Top Docs Radio Archives - Business RadioX ®

Adopting Innovation – Top Docs Radio

April 21, 2016 by angishields

Top Docs Radio

Adopting Innovation - Top Docs Radio

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Adopting Innovation

I sat down with Judy Mod and Trent McEwan of RevenueSphere. We are in the midst of a significant business transformation – as organizations are redefining their own path to adoption – from recognition of pain through problem resolution. What’s broken?

The fundamental shift in the way buyers are now adopting technology is increasing the complexity surrounding the decisions being made about what strategic business problems to adopt – what operational approaches to adopt to fix the problem – and ultimately technically what to buy.

The rule of thumb is the more complex the organization, the more disruptive your innovation, the more difficult your market development; the bigger drag this adoption problem is likely having on your business growth. The more disruptive the innovation = The more complex the adoption.

One critical effect – 80% of sales today are being lost – not to the competition – but to “non-decision”; RevenueSphere, LLC, the problem we solve is the process of adoption across the entire life cycle (problem, operational, technical, and financial), bridging the widening gap between buyers and sellers.

Special Guests:

Judy Mod, CEO, Chief Adoption Officer, RevenueSphere

Trent McEwan, COO/CTO, RevenueSphere

Health Care Fraud and False Claims – Top Docs Radio

February 29, 2016 by angishields

Top Docs Radio

Health Care Fraud and False Claims - Top Docs Radio

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Health Care Fraud and False Claims

I hosted 2 False Claims Act legal experts on this week’s MAG edition of Top Docs Radio. You’re going to want to check out what they have to say, as it could mean the difference between practicing medicine or not, in the end.

Scott Grubman is a partner with the law firm of Chilivis Cochran Larkins & Bever in Atlanta. He represents health care providers of all types and sizes with government investigations and audits, False Claims Act, and other complex litigation and various regulatory and compliance matters. Prior to joining private practice, Scott served as a trial attorney with the U.S. Department of Justice in Washington, D.C., and as an assistant U.S. attorney in Savannah – where he served on a district health care fraud taskforce. Scott also serves as an adjunct professor at Georgia State University’s College of Law, where he teaches a course in health care fraud and abuse.

Jason Marcus is among a select group of lawyers who devote their practice to qui tam and related retaliation claims under federal and state False Claims Acts. He has practiced FCA law exclusively since 2008, and he formed the firm of Bracker & Marcus in January of 2015 with partner Julie Bracker, who is dedicated to representing whistleblowers nationwide. Jason is a 2006 graduate of the University of Georgia School of Law, a former clerk to the honorable Magistrate Judge G.R. Smith of the Southern District of Georgia, and a member of Taxpayers Against Fraud Education Fund and the Georgia affiliate of the National Employment Lawyers Association.

Health care is one of the fastest growing and most heavily-regulated industries in the United States. Given that government payers (Medicare, Medicaid, etc.) finance a significant portion of the system, regulators and law enforcement have dedicated tremendous resources to rooting out and punishing fraud and abuse in health care. In fiscal year 2015 alone, the federal government recovered nearly $2 billion in settlements and judgments from health care providers under the federal False Claims Act, which does not include recoveries through audits and other administrative avenues.

Moreover, not only are the actions of healthcare providers constantly scrutinized by federal and state auditors

and law enforcement, but also by competitors, commercial insurance companies, private whistle blowers, and the public. Big hospitals and health care entities with “deep pockets” have historically carried the bulk of the liability in government enforcement actions. But beginning in 2015, the federal government announced a new policy which focuses on holding individuals – particularly individual health care providers – responsible and liable for unlawful conduct. A lot of the laws governing health care fraud and abuse do not require a specific intent to defraud or even actual knowledge of the unlawful nature of the conduct. In fact, one of the major laws governing health care fraud and abuse (the physician self-referral law or “Stark law”) requires no culpable mindset whatsoever. Accordingly, it is crucial for health care professionals of all types to be aware of the various statutory and regulatory schemes that govern health care billing and to act accordingly.

MORE INFO SOON!

