Alex Kirkland and Matt Jensen join Mark to talk about the latest evaluation and management code updates to the Medicare Physician Fee Schedule. The Centers for Medicare and Medicaid Services (CMS) decreased the conversion factor for evaluation and management (E/M) codes for 2022.

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Episode Synopsis

CMS increased the RVUs for which they reimburse outpatient E/M services and decreased the conversion factor to remain budget neutral. The conversion factor cuts will affect reimbursement for all services in the fee schedule to increase reimbursement for more cognitive E/M services.

Organizations with RVU-based compensation plans need to revalue their wRVU rates to remain economically aligned with the fee schedule, especially if their provider compensation plans tie to wRVU values in the most recent Medicare Physician Fee Schedule.

Click to listen to the episode.

Extras

2022 E/M Coding Calculator

How the CY 2022 PFS Final Rule Affects Split/Shared Visits and Critical Care Services

Rick Hindmand, an attorney with McDonald Hopkins, and Andy Sobczyk, a senior manager with Coker Group, join Mark to talk about the No Surprises Act. They focus their discussion on implications and action steps for healthcare providers and facilities.

Podcast Information

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Episode Synopsis

Rick explains the No Surprises Act. The legislation protects patients from surprise billing by prohibiting balance billing unless the patient is notified and consents and protects patients from cost-sharing obligations that exceed in-network amounts.

Rick and Andy focus their discussion on the impact on healthcare providers (facilities and providers that are out of network) and the act's key provisions impacting their revenue stream.

Extras

CMS Releases New Rules for No Surprise Act

Surprise billing regulations establish procedures to determine out-of-network rates

Emergency Physicians Recover A Higher Share Of Charges From Out-Of-Network Care Than From In-Network Care

The Six Provider Lawsuits Over The No Surprises Act: Latest Developments

Connect with Rick

Connect with Andy

Rob Mendoza and Roz Cordini join Mark to talk about the compliance risk assessment process. Now more than ever, these organizations must maintain an effective compliance program. The industry recognizes conducting a compliance risk assessment regularly as one of the key elements of an effective compliance program.

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Episode Synopsis

A compliance risk assessment is a structured process for identifying, evaluating, and prioritizing legal and regulatory risks that could negatively impact the organization. It allows the organization to focus essential resources on the most significant risks and areas lacking adequate controls.

There can certainly be a level of ambiguity when one hears the term compliance risk assessment. It can easily be confused with other reviews or examinations an organization conducts. Rob and Roz also share what is not considered a compliance risk assessment.

Click to listen to the episode.

Extras

How to Conduct a Compliance Risk Assessment (and Why You Should)

What is Compliance Program Effectiveness?

Episode 44: Compliance Program Effectiveness

Mark interviews Dr. Kelly Firesheets, VP Community Business, and Cam Teems, Senior Director Healthcare Business, about Cordata Health. Cordata Health is continuously innovating in comprehensive SaaS solutions to partner with our clients to reach the highest need populations and connect them to the care and support they need.

Podcast Information

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Episode Synopsis

Throughout the interview, they discuss the intersection of healthcare and the community and how systems can work together to create healthy people. The ongoing pandemic has brought the prevalence of specific community health issues to light, such as mental health and addiction. Cordata strives to connect hospitals and health systems technologically with the community they serve.

Extras

Learn more about Cordata Health

The Significance of a Physician Needs Assessment

Is Information Technology a Competitive Necessity or a Competitive Advantage?

Mark Reiboldt and Richard Romero chat with Chris Pusey (Rural Partners in Medicine) about healthcare challenges in rural communities. Chris shares his company's experience building specialty surgical programs in rural America.

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Episode Synopsis

Chris, Mark, and Richard discuss their shared passion for rural healthcare. Chris discusses Rural Partners in Medicine's unique approach to providing surgical services locally to smaller communities. Patients within these communities prefer to receive care near their homes instead of traveling 100 miles away from their support systems.

Listen to the episode and learn how Rural Partners in Medicine keep rural healthcare local.

