The Compliance Guy

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 “Cul

The Compliance Guy is a business podcast hosted by Sean M. Weiss, with 417 episodes on record and a Required Pod Score of 80.

Sean M. Weiss hosts The Compliance Guy, a business show with 417 episodes published.

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  Episode #439

  Season 10 - Episode 439 - #TerryTuesday - RAC Audits, TPE Reviews, and Why Ignoring Requests Can Hurt

  Sep 14, 202624 minS10

  Sean and Terry cover a practical warning for providers and billing teams: do not ignore audit letters, documentation requests, or compliance notices just because the language says you can if you agree. They also break down how RAC and TPE reviews work, why silence can be read as weakness, and why timely responses matter even when you think the issue is minor. Main topics In this episode, Sean Weiss and Terry Fletcher discuss why before you appeal anything, you need to confirm it is actually appealable and supported by the record. Terry shares what she is seeing with RAC audits and TPE reviews picking up again, especially the habit of practices ignoring letters that invite them to “ignore this if you agree.” Sean explains the difference between automated RAC review and complex review, including the role of algorithmic flagging and human review. They stress that silence can be used against a practice later, especially if auditors expand the scope because no response was made. The conversation covers why downcoding without reviewing the medical record is not something auditors should do casually. Terry and Sean both warn that response deadlines matter, and putting audit requests in a tray to deal with later can lead to denials and takebacks. Sean explains his ethical standard for appeal work: just because he can take a case does not mean he should. Terry gives a real-time cybersecurity alert about a reported eAssist breach and urges immediate password and HIPAA review. The episode closes with a strong reminder to treat HIPAA security, privacy, and documentation standards seriously.

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  Episode #438

  Season 10 - Episode 438 - #TerryTuesday - Stay in Your Lane: The Advice Healthcare Consultants Ignore

  Sep 11, 202633 minS10

  In this episode Sean and Terry take on a very real issue plaguing healthcare! Our dynamic duo in this episode focuses on a deceptively simple idea with high stakes in healthcare and consulting: verify claims before you trust them. Sean and Terry discuss why vetting staff, contractors, and consultants matters just as much as checking credentials on a resume. They connect that idea to compliance risk, real-world billing mistakes, and the importance of knowing your lane. Why practices should vet all staff—not just providers—including medical assistants, revenue cycle staff, and anyone with patient or financial access. The compliance consequences of hiring an excluded individual, including mandatory reporting and possible repayment to federal payer programs. Why people can look qualified on paper but lack the practical skills required for the job. The difference between credentials and real-world competence. How consultants can damage their credibility by misrepresenting their background or working outside their expertise. Why honesty about professional limitations builds more trust than pretending to know everything. The importance of practical testing during the hiring process. Why consultants should refer work out when a matter falls outside their lane. How strong arguments can still produce unexpected outcomes in administrative law judge hearings. The central lesson: know your lane, stay in your lane, and verify the lane of everyone you rely on. Key Topics Why practices should vet all staff—not just providers—including medical assistants, revenue cycle staff, and anyone with patient or financial access. The compliance consequences of hiring an excluded individual, including mandatory reporting and possible repayment to federal payer programs. Why people can look qualified on paper but lack the practical skills required for the job. The difference between credentials and real-world competence. How consultants can damage their credibility by misrepresenting their background or working outside their expertise. Why honesty about professional limitations builds more trust than pretending to know everything. The importance of practical testing during the hiring process. Why consultants should refer work out when a matter falls outside their lane. How strong arguments can still produce unexpected outcomes in administrative law judge hearings. The central lesson: know your lane, stay in your lane, and verify the lane of everyone you rely on.

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  Episode #437

  Season 10 - Episode 437 - #TerryTuesday - Proposed CMS Changes 2027

  Aug 27, 202631 minS10

  Summary In this episode, Terry Fletcher and Sean Weiss discuss the latest Medicare final rule, its implications for healthcare providers, and how stakeholders can engage in the comment process to influence policy changes. They explore key topics like telehealth flexibilities, modifiers, and upcoming payment adjustments for 2027. Key Topics Medicare final rule published on July 14th Comment period ending September 14th, 2023 Telehealth flexibilities extended until 2028 Modifiers BB and BC for incident two services Proposed payment reductions for multiple procedures Importance of stakeholder comments in policy shaping Impact of Medicare policies on commercial payers G2211 complexity add-on code changes Future implications for physician billing and RVUs Stakeholders must comment by September 14 to influence policy. Telehealth flexibilities are extended until the end of 2027. Modifiers BB and BC will identify platform ownership and incident two services. Proposed rules include payment reductions for multiple procedures. Engaging with professional societies amplifies advocacy efforts. Takeaways Stakeholders must comment by September 14 to influence policy. Telehealth flexibilities are extended until the end of 2027. Modifiers BB and BC will identify platform ownership and incident two services. Proposed rules include payment reductions for multiple procedures. Engaging with professional societies amplifies advocacy efforts.

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  The Compliance Guy

  Season 10 - Episode 436 - #TerryTuesday - The Complexities of Lifestyle Medicine

  Aug 19, 202626 min

  In this episode, Terry Fletcher and Sean discuss the complexities of lifestyle medicine, insurance reimbursement, and the importance of understanding what services are covered. They explore how providers can navigate insurance limitations while advocating for patient care. Key Topics Insurance reimbursement for lifestyle medicine Medical necessity and insurance coverage Billing and coding challenges in healthcare Advocating for patient services outside insurance coverage Impact of diagnosis on service reimbursement Legal considerations in billing non-covered services Strategies to appeal insurance denials The role of preventive and lifestyle services in healthcare Limitations of insurance plans for wellness services Provider-patient communication about costs and coverage

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  Episode #435

  Season 10 - Episode 435 - #TerryTuesday: Incident Two, Split Shared Visits, and Why Medical Student Documentation Cannot Be Billed

  Aug 19, 202629 minS10

  This episode focuses on a compliance issue that keeps tripping up practices: incident to billing, split shared visits, and the limits of what medical students can document. Sean M Weiss and Terry walk through where the rules apply, where they do not, and why using student documentation to support a billable service is not allowed. Terry also shares a real world question from recent presentations that pushed the conversation into medical student use, supervisory rules, and the risk of stretching billing frameworks beyond their intent. The discussion closes with a cautionary look at fraud, waste, and abuse, plus the importance of proper credentialing and supervision. Key topics Incident to vs. split shared visits What counts as a shared service Medical student documentation is not billable What a teaching physician may use Why cut and paste is not allowed Students are for education, not revenue Employment and supervision requirements still matter Telehealth supervision and ancillary services Fraud, waste, and abuse concerns

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