts.

AI is moving fast in healthcare. But adoption, trust, and safety? Those are moving slower — for good reason. Dr. Ashok Gupta has been on both sides of it. He spent years as a clinician, then built TheraNow, a virtual physical therapy platform that has supported over 70,000 patients across the US. These days he's also building AI-powered clinical documentation tools. In this episode of Compliance Conversations, Ashok joins host CJ Wolf for a candid, practical conversation about what compliance leaders need to understand about AI in clinical settings right now. You'll hear: How to spot the conditions that lead to AI errors in clinical settings Why understanding a tool's limitations matters as much as its capabilities What's ahead in healthcare technology, and how to build for it thoughtfully  Thank you for listening! Please share, like, and subscribe.If you'd like to see more compliance and auditing content feel free to follow us on social media.LinkedInYoutubeFacebookInstagramCheck out our resource center and weekly compliance newsletter for additional compliance and auditing content from our experts.

Each year, conferences like HCCA’s Compliance Institute and AAPC’s HEALTHCON offer more than education. They provide a window into where compliance is headed—what regulators are prioritizing, how risks are evolving, and what organizations need to prepare for next. In this episode of Compliance Conversations, CJ Wolf and Brian Burton share their perspective on what to watch this conference season, including emerging trends, regulatory insights, and practical strategies for strengthening your program. You’ll hear about: The value of direct insight from OIG, CMS, and other regulators  How AI is changing the compliance landscape  Why proactive audit planning is becoming essential  Practical ways to improve audit execution using project management techniques  Thank you for listening! Please share, like, and subscribe.If you'd like to see more compliance and auditing content feel free to follow us on social media.LinkedInYoutubeFacebookInstagramCheck out our resource center and weekly compliance newsletter for additional compliance and auditing content from our experts.

Vendors and business associates are critical to healthcare operations—but they also introduce significant compliance, privacy, and security risks. In this episode of Compliance Conversations, CJ Wolf and Susan Walberg break down what organizations often miss when it comes to vendor oversight—and why those gaps matter more than ever. What You’ll Learn: Why compliance must be involved in vendor selection and strategy—not just contracts  The biggest gaps in vendor agreements (and how to fix them)  How to conduct meaningful due diligence beyond surface-level checks  What to look for in privacy, security, and data use provisions  How to monitor vendors without overextending resources Interested in a deeper dive? You can read Susan’s recent article on vendor compliance here.  Thank you for listening! Please share, like, and subscribe.If you'd like to see more compliance and auditing content feel free to follow us on social media.LinkedInYoutubeFacebookInstagramCheck out our resource center and weekly compliance newsletter for additional compliance and auditing content from our experts.

The CRUSH initiative (Comprehensive Regulations to Uncover Suspicious Healthcare) is more than just another acronym, it’s a signal of where healthcare regulation is headed next.  In this episode of Compliance Conversations, CJ Wolf is joined by Lisa Taylor, a seasoned Chief Compliance Officer, to break down what this request for information (RFI) means for organizations today—and what it could become tomorrow. What You’ll Learn Why RFIs matter and how they shape future rules  The government’s focus areas, including AI and data analytics  The operational impact on hospitals and health systems  Where compliance programs may need to evolve  How to engage proactively instead of reactively  Why It Matters With increasing pressure on fraud detection and payment integrity, compliance programs are at the center of a rapidly changing landscape. Understanding CRUSH now helps you prepare for what’s next. Resources: June 6, 2025 Presidential Memorandum - https://www.whitehouse.gov/presidential-actions/2025/06/eliminating-waste-fraud-and-abuse-in-medicaid/  Request for Information for CRUSH - https://www.federalregister.gov/documents/2026/02/27/2026-03968/request-for-information-rfi-related-to-comprehensive-regulations-to-uncover-suspicious-healthcare  Thank you for listening! Please share, like, and subscribe.If you'd like to see more compliance and auditing content feel free to follow us on social media.LinkedInYoutubeFacebookInstagramCheck out our resource center and weekly compliance newsletter for additional compliance and auditing content from our experts.

