Our compliance expert, CJ Wold M.D., spoke with two Reiki practitioners, Justin Larsen and Julie Crane R.N., about the history, science, and practical uses of Reiki.

Integrative Health For Compliance Officers: Understanding Energy Healing and Reiki

When it comes to compliance for mental health services, you’ve got to pay extra attention to your billing and coding. Learn a brief history of Psychotherapy and compliance risks associated with therapy services.

All Things Therapy and Compliance Risks

For an honest and informative dialogue on what it's really like to spend your days in compliance. This episode is for folks looking for a new career and seasoned professionals alike. In this episode, we cover:  

- A snapshot of a compliance officer’s unpredictable day 
- Career regrets and wisdom gained 
- Tips to help you understand if compliance is right for you

Compliance Pathways Part 3: Regrets, Redo's, and the Realities of a Compliance Career

The compliance and coding worlds are filled with acronyms – and we’ve got another one for you: CDI. That stands for Clinical Documentation Improvement, and it’s a crucial piece of the healthcare puzzle. 

We invited Joanne Spethman, a Coding, CDI, and HIM Consultant, to share insights from her 30+ year career in inpatient and professional coding, CDI and HCC auditing on our latest episode of Compliance Conversations.

Clinical Documentation Improvement – What is it and Why is it so Important?

If you haven’t had the time yet to read all 90+ pages of the OIG’s New Compliance Program Guidance, we’ve got a great place for you to start. 

We invited Sarah Couture, a nurse turned compliance consultant, to discuss the new guidance with us in our latest episode of Compliance Conversations. Join Sarah and CJ Wolf, MD as they break down the essential elements and updates, including: 

- The evolving role of Chief Compliance Officers 

- The significance of incentives in compliance programs 

- Collaborative risk management approaches 

- Emphasizing medical necessity in billing audits 

Sarah is the Principal of Couture Compliance, an organization dedicated to elevating compliance program effectiveness through tailored compliance solutions. You can reach her at sarah@couturecompliance.co.

New OIG Guidance for a Changing Compliance Landscape

In this episode, Jenny Hamilton the Clinical Project Research Manager at Barrow Neurologic Institute, joins CJ Wolf, MD for an in-depth discussion on compliance considerations for clinical trials. 

From the complexities of protocol deviations to the vital role of Institutional Review Boards, they cover a wide range of topics. Tune in for valuable insights into the compliance landscape of clinical trials and learn more about the crucial role patients play in advancing medical research. 

Jenny and CJ also cover: 

- The importance of informed consent in clinical trials 

- Insights into FDA audits and the role of Clinical Research Associates 

- The fascinating and diverse landscape of global clinical trials 

You can also learn more about Jenny’s work here. https://www.barrowneuro.org/centers-programs/als-neuromuscular-disease/

Research Realities: Insights into Clinical Trials

Ready for a crash course into regulatory considerations in health tech?  

In this episode of Compliance Conversations featuring Susan Walberg, a seasoned regulatory and compliance professional and published author of fiction and non-fiction 

In this interesting interview, Susan shares her journey from novels to HIPAA, offering a behind-the-scenes look at the challenges and triumphs of navigating compliance in the rapidly evolving health tech landscape. 

Tune in to the episode to discover: 

- Some surprising realities of health tech compliance 

- Real-word intriguing cases (like the Jelly Bean dilemma!) 

- Key lessons for startups and small organizations as they navigate compliance concerns  

Thanks to Susan for joining us for this episode – we hope you enjoy! 

Susan Walberg has worked in health care for nearly 30 years, from working as a fraud investigator at a health plan, to a regulatory attorney and privacy officer for a very large health system. She has worked as a compliance officer, and a subcontractor working with CMS on Part C and D Medicare fraud and abuse. Susan has also worked as an interim compliance officer for a range of healthcare organizations, designing and building compliance programs unique to the needs of those organizations.  

Her specific experiences include helping clients manage a Corporate Integrity Agreement and developing programs for new organizations or those going through an organizational transition. Susan has trained and mentored many new compliance professionals, and strives to help those new to compliance to succeed in their roles. As a consultant, Susan uses her passion for building, creating, and organizing compliance programs along with a true understanding of the needs of healthcare organizations to help create programs that really fit within the each client’s unique culture and environment.

The Rise of Health Tech: Balancing Innovation and Regulation

We’re excited to announce a new episode of Compliance Conversations! Join CJ Wolf and special guest Kimberly Jolivette Williams as they explore the complexities of anesthesia coding and billing. 

In this episode: 

- Kimberly’s journey from unit secretary to compliance expert. 

- Unique aspects of anesthesia coding and essential resources. 

