The specific nuances of performing fair value analyses for transactions involving for-profit and not-for-profit health systems and certain other healthcare entities are highlighted in this presentation. Also discussed are: identifying the specific needs of the engagement as it relates to the engagement, and valuing tangible and intangible assets and the support they need from clients and auditors to ensure a quality work product.
Navigating Relationships Between Hospital and Physicians--Negotiating and Val...PYA, P.C.
Offering a broad understanding of laws and regulations in the healthcare industry, this presentation serves as a valuable training program for new associates and in-house counsel, and an excellent refresher for experienced health lawyers as well.
Expert Witness Testimony in Family Law: Real Life Pitfalls and How to Avoid ThemPYA, P.C.
Tips on how to avoid snares as an expert witness in family law are covered. Including: deposition tips and techniques, trial scripting for direct testimony, preparing for cross-examination, and how to recover during re-direct.
New regulations have many executives wondering if their retirement plan is in compliance. Chances are you have a compliance violation. Patrick Shelton, Managing Member – Benefit Plans Plus, an affiliated company of Brown Smith Wallace, discusses retirement plan regulations and the critical importance of benchmarking.
The Insurance Act 2015 has introduced the most significant reform to insurance law in over 100 years. The Act impacts all those involved in the insurance sector. In this report we review key markets' response to the Act and outline the practical steps you should have addressed ahead of the Act coming into force.
Visit our hub to access information and resources tailored to brokers: www.brownejacobson.com/brokers
Navigating Relationships Between Hospital and Physicians--Negotiating and Val...PYA, P.C.
Offering a broad understanding of laws and regulations in the healthcare industry, this presentation serves as a valuable training program for new associates and in-house counsel, and an excellent refresher for experienced health lawyers as well.
Expert Witness Testimony in Family Law: Real Life Pitfalls and How to Avoid ThemPYA, P.C.
Tips on how to avoid snares as an expert witness in family law are covered. Including: deposition tips and techniques, trial scripting for direct testimony, preparing for cross-examination, and how to recover during re-direct.
New regulations have many executives wondering if their retirement plan is in compliance. Chances are you have a compliance violation. Patrick Shelton, Managing Member – Benefit Plans Plus, an affiliated company of Brown Smith Wallace, discusses retirement plan regulations and the critical importance of benchmarking.
The Insurance Act 2015 has introduced the most significant reform to insurance law in over 100 years. The Act impacts all those involved in the insurance sector. In this report we review key markets' response to the Act and outline the practical steps you should have addressed ahead of the Act coming into force.
Visit our hub to access information and resources tailored to brokers: www.brownejacobson.com/brokers
Enterprise Act 2016 and its impact on brokers - survey resultsBrowne Jacobson LLP
From 4 May 2017, the Enterprise Act updated the law to enable policyholders to recover unlimited damages caused by the late payment of claims from insurers. This is not a penalty against insurers for negligently delaying payment. Policyholders must demonstrate and evidence the actual loss they have suffered and show that it was caused by a delay in the payment of a claim. Any damages claim against the insurer must be brought within 1 year of the claims payment under the policy.
We have conducted a survey of insurers, brokers and loss adjusters to understand the expected impact of the Act. Here’s a summary of the key findings.
Visit our hub to access information and resources tailored to brokers: www.brownejacobson.com/brokers
Webinar on Hidden Fees in 401k plans. How they impact plan holders and the potential liability that business owners and fiduciaries are now exposed to.
This paper is provided by NAPLIA.
The Investment Advisor’s Guide to Errors & Omissions Insurance will help you anticipate areas of underwriter concern as it relates to your specific investment practice, helping you internally evaluate your risk exposures and better define your activities and professional services.
OIG’S VOLUNTARY COMPLIANCE TO MEDICAL BILLING COMPANIESJessica Parker
Health care providers are relying on billing companies to a greater degree in assisting them in processing claims in accordance with applicable statutes and regulations. Additionally, health care professionals are consulting with billing companies to provide timely and accurate advice with regard to reimbursement matters, as well as overall business decision-making.
Our endeavour upheld group has more than 50 years of experience working with systematic investment management, and software development. By utilizing machine learning, data science and automation, we enable advisors to manage portfolio risk in near real-time.
Enterprise Act 2016 and its impact on brokers - survey resultsBrowne Jacobson LLP
From 4 May 2017, the Enterprise Act updated the law to enable policyholders to recover unlimited damages caused by the late payment of claims from insurers. This is not a penalty against insurers for negligently delaying payment. Policyholders must demonstrate and evidence the actual loss they have suffered and show that it was caused by a delay in the payment of a claim. Any damages claim against the insurer must be brought within 1 year of the claims payment under the policy.
We have conducted a survey of insurers, brokers and loss adjusters to understand the expected impact of the Act. Here’s a summary of the key findings.
Visit our hub to access information and resources tailored to brokers: www.brownejacobson.com/brokers
Webinar on Hidden Fees in 401k plans. How they impact plan holders and the potential liability that business owners and fiduciaries are now exposed to.
This paper is provided by NAPLIA.
The Investment Advisor’s Guide to Errors & Omissions Insurance will help you anticipate areas of underwriter concern as it relates to your specific investment practice, helping you internally evaluate your risk exposures and better define your activities and professional services.
OIG’S VOLUNTARY COMPLIANCE TO MEDICAL BILLING COMPANIESJessica Parker
Health care providers are relying on billing companies to a greater degree in assisting them in processing claims in accordance with applicable statutes and regulations. Additionally, health care professionals are consulting with billing companies to provide timely and accurate advice with regard to reimbursement matters, as well as overall business decision-making.
Our endeavour upheld group has more than 50 years of experience working with systematic investment management, and software development. By utilizing machine learning, data science and automation, we enable advisors to manage portfolio risk in near real-time.
PYA Principal Carol Carden and Senior Manager Angie Caldwell presented “Hot Topics in Physician Compensation” at the Kentucky Society of CPAs (KY CPA) Health Care Conference, May 18, 2016. The presentation explored the latest developments in physician compensation structure, as well as considerations related to stacking compensation elements, the role and impact of quality incentives, the latest in affiliation models, and population health initiatives.
Regulatory Compliance, Risk Management, and the Trustee's RolePYA, P.C.