Telehealth remains one of the most dynamic and closely watched areas in healthcare compliance. In this episode of Compliance Conversations, CJ Wolf welcomes back telehealth compliance expert Keisha Wilson, founder of KW Advanced Consulting, for a timely discussion on the latest telehealth developments, including newly extended flexibilities, evolving documentation requirements, and the audit risks organizations cannot afford to ignore. With key telehealth provisions now extended through December 31, 2027, many providers may feel a sense of relief. But as Keisha explains, the extension of flexibilities does not eliminate the complexity. In many ways, it raises the stakes for compliance teams, coders, administrators, and revenue cycle leaders who need to ensure their organizations are using telehealth appropriately, documenting correctly, and staying aligned with changing payer and regulatory expectations. During the conversation, CJ and Keisha break down what the latest legislative changes mean in practical terms, including the continued use of the patient’s home for telehealth services, ongoing allowances for audio-only services in certain situations, and continued telehealth participation for FQHCs, RHCs, physical therapists, occupational therapists, speech-language pathologists, and audiologists. They also discuss where organizations may be most vulnerable, including: Documentation requirements for audio-only visits Appropriate use of modifiers and place of service codes Payer-specific and state-specific telehealth variation Behavioral health in-person visit requirement delays Virtual direct supervision and the compliance concerns surrounding Incident To billing Remote patient monitoring oversight issues Medical necessity concerns Fraud, waste, and abuse risks in telehealth delivery Keisha also shares practical recommendations for staying current, including which websites and resources compliance leaders should monitor as telehealth rules continue to evolve across Medicare, Medicaid, commercial payers, and state laws. If your organization provides telehealth services, this episode offers a valuable look at the operational and compliance details that deserve closer attention in 2026. Episode Resources: KW Advanced Consulting:  https://kwadvancedconsulting.com/telehealth-in-2026-and-beyond-what-the-latest-extensions-mean-for-healthcare/ Center for Connected Health Policy (CCHP):  https://www.cchpca.org/ American Telemedicine Association (ATA): https://www.americantelemed.org/ CMS:  https://www.cms.gov/medicare/coverage/telehealth HHS: https://www.hhs.gov/press-room/dea-telemedicine-extension-2026.html , https://telehealth.hhs.gov/providers/telehealth-policy/telehealth-policy-updates Caregiver Resource Hub: https://byhersidefaithfulcaregiver.com/  Thank you for listening! Please share, like, and subscribe.If you'd like to see more compliance and auditing content feel free to follow us on social media.LinkedInYoutubeFacebookInstagramCheck out our resource center and weekly compliance newsletter for additional compliance and auditing content from our experts.

Medical decision making shouldn’t feel like a coding puzzle, and your documentation shouldn’t read like a template checklist. In this episode, CJ Wolf is joined by Amanda Reikowsky, a coding quality audit & education supervisor at Hackensack Meridian Health and founder of CodeWise Solutions, LLC, to break down what MDM documentation should look like today—and why the best notes focus on the story and rationale behind care. What you’ll learn The most common MDM documentation gaps auditors see, and how to fix them How to connect diagnoses to plans so each condition is clearly managed Why “reviewed results” or “discussed with specialist” isn’t enough (and what to add) How to document risk based on patient-specific factors (COPD, CKD, diabetes, pregnancy, and more) How the E/M guideline shift changed what matters, and why templates need to catch up Why this matters Over-documentation and cloned notes don’t just create compliance risk—they make it harder for clinicians to find what’s relevant, and harder for coders and auditors to validate the level of service. Clear clinical reasoning protects patient care, supports accurate coding, and strengthens defensibility. Reach out to Amanda at [email protected] or visit her website at www.codewisesolutionsllc.com.  Thank you for listening! Please share, like, and subscribe.If you'd like to see more compliance and auditing content feel free to follow us on social media.LinkedInYoutubeFacebookInstagramCheck out our resource center and weekly compliance newsletter for additional compliance and auditing content from our experts.