- The importance of modifiers in compliance and billing. 

- Tips for accurate documentation and minimizing compliance risks. 

Don't miss out on Kimberly's expert advice and passion for lifelong learning. 

Here are some additional resources around this important topic: 

Centers for Medicare & Medicaid Services Anesthesiologists Center - https://www.cms.gov/medicare/payment/fee-schedules/physician/anesthesiologists-center

Certified Anesthesiologist Assistants Now Authorized to Practice in Washington State - https://www.asahq.org/about-asa/newsroom/news-releases/2024/03/certified-anesthesiologist-assistants-now-authorized-to-practice-in-washington-state#:~:text=SEATTLE%20%E2%80%93%20Washington%20state%20Gov

Demystifying Anesthesia Coding and Billing

Our latest episode of Compliance Conversations features Johanna Brown, the recipient of Healthicity's 2023 Compliance Officer of the Year Award!  

Join our host, CJ Wolf, as he delves into Johanna’s journey in compliance, her leadership philosophy, and the qualities that make her an outstanding compliance officer.  

Here’s what you can expect: 

- Career Journey: Learn about Johanna’s path from journalism to compliance. 

- Leadership Insights: Discover her secrets to fostering teamwork, maintaining work-life balance, and navigating the complex world of healthcare compliance. 

- Heartfelt Recognition: Hear the glowing recommendations from her colleagues and what they appreciate most about her approach to compliance.

Meet Healthicity's Inaugural Compliance Officer of the Year Award Recipient

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.

Expert Tips on Gastrointestinal Coding and Billing

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.

Healthcare's Legal Tightrope: Navigating Physician Contracts

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).

Navigating Medicare Audits and Appeals

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!

Behavioral Health Compliance: Insights and Challenges

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 depositions

Healthcare Fraud, Compliance, and Expert Testimony

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!

Expert Insights on E/M Coding

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. 

Behind the Mic: 100 Episodes of Compliance and Auditing Insights

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.  

Improper Payments Explained: Tips from the Field

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. -

Lessons on Compliance Communication and Leadership

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.

Inside Payment Integrity: Key Insights from a Payer’s Lens

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.

The Next Big Shift: AI in Healthcare Compliance and Coding

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 EAdler@ralaw.com.

Beyond the Deal: Compliance Lessons for Healthcare Transactions

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.

What DOJ and FDA Are Looking For in Compliance Programs

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. 

Telehealth Fraud, AI, and Cybersecurity: The Compliance Landscape in 2025

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 

Top Enforcement Trends Every Healthcare Compliance Officer Should Watch

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. 

Stay Compliant, Stay Connected: Navigating Healthcare Outreach

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 

From Templates to Time-Savers: EHR Tips for Coders and Clinicians

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 

Inside IROs: What Compliance Professionals Need to Know

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 CKuta@ralaw.com. 

What to Do When the Audit Letter Arrives

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 

Conferences, Coding, and Compliance: What We Learned

Recently, I sat down with Brian Burton, our new Chief Compliance and Privacy Officer, for an all-new episode of the Compliance Conversations podcast. Given the time of year, and his area of expertise, we focused our discussion on a topic on many people’s minds: Privacy and Security Risk Assessments. I know these assessments can be daunting to approach or, as Brian put it, “I think a lot of organizations struggle with what does that mean, and how can I accomplish this activity with the minimum amount of effort, but still know that it’s accurate, and that your organization is protected from cyber security threats.”

Having worked in the healthcare industry for more than 15 years, Brian become an expert in all things project management and technology. He's devoted most of his career to developing, implementing, and providing oversight for Compliance and Privacy program initiatives, working with more than one hundred healthcare facilities. 
Considering Brian’s vast experience, we discussed the symbiosis between project management and risk assessments, and how organizations should “initiate a project, then execute, monitor, control, and close,” in order to successfully identify and mitigate their risks. 
To hear more of Brian’s advice and best practices, listen to our latest episode of Compliance Conversations, “A Pro’s Guide to Conducting Your Annual Privacy and Security Risk Assessment,” where we cover topics including:

•	How to Protect Your Organization from Cyber Security Threats
•	What Tools You Should Use to Conduct Your Annual Security Risk Assessment
•	Which Cyber Security Framework Your Organization Should Deploy

A Pro’s Guide to Conducting Your Annual Privacy and Security Risk Assessment

Compliance Conversations is a monthly podcast for healthcare professionals and compliance officers who want to stay on top of the compliance game. Host CJ Wolf has in-depth conversations with industry experts to explore the riddles and complexities of the compliance world. Wolf chats with fellow compliance experts, auditors, physicians and government officials. Compliance Conversations is produced by Healthicity.

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