Compliance Conversations by Healthicity

CJ Wolf
  • 4.8 (17)
  • Education
  • Updated Semimonthly

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. May 21

    42 CFR Part 2 Explained: New Rules, New Risks, New Enforcement

    Healthcare organizations are navigating a rapidly changing privacy landscape, and many compliance teams are being asked to manage new risks faster than ever before.  Between evolving 42 CFR Part 2 requirements, increasing OCR enforcement expectations, and the rapid adoption of AI tools across healthcare operations, organizations are facing growing pressure to ensure privacy, compliance, and operational teams are aligned.  In this episode of Compliance Conversations, CJ Wolf sits down with healthcare attorney Debbie Cmielewski to discuss:  Recent 42 CFR Part 2 updates and implementation deadlines  How enforcement expectations may evolve moving forward  Why AI vendor agreements deserve closer scrutiny  Common privacy and compliance gaps organizations overlook  Practical advice for organizations that feel overwhelmed or understaffed  The conversation also explores the real-world operational challenges providers face when implementing privacy requirements, training staff, managing vendor relationships, and balancing innovation with compliance oversight.  Whether your organization is highly mature or just beginning to strengthen its privacy and compliance infrastructure, this episode offers practical insights healthcare leaders can apply immediately.  Listen now to hear how compliance, legal, IT, and operational teams can work together to reduce risk in an increasingly complex healthcare environment.   ABOUT DEBBIE A. CMIELEWSKI:  Debbie A. Cmielewski is a member of the Health Care Law and Corporate Practice Groups and co-chair of the Firm's Pharmaceutical Industry and Pharmacy Practice Group. Debbie has also served as a member of the Firm's Management Committee.  Debbie advises and counsels health care providers, including hospital systems; physicians; providers of services to the intellectually and developmentally disabled; mental health and substance use disorder facilities; long term care facilities and home care agencies. She also advises pharmaceutical manufacturers and myriad vendors in the healthcare space. Debbie has significant experience in the representation of regulated professionals before administrative agencies in both health and non-health related professions. She also lectures frequently on health care and human resources topics and provides workplace compliance training in a variety of areas, including HIPAA and 42 CFR Part 2.  Debbie previously served as Vice President, General Counsel of Armada Health Care LLC (n/k/a Asembia), where she also oversaw the compliance and human resources functions in the organization. She has over 20 years' experience as a practicing attorney, holding key positions in health care corporate law and commercial/bankruptcy litigation. Early in her legal career, Debbie served as Chief of Regulatory Affairs for the New Jersey State Division of Consumer Affairs. Debbie holds a B.B.A in Finance from Pace University, and a J.D from Seton Hall University.     ABOUT SCHENCK, PRICE, SMITH & KING:  Schenck, Price, Smith & King is a full-service law firm with offices in Northern New Jersey and Manhattan, serving closely held, growing companies. For 112 years, Schenck Price has represented commercial businesses, individuals, public institutions and charitable organizations with excellence and integrity. We are proud that, in addition to their expertise and experience as legal practitioners, our attorneys have served in positions of leadership in public institutions, as well as community and charitable organizations.  Founded in 1912 as a two-person law firm in Morristown, Schenck Price has entered its second century of service as a firm of 80+ attorneys, serving virtually all legal needs of businesses and individuals. Our Firm’s long history of legal excellence in the areas of health care, education, construction, trust and estate planning, corporate law, real estate, insurance defense, banking and commercial litigation, has expanded as the Firm has grown. Our areas of practice also include telecommunications, technology, environmental law, corporate governance, labor and employment law, and family law. Many of our attorneys have been recognized as leaders in their respective practice areas.  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 for additional compliance and auditing content from our experts.

    31 min

  2. May 7

    Designing AI That Works in Clinical Care

    AI is moving fast in healthcare. But adoption, trust, and safety? Those are moving slower — for good reason.  Dr. Ashok Gupta has been on both sides of it. He spent years as a clinician, then built TheraNow, a virtual physical therapy platform that has supported over 70,000 patients across the US. These days he's also building AI-powered clinical documentation tools.  In this episode of Compliance Conversations, Ashok joins host CJ Wolf for a candid, practical conversation about what compliance leaders need to understand about AI in clinical settings right now.  You'll hear:  How to spot the conditions that lead to AI errors in clinical settings Why understanding a tool's limitations matters as much as its capabilities What's ahead in healthcare technology, and how to build for it thoughtfully  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 for additional compliance and auditing content from our experts.

    30 min

  3. Apr 23

    What to Watch at HCCA’s Compliance Institute and HEALTHCON

    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 for additional compliance and auditing content from our experts.

    28 min

  4. Apr 9

    Who’s Watching Your Vendors? Rethinking Compliance Oversight

    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 compliance newsletter for additional compliance and auditing content from our experts.

    28 min

  5. Mar 26

    Inside CRUSH: The Government’s Next Move on Fraud, Waste & Abuse

    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-waste-fraud-and-abuse-in-medicaid/  Request for Information for CRUSH - https://www.federalregister.gov/documents/2026/02/27/2026-03968/request-for-information-rfi-related-to-comprehensive-regulations-to-uncover-suspicious-healthcare  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 for additional compliance and auditing content from our experts.

    36 min

  6. Mar 12

    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/ CMS:  https://www.cms.gov/medicare/coverage/telehealth HHS: https://www.hhs.gov/press-room/dea-telemedicine-extension-2026.html , https://telehealth.hhs.gov/providers/telehealth-policy/telehealth-policy-updates Caregiver Resource Hub: https://byhersidefaithfulcaregiver.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. LinkedInYoutubeFacebookInstagramCheck out our resource center and weekly compliance newsletter for additional compliance and auditing content from our experts.

    36 min

  7. 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. LinkedInYoutubeFacebookInstagramCheck out our resource center and weekly compliance newsletter for additional compliance and auditing content from our experts.

    28 min

  8. 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. LinkedInYoutubeFacebookInstagramCheck out our resource center and weekly compliance newsletter for additional compliance and auditing content from our experts.

    31 min
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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.

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