PYA Principal Shannon Sumner and Consulting Manager Susan Thomas presented “Regulatory Compliance, Risk Management, and the Trustee’s Role.” In this presentation, they will:
Describe the evolving compliance and risk management landscape, including government agencies’ expectations for compliance oversight. This presentation will:
- Outline recent government investigations and settlements.
- Provide key takeaways regarding responsibilities for ensuring an effective compliance program.
- Connect trustee duties to specific elements of enterprise risk management.
- Empower trustees with questions to ask leadership teams in preparation for playing a more active role in the compliance program.
Alex Howard and Neil Beaton discussed valuations in dissenter’s rights and oppression actions in a webinar sponsored by the AICPA Business Valuation Web Seminar Series: Core Competencies from the Nation’s Leading Experts.
1 2Week 4 Evidence and Standards ACC49142020Week .docxsmithhedwards48727
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Week 4 Evidence and Standards ACC/491
4/20/20Week 4 Evidence and Standards
Comparison of Audit, Scientific and Legal Evidence Standards.
According to "Investopedia" (2020), generally accepted auditing standards (GAAS) are a set of systematic guidelines used by auditors when conducting audits on companies' financial records. GAAS helps to ensure the accuracy, consistency, and verifiability of auditors' actions and reports. The Auditing Standards Board (ASB) of the American Institute of Certified Public Accountants (AICPA) created GAAS. (para 1).
Scientific evidence is information gathered from scientific research, which takes a lot of time to conduct. But there are a few things that all this research needs to have in common to make it possible for businesses to accept it as "evidence" ("The Conversation," 2020).
Legal evidence is represented by what is lawful to be proven by law to be valid or invalid, true or untrue.
Consideration of Sample Sizes and Methods (random, haphazard, monetary unit sample, judgmental) and how sampling affects evidence.
Evidence gathered should be representative of the population. The chances that the sample taken is not representative of the population is sampling risk, which should be controlled by using proper sample size and appropriate selection. (Arens, Elder, & Beasley, 2014, p. 476)
The selection of a sample is made using the following methods: random, haphazard, monetary unit, and judgmental.
Random sample selection is made by giving all items in a population the same chance of being selected. Sample selection is used when there is no need to emphasize some items in the population. (Arens, Elder, & Beasley, 2014, p. 478)
Haphazard sample selection is made without any distinguishing characteristics such as size or source. (Arens, Elder, & Beasley, 2014, p. 480)
Monetary unit sampling is a statistical method used for testing details of balances. Samples are selected based on the probability proportional to size sample selection. (Arens, Elder, & Beasley, 2014, pp. 566-567)
Judgmental sampling is based on the auditor's decision on which items from the population to review. It's based on auditor's knowledge of the business and industry, as well as their experience in auditing.
Relevance, Reliability and Sufficiency of Evidence.
Our company's control over financial reporting is a process that's designed to assure the reliability of financial reporting and the preparation of financial statements for external purposes under generally accepted accounting principles. Management is responsible for establishing and maintaining internal control over financial reporting (as defined in Rule 13a-15(f) under the Exchange Act). They assess the effectiveness of the internal control over financial reporting based on the criteria that were set forth in the Internal Control-Integrated Framework that was issued by the Committee of Sponsoring Organizations of the Treadway Commission (2013 framework). Managem.
Related Party Transaction and Performance of Quoted Banks in Nigeriaijtsrd
This study examined the effect of related party transactions on return on total equity of quoted commercial banks in Nigeria. Data for the study were analyzed with descriptive statistics and ordinary least squares OLS analysis was used to test the hypothesis using Statistical Package for Social Sciences SPSS . The findings show that related party transaction has statistical positive relationship on the return on equity of the quoted Nigerian commercial banks. Based on the findings of this study, the researcher recommends that equity shareholders must always ensure that dividend declared are not based on falsified profit especially when related party transactions which has inherent risk of corporate failure are involved. Okerekeoti, Chinedu U. "Related Party Transaction and Performance of Quoted Banks in Nigeria" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-6 | Issue-1 , December 2021, URL: https://www.ijtsrd.com/papers/ijtsrd47968.pdf Paper URL: https://www.ijtsrd.com/management/accounting-and-finance/47968/related-party-transaction-and-performance-of-quoted-banks-in-nigeria/okerekeoti-chinedu-u
This article analyzes a current financial reporting and accounting issue regarding diversity in
financial reporting practice. Since the Financial Accounting Standards Board (FASB) first issued accounting
statement 157 Fair Value Measurements, entities have been required to measure investments at fair market
values. This included the requirement to categorize investments within a fair value hierarchy in preparation to
report such in the financial statements. To do this, the FASB allows companies to either categorize the
investment in the fair value hierarchy using three different input levels (Level 1, 2 and 3) or by estimating the
net asset value as a practical expedient. If the entity uses the practical expedient, the investment would be
placed within the fair value hierarchy based on whether the investment is redeemable with the investee at the
measurement date, never redeemable, or redeemable in the future. Based on this information, the investment
would be placed in either level 2 or 3 of the hierarchy. As a result, there is diversity in practice when estimating
the length of time in the near term the investment would be redeemed. This article reports the results of
evaluating how can the diversity in accounting practice related to how certain investments measured at net asset
value are categorized within the fair value hierarchy be resolved. The results of the qualitative research
conducted on the FASB proposal concluded that fourteen out of the eighteen public comment letters agreed
with FASB proposal that eliminating the requirements to classify these investments in the fair value hierarchy
would increase comparability in accounting practice among entities.
This article analyzes a current financial reporting and accounting issue regarding diversity in financial reporting practice. Since the Financial Accounting Standards Board (FASB) first issued accounting statement 157 Fair Value Measurements, entities have been required to measure investments at fair market values. This included the requirement to categorize investments within a fair value hierarchy in preparation to report such in the financial statements. To do this, the FASB allows companies to either categorize the investment in the fair value hierarchy using three different input levels (Level 1, 2 and 3) or by estimating the net asset value as a practical expedient. If the entity uses the practical expedient, the investment would be placed within the fair value hierarchy based on whether the investment is redeemable with the investee at the measurement date, never redeemable, or redeemable in the future. Based on this information, the investment would be placed in either level 2 or 3 of the hierarchy. As a result, there is diversity in practice when estimating the length of time in the near term the investment would be redeemed. This article reports the results of evaluating how can the diversity in accounting practice related to how certain investments measured at net asset value are categorized within the fair value hierarchy be resolved. The results of the qualitative research conducted on the FASB proposal concluded that fourteen out of the eighteen public comment letters agreed with FASB proposal that eliminating the requirements to classify these investments in the fair value hierarchy would increase comparability in accounting practice among entities.
