Season 9 - Episode 407 - Monday Compliance Roundtable

Summary

The 2026 Compliance Roundtable discusses critical issues in healthcare compliance, focusing on prior authorizations, telehealth, clinical laboratories, and incident two billing provisions. Experts (Joe Rivet, Terry Fletcher, Scott Kraft, Stephanie Allard, Jordan Johnson, and David Duhaime) share insights on the challenges faced by providers, the impact of legislation, and the evolving landscape of healthcare regulations. The conversation highlights the need for reform and the importance of understanding the complexities of compliance in the healthcare industry.

Takeaways

• Prior authorizations serve as a gatekeeper to control healthcare costs.
• The burden of prior authorizations can create barriers to timely care.
• Congress is considering reforms to the prior authorization process.
• Medicare Advantage plans often complicate access to care compared to traditional Medicare.
• Virtual supervision has changed the definition of direct supervision in healthcare.
• Incident two billing provisions pose significant compliance risks for providers.
• The error rate in incident two billing is alarmingly high.
• PAMA cuts to laboratory services could negatively impact patient care.
• AI in healthcare presents risks related to patient information security.
• The importance of understanding the nuances of healthcare regulations is critical for compliance.