1st Talk Compliance

Private equity has become increasingly entrenched in the healthcare sector, offering various financing options for providers to consider. However, like all types of financing, private equity introduces its own unique set of benefits and drawbacks and carries important legal implications. It’s essential to understand all the factors at play in order to maximize financial impact and preserve operational efficiencies while avoiding sacrificing compliance and quality of care. Tune in to hear Grace Walsh in conversation with Rachel Rose, JD, MBA, to explore this timely topic. In addition to providing a detailed overview of private equity in healthcare and its various pros and cons, Rachel shares valuable updates on enforcement actions by the U.S. Department of Justice and Congressional inquiries.

Grace Walsh speaks with Kevin Chmura, CEO at Panacea Healthcare Solutions, to explore an extremely timely topic: price transparency and its far-reaching impact on how healthcare providers interact with consumers, with each other, and with the market at large. Tune in as Kevin shares some important insights about how price transparency has opened the door to a whole new world of data analysis and strategic business strategies for healthcare providers, and covers what we might expect to see for the future of price transparency. We’ll also include some key resources for listeners hoping to boost their knowledge of CMS price transparency regulations and learn how they can leverage price transparency data to empower their own strategic initiatives.

Grace Walsh is joined by Govi Goyal, President of Panacea's Financial Services Division, and Brian Prokop, Senior Vice President of Financial Consulting Services at Panacea, to discuss the importance of undertaking a strategic pricing initiative for your organization. In our current healthcare climate, it's more crucial than ever to maintain defensible and rational healthcare pricing while remaining competitive and optimizing net revenue. As Govi and Brian can tell you, it's a tricky balance to strike. Tune in as they share their tried-and-true approaches to developing defensible pricing strategies and learn how these measures can position hospitals for success in the era of price transparency.

Grace Walsh is joined by Becky Jacobsen, Vice President of CDM, Coding & Audit Services at Panacea Healthcare Solutions, to explore the key updates to evaluation and management (E/M) guidelines for 2024. On the surface, this year's changes may appear fairly straightforward, but dig a little deeper and you’ll find that the updates have important implications for correct coding procedures. From payers, providers, and coders to those who work in auditing or IT template development, it is essential to keep up a comprehensive grasp on E/M coding guidelines. Tune in as Becky breaks down a few of the most significant guideline updates, clarifies some common areas of confusion, and shares her insider tips as an expert in the field of coding compliance auditing and education.

Grace Walsh is joined by Becky Jacobsen, Vice President of CDM, Coding & Audit Services at Panacea Healthcare Solutions, to explore the key updates to evaluation and management (E/M) guidelines for 2024. On the surface, this year's changes may appear fairly straightforward, but dig a little deeper and you’ll find that the updates have important implications for correct coding procedures. From payers, providers, and coders to those who work in auditing or IT template development, it is essential to keep up a comprehensive grasp on E/M coding guidelines. Tune in as Becky breaks down a few of the most significant guideline updates, clarifies some common areas of confusion, and shares her insider tips as an expert in the field of coding compliance auditing and education.

In this episode of 1st Talk Compliance, we dive into an increasingly crucial topic in healthcare: price transparency and its ever-growing impact on the industry. Kevin Chmura, CEO at Panacea Healthcare Solutions, joins us to share expert insights on strategic pricing and compliance, emphasizing the transformative benefits for healthcare providers. Learn how to proactively engage with CMS regulations and set your organization apart as an ethical leader in the realm of price transparency.

Rachel V. Rose, JD, MBA, principal with Rachel V. Rose – Attorney at Law, P.L.L.C., Houston, TX will be presenting this informative webinar. Cybersecurity risk management and the potential for enforcement actions is not diminishing. An area of increasing interest by the Federal Trade Commission, the United States Department of Justice, and Congress is third parties taking sensitive data (especially by social media and search engine giants), including protected health information, without obtaining affirmative patient/consumer consent and benefiting financially. The U. S. Department of Health and Human Services, the agency tasked with enforcing HIPAA, also plays a critical role. The purpose of this presentation is to address different federal government initiatives, recent enforcement actions and incidents, and risk mitigation.

