This transcript was auto-generated using Adobe Premiere Pro.
00;00;05;03 - 00;00;32;24
Meg Pekarske
Hello and welcome to Hospice Insights: The Law and Beyond, where we connect you to what matters in the ever changing world of hospice and palliative care. Behind the Curtain: Enhanced Provider Enrollment Oversight. Adam, I'm so glad you're here because I can't keep track of all these things that keep happening and coming out. And so I appreciate your joining to talk about all these new enrollment things.
00;00;32;25 - 00;00;41;04
Adam Royal
Yeah, Thank you, Meg. Happy to be here and excited about changes to A55 and all these enrollment requirements we've got going on.
00;00;41;22 - 00;02;52;10
Meg Pekarske
Well, and I think that you and I have been thinking about these in a very practical way since we're in the middle of a lot of different transactions right now. You and I recently did a podcast on consolidation through member substitution. So we have a lot of those going on. And so when these things came out, it it was, you know, trying to bring out how they might affect some of the things that we're working on currently. So this isn't sort of pontificating, it's actually how do we navigate going forward. And I think that that sort of I know I feel fatigued by all these changes and I'm sure everyone else does, because it's just like it's just the number of changes coming out. Absolutely. You know, the pace and then just you know, we used to have the hospice wage index rule. That was the rule making, you know, that we really focused on. And now it's like all these other rules coming out that have stuff that is impacting hospice and then things that aren't net, you know, just in guidance. And so it's a lot to keep track of. And so I think our hope today for people listening is to break down these different changes. And many of them are in proposed format. But given the climate right now and you know, all of the sort of fallout that has happened since that new Yorker article, I mean, I don't think anyone's expecting these things will be finalized as they're proposed. So but it is important to note a lot of this is the proposed rule. So, Adam, we did a prior podcast with Ragini on the 36 month rule, so we're not going to get into that here. But that was something big of extending the 36 month rule to hospices. But I guess tell me as you sort of piece together all these different things coming out, you know, what do you think the government's trying to accomplish and, you know, what's what's sort of the framing around all of this from your perspective?
00;02;52;19 - 00;04;04;18
Adam Royal
Yeah, these are kind of flowing naturally from the same concern, the 36 month rule addresses, which is, you know, mainly preventing flipping of hospices or conducting transactions or changes of ownership and rapid sequence. And then more specifically within that doing that without reporting those changes to the government. And so where the 36 Montreal kind of places this temporal limitation on when you can do those things, all of these other roles are sort of coming in around that saying, okay, short of or or even in addition to those changes, if you're making changes in ownership or control of the hospices, we CMS want to know about it. You need to report it and they're really, really getting into the weeds in how hospices are operated and and who who has control over the hospices. And this is all a result it appears from from the concern about fraud going on in the hospice industry.
00;04;04;19 - 00;07;51;09
Meg Pekarske
Well and I think a backdrop to this which I think we were getting wind of this from clients about this national site visits. So CMS has reported that it is completing a site visit of every single hospice in the country, which is now 5000 something. And so we know that that was done because I think to your point, a lot of these concerns were there is hospices that are not operational. And so the site visits, I mean, this isn't survey stuff. It is just like, do you exist? Is there anyone here? Is this the legitimate business? And so we have that as a backdrop. They didn't need to do a rulemaking to do those kinds of site visits. We also know that the four stayed focused and that December article has been Arizona, California, Nevada and Texas. And then they announced enhanced oversight for those particular states, which we're not going to go into great depth on that. But, you know, I don't think I've ever seen the government move so quickly in the matter of no, we're not even at nine months from the time of that article. But just a lot a lot of changes. And and as you know, I Brogan and I talked about the 36 month rule. I mean, many of these things are were on the list of things that we as an industry suggested. So I don't think they're surprises, but I think it's just the pace is a lot to keep track of. But jumping into the meat of this. So we're going to be talking about the home health proposed rule, which was very long and came out, of course, on a Friday of like 4:00, I think was this like 4th of July weekend or something like that. You know, you're just sort of like, oh, God, you know, and of course, like the pre federal Register version is always like, you know, quadruple the pages because it's single spaced and all that stuff. But so there was a lot of hospice staff in this home health role. And that's why, you know, most of what we're going to talk about today is so that stark I start unpacking what was in this rule and and well, maybe before we even do that, Adam, I think something that's come up in these transactions we've been working on is, you know, what the attention that people are putting on enrollment is. I just think that maybe word to the wise and we'll probably circle back to this again as a takeaway, but just really make sure you're Paco's enrollment staff is updated and that when there are changes in board members and management employees and all those other things, separate and apart from any of these changes, you really need to make sure you're keeping your enrollment up to date. And don't wait till revalidation to do that. You really need to be making those changes when they're happening, because I do think a lot of the things that we've experienced even before these rules came out is I think the government is spending a lot more time looking at enrollment. And I think that there could be negative inferences if somehow you're not keeping your pay goes up to date and like some, how are you trying to, you know, hide something, which I don't think any of the situations we've dealt with, anyone's trying to hide something. But you are not keeping track of change or notifying the government of changes that happened quite some time ago. I guess. I don't know if you want to add any color to that.