Mentorship can be the difference between feeling stuck and building a career with real direction. In this episode of Compliance Conversations, CJ Wolf is joined by Barbara Shaw, a seasoned healthcare coding, auditing, and risk adjustment professional who has made mentoring new coders a meaningful part of her work, especially through her involvement as an AAPC local chapter officer. Barbara shares why mentorship is so rewarding, how she structures mentoring relationships in a realistic way, and what she’s learned about helping people move from “interested” to “ready.” What you’ll learn How mentorship actually works: what to expect from mentor/mentee check-ins and career guidance Where to find support: why AAPC chapters are an underrated resource for new coders Choosing your next step: credentials, specialties, and how to decide what’s worth pursuing Remote work expectations: the accountability and discipline required to thrive long-term Sustaining professional growth: avoiding plateaus by taking ownership of development—and giving back About Barbara Shaw Barbara Shaw brings decades of hands-on experience across coding, auditing, and population health. She spent 20 years working in OB/GYN practices and later went on to build and lead a risk adjustment auditing team. During her time at Duke University, she used Healthicity to support audit workflows, with a focus on OB/GYN, emergency department, and risk adjustment audits. Her career has also included work with several Medicare Advantage payers and ACOs. Today, she is part of the team at Mass General Brigham, where she is happy to be back in Population Health, focusing on outpatient CDI. Barbara is a strong supporter of AAPC and is actively involved at the chapter level. She frequently speaks at local chapter meetings and currently serves her local chapter as the education officer, helping support and mentor the next generation of coding professionals.  Thank you for listening! Please share, like, and subscribe.If you'd like to see more compliance and auditing content feel free to follow us on social media.LinkedInYoutubeFacebookInstagramCheck out our resource center and weekly compliance newsletter for additional compliance and auditing content from our experts.

Compliance risks don’t always start in obvious places—and that’s what makes them dangerous. In this episode of Compliance Conversations, host CJ Wolf talks with Amy Bailey of HBE Advisors about the real-world compliance failures she sees most often across hospitals and physician groups nationwide. Drawing on decades of experience with investigations, self-disclosures, and Corporate Integrity Agreements, Amy shares practical insights compliance leaders can apply immediately. In this episode, you’ll learn: Where compliance blind spots commonly occur—and why frontline teams matter How missed or misunderstood payer correspondence can escalate into enforcement actions What works (and what doesn’t) when gaining physician buy-in Why traditional audit approaches miss documentation and behavior risks Key enforcement and audit trends shaping compliance priorities today Whether you’re managing audits, responding to payer inquiries, or building a proactive compliance strategy, this episode delivers candid insights you won’t find in a policy manual. You can also see Amy at the upcoming HCCA 30th Annual Compliance Institute where she’ll be presenting  “Bridging Boundaries: Strengthening Collaboration Between Healthcare Organizations, Independent Review Organizations, and OIG Monitors.”  Thank you for listening! Please share, like, and subscribe.If you'd like to see more compliance and auditing content feel free to follow us on social media.LinkedInYoutubeFacebookInstagramCheck out our resource center and weekly compliance newsletter for additional compliance and auditing content from our experts.

Refunds and overpayments sit at the intersection of compliance, finance, and legal risk. In this episode of Compliance Conversations, CJ Wolf speaks with David Glaser, healthcare attorney and in Fredrikson’s Health Law group, about how organizations can navigate refund decisions with greater confidence and clarity. Drawing from years of advising providers nationwide, David explains: The difference between binding law and non-binding guidance Navigating refunds How far Medicare can actually look back on claims This practical, real-world conversation is essential listening for compliance, audit, revenue integrity, and legal professionals.  Thank you for listening! Please share, like, and subscribe.If you'd like to see more compliance and auditing content feel free to follow us on social media.LinkedInYoutubeFacebookInstagramCheck out our resource center and weekly compliance newsletter for additional compliance and auditing content from our experts.

