Value-Based Arrangements, Medical Necessity, and Audit Work Plan Development Episodes
Check out the latest episodes on the Stark Integrity podcast hosted by Nelson Mullins Riley & Scarborough LLP's Nashville partner Bob Wade, featuring professionals in the healthcare industry.
Value-Based Arrangements Key Issues: A Discussion with Kelly Conroy from Pinnacle Healthcare and Ed White from Nelson Mullins
The new rules create new standards that reduce compliance risk. In this episode, Wade discusses the key issues in value-based arrangements with Kelly Conroy, Principal at Pinnacle Healthcare, and Ed White, partner at Nelson Mullins. Hear why now is the time to start your value-based care strategy. Value-based enterprises can be used as a strategy for providers to leverage their value proposition with payers, it’s time to get a fresh perspective on the healthcare market landscape, where the government will help most, and the “Holy Grail” of arrangements.
Medical Necessity: A Major Compliance Issue and Risk
Physicians may believe a test or procedure is medically necessary, but payers make the final determination. In this episode, Wade details medical necessity and the implications for Stark Law compliance. Hear why payers make the medical necessity determination, how patients are in control, how a physician can get compensated if the patient desires additional services, what the Medicare payment rules say, and examples from the medical field.
Audit Work Plan Development: The Who, What, and How
How do you audit practically? In this episode, Wade breaks down the who, what, and how of audit work plan development under the Stark Law. Hear why you shouldn’t do it alone, how to look at the government resources out there, how to use some type of numerical weighting to assess risks, why auditing isn’t rocket science, and a sausage analogy from Wade.
These materials have been prepared for informational purposes only and are not legal advice. This information is not intended to create, and receipt of it does not constitute, an attorney-client relationship. Internet subscribers and online readers should not act upon this information without seeking professional counsel.