00;07;51;14 - 00;08;45;17
Adam Royal
Yeah. Yeah, there are They definitely are looking into it with more scrutiny and that too is the general direction of all these new roles. And so, you know, to, to contrast it with the 36 month rule, which is sort of easy to avoid by either not doing the transaction at all or maybe structuring a transaction a certain way. A lot of these changes are going to be implicated, whether you're doing a transaction or not, in day to day management of a hospice managing employee is are going to turn over. And when they do, the information that you have reported to CMS will no longer be accurate. And in the context of the scrutiny we're seeing the government put into all these all these reporting requirements, kind of just in thinking through the implication that these roles, they do seem to be far reaching and pretty significant for hospices.
00;08;46;02 - 00;10;11;05
Meg Pekarske
Yeah, I think that's a great point is the things that we're talking about, like people who are in management of hospices need to know and understand this isn't something we should just leave to compliance people or whoever in your organization because just like I say, folks who work with patients on getting election form signed, they oftentimes don't know and understand the importance of that document, right? So if there's blanks that are left or whatever, that person might not know what a linchpin that document is in terms of us getting paid. And I think the same thing with this enrollment stuff. It hasn't probably been something a CEO is really fretting about. But and I'm not saying you need to, Fred, but I think that there needs to be more focus on this is really important staff because if you're not keeping things updated, as I said, that negative inference by right, are you trying to hide something or whatever. And so I just think we're to the wise I think we're talking about exactly right. Everyone who's operating the hospice needs to know and understand these because it's not just go do a transaction and then I don't need to worry about this. So let's jump into the so we have first, what do we want to talk about first here at about this enhanced oversight?
00;10;11;14 - 00;10;55;00
Adam Royal
Yeah. Well, you had mentioned in the introduction the four specific states that were targeted, Arizona, California, Nevada and Texas, where this enhanced oversight for new provider enrollments and this was this was announced previously, but this general concept of enhanced oversight and prepayment review was included in the home health proposed rule for hospices. And so to date, it hasn't been we haven't seen it applied to hospices in other states. And the focus has only been those four. That's prepayment review, maybe applied to two other states and other hospices as well.
00;10;55;10 - 00;11;16;10
Meg Pekarske
So but the four state review goes into it's already in effect July 13th. And this enhanced oversight is sort of the new provider review kind of thing. So after you so if you're brand new to Medicare, you are going to get some type of prepayment review, Right?
00;11;16;22 - 00;11;17;00
Adam Royal
Right.
00;11;17;20 - 00;12;20;17
Meg Pekarske
And so that's I feel like in talking to clients, I would always say you're going to get prepayment review and whatever. But I think the new thing here was about if there is change in ownership or change of information, and I want to break that down a little bit, that you will also get prepayment review. And that's sort of getting at. The concern is you have some hospice who, you know, passes accreditation, doesn't ever submit a claim, you know, then there is a change of information or whatever. And then that new provider who bought that is going to be considered a new provider, right? Because they they're assuming that Medicare provider number, they wouldn't be, you know, put in to a prepayment review. But this is actually saying even if you're, you know, coming into Medicare and you've assumed a medicare provider number, you're still going to be subject to prepayment review right at them, Right?