In this episode of Compliance Conversations, host CJ Wolf sits down with Jill Fallows Macaluso, Corporate Vice President and Chief Compliance Officer at Novo Nordisk, to explore how ethical culture, psychological safety, and empowered risk-taking can transform compliance from a regulatory obligation into a strategic asset. Jill shares insights from more than two decades in a highly regulated industry, discussing how organizations can move beyond check-the-box compliance and build cultures that foster trust, innovation, and sustainable business results. In this episode, you’ll learn: Why ethical culture consistently correlates with stronger business performance How psychological safety strengthens both compliance and innovation What “risk-based decision-making” really looks like in practice How leaders can empower teams without sacrificing accountability Why inclusion is foundational to ethical, high-performing organizations Whether you’re a compliance officer, legal leader, or executive, this conversation offers practical guidance for building a culture where people feel safe to speak up, take smart risks, and do the right thing.  Thank you for listening! Please share, like, and subscribe.If you'd like to see more compliance and auditing content feel free to follow us on social media.LinkedInYoutubeFacebookInstagramCheck out our resource center and weekly compliance newsletter for additional compliance and auditing content from our experts.

In this episode of Compliance Conversations, healthcare compliance expert Jessica Zeff, the Founder & CEO of Simply Compliance, shares real-world insight into why structured, electronic case management is essential for demonstrating compliance, managing risk, and responding efficiently to audits and investigations. What You’ll Learn What compliance case management actually looks like in practice Why consistency and categorization matter for risk analysis Common mistakes organizations make when handling compliance cases How case management supports audits, investigations, and leadership reporting Why even basic systems are better than none Who Should Listen Compliance officers, privacy professionals, legal teams, audit teams, and anyone responsible for managing compliance or incident investigations. About Jessica Zeff: Jessica Zeff is the CEO & Founder of Simply Compliance, a healthcare compliance consulting firm specializing in regulatory compliance, privacy, and risk management. A strategic leader with nearly 25 years of experience, Jessica is skilled in building compliance programs, translating complex regulations into actionable strategies, and mitigating compliance risks through proactive program development and data-driven decision making. Jessica is also an experienced speaker and educator, having delivered presentations and webinars for the Health Care Compliance Association (HCCA) and numerous healthcare partners on topics ranging from privacy and data security to compliance risk management. She is the creator and host of the Compliance Deconstructed podcast, where she explores practical approaches to healthcare compliance, and the author of the popular blog series Olivia’s Compliance Diaries, which brings real-world compliance lessons to life through storytelling.  Thank you for listening! Please share, like, and subscribe.If you'd like to see more compliance and auditing content feel free to follow us on social media.LinkedInYoutubeFacebookInstagramCheck out our resource center and weekly compliance newsletter for additional compliance and auditing content from our experts.

Critical care coding isn’t just about time at the bedside. In this new episode of Compliance Conversations, CJ Wolf and Maya Turner discuss how recent CPT® guidance expands what’s billable, from telehealth consults to pre-arrival care coordination. Key Takeaways: When critical care starts (and where it doesn’t) CPT® vs. CMS Guidance— and what happens when they differ How to handle transport, telehealth, and overlapping E/M services Ways to help providers feel recognized — even when the answer is “no” Here is a link to the OIG audits referenced in the episode. You can read Maya’s book, Billable: The Revenue Cycle Professional's Guide to Branding, for more insights.  Thank you for listening! Please share, like, and subscribe.If you'd like to see more compliance and auditing content feel free to follow us on social media.LinkedInYoutubeFacebookInstagramCheck out our resource center and weekly compliance newsletter for additional compliance and auditing content from our experts.

As federal deadlines, a shutdown, and stalled legislation churn the rules, telehealth coverage looks different across Medicare, Medicaid, and commercial payers. In this episode, CJ Wolf, MD and Keisha Wilson (Founder/CEO of KW Advanced Consulting) breaks down what’s actually covered right now—and how to stay compliant without disrupting care. You’ll learn: Where Medicare telehealth reverted and where behavioral health remains an exception How to use ABNs correctly (and why timing is everything) Why payer & state policies diverge—and how to operationalize a payer matrix The must-have front desk workflow: eligibility, POS, modifiers, codes HIPAA platform requirements and documentation tips Who should listen: Compliance leaders, revenue cycle teams, practice managers, telehealth program leads, behavioral health providers. Recorded: October 30, 2025 (details current as of this date) You can also tune into our previous Compliance Conversations episode with Keisha, The ABCs of ABNs.  Thank you for listening! Please share, like, and subscribe.If you'd like to see more compliance and auditing content feel free to follow us on social media.LinkedInYoutubeFacebookInstagramCheck out our resource center and weekly compliance newsletter for additional compliance and auditing content from our experts.

