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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

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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 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

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

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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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