PYA’s Angie Caldwell, a healthcare consulting and financial audit services principal, along with Emily Smithson, a tax services manager, discussed “Finance for the Non-Finance Manager.” Their presentation covered the basics of financial reporting and financial statements and budgeting.
Key Internal Auditing Perspectives for Advanced Practice ProvidersPYA, P.C.
This presentation explained how employed physicians may leverage APPs, and described billing and compliance considerations involving physicians utilizing APPs; analyzed the potential impact on employed physician compensation, including fair market value and commercial reasonableness considerations; summarized government and payer perspectives; equipped attendees with an internal audit framework for assessing their organizations’ compliance risks.
Accounting and Financial Reporting Update for the Health Care IndustryPYA, P.C.
Recent Financial Accounting Standards Board and Governmental Accounting Standards Board activity related to revenue recognition, leases, and other audit and accounting topics are discussed within this presentation.
IQ from a QOE: Key Considerations When Performing a Quality of Earnings Analy...PYA, P.C.
Given the complexity of healthcare’s reimbursement environment, determining the quality of reported earnings during a transaction’s due-diligence process can prove challenging. In his presentation, “IQ from a QoE: Key Considerations When Performing a Quality of Earnings Analysis Involving Healthcare Entities,” PYA Pricipal Michael Ramey introduced key considerations when planning and performing effective QoE engagements for various healthcare entities.
Key Internal Auditing Perspectives for Advanced Practice ProvidersPYA, P.C.
This presentation explained how employed physicians may leverage APPs, and describe billing and compliance considerations involving physicians utilizing APPs.
Analyzed the potential impact on employed physician compensation, including fair market value and commercial reasonableness considerations.
Summarized government and payer perspectives.
Equipped attendees with an internal audit framework for assessing their organizations’ compliance risks.
Similar to Fair Value Analysis of Healthcare Entities (20)
“CARES Act Provider Relief Fund: Opportunities, Compliance, and Reporting”PYA, P.C.
PYA Principal Martie Ross spoke at the virtual North Carolina Healthcare Association Critical Access Hospital Statewide Meeting. The two-day event, “Quality Focus is a Finance Focus,” provided critical access hospital leaders with the opportunity to network and review data-informed strategies as well as updates to the Medicare Flexibility Program Project. It also provided guidance on federal compliance and tracking of Provider Relief Funds.
In “CARES Act Provider Relief Fund: Opportunities, Compliance, and Reporting,” Martie gave an overview of the history of distribution of those funds as well as regulations and guidelines including:
Statutory Language
Reporting Requirements
Use of Funds Calculation
Expenses
Risk Management
Martie presented Thursday, March 4, 2021.
If you would like guidance related to Provider Relief Fund regulations, or for assistance with any matter related to strategy and integration, compliance, or valuation, contact one of our PYA executives at (800) 270-9629.
PYA Presented on 2021 E/M Changes and a CARES Act Update During GHA Complianc...PYA, P.C.
The Georgia Hospital Association (GHA) Compliance Officers Roundtable, an active GHA group that meets quarterly and includes educational sessions featuring government representatives, industry experts, and other thought leaders speaking about compliance-related issues, conducted their latest meeting virtually. PYA Principals Lori Foley, Tynan Kugler, and Valerie Rock were among the presenters at this quarter’s event. In their session, they:
Described key elements associated with 2021 E/M changes, and strategies for preparation and implementation.
Explained the impact of 2021 E/M changes on physician compensation and contracting, including potential mitigation approaches.
Presented key components of Stark Law and Anti-Kickback Statute final rules.
Provided an update on the CARES Act.
The Compliance Certification Board offered CEUs for this event, which took place on Friday, December 4, 2020.
Webinar: “Trick or Treat? October 22nd Revisions to Provider Relief Fund Repo...PYA, P.C.
On October 22nd, the Department of Health and Human Services released revised Provider Relief Fund (PRF) reporting requirements. Under HHS’ September 19 directive, “lost revenue” was defined narrowly as a negative change in year-over-year patient care operating net income. Now, HHS will permit providers to use PRF funds to cover the difference between their 2019 and 2020 actual patient care revenue with some adjustments for COVID-related expenses. The October 22nd notice is available here.
PYA Principals Martie Ross and Michael Ramey hosted a complimentary 30-minute webinar, “Trick or Treat? October 22nd Revisions to Provider Relief Fund Reporting Requirements” on Thursday, October 29th.
“Regulatory Compliance Enforcement Update: Getting Results from the Guidance” PYA, P.C.
PYA Principal and Chief Compliance Officer Shannon Sumner and Consulting Senior Manager Susan Thomas presented “Regulatory Compliance Enforcement Update: Getting Results from the Guidance” at the virtual 2020 Montana Healthcare Conference. They reviewed the sources of regulatory enforcement and investigation information—guidelines, statutory updates, best practices, settlements, case studies, etc.—available to healthcare organizations. They will also discuss how to interpret and implement the guidance in order to strengthen the compliance function and protect the organization. The presentation covered:
Compliance regulatory requirements for healthcare organizations.
Guidance available for consideration in organizational compliance programs.
Internal and external reporting to ensure regulatory requirements are met.
Best practices for implementation of guidance.
Case studies for illustration of guidance implementation.
“Federal Legislative and Regulatory Update,” Webinar at DFWHCPYA, P.C.
The Dallas Fort Worth Hospital Council (DFWHC) and PYA co-hosted an exclusive complimentary webinar, “Federal Legislative and Regulatory Update,” on Wednesday, September 23.
