Healthcare - (Monday)

Regulatory Overview for Valuation Professionals

Monday, June 21, 2021 10:45 a.m. - 12:25 p.m. ET

Since the 2010 passage of the ACA, providers are facing increased regulatory scrutiny, much of which attention is focused on the strict prosecution of fraud and abuse violations, in part, as an avenue to help finance the ACA. The sweeping nature of the ACA will continue to drive ongoing changes in the structure, operation, and financing of many healthcare provider enterprises, likely resulting in an even further increase in hospital/physician practice integration/transactional activities, as well as an increase in the number of U.S. physicians that are currently employed by hospitals. 

This session will present an overview of the healthcare industry’s regulatory environment and will explore the framework through which the interplay between the various federal and state laws within the U.S. healthcare delivery system interact within the context of fraud and abuse regulation and enforcement; tax regulations; licensure and accreditation; competition laws; privacy laws; other federal regulations; and the ACA.
 

After completing this session, attendees will be able to:

  • Recognize tax regulations as they relate to tax-exempt healthcare organizations and their employees, as well as provider taxes, ad valorem taxes, and excise, sales, and use taxes, and how they impact the valuation of a healthcare organization
  • Identify the healthcare fraud and abuse laws, including the Anti-Kickback Statute, the Stark Law, and the False Claims Act, as well as the regulatory bodies that enforce them
  • Describe the thresholds of fair market value and commercial reasonableness

Total CPE: 2
Fields of Study: Business Law: 1, Regulatory Ethics: 1
Program Level: Basic - Learning activity level most beneficial to individuals new to a skill or an attribute.

Who Should Attend:

Legal professionals and healthcare providers, as well as those valuation professionals wishing to expand their scope of activities in healthcare valuation engagements, and those seeking to enhance their current healthcare valuation service lines.

Prerequisites:

Previous training or experience with the fundamentals of accounting, finance, economics, and business writing. These individuals are often at the staff or entry level in organizations, although such programs may also benefit a seasoned professional with limited exposure to the area.

Advanced Preparation:

None

John Kirsner

John  Kirsner

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Todd Zigrang

Todd  Zigrang

Esq.

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The Due Diligence Imperative in the Era of Value-Based Reimbursement

Monday, June 21, 2021 12:40 p.m. - 2:20 p.m. ET

With the emergence of value-based reimbursement models, which rely on achieving the “Triple Aim” of healthcare at lower cost, healthcare providers are increasingly looking to change how services are being delivered by seeking more collaborative relationships with physicians. The increase in these alignments to address value-based reimbursement initiatives has led to a growing number and complexity of transactions in the healthcare delivery marketplace, accompanied by increased federal and state regulatory scrutiny regarding the legal permissibility of these arrangements. Therefore, now more than ever, conducting a level of due diligence appropriate to the scope and complexity of a given assignment is critical to the transactional risks (financial, operational, and regulatory) that may impact the development and defensibility of the valuation opinion. This session will discuss the due diligence process of a healthcare transaction within the Four Pillars of Healthcare Valuation, i.e., regulatory, reimbursement, competition, and technology.

After completing this session, attendees will be able to:

• Describe the regulatory and compliance issues arising from healthcare transactions that are necessitating the increased importance of the due diligence process
• Define the two distinct classes of information required for the due diligence and explain its applicability to the healthcare valuation process
• Identify sources of information that will allow for the appropriate level of analysis required of a transaction in the changing healthcare industry and of the development of a credible valuation opinion


Total CPE: 2
Fields of Study: Economics: 2
Program Level: Intermediate - Learning activity level that builds on a basic program most appropriate for individuals with detailed knowledge in an area.

Who Should Attend:

Legal professionals and healthcare providers, as well as those valuation professionals wishing to expand their scope of activities in healthcare valuation engagements, and those seeking to enhance their current healthcare valuation service lines.

Prerequisites:

Previous training or research on subject matter being taught. Such persons are often at a mid-level within the organization, with operational and/or supervisory responsibilities.

Advanced Preparation:

None

Jessica Bailey-Wheaton

Jessica  Bailey-Wheaton

Esq.

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Todd Zigrang

Todd  Zigrang

Esq.

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The Valuation of Healthcare Enterprises in a Changing Reimbursement Environment

Monday, June 21, 2021 3:00 p.m. - 4:40 p.m. ET

Valuation professionals advising healthcare industry individuals and entities should develop and maintain an in-depth understanding of current and future trends related to the U.S. healthcare reimbursement environment, particularly in an era of healthcare reform. Such trends, such as the transition from volume-based to value-based reimbursement, have the potential to change the way reimbursement is provided and significantly affect provider compensation. This session will discuss healthcare reimbursement within the context of how most providers receive reimbursement for their services from third parties, including: (1) government agencies; (2) commercial payors and insurance companies; (3) employers; and (4) patients and their families. The session will also explore the healthcare revenue cycle and emerging reimbursement trends.

After completing this session, attendees will be able to:

• Create an outline of the steps of the healthcare revenue cycle and describe the applicability of those steps in the current reimbursement environment
• Identify the types of public and private payors, as well as the methods of reimbursement that currently exist and are likely to exist going forward
• Recognize the impact of healthcare reform as to the reimbursement methods utilized by emerging healthcare organizations such as accountable care organizations and patient-centered medical homes
 


Total CPE: 2
Fields of Study: Economics: 1, Finance: 1
Program Level: Basic - Learning activity level most beneficial to individuals new to a skill or an attribute.

Who Should Attend:

Legal professionals and healthcare providers, as well as those valuation professionals wishing to expand their scope of activities in healthcare valuation engagements, and those seeking to enhance their current healthcare valuation service lines.

Prerequisites:

Previous training or experience with the fundamentals of accounting, finance, economics, and business writing. These individuals are often at the staff or entry level in organizations, although such programs may also benefit a seasoned professional with limited exposure to the area.

Advanced Preparation:

None

Lisa Han

Lisa  Han

Esq.

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Todd Zigrang

Todd  Zigrang

Esq.

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Stark Law Modernization: The Healthcare Valuation Implications

Monday, June 21, 2021 4:55 p.m. - 6:35 p.m. ET

On October 9, 2019, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule to modernize and clarify the Stark Law. These proposed rule changes have potentially significant implications, and may serve to create additional opportunities for healthcare valuation professionals, with CMS recognizing and confirming the close link between “the regulated [healthcare] industry and its complementary parts, such as the health care valuation community ...” This session will summarize the Stark Law proposed rule in brief; discuss CMS’s proposed changes to the definitions of fair market value and commercial reasonableness; and review the potential implications of these rule changes on healthcare valuation.
 

After completing this session, attendees will be able to:

• Identify the differences between the current fair market value definition and the proposed definition
• Describe the two proposed definitions of commercial reasonableness
• Explain potential implications of the Stark Law proposed rule on healthcare valuation


Total CPE: 2
Fields of Study: Business Law: 2
Program Level: Update - Learning activity level that provides a general review of new developments.

Who Should Attend:

Legal professionals and healthcare providers, as well as those valuation professionals wishing to expand their scope of activities in healthcare valuation engagements, and those seeking to enhance their current healthcare valuation service lines.

Prerequisites:

Participants need a background in the subject area and desire to keep current.

Advanced Preparation:

None

Jessica Bailey-Wheaton

Jessica  Bailey-Wheaton

Esq.

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Todd Zigrang

Todd  Zigrang

Esq.

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