00;12;20;18 - 00;13;26;12
Adam Royal
Yeah. And it applies. So like you're saying, not just to new enrollees, but also those undergoing a change of ownership and also 100% of ownership through another means. So a change of information. So these two categories would be, you know, what you would typically think of as an asset purchase for a change of ownership where traditionally that tax ID associated with the provider agreement would change, but also transactions that that wouldn't be classified as a change of ownership. So an equity deal where the tax ID may be staying the same, but the ownership will change. And so the threshold they've set for for changes of information based on ownership is 100%. So it's unlike the 36 month rule which addresses, you know, 51% or more. This this requires 100% change in equity, but is still expanded beyond the change of ownership.
00;13;26;20 - 00;14;20;16
Meg Pekarske
Category as well. And we've done other podcasts on the difference between a Chao and a Choi, and it can be very confusing. But I think the takeaway here is if there is a transaction and you're assuming, you know, ownership, no matter sort of how that deal is structured, you're likely going to have prepayment reviews. So, you know, I think diligence has always been really important in deals, but like there is going to be no breathing room, like you are going to be immediately probably getting prepayment review and that's going to immediately have a cash flow issue, right. And stuff. So, you know, I think that that that's something for folks to be prepared of and that that could sometimes impact, you know, transact oceans where, you know, there is member substitution, right?
00;14;20;16 - 00;14;45;07
Adam Royal
Adam Yes, particularly under under this this final prong of the change of ownership and control, where you may be kind of creating a new sole member that would be reported on your 855 as is the managing or controlling entity that would trigger this type of a review as well.
00;14;45;21 - 00;15;23;06
Meg Pekarske
So I think listeners out there who, you know, just because you're a nonprofit and you know, oh, it's not really like a change of ownership, right? Because it's just like they're coming under umbrella, you know, you this might impact you as well. Again, it doesn't it doesn't mean that you're not going to get paid or anything like that. But it's just in terms of I always talk about what's the runway ahead look like when you're doing this And when we're advising clients as to just be prepared. Right. That this is going to be a thing and it's like you're going to be have teepees like out of the gates, right?
00;15;23;06 - 00;15;46;23
Adam Royal
So and the structuring transactions, knowing and anticipating some kind of a cash flow issue. So whether that's with an escrow concept or a working capital concept in the purchase agreement is to make make sure a buyer has capital on hand, maybe more than you would anticipate otherwise because of those cash flow disruptions now.
00;15;46;23 - 00;16;29;07
Meg Pekarske
Good point. Good point. So then let's talk about this screening. So with and we're going to be talking about Medicare here, but I think state Medicaid programs can have their own screening. And this is about how high risk certain provider types are viewed because, you know, there can be different hoops you have to jump through in terms of how long this might take to process or what hoops I have to jump through, depending on my risk for what I think let's just call fraud right? So hospice got moved to high risk, is that right?
00;16;29;07 - 00;16;54;03
Adam Royal
Adam Yes, that's right. And so practically speaking, in terms of the additional screening hospices can expect, they are now required to submit fingerprints for anyone with a 5% or greater direct or indirect ownership interest. And then those individuals will all be subject to a national background check.
00;16;54;03 - 00;17;22;27
Meg Pekarske
Okay. And I know in talking to some clients, they're like, we already do this. So it wasn't a big deal. And this talks about so brand new enrollment. So people listening are like, I'm already a hospice. This isn't a big deal. I don't need to worry about this. But then there is this and any new owner. So let's explore that a little bit more about what is considered an owner and and stuff. I break that down a bit more.
00;17;22;27 - 00;18;29;21
Adam Royal
Yeah. The owner includes both a direct and indirect ownership interest with a threshold of of 5%. And so this could be, for example, a direct owner. So an individual that has an ownership interest and the hospice itself, but by including indirect owners, they're also including those owners of holding companies. So any individual bar up the chain or however are related to the hospice. If they have an ownership interest of 5% or more, they'll they'll have to submit these names, fingerprints and background check. And so one of the issues discussed often is the increase in private equity in these transactions. We know kind of from the structure of those transactions, you see a lot more holding companies, a lot more complicated structures. And so you can anticipate this to impact those types of purchases. And the private equity world pretty heavily.