DFWHC President/CEO Stephen Love hosted a discussion with PYA Senior Manager Kathy Reep about concerns that have dropped from the radar during the last four months of COVID-19, addressing issues for which hospitals must prepare in approaching 2021. This session focused on these key areas:
Appropriate use criteria
Transparency
Site neutral payments
The future of the Medicare Trust Fund
The federal budget
Key provisions of the final rule for the inpatient prospective payment system for FY2021 and the proposed outpatient rule for CY2021
On-Demand Webinar: Compliance With New Provider Relief Funds Reporting Requir...PYA, P.C.
On September 19, the Department of Health and Human Services (HHS) published its Post-Payment Notice of Reporting Requirements. The Notice details the reporting requirements for all Provider Relief Fund (PRF) recipients that have received $10,000 or more in aggregate payments.
Under the PRF Terms and Conditions, a recipient may use the funds only for healthcare-related expenses and lost revenue attributable to coronavirus. The Notice provides the clearest direction to date regarding permissible uses of PRF funds.
PYA offered a 45-minute complimentary webinar that explained the new reporting requirements and delved into permissible uses. While many questions remain, we provided practical advice on the next steps in the reporting process.
The webinar took place Monday, October 5 at 11 a.m. EDT.
Webinar: “While You Were Sleeping…Proposed Rule Positioned to Significantly I...PYA, P.C.
You likely know from the headlines that the 2021 Medicare Physician Fee Schedule (MPFS) Proposed Rule slashes payments for surgical specialists. But the impact of the Proposed Rule is far broader, reflecting a fundamental realignment driven by the transition to value-based payments. In our webinar, “While You Were Sleeping…Proposed Rule Positioned to Significantly Impact Physician Compensation,” PYA experts addressed these proposals, helping you understand and prepare for the changes ahead.
Following this presentation, attendees were able to:
Understand how a handful of wRVU changes would alter Medicare reimbursement for nearly all physicians.
Appreciate the operational impact of these changes.
Recognize the challenges to existing physician compensation models.
Identify strategies and tactics to prepare for and manage these impacts.
Presenters include PYA Principals Angie Caldwell, Martie Ross, and Valerie Rock. The webinar took place Thursday, September 10 and was hosted in conjunction with the Florida Hospital Association.
If you have additional questions about the MPFS Proposed Rule and its impact on physician compensation or need assistance with any matter involving physician compensation, valuation, strategy and integration, or compliance, contact a PYA executive below at (800) 270-9629.
Webinar: “Cybersecurity During COVID-19: A Look Behind the ScenesPYA, P.C.
Cybersecurity breaches have been in the news almost daily for some time now. COVID-19 has amplified the problem, as “bad actors” seize upon the opportunity to take advantage of hospitals at their most vulnerable time. Given this climate and an aging HIPAA rule, it is difficult to anticipate and prepare for the future.
PYA Principal Barry Mathis presented “Cybersecurity During COVID-19: A Look Behind the Scenes,” on Wednesday, August 12, 2020. This one-hour, complimentary webinar was hosted by PYA in conjunction with the Montana Hospital Association as Part 2 of the Frontier States Town Hall Meeting.
Barry covered information related to HIPAA, cybersecurity, and a special behind-the-scenes view into the tradecraft of bad actors. This unique presentation included:
Recent enforcement trends by the Office for Civil Rights.
The current environment for ransomware.
An opportunity to watch as Barry logs onto the Dark Web and shows you first-hand how bad actors operate.
Ideas for managing cybersecurity threats.
On Friday, August 21, 2020, a webinar co-hosted by PYA prepared hospitals for a new rule taking effect on January 1, 2021, to address price transparency in healthcare. The Centers for Medicare & Medicaid Services published a rule in November 2019 requiring hospitals to establish, update, and make public a list of their standard charges for items and services they provide. In addition to the current requirement to post standard charges on their websites, the Final Rule requires hospitals to publish online, in a machine-readable format, their payer-specific negotiated rates for 300 “shoppable” services and their standard charges for all items and services provided, defined as the gross charge, payer-specific negotiated charges, discounted cash price, and the de-identified minimum and maximum charges.
As we approach January 2021, it is vital that hospitals understand the requirements of the pricing transparency rule and options for compliance. It is unlikely that this rule will “go away”–court decisions are always subject to appeal, and there is even concern that Congress is considering action that would transform these requirements from regulation to legislation.
During the complimentary webinar, PYA Senior Manager Kathy Reep discussed hospital requirements related to pricing transparency, and Chris Kenny, Partner in the Washington, D.C., office of King & Spalding, addressed concerns related to compliance and the legal challenges associated with the final transparency rule.
This webinar was presented in conjunction with:
Dallas-Fort Worth Hospital Council
Florida Hospital Association
Georgia Hospital Association
Kansas Hospital Association
Louisiana Hospital Association
Montana Hospital Association
Not a surprise to most — healthcare is making headlines on an international level. Though not front and center, still of importance to the hospital community are issues working their way through government agencies and the legislature.
As one of the keynote speakers of this year’s virtual Florida Institute of CPAs Health Care Industry Conference, PYA Senior Manager Kathy Reep presented a “Federal Legislative and Regulatory Update.” She covered a number of current issues affecting healthcare providers, including:
Price transparency.
Congressional action on surprise billing.
The Administration’s budget for 2021.
Medicare proposed rules related to hospital inpatient payments and post-acute care for FY2021.
The virtual event took place June 23-24, 2020.
Webinar: Post-Pandemic Provider Realignment — Navigating An Uncertain MarketPYA, P.C.
The COVID-19 pandemic will materially affect U.S. provider industry structure, as financial weaknesses are exposed, risk tolerances are tested, and uncertainties persist. As a result, provider mergers-and-acquisitions (M&A) activities across industry sectors will likely spike in the short- to medium-term future. Providers of all types need to be aware of, and prepared for, the changes they will face.
In this 45-minute joint webinar, PYA Principal Brian Fuller and Juniper Advisory Managing Director Jordan Shields provided a real-time assessment of the COVID-19 pandemic, as well as shared predictions for what the extending crisis means in coming years for M&A activity in the provider space.
The webinar took place Thursday, August 6, 2020, at 11 a.m. EDT.
Since March, PYA experts have closely tracked and carefully evaluated the pandemic’s impact on employed physician compensation. During this complimentary one-hour webinar, PYA Principals Angie Caldwell and Martie Ross highlighted five immediate considerations for hospitals and health systems to manage the storm. They also explored five longer-term considerations impacting future planning.