Headlines change. Your mandate doesn’t.  In this Compliance Conversations episode, CJ Wolf, MD, and Brian Burton, Healthicity Chief Compliance & Privacy Officer, cut through the noise to show how to keep programs objective, patient-first, and audit-ready—even amid shutdowns, delayed rules, and shifting priorities. What you’ll learn Enforcement reality check: Why fraud, waste, and abuse actions keep moving—and how to prepare. Backlogs & timing: Practical impacts of shutdowns on OCR complaints, self-disclosures, and CIAs. Medicare Advantage focus: Signals that MA audits are scaling and what that means for you. Telehealth decisions: “Hold or bill?” Cash-flow, denial risk, and documenting your rationale.  Thank you for listening! Please share, like, and subscribe.If you'd like to see more compliance and auditing content feel free to follow us on social media.LinkedInYoutubeFacebookInstagramCheck out our resource center and weekly compliance newsletter for additional compliance and auditing content from our experts.

CJ Wolf sits down with Jacklyn DeMar (President and Chief Executive Officer of The Anti-Fraud Coalition) and Elin Kunz (testifying expert and former whistleblower) to explore the False Claims Act (FCA), the realities of retaliation, and how compliance programs move from “paper tiger” to practice. What You’ll Learn FCA in plain English: How cases start, why most settle, and the government’s role Real-world whistleblowing: Documenting concerns, building evidence, and choosing counsel Anti-retaliation basics: What protections exist and how to think about timing Stronger programs: Closing gaps between contracting, coding, and monitoring Guests Jacklyn DeMar, President & CEO, Anti-Fraud Coalition Elin Kunz, coding/billing expert witness; former whistleblower Resources from The Anti-Fraud Coalition https://www.taf.org/  https://www.taf.org/podcast/  https://www.taf.org/latest-news/   Thank you for listening! Please share, like, and subscribe.If you'd like to see more compliance and auditing content feel free to follow us on social media.LinkedInYoutubeFacebookInstagramCheck out our resource center and weekly compliance newsletter for additional compliance and auditing content from our experts.

Artificial intelligence is no longer a future concept; it’s here, embedded in healthcare systems, vendor platforms, and even your day-to-day operations. But with innovation comes risk. In this episode of Compliance Conversations, host CJ Wolf, MD, talks with Santosh Kaveti, Founder and CEO of ProArch, about: Emerging AI Risks: From shadow AI to model drift Governance & Education: Why AI literacy across your workforce matters Explainability: The critical requirement compliance leaders should insist on Future-Proofing: How to prepare your compliance program for the next wave of AI innovation Get actionable insights to help you stay ahead of regulation, strengthen data security, and keep patient safety at the center of your strategy.  Thank you for listening! Please share, like, and subscribe.If you'd like to see more compliance and auditing content feel free to follow us on social media.LinkedInYoutubeFacebookInstagramCheck out our resource center and weekly compliance newsletter for additional compliance and auditing content from our experts.

Artificial intelligence is transforming healthcare, from ambient documentation to virtual assistants. But as opportunities grow, so do risks. How can compliance and security leaders enable innovation while ensuring patient safety and regulatory alignment? In this episode of Compliance Conversations, CJ Wolf talks with Walter Haydock, former national security advisor and founder of StackAware. Together they unpack: ISO 42001: The emerging “SOC 2 for AI” standard The balance between AI innovation and patient safety Shadow AI and the risks of unmonitored deployments Key U.S. and EU regulations shaping AI in healthcare Resources: You can find additional resources from Walter Haydock below: Free in-person risk assessment for healthcare CxOs Free email course on ISO 42001 Blog Article: How to deploy high-risk artificial intelligence systems and still comply with Colorado SB-205  Thank you for listening! Please share, like, and subscribe.If you'd like to see more compliance and auditing content feel free to follow us on social media.LinkedInYoutubeFacebookInstagramCheck out our resource center and weekly compliance newsletter for additional compliance and auditing content from our experts.

