Episode Summary: In this episode of Gosfield and Shay on Health Law, healthcare attorney Daniel Shay delves into the complexities of Medicare billing and supervision rules for physician practices employing nurse practitioners (NPs) and physician assistants (PAs). Daniel explains the critical incident-to billing and diagnostic testing rules, highlighting the financial implications of each approach. He addresses common misunderstandings about supervision levels, the potential for overpayments, and the legal risks associated with false claims. Daniel also discusses the importance of aligning state licensure laws with federal requirements and suggests strategic staffing models that maximize the roles of NPs and PAs without compromising compliance. This episode is essential for healthcare providers aiming to optimize their billing practices while maintaining regulatory compliance.

Key Timestamps: 00:01 – Introduction 00:29 – Using NPs and PAs in Compliance 00:52 – Key Medicare Billing Rules 01:54 – Reimbursement Rates for NPs and PAs 02:32 – Balancing Reimbursement and Compliance 03:01 – Common Misunderstandings of Supervision Rules 04:23 – Risks of Misunderstanding Supervision Levels 05:51 – Structuring Responsibilities in Practices 07:33 – Diagnostic Testing vs. Office Visits 09:02 – State Licensure Laws and Supervision 10:21 – Small Mistakes Leading to Compliance Issues 12:02 – Rethinking Staffing Models 13:07 – Shifting Mindsets for Optimal Use of NPs and PAs

About the Show: Gosfield and Shay on Health Law is a podcast dedicated to unraveling the complexities of healthcare compliance for medical professionals. Hosted by experienced healthcare attorneys, the show offers practical insights into regulatory challenges, focusing on Medicare, billing, and fraud prevention. Designed for healthcare providers, administrators, and legal professionals, the series aims to make intricate compliance topics accessible and actionable. Through expert interviews and detailed analyses, listeners gain valuable knowledge to navigate the ever-evolving landscape of healthcare law effectively.

For more information, visit our website: www.gosfield.com

Episode Summary: In this episode of Gosfield and Shay on Health Law, healthcare attorney Dan discusses the intricacies of electronic health record (EHR) contracts with host Evan Mack. They delve into the critical aspects of EHR agreements, focusing on the legal and operational risks that physician practices face. Dan highlights the importance of understanding contract terms, especially regarding data control and compliance with HIPAA regulations. The conversation covers potential pitfalls such as loss of access to critical data, challenges in switching EHR systems, and the implications of integrating artificial intelligence into EHR platforms. Listeners will gain valuable insights into how to protect their practices from legal liabilities and ensure smooth operational transitions when dealing with EHR vendors.

Key Timestamps: 00:01 – Introduction 0:27 – Importance of EHR Contracts 1:45 – Legal Responsibility for Data Control 3:42 – Risks of Losing System Access 5:39 – Challenges in Exiting EHR Contracts 7:12 – Data Transfer Obstacles 9:45 – Financial and Operational Contract Provisions 12:35 – EHR Integration with Existing Technology 14:47 – Negotiating Key Contract Provisions 16:22 – Operational Control and Vendor Relationships

About the Show: Gosfield and Shay on Health Law is a podcast dedicated to exploring the complex legal landscape of healthcare. Designed for healthcare professionals, legal practitioners, and compliance officers, the show offers in-depth discussions on regulatory compliance, data privacy, and emerging legal challenges in the medical field. With expert insights and practical advice, the series aims to make intricate legal concepts accessible and actionable, empowering listeners to navigate the evolving healthcare environment confidently.

For more information, visit our website: www.gosfield.com

Episode Summary:

In this episode of Gosfield and Shay on Health Law, Alice Gosfield, a renowned healthcare attorney, dives deep into the complexities of Stark Law and its implications for physician compensation. Joined by host LeAnn Lyon, Alice unpacks the intricacies of productivity formulas, profit sharing, and the common pitfalls physician groups encounter. She explains how Stark Law regulates internal compensation decisions, emphasizing the importance of understanding designated health services and the impact of referrals. Alice also distinguishes between Stark and the anti-kickback statute, providing clarity on compliance and legal obligations. The episode offers valuable insights into structuring compensation formulas that align with Stark's regulations while addressing the evolving landscape of value-based care. Listeners gain a comprehensive understanding of how to navigate these legal frameworks to ensure compliance and optimize compensation strategies.

Key Timestamps:

00:01 – Introduction

0:53 – Understanding Stark Law's Impact on Compensation

1:24 – Key Provisions of Stark Law

2:04 – Group Practice Regulations and Profit Sharing

3:04 – Designated Health Services Explained

4:32 – Technical Component Revenue Allocation

5:06 – Historical Context and First Settlements

6:01 – Incident to Billing and Its Implications

7:20 – Importance of Referral Distinctions

8:33 – Productivity Compensation vs. Profit Sharing

9:43 – Stark vs. Anti-Kickback Statute

12:32 – Value-Based Care and Stark Regulations

14:56 – Designing Practical and Defensible Compensation Formulas

15:24 – Documenting Compensation Formulas

About the Show:

Gosfield and Shay on Health Law is a podcast dedicated to providing healthcare professionals with in-depth analysis and insights into the legal and regulatory challenges facing the industry. Hosted by Alice Gosfield, a leading healthcare attorney, and LeAnn Lyon, the show covers a wide range of topics including Medicare compliance, physician compensation, and healthcare regulatory strategy. With a focus on clarity and strategic guidance, the podcast aims to empower listeners with the knowledge needed to navigate the complex landscape of healthcare law effectively.