Extras

Learn more about Rural Partners in Medicine

Physicians in Practice: Ways to Align and Remain Independent

Expanded Guidance from CMS for Telehealth Services Provided at Rural Health Clinics and Federally Qualified Health Centers During the COVID-19 Public Health Emergency

Mark interviews Rick Langosch, an independent contractor with Coker Group, about his experience providing interim CFO and CEO services for hospitals. Rick shares his experience over the years and talks about how he handled a challenging situation recently. Podcast Information

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Episode Synopsis

Perhaps your organization recently experience a sudden transition, leaving a C-suite position vacant, or your organization is adding a new position no one has traditionally held. Hiring an interim executive to fill the job while you search for a permanent placement helps stabilize the hospital during a turbulent time.

Click the play button to listen to the episode.

Extras

Interim Management: Allow your Organization Time to Find Expert Leadership

Episode 31: Performing a Healthcare Organization Executive Search

Interim Management in Healthcare

Mark interviews Dr. Caesar Richburg, Chairman of Regional Medical Center, about chairing a board of trustees during turbulent times. Dr. Richburg shares how he came to be a board member and his experience navigating leadership transitions.

Podcast Information

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Episode Synopsis

Rural hospitals continue to face challenges the pandemic brought to the forefront. As a board chairman of a rural facility, Dr. Richburg works with colleagues from different backgrounds and levels of business experience. As chairman, he ensures the Board applies sound business principles for the betterment of the community.

Click the play button to listen to the episode.

Extras

Interim Management: Allow your Organization Time to Find Expert Leadership

Episode 31: Performing a Healthcare Organization Executive Search

Interim Management in Healthcare

Matt BonDurant with ProCARE Portal joins Mark to discuss how to make provider compensation scalable. Matt explains the advantages of compensation automation and how streamlining compensation models is detrimental to your strategic plan and goals.

Podcast Information

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Episode Synopsis

Every provider compensation model is unique. While there may be certain structural areas of overlap, the details of the methodology, data process, exceptions, timing needs, and business rules are all different. ProCARE Portal is a compensation automation framework configured in a user interface (UI) to manage and adapt to ongoing complexities.

Mark and Matt talk about the advantages of ProCARE Portal and how healthcare organizations are using it to make their provider compensation models scalable, regardless of how complex they are.

Click the play button to listen to the episode.

Extras

Learn more about ProCARE Portal

Provider Compensation Management: Solving the Compensation Conundrum

Compensation Best Practices for Physician Enterprises

Brandt Jewell joins Mark to discuss how to start building a high-performing physician enterprise. Brandt and Mark discuss a recent case study and white paper Brandt published this year. While each physician enterprise is unique, one can learn a lot from this successful project.

Podcast Information

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We welcome all feedback from our listeners. Email us questions on any of the topics we discuss or questions about issues that interest you. You can also provide recommendations on matters for future episodes.

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Episode Synopsis

Brandt and Mark discuss today's healthcare place, which offers significantly more strategic opportunities than existed ten years ago, and the confusion of where to focus when developing a high-performing physician enterprise. In many cases, physician enterprises will focus on one area (usually financial) and unravel the underlying operational issues affecting the bottom line.

Click the play button to listen to the episode.

Extras

Case Study: Developing a High-Performing Physician Enterprise

White Paper: Building a High-Performing Physician Enterprise

Learn more about our performance improvement services

Max Reiboldt joins Mark to discuss the economic terms to consider when pursuing a private equity deal. Max and Mark provide a high-level overview of the financial terms of private equity deals, including determining up-front value and the future sale of the practice.

Podcast Information

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We welcome all feedback from our listeners. Email us questions on any of the topics we discuss or questions about issues that interest you. You can also provide recommendations on matters for future episodes.

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Episode Synopsis

Max and Mark discuss their experience with private equity transactions and which economic terms to consider when pursuing a private equity deal. Normally, the practice retains all profits and distributes them to the partners within the practice annually. Therefore, when reviewing an income statement, there is little to no EBITDA. As part of a private equity deal, the practice needs to create upfront value through other means.

Max and Mark discuss how to create upfront value and the various approaches to the valuation of a medical practice for a private equity transaction.

Click the play button to listen to the episode.

Extras

Episode 85: Non-Economic Considerations for Private Equity Transactions

Episode 56: Private Equity Deals: Operational Components of the Transaction

The Role of Management Services in Private Equity Transactions

Episode 55: Private Equity Deals: Approaching a Deal Strategically

Defining Private Equity Transactions in Healthcare and Understanding Deal Options for Medical Groups