Compliance Conversations By Healthicity

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 fo

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 complian

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

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 te

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 c

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 d

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 wo

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. LinkedIn Youtube Facebook Instagram Check 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 off

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 wi

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. LinkedIn Youtube Facebook Instagram Check 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!

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. LinkedIn Youtube Facebook Instagram Check out our resource center and weekly compliance newsletter for additional compliance and auditing

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

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. LinkedIn Youtube Facebook Instagram Check out our resource center and weekly compliance newsletter for addition

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

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. LinkedIn Youtube Facebook Instagram Check 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. LinkedIn Youtube Facebook Instagram Check 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. LinkedIn Youtube Facebook Instagram Check 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. LinkedIn Youtube Facebook Instagram Check out our resource center and weekly compliance newsletter for additional compliance and auditing conte