This webinar took place Friday, July 24, 2020, at 11 a.m. EDT, and was held in conjunction with:
Dallas-Fort Worth Hospital Council
Florida Hospital Association
Kansas Hospital Association
Montana Hospital Association
The COVID-19 pandemic has exposed organizational and industry weaknesses. To build a more resilient delivery system, leaders now must engage their governing boards in re-calibrating strategic plans, re-evaluating investments, and re-imagining hospitals’ and health systems’ roles in their communities.
In this 45-minute webinar, PYA Principals Martie Ross and Brian Fuller provided a framework for these critical discussions including root-cause analysis, market assessment, new realities, guiding principles, and strategic and operational priorities.
This webinar originally took place on Wednesday, June 24, 2020.
Webinar: Free Money with Strings Attached – Cares Act Considerations for Fron...PYA, P.C.
PYA, in conjunction with the Montana Hospital Association, recently co-hosted a Frontier States Town Hall Meeting webinar, “Free Money With Strings Attached: CARES Act Considerations for Frontier States’ Healthcare Provider Organizations.” Principals Lori Foley, Martie Ross, and David McMillan introduced the CARES Act Provider Relief Fund including distribution formulas, the attestation process, the verification and application process, and ongoing recordkeeping requirement. They also answered attendees’ numerous questions regarding these matters.
Webinar: “Got a Payroll? Don’t Leave Money on the Table”PYA, P.C.
Under the CARES Act, every employer with a payroll has an opportunity to retain cash–whether they have a PPP loan or not. What employers need to know right now.
The Coronavirus Aid, Relief, and Economic Security Act (CARES Act) along with the Payroll Protection Program (PPP) offer all business owners relief, but the details can be confusing or overlooked.
Perhaps you don’t fully understand how the deferral of the employer’s share of Social Security taxes works. Maybe you wonder if the deferral even applies to you—good news, it does if you have a payroll!
Failure to fully understand your options could cost you money, at a time when “cash is king.”
As part of PYA’s ongoing commitment to sharing helpful guidance, Tax Principals Debbie Ernsberger and Mark Brumbelow outlined issues and opportunities within the CARES Act, and answered questions during a one-hour webinar that originally aired on Wednesday, May 20, 2020.
Webinar: So You Have a PPP Loan. Now What?PYA, P.C.
The CARES Act provides relief to small businesses through Paycheck Protection Program (PPP) loans, but receiving the loan is only the first part of the equation. PYA discussed what businesses need to know and do next.
Failure to fully understand the requirements for PPP loan forgiveness could cost employers money, at a time when every penny counts. Employers need to stay up-to-date on recent activities regarding the PPP loan forgiveness application, necessary documentation, and other best practices to ensure they are well-prepared for the next steps under the PPP.
As part of PYA’s ongoing commitment to sharing helpful guidance, Tax Principals Debbie Ernsberger and Mark Brumbelow outlined PPP loan forgiveness requirements and answered questions during a one-hour webinar on Wednesday, June 3, 2020.
Webinar: “Making It Work—Physician Compensation During the COVID-19 Pandemic”PYA, P.C.
What to do with your physician compensation plan in the face of the COVID-19 pandemic? It’s a question that leaves administrators searching for answers.
PYA Principal Angie Caldwell and Senior Manager Katie Culver introduced several key considerations for provider compensation during and after the COVID-19 pandemic. In PYA’s complimentary webinar, they:
Summarized the current environment impacting physician compensation associated with the pandemic.
Provided an overview of the Stark Blanket Waivers and opportunities created for physician compensation.
Described restoration and recovery strategies for physician resources.
PYA hosted this one-hour webinar Tuesday, April 28, 2020, at 11 a.m. EDT in conjunction with the Florida Hospital Association.
Webinar: “Provider Relief Fund Payments – What We Know, What We Don’t Know, W...PYA, P.C.
The federal government is now making CARES Act Relief Fund payments to Medicare providers. These payments are not loans—they do not have to be repaid or forgiven. However, this money comes with strings attached.
During PYA’s 30-minute webinar, Provider Relief Fund Payments—What We Know, What We Don’t Know, What To Do Now, PYA Principals Martie Ross and Lori Foley discussed:
The source of the funds.
The required attestation process.
Compliance, tax, and audit concerns.
The webinar took place Friday April 17, 2020.
Webinar: “Hospitals, Capital, and Cashflow Under COVID-19”PYA, P.C.
Hospitals and providers need to think creatively, strategically, and long-term about capital and cashflow under the pressures of the COVID-19 pandemic. A one-hour webinar hosted by PYA discussed the current state of capital markets for non-profit healthcare systems, and considerations for capital management, including the role of real estate assets.
PYA Principal Michael Ramey joined Realty Trust Group Senior Vice-President Michael Honeycutt and Ponder & Company Managing Director Jeffrey B. Sahrbeck to present “Hospitals, Capital, and Cashflow, Under COVID-19” In this webinar, they covered:
Hospital industry capital market updates and trends, including how the capital markets are responding to the crisis.
Access to capital under recent regulations.
Cash preservation techniques for hospitals considering real estate operations and assets.
The webinar took place Thursday, April 9, 2020, at 11 a.m. EDT.
PYA Webinar: “Additional Expansion of Medicare Telehealth Coverage During COV...PYA, P.C.
Late on March 30, CMS released an interim rule which, among other things, significantly expands Medicare telehealth coverage, even beyond the initial Section 1135 waivers. PYA’s complimentary one-hour webinar explained these changes and how they make telehealth an even more attractive option in response to the COVID-19 pandemic.
PYA Principals Martie Ross and Valerie Rock addressed the latest developments, including:
New reimbursement for telephone-only services.
Broader coverage for remote patient monitoring.
New payments for rural health clinics and federally qualified health centers.
Use of telehealth to meet supervision requirements.
New rules regarding coding and billing as well as the changed payment rates for telehealth services.
The webinar took place Friday April 3, 2020, at 11 a.m. EDT.
Navigating the Health Insurance Market_ Understanding Trends and Options.pdfEnterprise Wired
From navigating policy options to staying informed about industry trends, this comprehensive guide explores everything you need to know about the health insurance market.