Special Guests:

Scott Grubman

Jason Marcus

MAG’s MEP 401(k) – Top Docs Radio

February 12, 2016 by angishields

Top Docs Radio

MAG's MEP 401(k) - Top Docs Radio

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MAG's 401(k) — Kevin Rainwater talks MAG’s 401(k) plan

MAG’s MEP 401(k)

We continue our series with Medical Association of Georgia, hosting Kevin Rainwater of Atlanta Capital Group to learn about MAG’s MEP 401(k) plan. Kevin Rainwater is a managing partner with Atlanta Capital Group, specializing in retirement planning.

Kevin began his career in the financial services industry more than 16 years ago. He has a passion for helping employees, executives and business owners reach their retirement goals. Kevin provides investment and plan advisory services to companies and individuals throughout the nation.

He relies on his extensive knowledge of qualified plan design and investment offerings to provide business owners and participants with the most competitive retirement plan option available.

MAG member practices can save time and money and retain employees by participating in a MAG-sponsored 401(k) retirement plan that’s available through the Atlanta Capital Group and Transamerica.

The MAG 401(k) Plan is treated like one large plan from a government Form 5500 reporting standpoint. The result is a 401(k) plan with competitive investments, outstanding service, and someone else doing a majority of the plan maintenance leg work. With more than 7,800 members, MAG offers a large, unified plan.

When you utilize the MAG 401(k) Plan, you have all of the advantages and flexibility of a stand-alone plan, while avoiding the expenses and administrative headaches associated with sponsoring a stand-alone plan.

Member benefits include cost savings on the investments; No individual Form 5500 reporting; Minimal plan maintenance; Flexible plan features, including safe harbor; Roth and profit sharing; Customizable 401(k) plan design options involving eligibility, matches, and vesting schedules; No audit at member level.

By participating in the MAG 401(k) Plan, virtually all of the administrative tasks can be offloaded from the practice to Transamerica, ACG, and MAG.

Special Guest:

Kevin Rainwater, Partner, Atlanta Capital Group

BS, Marketing, University of Alabama
Previous Regional Sales Director, First Mercantile
Former Director, National Accounts, The Standard

Representative Sharon Cooper – Top Docs Radio

February 1, 2016 by angishields

Top Docs Radio

Representative Sharon Cooper - Top Docs Radio

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Representative Sharon Cooper

I hosted MAG CEO/Executive Director, Donald Palmisano, Jr., and Georgia State Representative, Sharon Cooper. We talked about 2016 legislative priorities affecting healthcare in the state. More information soon!

Special Guests:

Sharon Cooper, Rep. Dist 43, Georgia State House of Representatives (R)

MA Education
MSN, Nursing
Authored 2 books on psychiatric nursing
Chair, Georgia Health and Human Services Committee

Donald Palmisano, CEO, Executive Director of Medical Association of Georgia

JD Law, Loyola School of Law
Board of Directors, Physician Advocacy Institute
Medical Payment Subcommitte Member, State Board of Workers’ Compensation
Treasurer, Board of Directors, Physicians’ Institute for Excellence in Medicine
Former Director, Government Relations/General Counsel/Director, GAMPAC

Blue Cross Blue Shield of Georgia – Top Docs Radio

January 18, 2016 by angishields

Top Docs Radio

Blue Cross Blue Shield of Georgia - Top Docs Radio

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Blue Cross Blue Shield of Georgia

On this week’s episode with our partner, Medical Association of Georgia, MAG CEO, Donald Palmisano, Jr., joined me in studio. We hosted Jeff Fusile, the recently-appointed President for Blue Cross Blue Shield of Georgia. Jeff joined the company in the lead role, coming over from Anthem in November of 2015.

Jeff Fusile is president of Blue Cross and Blue Shield of Georgia (BCBSGa), the state’s oldest and largest health insurance company. He oversees sales, account service, marketing, underwriting, and customer relationships. Jeff is involved in corporate strategy planning and execution, and he serves as the primary contact for state regulators to ensure compliance and manage any state-related matters.

Jeff previously served as Senior Vice President and Chief Financial Officer for the Commercial & Specialty Business Division of Anthem, Inc., which is Blue Cross and Blue Shield’s parent company. He joined Anthem in 2011 after spending 22 years as a strategic management consultant with PricewaterhouseCoopers. Jeff is a licensed CPA. He has qualified as an expert witness in insurance and the broader health care industry. He is widely recognized as an industry leader in health care strategy, corporate governance, compliance, enterprise risk management, HIPAA, and ICD-10.