00;18;29;21 - 00;20;18;22
Meg Pekarske
Yeah. So as you're you're talking about the stuff at home and caring about toys and Chows, and then we're talking about direct and indirect and all these percentages, I mean, I think that again, people didn't spend a lot of time thinking about, am I doing enrollment right right now and am I what do I have to report? And understanding what these definitions are, not just the timing, but like the WHO, right? Like the 5% of who, you know. And so I think that these are actually going to become more legal issues than maybe ever before, because I think all this enrollment staff and what you need to report and when and who and all the staff maybe is going to get more complicated. And I think, you know, probably talking with counsel is going to be more important because I think most of the time today, most people don't. The only time we're dealing with enrollment issues is in transactions. But I mean, I do think in terms of when do you need to update and you're 855, which we're going to talk about sort of now, I do think that, you know, there can be a role like you might want to cross-check staff with with counsel sometimes to just make sure you're doing things right because the stuff is not intuitive, Like it is like change of ownership means one thing, like from a corporate standpoint, which can mean a very different thing for seamless. And so I don't think it's like these are not like a lay person's understanding of what direct and indirect is, is not what the government necessarily thinks those terms mean. So, yeah.
00;20;19;00 - 00;20;43;20
Adam Royal
They're not aiming for for an intuitive definition, I don't think. But yeah that's a that's a great point. The especially as org charts get more sophisticated, identifying the direct and indirect interests can get complicated, but really identifying the percentage of interest and calculating that out and can get quite complicated too.
00;20;43;23 - 00;21;45;00
Meg Pekarske
Yeah. All right. So then that's talk about 855 staff and we've mentioned on other podcasts the Affiliations rule that came out now a number of years ago and that this was to sort of again in line with some of the stuff we were talking about. And it wasn't focused on hospice in particular, but more transparency around who are these, you know, companies that are owning health care organizations and are they behind lots of other health care organizations and all this stuff. And so that rule hasn't sort of been fully implemented because there needed to be infrastructure around how you report these things and stuff like that. But let's talk about these 855 updates and these are, again, coming out of the home health rule, right? Adam Yes. So why didn't you tick these off about what our new things in the 855.
00;21;45;07 - 00;22;26;17
Adam Royal
Yeah. So one is the addition of a checkbox to identify whether the provider is owned by an organization or not. And so the concept of reporting an owning or controlling organization is not a new concept. You're already required to report that. But the checkbox has not been there. So talking about the complexity of reporting corporate owners, I think this is another way of making people, first of all, make an affirmative statement, yes or no, and then getting them to think through it at a granular level who their owners really are.
00;22;27;02 - 00;23;35;28
Meg Pekarske
Just as you say, the checkbox and make an affirmative statement, sort of this idea of like and I don't want to plant seeds here, but you know, how can enrollment and you're make statements that are inaccurate on your enrollment form right. And you've made representations that are inaccurate. How can that be used against you later? And so I think all word to the wise, like these documents are really important because they're going to ask you while you represent it acts on this, right? And then that becomes inaccurate. And and again, there is human error in the world. I mean, I think things happen. But again, I think there's going to always be like a negative in France, like, well, you didn't disclose something because you didn't want to disclose that because you're really trying to hide something as opposed to I was very confused by this form where I overlooked it or whatever. So so I think it's like the checkboxes and to big deal. But in general, what is this representing? Think what you said about making, you know, affirmative statements about representations, about things.
00;23;36;22 - 00;23;52;24
Adam Royal
So yeah, yeah there's a an attestation at the end of the form or reason they may take this seriously. So even even though a checkbox may seem kind of innocuous, the scrutiny we're saying it's it's definitely worth paying attention to.
00;23;53;02 - 00;23;55;07
Meg Pekarske
Yeah. So what else do we have?
00;23;55;17 - 00;24;25;29
Adam Royal
We also have a new disclosure of whether or not the provider is owned by private equity or a real estate investment trust. And these are two new categories that we haven't seen before. And so, again, these are categories that I think CMS is particularly concerned with in terms of why hospices are being bought and sold and how that can affect not just fraud but also patient care.
00;24;26;07 - 00;25;35;11
Meg Pekarske
Yeah, Well, and I think that, you know, CMS is concerned about it. The Department of Justice has also indicated concerns about, you know, private equity and accountability and things like that. And so I think you have lots of different parts of the government, you know, interested in that. So this isn't really a surprise that they now are affirmatively asking about that. And, you know, 20 years ago, that was a two thing. So of course, it's not going to be on the form. But so and then this next change, I think, is really important because this is, again, something everyone needs to fill out. And that's the definition about managing employees. So on the 855, isn't it like section six or something where you have to list managing employees? And again, this is something that it's not always clear like, well, who is a managing employee? You know, there are some clarifications they made about managing employees, so why don't you talk about those?