Telehealth Psychology Building Trust with Clients.pptxThe Harvest Clinic
Telehealth psychology is a digital approach that offers psychological services and mental health care to clients remotely, using technologies like video conferencing, phone calls, text messaging, and mobile apps for communication.
Global launch of the Healthy Ageing and Prevention Index 2nd wave – alongside...ILC- UK
The Healthy Ageing and Prevention Index is an online tool created by ILC that ranks countries on six metrics including, life span, health span, work span, income, environmental performance, and happiness. The Index helps us understand how well countries have adapted to longevity and inform decision makers on what must be done to maximise the economic benefits that comes with living well for longer.
Alongside the 77th World Health Assembly in Geneva on 28 May 2024, we launched the second version of our Index, allowing us to track progress and give new insights into what needs to be done to keep populations healthier for longer.
The speakers included:
Professor Orazio Schillaci, Minister of Health, Italy
Dr Hans Groth, Chairman of the Board, World Demographic & Ageing Forum
Professor Ilona Kickbusch, Founder and Chair, Global Health Centre, Geneva Graduate Institute and co-chair, World Health Summit Council
Dr Natasha Azzopardi Muscat, Director, Country Health Policies and Systems Division, World Health Organisation EURO
Dr Marta Lomazzi, Executive Manager, World Federation of Public Health Associations
Dr Shyam Bishen, Head, Centre for Health and Healthcare and Member of the Executive Committee, World Economic Forum
Dr Karin Tegmark Wisell, Director General, Public Health Agency of Sweden
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1. Fair Value Analysis of
Healthcare Entities
AICPA Forensic & Valuation Services Conference
November 13-15, 2017
Presented by:
Annapoorani Bhat
Jim Lloyd
2. Prepared for AICPA Forensics & Valuation Services Conference Page 1
Not a “How To” Guide
Unique attributes of healthcare entities
Impact on valuation methodology and
processes
Coordination between valuation specialists
(real property, personal property, and BV),
auditors, and clients
3. Prepared for AICPA Forensics & Valuation Services Conference Page 2
Outline
Fair Value and Related Guidance
Types of Healthcare Entities
Anatomy of Healthcare Entities
Valuation Methodology
Unique Transaction Settings in Healthcare
Coordinating with Appraiser Firms/Auditors
Questions
5. Prepared for AICPA Forensics & Valuation Services Conference Page 4
Polling Question 1
What percentage of your projects involve
healthcare entities?
a) More than 50%
b) 20% to 50%
c) Less than 20%
6. Prepared for AICPA Forensics & Valuation Services Conference Page 5
Polling Question 2
What is your role as it relates to fair value
analyses?
a) Auditor
b) Valuation professional
7. Prepared for AICPA Forensics & Valuation Services Conference Page 6
Polling Question 3
Does your firm have all three relevant types of
valuation expertise in-house – i.e., real property
(RP), personal property (PP), and business
valuation (BV)?
a) Yes
b) No--have one component but subcontract with
outside party for other asset classes, or client
uses another firm
8. Prepared for AICPA Forensics & Valuation Services Conference Page 7
Polling Question 4
Have you worked on healthcare transactions under
ASC 958 – Not-For-Profit Entities?
a) Yes
b) No
10. Prepared for AICPA Forensics & Valuation Services Conference Page 9
Fair Value & Related Guidance
ASC 805 and ASC 958 are relevant guidance
For profit – ASC 805: Business Combinations
Not-for-profit (NFP) – ASC 958: Not-for-Profit Entities
ASC 820 – Fair Value Measurements and Disclosures
ASC 958 essentially makes financial reporting
requirements for not-for-profits similar to those for the
for-profit entities
11. Prepared for AICPA Forensics & Valuation Services Conference Page 10
Fair Value & Related Guidance
“Fair value is the price that would be received
to sell an asset or paid to transfer a liability in
an orderly transaction between market
participants at the measurement date.”
ASC 820-10-20
Exit Price
12. Prepared for AICPA Forensics & Valuation Services Conference Page 11
Fair Value & Related Guidance
For the most part, the actual transaction price tends to be the most
reliable indicator of fair value if it is at arm’s length and was executed
without any duress
But what if there was little or no purchase consideration?
13. Prepared for AICPA Forensics & Valuation Services Conference Page 12
Fair Value & Related Guidance
What makes healthcare transactions unique, is the
prevalence of not-for-profit hospitals
According to the American Hospital Association, approximately
3,800 of the 4,862 community hospitals are not-for-profit or state
and government owned – nearly 80%
14. Prepared for AICPA Forensics & Valuation Services Conference Page 13
Fair Value & Related Guidance
Piedmont Healthcare (PHC) entered into an affiliation
arrangement with Newton Health System (Newton)
whereby it became the sole corporate member of the
entity. Although no consideration was transferred, PHC
assumed all the assets and liabilities of Newton as of the
acquisition date. PHC assumed Newton’s lease with
County Authority which covers all the assets and liabilities
of Newton at inception of lease… cost of acquisition was
allocated in accordance with ASC 958...
At the termination of the lease, these assets and liabilities revert back to the authority. Lease
extended at transaction date to end in 40 years.
Source: Piedmont Healthcare Inc. and Affiliates, Consolidated Financial Statements: June 30, 2106
http://www.dacbond.com/dacContent/doc.jsp?id=0900bbc7801c4e78
…acquirer recorded the
fair value of all assets
acquired and liabilities
assumed resulting in a
contribution of $xxx,xxx
being recorded as
contribution received…
…
15. Prepared for AICPA Forensics & Valuation Services Conference Page 14
Fair Value & Related Guidance
The Tuomey transaction was accounted for as an acquisition
with an effective date of January 1, 2016, and therefore the
financial position and results of operations of Palmetto
Health Tuomey are included in the Palmetto Health
consolidated financial statements as of the effective date.
The acquisition price was allocated to acquired assets and
assumed liabilities based on their respective fair values,
and resulted in recognition of an excess of net assets
acquired over consideration transferred (a net
“contribution”) of $17,094 in the consolidated statement of
changes in net assets for the year ended September 30,
2016.