As the health care landscape undergoes an unprecedented transformation, the traditional relationships between providers and payers are also evolving. With the largest network of providers in the state, Blue Cross and Blue Shield of Georgia (BCBSGa) serves more than 3 million Georgians and is the only plan offered in all 159 counties. BCBSGa President Jeff Fusile will discuss how BCBSGa is developing programs to facilitate better collaboration with providers, make health care more affordable for consumers and simplify the access to care. Reaching out to rural communities and the impact of technology on delivering innovative solutions was also discussed.

Special Guest:

Jeff Fusile, CEO, Blue Cross Blue Shield of Georgia

BS, Accounting & Finance, Florida State University College of Business
Certified Public Accountant
Previous Managing Partner, PriceWaterhouseCoopers
Former Senior VP/CFO, Commercial & Specialty Business, Anthem

Dental Deserts – Top Docs Radio

December 23, 2015 by angishields

GDHA — Misty Mattingly, Charlie Craig, and Sarah Smith explain GA HB 684

Dental Deserts

In the state of Georgia, 118 counties out of 159 have too few dentists to treat those residents. 16 Georgia counties have NO DENTIST at all. Clearly, this leaves a large, rural population in the state with limited or NO access to even basic, preventive dental care.

Today, there are only 5 states that do not allow hygienists to operate under a dentist’s supervision unless the dentist is physically on site where the dental hygiene care is provided. One of those is Georgia.

President of Georgia’s Dental Hygienist Association, Misty Mattingly, stopped by, along with Sarah Smith and Charlie Craig of Solution Road to talk about a measure before the Georgia House of Representatives that will address the lack of access to preventive screenings and treatments that are provided by hygienists.

Currently, Georgia law requires that a dentist is ON SITE while a hygienist administers care. Obviously, this is impossible in 16 counties without some sort of medical mission on the part of dentist and hygienist, and limited in 118 Georgia counties. Under HB 684, hygienists would be able to be supervised remotely by a dentist rather than requiring them to physically be on site. This would empower hygienists to provide diagnostic screening and preventive care in these areas with limited to no access.

When problems requiring restoration such as a filling or crown would be identified by the hygienist during these visits, they would be referred to a dentist for appropriate care. Without question this is a win for all parties, particularly the patients who today, have problems often going undiagnosed until serious, often resulting in an ER visit for evaluation.

https://soundcloud.com/cwhall333/ga-hb-684-and-hb-350

Top Docs Radio on Midtown Business RadioX Spotlights the Medical Association of Georgia – Business RadioX

December 17, 2015 by angishields

ATLANTA, GA–(Marketwired – December 17, 2015) – On November 16, 2015, Top Docs Radio welcomed to the studio Donald Palmisano with the Medical Association of Georgia (MAG) and Dr. John Rogers with Coliseum Northside Hospital. Host CW Hall led this month’s MAG special to talk about the challenges and concerns arising from recently-proposed mergers between large health insurance companies that will significantly reduce the amount of competition in the space for Georgians to choose.

Donald Palmisano is the CEO and Executive Director of MAG. The Medical Association of Georgia (MAG) is the leading advocate for physicians in the state. MAG focuses on legislative, legal and third party payer issues. Serving as the Co-Medical Director of Coliseum Northside Hospital, Dr. John Rogers is also a MAG delegate from Bibb County. The studio discussion focused on the fact that Aetna/Humana and Anthem/Cigna are in the process of merging. At the same time, health insurers are offering insurance policies to the public that do not have adequate coverage, resulting in more out of network charges by physicians.

Aetna/Humana and Wellpoint/Cigna have proposed mergers in the health insurance market. If these inadequate policies are being offered in the current environment, MAG is concerned about how patients will be negatively impacted with a further narrowing of the networks and increased physician reliance on out of network charges.

MAG recently sent a letter to the U.S. Department of Justice to call for it to scrutinize the mergers for antitrust violations. According to Palmisano, “We believe the mergers would reduce competition and place physicians and their patients at an even greater disadvantage as a shrinking number of health insurance companies gain increasingly-dominant positions in the marketplace.”

“Physicians have little-to-no leverage to negotiate contract terms with these multi-billion dollar conglomerates,” explained Dr. Rogers, “which are imposing take-it-or-leave-it agreements and unilateral, mid-term amendments with growing impunity.”