00;25;35;21 - 00;27;33;06
Adam Royal
Yeah. So like you said, the managing employee is someone you have to disclose on the 855 A And so this proposed rule changes the, the definition of managing employee and the regulations to include a a medical director or a CMO, but they expressly use the term medical director. And so, you know, in general, the concept and definition for a managing employee to date has been someone who has operational control over the organization and exercises day to day management and administrative control. And so in the past and thinking through who you have to disclose to be responsive to that definition, the medical directors are, you know, sort of a a gray area depending on their specific job descriptions, job duties, what they're doing for the hospice, particularly since, you know, oftentimes they're obviously more involved in the clinical aspect of things as opposed to the administrative side. So this definition clarifies managing employees and and includes medical director. So moving forward, the medical directors are someone hospices will have to disclose to the government. And and I think, you know, circling back to to the beginning of the conversation and really the whole conversation about the importance of keeping your enrollment up to date, this is a position where, you know, as opposed to maybe a CEO, you might expect a little higher turnover rate. And so, you know, some providers may have a disinclination to report employees where you expect a high turnover rate with the expectation that if you report them, you also have to update them. This proposed rule now makes clear that medical directors do have to be disclosed.
00;27;33;13 - 00;29;22;14
Meg Pekarske
And this is again, different rule by the Hospice wage index now requires, you know, certified physicians to be enrolled in Medicare or have been filed for an exemption or whatever. And so I'm not surprised by this change because it's like physicians play such a huge role. They are the gatekeepers and understanding, right, their background and who they are. And then if someone a medical director, like 20 hospices, is that really possible? Right. What are you doing? And staff? And so I think there is going to be, you know, pulling back the curtain a little bit more because I think it's from a licensing perspective, I think oftentimes you don't need to report medical directors either. So this is something that will be a different change. And again, it will be interesting to see what comes out of all the staff. Right. Because, yeah, the point of this is we want to know this information and are going to create an affirmative obligation for you to tell us. But then it's not going to start off with just like, Oh, you reported it right? They're going to data mine that and there is going to be, you know, stuff that they're going to do with this information. But, you know, if they don't create obligations or report things, it's hard for them to then make connections and do all this data analytics stuff. So, I mean, I think that plays into a bigger, you know, scheme of things in terms of how the government might connect certain dots and whatnot. So yeah.
00;29;23;03 - 00;30;45;15
Adam Royal
And then yeah, the commentary also points out that this is not kind of establishing a floor to who you have to report. I think. I think on the contrary, expanding the definition to medical director really does point our attention to as clinical side of operations. Maybe that also should be reported. But the end of the day or at the end of the day, you know, you've got to look at not just the title but the roles these people are performing. So thinking through, you know, why did the EMTs make this change? We kind of have to think through at a broader level. What are they concerned about? What does this indicate about how they're going to interpret the definition? And so one thing that can be sort of a painful but fruitful exercise to do with clients is to think through what is your specific management structure, What are the titles, but also what do they actually do that as you may call somebody or CMO or an administrator that, you know, even if the term isn't expressly included in the definition, is someone that that should be reported or that may consider a medical director. And you also mentioned the state reporting requirements, which is something else to consider. What have you reported to the state? What have you reported to CMS? And are those matching up?
00;30;45;15 - 00;31;14;06
Meg Pekarske
Yeah, I think that's a really good way to think about it. Like it says, indicative of a signal of how we interpret operational control, right? Even though people would say, I don't have any power, right, I can't do anything. And then it's like, Yeah, but yeah, not really. Right? So. Right. But but anyway, I guess anything else before we talk about deactivation.
00;31;14;06 - 00;31;24;15
Adam Royal
No, I think that's, that's all I had on that. Just emphasizing really, really understanding and looking through your employees are in and what their job duties are.
