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.

Episode Summary:

In this episode of Gosfield and Shay on Health Law, Alice Gosfield, a renowned healthcare attorney, joins host LeAnn Lyon to delve into the complexities of prior authorizations in the healthcare system. They explore the historical context and recent scrutiny of prior authorizations, revealing how these processes have become a significant burden for physicians and patients alike. Alice discusses the role of pharmacy benefit managers and the controversies surrounding their practices, as well as the challenges posed by predictive algorithms and artificial intelligence in decision-making. The episode also covers Medicare Advantage's role in the prior authorization debate and the implications of new CMS rules aimed at increasing transparency and efficiency. Listeners will gain insights into the ongoing reforms and the potential for meaningful change in the healthcare landscape.

Key Timestamps:

00:01 – Introduction

00:54 – The Rise of Prior Authorizations

01:09 – Burden on Physician Practices

02:22 – Role of Pharmacy Benefit Managers

03:36 – Industry's Response to Criticism

04:31 – Administrative Burden on Physicians

05:41 – Impact of Predictive Algorithms

06:42 – Medicare Advantage and Prior Authorization

08:11 – New CMS Rules and Their Impact

09:46 – State Regulations and Physician Rights

10:14 – Future of Prior Authorization Reforms

About the Show:

Gosfield and Shay on Health Law is a podcast dedicated to exploring the intricate world of healthcare law and policy. Hosted by healthcare attorney Alice Gosfield and LeAnn Lyon, the show offers insightful discussions on topics like Medicare, fraud and abuse, and healthcare regulations. With a focus on strategic clarity and practical guidance, the podcast aims to inform and empower physicians, healthcare professionals, and policymakers navigating the complex legal landscape of healthcare. Whether you're a seasoned professional or new to the field, this series provides valuable perspectives on the ever-evolving world of health law.

Episode Summary:

In this episode of Gosfield and Shay on Health Law, healthcare attorney Daniel Shay discusses the intricacies of physician employment agreements. Daniel delves into the evolution of compensation structures over the past decade, highlighting the shift from fixed salaries to productivity-driven models. The conversation covers the impact of industry consolidation, the role of private equity, and the pressures on employers to maximize productivity. Daniel also examines the challenges physicians face with non-compete clauses, termination provisions, and tail coverage obligations. By understanding these elements, physicians can better navigate their contracts and protect their interests. This episode provides valuable insights for healthcare professionals looking to negotiate favorable terms and avoid common pitfalls in their employment agreements.

Key Timestamps:

00:01 – Introduction

00:10 – Evolution of Physician Employment Agreements

00:56 – Changes in Compensation Structures

02:14 – Productivity-Based Compensation Models

05:30 – Divergence of Expectations in Compensation

07:06 – Transparency in Compensation Calculations

09:02 – Non-Compete Clauses and Their Impact

12:25 – Termination Provisions and Their Implications

15:48 – Tail Coverage Obligations

18:12 – Employer Objectives in Employment Contracts

20:42 – Patterns in Contract Disputes

About the Show:

Gosfield and Shay on Health Law is a podcast dedicated to exploring the complex intersection of healthcare and legal issues. Hosted by experienced healthcare attorneys, the show provides in-depth discussions on regulatory compliance, employment agreements, and the business realities of medical practice. Listeners gain practical insights into navigating the legal landscape of healthcare, with a focus on making complex rules accessible and actionable. Whether you're a physician, healthcare administrator, or legal professional, Gosfield and Shay on Health Law offers valuable guidance to help you stay informed and make informed decisions.

Episode Summary: In this episode of Gosfield and Shay on Health Law, healthcare attorney Daniel Shay delves into the intricacies of Medicare enrollment, likening it to the ongoing responsibilities of homeownership. He highlights the necessity for constant updates and vigilance to maintain compliance, emphasizing the importance of responding to revalidation requests and updating application information within specified timelines. Daniel Shay discusses the consequences of failing to comply, such as deactivation and revocation of billing privileges, and provides real-world examples of how outdated information can lead to serious issues. He offers practical advice for healthcare practices to manage their enrollment processes effectively, ensuring they stay ahead of potential problems. Listeners will gain valuable insights into maintaining compliance and safeguarding their practice's financial health.

Key Timestamps: 00:01 – Introduction 00:10 – Understanding Medicare Enrollment 00:47 – Ongoing Obligations for Providers 01:21 – Importance of Updating Information 02:01 – Types of Changes Requiring Updates 02:54 – Common Compliance Failures 03:41 – Deactivation vs. Revocation 05:41 – Impact on Billing and Cash Flow 06:32 – Revalidation Process Explained 07:52 – Consequences of Outdated Information 10:27 – Best Practices for Enrollment Management

About the Show: Gosfield and Shay on Health Law is a podcast dedicated to providing healthcare professionals with clear and practical insights into the complex world of health law. Hosted by experienced attorneys, the show covers topics such as regulatory compliance, Medicare, and emerging legal issues in healthcare. With a focus on making intricate legal concepts accessible, the series aims to empower medical practices to navigate legal challenges confidently and effectively.

Episode Summary: In this episode of *Gosfield and Shay on Health Law* attorney Alice Gosfield delves into the complexities and potential pitfalls of billing for non-face-to-face services under Medicare. She discusses the shift in Medicare payment policies, specific documentation requirements, red flags for federal auditors, and the challenges posed by remote physiologic monitoring. Alice also explores rules for split shared visits and the implications for physician compensation models, offering valuable insights for healthcare providers navigating Medicare reimbursement.

Key Timestamps: 00:00 – Introduction 03:22 – Shift in Medicare payment policies 07:15 – Documentation requirements for non-face-to-face services 11:45 – Red flags for federal auditors 15:10 – Challenges of remote physiologic monitoring 19:30 – Rules for split shared visits 23:50 – Physician compensation models 27:40 – Special enforcement risks for billing codes

About the Show: *Gosfield and Shay on Health Law* provides in-depth analysis and expert insights into the legal landscape of healthcare, focusing on compliance, fraud avoidance, and navigating complex regulatory frameworks in the industry. Hosted by healthcare attorney Alice Gosfield, the show aims to educate and empower healthcare professionals with the knowledge needed to thrive in an evolving healthcare environment.

Episode Summary: In this episode of *Gosfield and Shay on Health Law*, healthcare attorney Alice Gosfield delves into the nuances of voluntary repayments in healthcare compliance. She highlights the importance of proactive auditing, the evolving definition of overpayments, common mistakes in calculating repayments, and the significance of proper documentation when returning money. Gosfield also emphasizes the implications of overpayments escalating to false claims and the hefty penalties providers face.

Key Timestamps: 00:00 – Introduction 01:30 – Ongoing Internal Auditing for Compliance 04:15 – Definition Changes in Overpayment Rules 06:50 – Calculating Total Repayment Account 08:30 – Safest Way to Return Money 10:45 – Obligations of Healthcare Entities and Vendors 13:20 – Overpayments and False Claims 15:40 – Quality-Based Value Payments and Reporting

About the Show: *Gosfield and Shay on Health Law* provides expert insights into Medicare reimbursement, fraud avoidance, and compliance strategies in the healthcare industry. Join for in-depth discussions with industry professionals and legal experts to navigate the complexities of health law.