Compliance Conversations by Healthicity

CJ Wolf

Compliance Conversations is a biweekly 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.

  1. 1D AGO

    Telehealth Rules, Risks, and Red Flags for 2026

    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/  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.

    36 min
  2. FEB 26

    Make It Make Sense: Medical Decision Making Documentation That Holds Up

    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 codewisemedical@gmail.com 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. LinkedIn Youtube Facebook Instagram Check out our resource center and weekly compliance newsletter for additional compliance and auditing content from our experts.

    28 min
  3. FEB 12

    Career Moves for Coders Who Want More

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

    31 min
  4. JAN 29

    Physician Buy-In, Audit Blind Spots, and Enforcement Trends

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

    33 min
  5. 12/18/2025

    Building Ethical Cultures That Drive Innovation

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

    29 min
  6. 12/04/2025

    Why Case Management Is Critical to Demonstrating Compliance

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

    42 min
4.8
out of 5
17 Ratings

About

Compliance Conversations is a biweekly 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.