00;31;25;09 - 00;31;56;01
Meg Pekarske
So then you know something that there is a big spotlight on was people who got Medicare provider numbers and they never build anything and so the law had already allowed them essentially if you're not using your number, that can be considered, you know, a voluntary termination or something like that. And so tell me what they did and this proposed rule that they had shortening it to if you haven't billed in six months.
00;31;56;13 - 00;33;14;13
Adam Royal
Yeah, they're shortened it from 40, shortening it from 12 months to six months of non billing or when they can deactivate a provider number. And so it was well and until the proposed rule goes into effect a 12 month period or a long time, we didn't see any enforcement around deactivation or lack of billing. All of a sudden we start seeing this type of activity declarations for not billing. And right on the heels of that activity, no surprise we see this shortening from 12 months to six months. And so, yeah, really just cracking down on on having these extra numbers. And the the intent is, again, to prevent fraud. And so the the worry is you have you have one number that you're operating under and keep another number on the side in case anything comes up, in case you have overpayment and then you just switch everything to this other number. And the official term used in the commentary is whack a mole arrangement. So I think this is the first time whack-a-mole has entered official discourse, but it's there now, hopefully to stay.
00;33;15;00 - 00;34;48;07
Meg Pekarske
Oh, that's hilarious. Well, and you and I have had to deal with some activations recently that, you know, it wasn't fraud related, but like because, you know, we had a client that hadn't used Part B number for a number of years for their palliative program because of, you know, just with COVID and being stretched for resources and, you know, but then suddenly they get a notice. And I mean, typically it's and it hasn't been a problem to get reactivated. I mean, it's obviously somewhat of a burden. But, you know, I think potentially in other situations, maybe it could be more difficult to get reactivated. But and people are probably like, when is this going to stop? We're like number six now or seven of these changes. But there are a lot and we're going to link to the rule so people have that. And this podcast is longer than many of ours just because there is just a lot here and a lot to like for us to take in. But I also think sort of breaking it down for for folks because this isn't like, Oh, I don't need to worry about this because I'm not a fraudster. This is going to impact every single hospice in the country. A lot of these changes. So so all right. So then we have expansion of the reapplication bar from three years to ten years. What's that about?
00;34;48;07 - 00;35;13;04
Adam Royal
So this is for providers who are terminated or revoked because of adverse final events, like an exclusion and or felony conviction and involuntary terminations, that kind of thing, expanding it from three years to ten years. The time period you have to wait before you can reapply to participate in the Medicare program.
00;35;13;21 - 00;35;18;17
Meg Pekarske
And how properly most people don't need to worry about that, right?
00;35;18;17 - 00;35;19;21
Adam Royal
Yeah, hopefully not.
00;35;19;25 - 00;36;21;19
Meg Pekarske
You know, it is it is in there. And then, you know, everything we've been focusing on is really about it in this home health proposed rule. But there is also the physician fee schedule, which is very, very long. And there are some changes in there that we just want to touch upon. One was about like prior notification of changes in practice location. Right. And this this rule wasn't specific to hospice. It was just general. And we've had some questions from clients about this. And I don't see this as having been very impactful for hospices just because are the hospice regulations, are they require prior notice or prior approval of multiple locations and changes in your primary practice location? This isn't necessarily new, but there was other things like reporting misdemeanors right out of and wasn't there one more thing to.
00;36;21;24 - 00;36;30;26
Adam Royal
Yeah so judgments under the False claims Act and the consequences of failure is to repay debts to the government.
00;36;31;11 - 00;37;16;21
Meg Pekarske
And that I think is a really important one because you know, there have been over the last decade or so in terms of hospice, some notable cases that have been in the media about someone had some big cap liability or some overpayment to the government and then they just closed down and then they restarted again. And now, you know, with this change that that actually could be much more impactful because it isn't just like, oh, we send it to U.S. Treasury and then they don't collect it and you're fine. It can actually mean like your ability to get back in. And why don't you talk about that little bit could be hampered your ability to get back in.
00;37;16;21 - 00;37;56;09
Adam Royal
And Yeah, exactly. Yeah. And this kind of works in conjunction with what the of the rules to in terms of a reporting owner or who they are individually. And you mentioned the affiliations role that that is also the type of behavior that the affiliations role is geared at preventing and allowing CMS the ability to determine you know who has been subject to these debts, hasn't repaid and may be trying to get back into the program as well. Now, it's not just any in an illegal business name. They're going to be kind of giving more attention to individual owners.
