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Tune in to 1st Talk Compliance with your host, Catherine Short, Partnership Marketing Specialist at First Healthcare Compliance. On this 30-minute, informative program, Catherine, and her guests will discuss the hottest topics, pain points and learning opportunities related to healthcare compliance management in America. Whether you’re wondering about federal fraud and abuse laws, OSHA, or human resources compliance, tune in to gain insight. Here you can also enjoy our archived library of audio webinars and partner interviews! We help healthcare compliance officers achieve peace of mind and we’re excited to bring some of the brightest minds together to 1st Talk Compliance!
261 Episodes
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In this episode of 1st Talk Compliance, Kevin Chmura and BreAnn Meadows discuss the challenges healthcare providers face due to payers increasingly denying claims for supplies that are missing HCPCS codes. The issue stems from recent payer policy changes, with supplies that were previously chargeable now being rejected if they lack a corresponding HCPCS code. The conversation tackles the complexities providers face in managing their chargemaster (CDM), maintaining accurate HCPCS coding, and addressing claim denials, which can result in lost revenue.
Tune in to equip yourself with actionable strategies to avoid claim denials, as Bre underscores the importance of adopting a strategic, focused approach to managing your CDM, adapting to evolving payer practices, and staying proactive in compliance efforts.
The Centers for Medicare and Medicaid Services (CMS) recently released additional guidance on the Two-Midnight rule that carries important implications for hospitals seeking to apply the rule correctly and consistently. In this episode of 1st Talk Compliance, host Kevin Chmura is joined by Stacy Pereira, Executive Director of Coding and Clinical Services in Panacea’s KA Consulting Division, to continue the discussion surrounding the Two-Midnight rule and the challenges it poses.
If you enjoyed Panacea’s recent webinar on the topic, or you’re simply looking for more information on how the rule might impact you, tune in for a deep dive into the potential challenges involved for hospitals seeking to apply the rule correctly, possible financial impacts of the rule’s enforcement, and pitfalls of over- or underusing observation status.
In case you missed our webinar on the Two-Midnight rule, you can watch it on-demand here.
In a landmark episode of 1st Talk Compliance, Kevin Chmura, CEO of Panacea Healthcare Solutions and host of the show, is joined by George Kelley, president of Panacea’s KA Consulting Services division.
For over 40 years, KA Consulting Services has delivered unmatched revenue cycle solutions, helping hospitals and health systems nationwide enhance reimbursement, improve compliance, and streamline Medicaid eligibility. Known for its eligibility services, clinical coding and auditing services, and revenue integrity solutions, KA Consulting has earned a reputation for providing solutions that go the extra mile to obtain appropriate reimbursement and to improve compliance. We are thrilled to welcome them as a division of Panacea Healthcare Solutions, further enhancing our commitment to delivering industry-leading healthcare financial, revenue integrity, and clinical solutions nationwide.
Tune in to get the inside scoop on this latest development as Kevin and George delve into KA’s background and our shared history and discuss how our newly combined expertise complements each other’s teams.
The False Claims Act—alongside the Anti-Kickback Statute and Stark Law—represents one of the five core fraud, waste, and abuse laws identified by the HHS Office of the Inspector General. Out of the billions of dollars reclaimed through False Claims Act recoveries in 2023, the majority was attributed to the healthcare industry. This concerning trend highlights the importance of maintaining robust compliance programs and prioritizing education surrounding these regulations.
In this episode of 1st Talk Compliance, Rachel Rose, JD, MBA discusses recent key developments in the False Claims Act landscape and shares tips on how healthcare providers can enhance their compliance strategies and mitigate regulatory risks. Tune in to gain a comprehensive understanding of the False Claims Act and its role in the healthcare sector, hear updates on several recent significant fraud, waste, and abuse cases, and receive actionable insights into bolstering your organization’s compliance initiatives.
Previously on First Talk Compliance, we spoke with Kevin Chmura, CEO of Panacea Healthcare Solutions, about how the advent of price transparency has caused the business of healthcare to evolve and opened up fresh possibilities for healthcare providers to gain a competitive advantage.
In this episode, we continue that conversation by inviting on two additional experts from Panacea—Govind Goyal, President of Financial Services, and Henry Gutierrez, Senior Vice President, Financial Consulting Services—to dive deeper into the recent changes to price transparency requirements and expand upon the many ways healthcare providers can adapt to succeed in this new consumer-driven arena. From navigating compliance regulations to leveraging data for a competitive advantage, tune into Part 2 of “The Sky’s the Limit – How Price Transparency Can Empower Healthcare Providers” to gain insight into the evolving landscape of price transparency and what lies ahead.
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.
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.
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.
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