1st Talk Compliance features guest Govi Goyal, President, Financial Services, at Panacea Healthcare Solutions, on the topic of Evolution of Price Transparency and How to Stay Ahead of CMS Requirements. Govi joins our host Catherine Short to discuss how the new CMS Price Transparency Rule and No Surprises Act are closely related. By providing Good Faith Estimates for healthcare services, hospitals can comply with both regulations. This helps patients understand their expected costs upfront and avoid surprise medical bills. Panacea's CMS Price Transparency and Hospital Zero-Base Pricing software solutions can assist hospitals in providing accurate Good Faith Estimates to their patients and stay compliant with the latest regulations.

1st Talk Compliance features attorneys Sean McKenna, Lauren Nelson, and Vincent Aiello of Spencer Fane LLP, on the topic of Healthcare Assets: How to Preserve and Protect. We will discuss the interplay between enforcement and liability proceedings with asset protection, explore how government and private litigation matters can impact healthcare companies, clinicians, and executives, and provide tips and preventative strategies to preserve income and assets prior to such action to ensure business continuity and succession planning.

Expert presenter, Rachel V. Rose, JD, MBA, principal with Rachel V. Rose – Attorney at Law, P.L.L.C., Houston, TX guides us through current trends and tips. With its roots stemming back to 1863, the False Claims Act continues to be the U.S. Department of Justice's primary enforcement tool for returning money to the Federal Treasury. It is also considered one of five fundamental fraud, waste, and abuse laws, which potentially impact a provider every time a claim is submitted to Medicare, Medicaid, and other government programs because of the attestation language. The purpose of this webinar is to provide a synopsis of the False Claims Act and the current landscape in relation to coverage determinations and the federal Anti-Kickback Statute.

1st Talk Compliance features guest Raymond Ribble, CEO and Founder at SPHER, Inc., on the topic of A Practical Approach to The Safe Harbor Law. Ray joins our host Catherine Short to discuss how HIPAA data breach penalties typically get measured in millions of dollars, even following an organization implementing NIST cybersecurity framework measures. However, with the new HIPAA Safe Harbor Law, signed in January 2021, HHS and OCR may consider some penalty mitigation. It is important to understand that the Safe Harbor Law, while offering substantial protection, does not provide a true safe harbor and only offers some protection. This episode will examine what the established security practices for healthcare are, and how to pivot your organization's security profile to mitigate breach penalties if an event occurs.

Raymond Ribble is the CEO and Founder at SPHER, Inc. HIPAA data breach penalties typically get measured in millions of dollars even following an organization implementing NIST cybersecurity framework measures. It is important to understand that the Safe Harbor Law, while offering substantial protection, does not provide a true safe harbor. Our presentation will examine what are the established security practices for healthcare, and how to pivot your organization's security profile in order to mitigate breach penalties in the event of an event.

1st Talk Compliance features guest Iliana L. Peters, Shareholder at Polsinelli PC, on the topic of The Risk of Data Sharing. Iliana joins our host Catherine Short to discuss how these days, health data is an incredibly valuable commodity. Companies of all types should consider the legal risk with data valuation, data ownership, and data sharing agreements. In this episode, we will be discussing the scope and breadth of data sharing projects in development in the health care sector, examine contractual, state, federal, and international legal obligations for data privacy and security for such projects, and discuss issues related to data ownership that may also be part of such projects.

1st Talk Compliance features guest Rachel V. Rose, JD, MBA, principal with Rachel V. Rose – Attorney at Law, P.L.L.C., on the topic “DMEPOS – In Compliance with CMS.” Rachel joins our host Catherine Short to discuss special payment rules associated with durable medical equipment, prosthetics, orthotics and supplies. DMEPOS products must meet quality standards, suppliers need to be accepted by Medicare to participate, similar to providers, and are subject to fraud, waste, and abuse laws. This episode will provide an overview of participation and quality requirements, relay the latest compliance and requirements updates, and discuss the consequences of non-compliance, as well as submitting false and fraudulent claims.