00;37;56;19 - 00;41;30;04
Meg Pekarske
Yeah. So. Huh, I think we've finished our long last because yeah, you always have to keep me on track of which rule is that again? And like it just as I feel like I know what they're doing, but it's just like all of the different rules and then the timeline matters and it's just like coming at every single direction. But I mean, I think the bottom line that I see here for folks is I really think 855 staff and what you're reporting to the government is is incredibly important. And if I'm a C-suite kind of person, I didn't probably spend much time thinking about this. But actually I think you want to understand this a little bit better so you can make sure that you know, your 850 fives, which most likely the CEO signing are accurate. Right because and that that people and because sometimes you know it's compliance but sometimes it's even a step down of who's filling out these 850 fives like it could maybe be a lower level administrative person and it's like they're doing their their best but like they didn't listen to this podcast and talk about this or maybe see the nuance there. And so I think it's just, you know, there's got to be if I were a CEO, I'd want to make sure my organization is really doing this right because I'm going to have to sign this and I'm the one that's citing in blood there that this stuff is accurate and like humans make mistakes. That's not you know what government's really focused on here, But you want to be able to make sure you're we're trying our best and like and so if that's like we review monthly, you know, at whatever meeting we have, are there any changes that we need to report? And the 855 do we have any do board members, do we have any new such insight? You know, it just building it in so it's not like, oh, it's revalidation time, which comes like every three years that make sure we get things updated and it's like, absolutely not. I but you need to do this on a real time sort of basis. So I think it's not it doesn't have to be rocket science, but I think that making this more part of routine conversations on a regular basis, just like, you know right. We screen for exclusion every month. Right. And people put that I mean, it just it's making a system around this and then obviously, if there are concerns about how to interpret managing employees or, you know, some of these more nuanced things, you know, then you can reach out to counsel and talk about those things. But if we don't have a forum in which to, you know, at least ask the question, I just think it's going to get because this is not exciting. STAFF No, it's like, woo hoo, this is really fun. This is a, you know, strategic insight and providing. But like incredibly important because we know the government's doing these things because they really want to, you know, get a better understanding of what's going on and go after people. Right. Like and create accountability and all the staff. So, you know, I think it's it's not the exciting stuff of health care. It's not the innovation. And but this kind of stuff really matters.
00;41;30;17 - 00;41;38;12
Adam Royal
Yeah, Yeah, exactly. It's important and it's kind of become part of operations or ought to Yeah.
00;41;39;03 - 00;42;24;12
Meg Pekarske
Sound like the just there's a lot of not fun things about you know health care and I think there's lots of exciting things going on right now in terms of, you know, value based care and new opportunities and staff. And so but we can't lose sight of sort of these nuts and bolts and making sure that someone who's really up to date is supervising this 855 staff. And you're not saying this isn't an exciting task, so I'm going to go give it to someone low on the totem pole because that is a recipe for disaster as this is actually becoming more and more sophisticated and important part of staying in good graces with the government.
00;42;24;28 - 00;42;26;17
Adam Royal
So exactly.
00;42;27;20 - 00;42;53;20
Meg Pekarske
We've got to do our next podcast on something exciting and innovation. Yes, but instead of 45 minutes of here are like hundred new rules to last. But anyway, well, I thanks for digging into these Adam. This was absolutely and for keeping me on track with I'm sure tomorrow I'll ask you again where is that one good that is that the physician fees schedule is schedules.
00;42;55;00 - 00;43;00;15
Adam Royal
Are you to our podcast. Yeah exactly to get those listener numbers up. Yeah I think this one.
00;43;00;17 - 00;43;17;05
Meg Pekarske
People got amnesia over that one. Anyway. Well thanks a lot for your time. And, and I think this was a great episode. Very important, even if not, you know, exciting. It is very important. So. So thanks for taking the time.
00;43;17;08 - 00;43;20;19
Adam Royal
Yeah, thank you for having me.
00;43;22;06 - 00;43;45;21
Meg Pekarske
Well, that's it for today's episode of Hospice Insights: The Law and Beyond. Thank you for joining the conversation. To subscribe to our podcast, visit our website at huschblackwell.com or sign up wherever you get your podcasts. Till next time, may the wind be at your back.