HEALTHCARE BOOTCAMP

Welcome to the McGuireWoods Healthcare Bootcamp. We intend for these videos to provide our clients tools to educate and train individuals within healthcare organizations. These videos are designed to provide basic background and information on the healthcare regulatory topics presented, and thus participants do not need any prior training or experience to benefit from the trainings contained herein. We hope you find these resources helpful and please do not hesitate to let your McGuireWoods counsel know if there are other topics that would be helpful to include.

Table of Contents

Introduction to MSO-PC Structures
Introduction to Medicare Enrollment and Changes of Ownership
Introduction to EKRA
Responding to a HIPAA Breach
What to Do When the Government Comes Knocking
Stark Law Group Practice: Physician Compensation
Medicare Audits
No Surprises Act: Payment Dispute Resolution Processes
No Surprises Act: Good Faith Estimates
No Surprises Act: Consents & Notices
Key Regulatory Issues Facing Ambulatory Surgery Centers
Anti-Kickback Statute: An Introduction
Building and Maintaining a Healthcare Antitrust Program Part 1: Antitrust Basics
Building and Maintaining a Healthcare Antitrust Program Part 2: Compliance Priorities
Building and Maintaining a Healthcare Antitrust Program Part 3: Compliance Tools

Introduction to MSO-PC Structures

Run time: 28:47
Presenters: Gretchen Heinze Townshend and Tim Fry
Summary: State corporate practice of medicine doctrines often prohibit non-clinicians from owning directly in healthcare providers, particularly physician and dental groups. Yet, often healthcare providers seek to partner with managers and business operators with additional business acumen to assist their patients and businesses. This introduction to MSO-PC structures (an acronym for management service organization-professional corporation) provides the basic framework utilized when providers desire such a relationship.

Introduction to Medicare Enrollment and Changes of Ownership

Run time: 19:20
Presenters: Colin McCarthy and Kristen Chang
Summary: The Medicare program is the largest payer for healthcare services in the United States. Any provider or supplier who seeks Medicare payments must comply with Medicare’s provider enrollment process and rules, which are implicated in any merger, acquisition, or other transaction involving health care businesses. This presentation provides an overview of the provider enrollment process and strategies for structuring transactions to minimize disruption to Medicare reimbursement.

Introduction to EKRA

Run time: 14:45
Presenter: Erica Jewell
Summary: The Eliminating Kickbacks in Recovery Act (“EKRA”), 18 U.S.C. § 220, prohibits the payment of remuneration in return for referring a patient to a recovery home, clinical treatment facility or laboratory. EKRA is based on the Anti-Kickback Statute (“AKS”), which applies only to federally funded health insurance programs, such as Medicare and Medicaid. EKRA, however, broadly applies to any “health care benefit” program, including commercial insurance. Unlike the AKS, there has been limited guidance on how to interpret EKRA. That changed somewhat in 2021, when EKRA claims began to work their way through various federal courts. In this video, we explore the nuance of EKRA and some of the important implications for laboratories and other business which have historically not been the focus of AKS inquiries.

Responding to a HIPAA Breach

Run time: 31:26
Summary: In this video, we discuss what covered entities and business associates must do to comply with HIPAA when responding to a potential breach. The discussion will cover:

How to apply the breach notification standard;
What is and is not a reportable breach;
What steps should be taken upon discovery of a potential HIPAA breach;
How to conduct an internal HIPAA investigation; and
How to minimize liability for breaches

What to Do When the Government Comes Knocking

Run time: 32:10
Presenters: David Pivnick and Brett Barnett
Summary: This video provides practical guidance for how to respond to government investigations, as well as an overview of the tools and methods used by the government in conducting investigations. It also includes recommendations for conducting an internal investigation.

Stark Law Group Practice: Physician Compensation

Run time: 37:40
Presenters: Tim Fry and Gretchen Heinze Townshend
Summary: The federal physician self-referral law (commonly known as the “Stark Law”) prescribes key rules for compensation paid by group practices to its physicians when such compensation includes revenue from certain ancillary services (known as designated health services). Effective January 1, 2022, these rules underwent their most significant change related to group practice compensation since the Stark Law’s regulatory adoption two decades ago. This video provides the legal background and multiple fact patterns to help physician groups understand the legal changes for developing and reviewing their own compensation programs.

Medicare Audits

Run Time: 52:02
Presenters: Samuel Bernstein and Colin McCarthy
Summary: All providers and suppliers participating in the Medicare program will be subject to an audit at some point. This presentation provides an overview of the Medicare audits and appeals process, including a summary of the various auditors, types of audits, and different levels of the appeals process. The presentation also discusses the importance of filing appeals to rebut overpayment determinations, and provides best practices for doing so.