Gone unchecked, a few insurers will be in a position to manipulate the marketplace to institute policies that will exacerbate the physician shortage and undermine the economic viability of the practice environment in the state, and limit the accessibility of care and individual patient choice.

To learn more about MAG’s position on healthcare mergers, listen to the entire interview onTop Docs Radio.

About Top Docs Radio:

Top Docs Radio is a forum for conversations with leading doctors and thought leaders. Discussions are about cutting edge trends and topics in health, wellness and lifestyle issues. Top Docs Radio is presented by Hyperbaric Physicians of Georgia and is hosted by Charles “CW” Hall. The program airs live every Thursday at Noon Eastern.

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Business RadioX® interviews dozens of innovative entrepreneurs and successful leaders each week. Its mission is to help local businesses Get the Word Out about the important work they’re doing for their market, their community, and their profession. With a pro-business slant and a long-form interview format, guests don’t have to worry about being ambushed or talking in “sound bites.” Guests have enough time to tell their whole story and to share their insights and experience without interruptions. Business RadioX® hosts are business professionals interviewing their peers, drilling down on the critical issues, and delivering practical information to an engaged business audience. Business topics that are frequently covered include: Law, Finance, Healthcare, Technology, Trade Shows, B2B Marketing, Venture Capital, Training and Development and other issues impacting the business community. For more information, visit: https://businessradiox.com.

Insurance Reimbursement – Top Docs Radio

December 15, 2015 by angishields

Top Docs Radio

Insurance Reimbursement - Top Docs Radio

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John Oxendine PC — John Oxendine talks insurance reimbursement.

Insurance Reimbursement

This week’s show was part of our monthly series with MAG and we focused our conversation on legal issues around commercial insurance reimbursement for physicians. Former insurance commissioner for the state of GA, attorney, and expert on the subject, John Oxendine, joined me in the studio to talk about some important things physicians need to know relating to commercial insurance reimbursement.

There are laws that lay out requirements for timeliness of payment and/or communications regarding submitted claims that must be adhered to by insurance companies. Additionally, there are also rules around documentation of assignment of representation that can be the difference between losing five or six figures to insurance company claw back or being able to deny those requests to return payment for previously-delivered care.

John Oxendine is uniquely qualified to provide advice and information to physicians on the subject of health insurance reimbursement. He spent over 15 years as Georgia’s State Insurance Commissioner. He has worked closely with MAG, the Georgia Association of Physicians of Indian Heritage, AMA, and numerous other health care provider organizations.

While Insurance Commissioner, John created a division at the Department of Insurance to help physicians with claims payment issues. Additionally, he was the first commissioner in the country to levy large fines against insurance companies not in compliance with the state’s prompt pay law.

Special Guest:

John Oxendine, Attorney, John Oxendine PC

Doctor of Law, Mercer University, Walter F. George School of Law
Former Commissioner, Georgia Department of Insurance, 1995-2011

Top Docs Radio on Midtown Business RadioX Explores Self Funded Insurance Plans – Business RadioX

November 20, 2015 by angishields

ATLANTA, GA–(Marketwired – November 19, 2015) – On November 9, 2015, Top Docs Radio welcomed to the studio Alan Conner with My Professional CFO. Host CW Hall sat down with Conner to discuss self funded insurance plans for contractor physicians.

Conner is a tax and accounting expert who works with a wide range of companies and professionals, including physicians. He founded My Professional CFO to take the mystery out of small business accounting, tax planning, and wealth management so a professional can focus their entrepreneurial energy on growing business and satisfying clients.

In addition to providing basic accounting and payroll functions, Conner also helps physicians develop effective, legal tax strategies, including self funded insurance plans to reduce their tax burden and risk at the same time. “Many physicians work as 1099 contractors for the respective practice they serve,” explained Conner. “In this relationship, the doctor receives a gross paycheck with no tax withheld. In this situation it is vital for the provider to plan for their tax obligation and pay it in a timely fashion or they face between 5-10% penalties, which can quickly add up to significant amounts, based on the numbers they’re working with.”

Conner shared with listeners several options available to physicians that work as 1099 contractors, including self funded insurance plans, pension plans, SEP IRA’s, and others, that will help them preserve their hard-earned revenue for later while protecting them from risk such as loss of medical license should that occur.

To learn more about Conner and My Professional CFO’s services, listen to the entire interview on Top Docs Radio.

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