In this episode of Compliance Conversations, CJ Wolf sits down with Melinda Hawk, recognized as Healthicity’s Revenue Cycle Manager of the Year, to talk about her career journey, leadership lessons, and the power of collaboration between compliance and revenue cycle teams. What You’ll Learn: Insights from 35 years in home health and hospice The importance of compliance-revenue cycle communication Strategies to mentor and prepare the next generation Practical ways to stay current with regulatory updates  Thank you for listening! Please share, like, and subscribe.If you'd like to see more compliance and auditing content feel free to follow us on social media.LinkedInYoutubeFacebookInstagramCheck out our resource center and weekly compliance newsletter for additional compliance and auditing content from our experts.

In this episode of Compliance Conversations, CJ Wolf speaks with Eddie Qureshi, CEO of Rainfall Health, to break down the new CMS TEAM Model—and what it means for your hospital’s future. What You’ll Learn: Which hospitals are impacted (and how to check the list) Why CMS is shifting post-acute accountability to hospitals What compliant documentation, coordination, and reporting looks like How AI and integrated tools can make all the difference  Thank you for listening! Please share, like, and subscribe.If you'd like to see more compliance and auditing content feel free to follow us on social media.LinkedInYoutubeFacebookInstagramCheck out our resource center and weekly compliance newsletter for additional compliance and auditing content from our experts.

In this episode of Compliance Conversations, CJ Wolf, MD, is joined by Rui Ribeiro, Co-Founder and CEO of Jscrambler, to dive into the client-side security threats healthcare organizations often overlook.  From patient portals to embedded video players, Rui explains how browser-based vulnerabilities are creating new risks that healthcare teams need to be aware of. You’ll learn: Why client-side protection could be the next step in HIPAA evolution How healthcare can follow the lead of PCI DSS standards The critical role of Zero-Trust Architecture and JavaScript integrity Simple ways to start reducing hidden compliance risks today  Thank you for listening! Please share, like, and subscribe.If you'd like to see more compliance and auditing content feel free to follow us on social media.LinkedInYoutubeFacebookInstagramCheck out our resource center and weekly compliance newsletter for additional compliance and auditing content from our experts.

In this powerful episode of Compliance Conversations, CJ Wolf interviews Dave Cardelle, RPh, Chief Strategy Officer at AMS, who shares practical insights on CMS’s shifting enforcement landscape and the real-world impact of hospital price transparency. What You’ll Learn: What makes a machine-readable file compliant (and what doesn’t) Why average negotiated rates are the most challenging—and most scrutinized—data element How automation and governance can save your hospital from costly penalties What CMS is planning next for labs, diagnostics, and even physician services You can also listen to Dave’s previous Compliance Conversations interview on payment integrity considerations from a payer’s perspective.  Thank you for listening! Please share, like, and subscribe.If you'd like to see more compliance and auditing content feel free to follow us on social media.LinkedInYoutubeFacebookInstagramCheck out our resource center and weekly compliance newsletter for additional compliance and auditing content from our experts.

In this episode of Compliance Conversations, CJ Wolf welcomes back Maya Turner, a nationally recognized expert in medical coding and consulting. Together, they explore how value-based care and ancillary services are transforming provider reimbursement, especially in a telehealth-enabled world. You'll learn: What value-based care really means (and why it matters) The billing codes you may be overlooking How to streamline documentation and consent Why ancillary staff and virtual care models are key to success What telehealth's future means for your billing strategy Whether you're already billing for chronic care or just starting to explore value-based models, this episode will help you uncover new revenue opportunities—without adding more hours to your day.  Thank you for listening! Please share, like, and subscribe.If you'd like to see more compliance and auditing content feel free to follow us on social media.LinkedInYoutubeFacebookInstagramCheck out our resource center and weekly compliance newsletter for additional compliance and auditing content from our experts.