Palmetto Health & Subsidiaries – Financial Statements for 9 months ended June 30, 2017
http://www.dacbond.com/dacContent/doc.jsp?id=0900bbc78020344e
“It is not atypical for not-for-profit
community hospitals to be
acquired where the purchase
consideration is lower than the
business enterprise value of the
entity. With respect to the
Tuomey transaction…, there
were a number of legal and
operational issues which drove
Tuomey to identify a potential
acquirer of its operations on an
accelerated basis. The excess
of net assets acquired over
consideration received arises
from the impact of these factors
on the negotiated purchase
price in the Tuomey transaction.”
17. Prepared for AICPA Forensics & Valuation Services Conference Page 16
Anatomy of Healthcare Entities
Hospitals and health systems
Surgery centers, oncology clinics, radiation
therapy centers
Dialysis clinics
Long-term acute care facilities
Long-term care facilities
Behavioral health facilities
Primary care and specialty physician practices
18. Prepared for AICPA Forensics & Valuation Services Conference Page 17
Anatomy of Healthcare Entities
Cash & AR
Supplies
Real property
Personal
Property
Intangible
assets and
GW
Hospital Assets
19. Prepared for AICPA Forensics & Valuation Services Conference Page 18
Anatomy of Healthcare Entities
Land Furniture &
fixtures
Medical
equipment
Leasehold
improvements
Building
Real & Personal Property
20. Prepared for AICPA Forensics & Valuation Services Conference Page 19
Anatomy of Healthcare Entities
Intangible Assets
Is it capable of being separated from the entity
and sold, transferred, licensed, rented, or
exchanged, either individually, or with a related
contract, identifiable asset, or liability, (regardless
of whether there is an intent to do so):
OR
Does it arise from contractual or other legal
rights?
Is it Separable?
Is it Contractual?
21. Prepared for AICPA Forensics & Valuation Services Conference Page 20
Anatomy of Healthcare Entities
ASC 805 provides examples of identifiable
intangible assets acquired in a business
combination:
Marketing-related intangible assets
Customer-related intangible assets
Artistic-related intangible assets
Contract-related intangible assets
Technology-related intangible assets
Trade Name
Certificate of Need
Non-Compete
Licenses-Medicare/LTAC
Above/Below Market
Leases
Developed
Technology/Patent
22. Prepared for AICPA Forensics & Valuation Services Conference Page 21
Anatomy of Healthcare Entities
24. Prepared for AICPA Forensics & Valuation Services Conference Page 23
Valuation Methodology
Typical Process:
Step 1: Perform an Internal Rate of Return
calculation based on the transaction price
Step 2: Assess WACC
Step 3: Identify and value intangible
and tangible assets
Step 4: Let auditors take care of the rest
25. Prepared for AICPA Forensics & Valuation Services Conference Page 24
Valuation Methodology
1) Accounts Receivable:
First confirm it is part of the transaction
Usually performed by management
2) Supplies (Inventory)
Calculation based on frequency of purchase
Or actual inventory count
26. Prepared for AICPA Forensics & Valuation Services Conference Page 25
Valuation Methodology
3) Trade Name:
Cost to Recreate
Relief from Royalty/Avoided Cost
Considerations: Co-Branded? Useful Life?
4) Certificate of Need (CON)
Cost to Recreate
Comparative Cash Flow
Considerations: Likelihood of new applications, moratorium, difficulty in
obtaining CON, likelihood of legal challenges
Avoided Cost Method
Cost Build-Up Method
Relief-from-Royalty Method
Comparative Cash Flow
Method (with/without)
27. Prepared for AICPA Forensics & Valuation Services Conference Page 26
Valuation Methodology
5) Licenses:
Cost to Recreate
Avoided Cost Method
Considerations: Identifying costs appropriately, useful life
6) Non-Compete (outpatient facilities/physician
practices)
Comparative Cash Flow
Considerations: Likelihood of competition, impact on
capital requirements and net working capital needs
Avoided Cost Method
Cost Build-Up Method
Comparative Cash Flow
Method (with/without)
28. Prepared for AICPA Forensics & Valuation Services Conference Page 27
Valuation Methodology
7) Favorable/Unfavorable Leases:
Income approach
Considerations: Market data on lease rate,
discount rate
8) Technology
Cost build-up (income approach?)
Considerations: Useful life, cost inputs
Income Approach
Cost Build-Up Method
29. Prepared for AICPA Forensics & Valuation Services Conference Page 28
Polling Question 5
When valuing a CON, what method do you usually use?
a) Income Approach
b) Cost Approach
c) Market Approach
d) Assume it is part of real property value; no separate
analysis done
30. Prepared for AICPA Forensics & Valuation Services Conference Page 29
Polling Question 6
Have you, in your experience, valued a patient-related
intangible asset?
a) Yes
b) No
31. Prepared for AICPA Forensics & Valuation Services Conference Page 30
Valuation Methodology
Aggregate amounts recognized
as a result of nine acquisitions
of surgery centers by a publicly
traded surgery center entity
32. Prepared for AICPA Forensics & Valuation Services Conference Page 31
Valuation Methodology
Details of intangible assets
recognized in surgery center
acquisitions
33. Prepared for AICPA Forensics & Valuation Services Conference Page 32
Valuation Methodology
“The Company’s intangible assets relate to contract-
based physician minimum revenue guarantees; non-
competition agreements; certificates of need and
certificates of need exemptions; and licenses, provider
numbers, accreditations and other.
Contract-based physician minimum revenue guarantees
and non-competition agreements are amortized over the
terms of the agreements. The certificates of need,
certificates of need exemptions, licenses, provider
numbers, accreditations and other have been determined
to have indefinite lives and, accordingly, are not
amortized.”
LifePoint Health Inc.
December 31, 2016
10-K
34. Prepared for AICPA Forensics & Valuation Services Conference Page 33
Valuation Methodology
9) Real Property and Personal Property
Cost
Income
Market
Considerations: Facilities and equipment are “special purpose
assets.” Value in the context of current use.
Total business enterprise value and operational issues should be
taken into consideration when valuing real and personal property
assets to determine at the onset, if any economic or functional
obsolescence adjustments need to be applied.