No Surprises Act: Payment Dispute Resolution Processes

Run Time: 26:37
Presenter: Kristen Chang
Summary: The No Surprises Act introduced new requirements for providers, facilities, and providers of air ambulance services to protect individuals from surprise medical bills. The No Surprises Act also created two separate dispute resolution processes related to out-of-network rates. The first, the Patient-Provider Dispute Resolution Process, allows self-pay/uninsured individuals to resolve payment disputes with Providers. The second, the Independent Dispute Resolution Process, allows health plans/issuers to resolve payment disputes with Providers. In this video, McGuireWoods explores both of these dispute resolution processes and highlights key compliance concerns for providers and facilities.

No Surprises Act: Good Faith Estimates

Run Time: 11:01
Presenters: Wendy Wright and Varsha Gadani
Summary: The No Surprises Act (NSA) placed new compliance obligations on healthcare providers and facilities with the aim of protecting individuals from surprise medical bills. This presentation delves into the good faith estimate (GFE) requirements created by the NSA. The GFE is a notification that outlines an uninsured or self-pay individual’s expected charges for a scheduled or requested item or service and must be provided to an uninsured or self-pay individual. In this presentation, McGuireWoods provides example GFE templates and discusses the various requirements related to the GFE that providers and facilities must now comply with, including when to provide the GFE, what the GFE must include, and how to calculate the GFE.

No Surprises Act: Consents & Notices

Run Time: 20:11
Presenter: Diana Castro
Summary: The No Surprises Act (NSA) introduced new requirements for providers, facilities and providers of air ambulance services to protect individuals from surprise medical bills. This presentation provides an overview of the NSA, the purpose for its enactment, and the notice and disclosure requirements for certain types of providers, including the requirements to provide public notice of restrictions on balance billing and good faith estimates. The presentation includes a review of model disclosure notices and a discussion of the various disclosure requirements and method of disclosure.

Key Regulatory Issues Facing Ambulatory Surgery Centers

Run Time: 43:00
Presenters: Gretchen Heinze Townshend and Jeffrey S. Alberg
Summary: This presentation provides an overview of key regulatory and business considerations related to investments in ambulatory surgery centers (“ASCs”). Specifically, the presentation reviews the requirements of the ASC Safe Harbor to the Anti-Kickback Statute and regulatory considerations for properly structuring sales and redemptions of shares in ASCs to comply with the ASC Safe Harbor. In addition, the presentation includes critical questions to ask in reviewing contracts between the ASC and physicians are reviewed. Finally, the presentation discusses fundamental conditions for coverage and licensure issues for ASCs.

Anti-Kickback Statute: An Introduction

Run Time: 40:13
Presenters: Timothy J. Fry and Erica L. Jewell
Summary: The federal anti-kickback statute (AKS) makes it illegal to provide anything of value to a person with the intent to induce or reward referrals for a federal healthcare program beneficiary patients. This video provides the legal background for the AKS and multiple fact patterns to help healthcare providers understand the implication of this law. It also provides certain key safe harbors to the AKS that immunize financial arrangements from prosecution that healthcare providers often utilize.

Building and Maintaining a Healthcare Antitrust Program Part 1: Antitrust Basics

Run Time: 23:25
Presenter: Holden Brooks
Summary: In the first installment of a three-part series on implementing and improving antitrust compliance programs, McGuireWoods covers healthcare antitrust basics, including an overview of federal and state antitrust laws and how they are applied within the healthcare provider space.

Building and Maintaining a Healthcare Antitrust Program Part 2: Compliance Priorities

Run Time: 25:55
Presenter: Holden Brooks
Summary: In the second installment of a three-part series on implementing and improving antitrust compliance programs McGuireWoods dives into current enforcement trends and issues that should be top of mind for healthcare providers. The presentation begins with a discussion of the current elevated healthcare antitrust risk environment before turning to the top compliance priorities for healthcare providers. This discussion includes real life examples taken from the headlines.

Building and Maintaining a Healthcare Antitrust Program Part 3: Compliance Tools

Run Time: 19:08
Presenter: Holden Brooks
Summary: In the third installment of a three-part antitrust compliance series, McGuireWoods discusses how to effectively assess the strength of an existing compliance program and how to build and maintain a new program. The presentation begins with a discussion of how to measure the ROI of an antitrust compliance program before turning to the necessary tools for building and maintaining an effective antitrust compliance program.

The information in these presentations is intended for training and informational purposes only. The information and opinions expressed are not offered in the context of an attorney-client relationship and therefore do not constitute legal advice. No viewer should act or refrain from acting on the basis of information provided in these presentations without first seeking legal advice from counsel licensed to practice law in the relevant jurisdiction. Any and all liability with respect to actions taken or not taken based upon the contents of these materials are hereby expressly disclaimed. Video and presentation materials © 2022 McGuireWoods LLP. All rights reserved.
*All lawyers featured in this video worked at McGuireWoods LLP at the time of filming.