Aaron Burnett, CEO of Wheelhouse Digital Marketing Group, joins CJ Wolf to decode the complex world of healthcare marketing, privacy laws, and risk mitigation. What You’ll Learn: The evolving legal landscape: OCR guidance, AHA lawsuits, FTC enforcement Why third-party tracking is out—and what to use instead How to collaborate across marketing, IT, and compliance What “data destiny” really means for covered entities Emerging solutions like media mix modeling and private analytics Who Should Listen:  Compliance officers, healthcare marketers, IT leaders, and anyone responsible for HIPAA risk management in a digital world.  Thank you for listening! Please share, like, and subscribe.If you'd like to see more compliance and auditing content feel free to follow us on social media.LinkedInYoutubeFacebookInstagramCheck out our resource center and weekly compliance newsletter for additional compliance and auditing content from our experts.

Join Healthicity’s CJ Wolf and Compliagent’s Paige Pennington as they break down the first industry-specific compliance program guidance (ICPG) from the OIG—focused entirely on skilled nursing facilities. Key Takeaways: Why the OIG prioritized SNFs Top risk areas flagged in the new guidance The evolving role of compliance in quality and contracting Actionable steps for aligning your risk assessments and audit plans This episode is a must-listen for compliance professionals navigating the post-acute space.  You can reach out to Paige at  [email protected] or via phone at 310-736-4972.  Thank you for listening! Please share, like, and subscribe.If you'd like to see more compliance and auditing content feel free to follow us on social media.LinkedInYoutubeFacebookInstagramCheck out our resource center and weekly compliance newsletter for additional compliance and auditing content from our experts.

In this episode of Compliance Conversations, Anurag Lal, CEO of NetSfere and former U.S. broadband official, explains why healthcare remains the top target for cybercriminals—and what you can do about it. What You’ll Learn: The evolving tactics behind healthcare cyberattacks How to identify insecure communication practices within your org What true end-to-end encryption really means Why patient care and cybersecurity are more connected than you think Tune in now and learn how to protect your organization from today’s cyber threats.  Thank you for listening! Please share, like, and subscribe.If you'd like to see more compliance and auditing content feel free to follow us on social media.LinkedInYoutubeFacebookInstagramCheck out our resource center and weekly compliance newsletter for additional compliance and auditing content from our experts.

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 Thank you for listening! Please share, like, and subscribe.If you'd like to see more compliance and auditing content feel free to follow us on social media.LinkedInYoutubeFacebookInstagramCheck out our resource center and weekly compliance newsletter for additional compliance and auditing content from our experts.

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 [email protected]. Thank you for listening! Please share, like, and subscribe.If you'd like to see more compliance and auditing content feel free to follow us on social media.LinkedInYoutubeFacebookInstagramCheck out our resource center and weekly compliance newsletter for additional compliance and auditing content from our experts.

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 Thank you for listening! Please share, like, and subscribe.If you'd like to see more compliance and auditing content feel free to follow us on social media.LinkedInYoutubeFacebookInstagramCheck out our resource center and weekly compliance newsletter for additional compliance and auditing content from our experts.

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 Thank you for listening! Please share, like, and subscribe.If you'd like to see more compliance and auditing content feel free to follow us on social media.LinkedInYoutubeFacebookInstagramCheck out our resource center and weekly compliance newsletter for additional compliance and auditing content from our experts.

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. Thank you for listening! Please share, like, and subscribe.If you'd like to see more compliance and auditing content feel free to follow us on social media.LinkedInYoutubeFacebookInstagramCheck out our resource center and weekly compliance newsletter for additional compliance and auditing content from our experts.

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 Thank you for listening! Please share, like, and subscribe.If you'd like to see more compliance and auditing content feel free to follow us on social media.LinkedInYoutubeFacebookInstagramCheck out our resource center and weekly compliance newsletter for additional compliance and auditing content from our experts.

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. Thank you for listening! Please share, like, and subscribe.If you'd like to see more compliance and auditing content feel free to follow us on social media.LinkedInYoutubeFacebookInstagramCheck out our resource center and weekly compliance newsletter for additional compliance and auditing content from our experts.