An audio version from the live event: It’s important to understand how the application of the 2023 E&M codes impacts reimbursement. Inaccurate coding and inefficient documentation practices can result in a decline in revenue and increase the likelihood of downstream inaccuracies of patient data. Join Panacea Healthcare Solutions’ Director of Coding & Documentation Services, Becky Jacobsen, CCS-P, CPC, CPEDC, CBCS, MBS, CEMC, BSN, and Executive Vice President of Coding & Documentation, Kathy Pride, RHIT, CPC, CCS-P, for a complimentary 90-minute training where they will review the 2023 E&M documentation guidelines and requirements and provide examples on how to improve your internal documentation processes to ensure appropriate reimbursement and avoid compliance issues.

Expert presenter, Rachel V. Rose, JD, MBA, principal with Rachel V. Rose – Attorney at Law, P.L.L.C., Houston, TX guides us during this important and informative webinar. Breaches and the lack of the requisite technical, administrative, and physical safeguards can have criminal consequences. While most people are familiar with civil cases, there is the potential for HIPAA violations and ransomware attacks to be prosecuted criminally. The purpose of this webinar is to highlight potential areas of criminal liability, give specific examples, and address mitigation techniques - both before and after a government discovery request or grand jury subpoena emerges.

1st Talk Compliance features guest Raymond Ribble, CEO and Founder at SPHER, Inc., on the topic of “Employee Snooping & Insider Threats.” Ray joins our host Catherine Short to discuss snooping and insider threats and why user monitoring and ePHI access strategies are vital to the security of sensitive patient information and data protection. With so much attention and money surrounding cybersecurity in the healthcare industry, malicious employees may decide to purposefully disclose patient information. Since employees and contractors may have knowledge of your network setup, vulnerabilities, and access codes, snooping employees with malicious intent hold the key to exposing your organization to a series of unwanted risks and threats. Listen as we identify signs of unauthorized access, provide guidelines to prevent snooping, and offer procedures to detect insider threats.

Iliana L. Peters, Shareholder at Polsinelli PC will be leading this engaging audio version of her webinar presentation. These days, data is more valuable than oil. And health data is the most valuable of all data! Companies of all types should consider the legal risk with data valuation, data ownership, and data sharing agreements. Data sharing projects take many forms and address many important issues, including improvements in patient safety, fraud and abuse, population health, research, and costs to the health care system. That said, the contractual, state, federal, and international regulatory requirements applicable to such data sharing projects are significant. As such, health care entities may be particularly vulnerable to legal risk related to data sharing projects involving health data. Specifically, health care entities should consider contractual obligation, HIPAA, state privacy laws, and other requirements, as well as discuss risk assessment, data sharing agreements, key provisions, and business associate relationships. The presentation offers best practices for these important issues and projects.

1st Talk Compliance features guest Lauren Moak Russell, Counsel at Young Conaway Stargatt & Taylor, LLP in Wilmington, Delaware, on the topic of “A Harassment-Free Workplace vs the Right to Engage in Concerted Activity.” Lauren joins our host Catherine Short to discuss how the National Labor Relations Board under the Biden Administration has expressed a renewed interest in expanding its influence into non-unionized work forces. This includes reviewing and--in the right circumstances challenging--employers' use of workplace civility, confidentiality, and anti-harassment policies. Listen as we discuss what you need to know to safely navigate the National Labor Relations Act while ensuring that your employees enjoy a safe and respectful work environment.

1st Talk Compliance features guest Rachel V. Rose, JD, MBA, principal with Rachel V. Rose – Attorney at Law, P.L.L.C., Houston, TX, on the topic of “A Business Associate Agreement? Tell Me More!” Rachel joins our host Catherine Short to discuss how Business Associate Agreements (BAA) are not new; however, some individuals are new to healthcare and others never understood what a BAA is exactly. A BAA is a contract that fundamentally gives assurances that the parties are complying with the Security Rule and Privacy Rule, setting parameters in the event of a reportable security incident or a breach, and states how the sensitive data will be returned and destroyed at the end of the relationship. This presentation not only seeks to dispel myths about why certain language is prevalent in nearly all BAAs, but also provides insight into other provisions, and items for consideration, in light of the 21st Century Cures Act.