36. Prepared for AICPA Forensics & Valuation Services Conference Page 35
Unique Transaction Settings in Healthcare
Typical Process:
Step 1: Perform an Internal Rate of Return calculation
based on the transaction price
Step 2: Assess WACC
Step 3: Identify and value intangible and tangible assets
Step 4: Let auditors take care of the rest
37. Prepared for AICPA Forensics & Valuation Services Conference Page 36
Unique Transaction Settings in Healthcare
What If
the BEV of the hospital
is in excess of the
purchase consideration
and
the fair value of the
assets acquired exceeds
the BEV of the
hospital??
38. Prepared for AICPA Forensics & Valuation Services Conference Page 37
Unique Transaction Settings in Healthcare
Call the
Accountant
39. Prepared for AICPA Forensics & Valuation Services Conference Page 38
Unique Transaction Settings in Healthcare
Start with qualitative assessment of the
transaction
Perform an independent valuation of the
business enterprise of the healthcare entity to
confirm if the purchase consideration is
consistent with the BEV
Ask if a Fair Market Value analysis of the
entity was performed for regulatory purposes
What If
the purchase
consideration is
zero or very
minimal? Is that
fair value?
40. Prepared for AICPA Forensics & Valuation Services Conference Page 39
Unique Transaction Settings in Healthcare
What if the calculated fair value
of the assets exceeds the BEV
of the Hospital
i.e.,
the sum of the parts is more
than the whole?
Purchase price = $0
BEV of hospital = $60 mil
-FV of buildings = $70 mil
-FV of equipment = $10 mil
-FV of intangibles = $5 mil
-Current liabilities = $5
-Implied BEV = $80
41. Prepared for AICPA Forensics & Valuation Services Conference Page 40
Unique Transaction Settings in Healthcare
Economic and Functional Obsolescence:
Consider if there is a case for economic and/or
functional obsolescence in the real and personal
property
Business is not capable of generating sufficient
cash flows to cover the value of the fixed assets
e.g., 150-bed hospital at 30% occupancy and poor
payer mix (external)
OR
Hospital invested in expensive equipment that is
now obsolete because of new technology
Purchase price = $0
BEV of hospital = $60 mil
-FV of buildings = $50 mil
-FV of equipment = $10 mil
-FV of intangibles = $5 mil
-Current liabilities = $5
-Implied BEV = $60
43. Prepared for AICPA Forensics & Valuation Services Conference Page 42
Coordinating with Appraisers/Auditors
Work closely with auditors and appraisal firms from the start of
the engagement
Use the kickoff call, or a similar contact point, to share selected
assets and valuation approach; obtain confirmation or
feedback on both
If real and personal property valuations are performed by an
outside firm, discuss upfront the process that would be
followed to share results and identify needs related to
economic and/or functional obsolescence
Reconcile calculations to fact pattern
44. Prepared for AICPA Forensics & Valuation Services Conference Page 43
Thank You
45. Prepared for AICPA Forensics & Valuation Services Conference Page 44
Annapoorani Bhat
Experience
Annapoorani Bhat is a Senior Manager with PYA (Pershing Yoakley & Associates, PC), a management
consulting and accounting firm specializing in the healthcare industry. Anna specializes in valuation and
related consulting services for companies in the health sciences sector, with her primary area of expertise in
the valuation of businesses and assets for financial reporting and tax purposes. She also has extensive
experience in performing valuations for regulatory compliance, specifically related to fair market value
analyses for transactions within the healthcare space, fair market value analysis of services, and physician
compensation. She is also focused on assisting healthcare organizations with evaluating the value of their
brands in the context of affiliations and joint ventures.
Anna received a Bachelor of Social Sciences from the National University of Singapore, a Master of
Business Administration degree from Boston College, and a Master of Social Science degree in Applied
Economics from the National University of Singapore. Anna is a member of the American Society of
Appraisers (ASA) and is an ASA Accredited Senior Appraiser in the Business Valuation discipline.
Professional & Civic Organizations
• American Society of Appraisers – Accredited Senior Appraiser
• American Health Lawyers Association, Women’s Council, Social Media Coordinator
Education & Credentials
• National University of Singapore
• Bachelor of Arts (Economics)
• Master of Social Sciences
(Applied Economics)
• Boston College
• MBA
• Accredited Senior Appraiser (ASA)
Senior Manager, PYA (Pershing Yoakley & Associates, PC)
865-673-0844 abhat@pyapc.com 2220 Sutherland Avenue | Knoxville, TN 37919
46. Prepared for AICPA Forensics & Valuation Services Conference Page 45
W. James Lloyd
Experience
W. James (Jim) Lloyd is a Shareholder with PYA (Pershing Yoakley & Associates, PC), a management
consulting and accounting firm specializing in the healthcare industry. Jim’s primary areas of expertise
include valuation (entities, joint ventures, complex business arrangements, and physician services
agreements), transaction advisory, hospital-physician alignment, affiliations and alliances, and
litigation/expert testimony services.
Jim regularly assists clients with structuring business transactions and arrangements and has led multiple
projects involving trade names and/or the “brand” value of organizations. He has broad healthcare industry
experience that spans a wide range of provider organizations such as ambulatory surgery centers, cancer
centers, dialysis facilities, imaging centers, hospitals, long-term care facilities, and physician practices. Other
relevant industry experience includes managed care organizations, pharmaceutical manufacturers,
pharmacies, manufacturing, real estate, and wholesale distribution, among others. Additionally, he has
substantial litigation/expert testimony experience related to a broad range of disputes involving antitrust,
diminution of value, fraud, intellectual property, lost profits, marital dissolution, post and failed acquisition
transactions, and shareholder oppression matters.
Professional & Civic Organizations
• American Institute of CPAs - Past Chair, ABV Credential Committee
• American Society of Appraisers - Past Member, Board of Examiners
• Helen Ross McNabb Foundation – Board of Directors
Education & Credentials
• University of Tennessee
• Bachelor of Science in
• Business Administration
• Certified Public Accountant (CPA)
• Licensed in Tennessee
• Accredited in Business Valuation (ABV)
• Accredited Senior Appraiser (ASA)
• Certified Fraud Examiner (CFE)
Shareholder, PYA (Pershing Yoakley & Associates, PC)
865-673-0844 jlloyd@pyapc.com 2220 Sutherland Avenue | Knoxville, TN 37919