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.Thank you for listening! Please share, like, and subscribe.If you'd like to see more compliance and auditing content feel free to follow us on social media.LinkedInYoutubeFacebookInstagramCheck out our resource center and weekly compliance newsletter for additional compliance and auditing content from our experts.

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 [email protected] you for listening! Please share, like, and subscribe.If you'd like to see more compliance and auditing content feel free to follow us on social media.LinkedInYoutubeFacebookInstagramCheck out our resource center and weekly compliance newsletter for additional compliance and auditing content from our experts.

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.Thank you for listening! Please share, like, and subscribe.If you'd like to see more compliance and auditing content feel free to follow us on social media.LinkedInYoutubeFacebookInstagramCheck out our resource center and weekly compliance newsletter for additional compliance and auditing content from our experts.

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.Thank you for listening! Please share, like, and subscribe.If you'd like to see more compliance and auditing content feel free to follow us on social media.LinkedInYoutubeFacebookInstagramCheck out our resource center and weekly compliance newsletter for additional compliance and auditing content from our experts.

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. -Thank you for listening! Please share, like, and subscribe.If you'd like to see more compliance and auditing content feel free to follow us on social media.LinkedInYoutubeFacebookInstagramCheck out our resource center and weekly compliance newsletter for additional compliance and auditing content from our experts.

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. Thank you for listening! Please share, like, and subscribe.If you'd like to see more compliance and auditing content feel free to follow us on social media.LinkedInYoutubeFacebookInstagramCheck out our resource center and weekly compliance newsletter for additional compliance and auditing content from our experts.

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. Thank you for listening! Please share, like, and subscribe.If you'd like to see more compliance and auditing content feel free to follow us on social media.LinkedInYoutubeFacebookInstagramCheck out our resource center and weekly compliance newsletter for additional compliance and auditing content from our experts.

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!Thank you for listening! Please share, like, and subscribe.If you'd like to see more compliance and auditing content feel free to follow us on social media.LinkedInYoutubeFacebookInstagramCheck out our resource center and weekly compliance newsletter for additional compliance and auditing content from our experts.

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 depositionsThank you for listening! Please share, like, and subscribe.If you'd like to see more compliance and auditing content feel free to follow us on social media.LinkedInYoutubeFacebookInstagramCheck out our resource center and weekly compliance newsletter for additional compliance and auditing content from our experts.

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.Thank you for listening! Please share, like, and subscribe.If you'd like to see more compliance and auditing content feel free to follow us on social media.LinkedInYoutubeFacebookInstagramCheck out our resource center and weekly compliance newsletter for additional compliance and auditing content from our experts.

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!Thank you for listening! Please share, like, and subscribe.If you'd like to see more compliance and auditing content feel free to follow us on social media.LinkedInYoutubeFacebookInstagramCheck out our resource center and weekly compliance newsletter for additional compliance and auditing content from our experts.

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).Thank you for listening! Please share, like, and subscribe.If you'd like to see more compliance and auditing content feel free to follow us on social media.LinkedInYoutubeFacebookInstagramCheck out our resource center and weekly compliance newsletter for additional compliance and auditing content from our experts.

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.Thank you for listening! Please share, like, and subscribe.If you'd like to see more compliance and auditing content feel free to follow us on social media.LinkedInYoutubeFacebookInstagramCheck out our resource center and weekly compliance newsletter for additional compliance and auditing content from our experts.

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.Thank you for listening! Please share, like, and subscribe.If you'd like to see more compliance and auditing content feel free to follow us on social media.LinkedInYoutubeFacebookInstagramCheck out our resource center and weekly compliance newsletter for additional compliance and auditing content from our experts.

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. Thank you for listening! Please share, like, and subscribe.If you'd like to see more compliance and auditing content feel free to follow us on social media.LinkedInYoutubeFacebookInstagramCheck out our resource center and weekly compliance newsletter for additional compliance and auditing content from our experts.

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.Thank you for listening! Please share, like, and subscribe.If you'd like to see more compliance and auditing content feel free to follow us on social media.LinkedInYoutubeFacebookInstagramCheck out our resource center and weekly compliance newsletter for additional compliance and auditing content from our experts.