PYA Principal Denise Hall and Michelle Calloway of Hancock, Daniel, Johnson & Nagle, P.C., copresented at the 2013 American Health Lawyers Association/Health Care Compliance Association Fraud & Compliance Forum in Baltimore. They addressed “The Hidden Dangers of Trying to ‘Do the Right Thing:’ A Practical Look at Auditing, Monitoring and Investigation Pitfalls.” The presentation covered best practices for investigating reported compliance concerns, compliance auditing techniques, repayment practices, and corrective action implementation and monitoring procedures.
Creating and Effective Associate Development Program for Tomorrow's Leaders.
This presentation reviews the essential components of an effective program including:
- evaluation and feedback
- practice planning
- compensation
- advanced criteria
Creating and Effective Associate Development Program for Tomorrow's Leaders.
This presentation reviews the essential components of an effective program including:
- evaluation and feedback
- practice planning
- compensation
- advanced criteria
WITHIN THE NEXT FIVE YEARS, FINANCE WILL OPERATE DIFFERENTLY
Member of the Team that gives DIRECTION, comes up with strategy and evaluates the structural content of the organization.
NEW TOOLS:
JIT, CAD/CAM, ABC. ABMS, TQM, FMS, CI, TC
NEW MEDIUM:
Computers - PC- Networks - “The Virtual Close” - AA Instant Info
FLT ANALOGY SHOWS IN TROUBLE BUT NOT WHY; NO CAUSALITY
DeepOffice is a Philippine-based accounting agency located in Rockwell. We help our clients save on taxes, bookkeeping, financial services, business consulting services.
We can become your online virtual CFO and or accounting agency and help to lower your tax burden whilst helping to manage and manuever your business financial goals.
Contact us today to learn more
How to create the bond between client and vendor that will bring the success in the uncertain world of software development?
Communication between client and supplier is a key to successful vendor management. Getting things done in the respect with legal, cultural, resource and location constraints has proven to be challenging. From the perspective of the client, let’s see how to use Agile and create definition of done, obtain team buy-in and how to empower the supplier team. On the other side, from the supplier point of view, let’s see what to give to provide to the client and how to communicate with during the development.
WITHIN THE NEXT FIVE YEARS, FINANCE WILL OPERATE DIFFERENTLY
Member of the Team that gives DIRECTION, comes up with strategy and evaluates the structural content of the organization.
NEW TOOLS:
JIT, CAD/CAM, ABC. ABMS, TQM, FMS, CI, TC
NEW MEDIUM:
Computers - PC- Networks - “The Virtual Close” - AA Instant Info
FLT ANALOGY SHOWS IN TROUBLE BUT NOT WHY; NO CAUSALITY
DeepOffice is a Philippine-based accounting agency located in Rockwell. We help our clients save on taxes, bookkeeping, financial services, business consulting services.
We can become your online virtual CFO and or accounting agency and help to lower your tax burden whilst helping to manage and manuever your business financial goals.
Contact us today to learn more
How to create the bond between client and vendor that will bring the success in the uncertain world of software development?
Communication between client and supplier is a key to successful vendor management. Getting things done in the respect with legal, cultural, resource and location constraints has proven to be challenging. From the perspective of the client, let’s see how to use Agile and create definition of done, obtain team buy-in and how to empower the supplier team. On the other side, from the supplier point of view, let’s see what to give to provide to the client and how to communicate with during the development.
The Importance of Internal Controls in Fraud Prevention Rea & Associates
Presentation made by Ohio Accounting Firm, Rea & Associates, on the how strong internal controls can help Ohio companies deter fraud in the workplace. Special attention is given to the 5 components of internal controls and how to diffuse the traingle of fraud.
5 Steps to Creating an Ethical Work CultureCase IQ
You get it. Being an ethical organization matters. A lot.
But ethics isn’t just a quarterly HR campaign or a glossy conduct guide; in order to really have a bottom-line business impact, organizational ethics must function as an integral pillar of company culture over time.
So, what are the best practices to make sure your organization is regularly thinking about ethics and including it in everyday decision making? What are some creative ways to bring focus to this vital but often overlooked function? And how can you most effectively deal with and investigate an incident or a breach when it occurs?
Internal control is a process designed to provide reasonable assurance regarding the achievement of objectives in the following categories:
Effectiveness and efficiency of operations
Reliability of financial reporting
Compliance with applicable laws and regulations
This presentation examines ICs and their effectiveness.
“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.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
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Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...
The Hidden Dangers of Trying to ‘Do the Right Thing:’ A Practical Look at Auditing, Monitoring and Investigation Pitfalls
1. DENISE HALL
PERSHING, YOAKLEY,
& ASSOCIATES, P.C.
THE HIDDEN DANGERS OF TRYING
TO “DO THE RIGHT THING”
A Practical Look at Auditing, Monitoring,
Investigation, and Corrective Action
AHLA/HCCA FRAUD AND COMPLIANCE FORUM
September 29–October 1, 2013 | Baltimore, MD
MICHELLE CALLOWAY
HANCOCK, DANIEL,
JOHNSON & NAGLE, P.C.
3. WHY WE ARE HERE
• “To Do the Right Thing” in an effective
manner.
• Today’s presentation will focus on the
following elements of an effective
Compliance Program:
Internal auditing and monitoring
‒ Routine and investigative
Responding to detected offenses –
‒ Investigating reported or identified compliance
concerns and undertaking corrective action
‒ We will also offer some:
Tools for “doing it right”
Hidden dangers to watch out for
3
5. INTERNAL AUDITING
• Routine Audits
Audit prospectively, not retrospectively.
Define methodology at the outset.
Start with a small investigative sample (5-15 units).
Depending on results, it may be necessary to expand the scope of the
audit (e.g. 30, 50, 100, statistically valid sample).
Expanded audits should include Compliance Officer’s involvement.
• Investigative Audits
Directed by Compliance Department.
Start with a small probe audit (e.g. 30 claims) unless you know the scope
of the problem.
Determine the “trigger point.”
Assess whether attorney/client privilege should be invoked.
Methodology driven by the specific facts and issue.
5
6. AUDITING TECHNIQUES
AND METHODS
• Retrospective Audits – claims that have already
been billed/paid.
Used to investigate past billing compliance issues.
Audit results may lead to a repayment obligation.
• Concurrent Audits – claims that have not yet
been billed.
Used to monitor ongoing compliance concerns or
scheduled audits per the Audit Plan.
If planned correctly, improperly billed claims can be
corrected by submitting an adjustment claim.
May reveal need for retrospective auditing (“deliberate
ignorance”).
6
7. ROUTINE AUDITING
• Annual Risk Assessment and Audit Plan
Resources to identify potential risk areas:
‒ Annual OIG Work Plan
‒ OIG Compliance Guidance Risk Areas
‒ RAC Approved Issues List
‒ PEPPER reports
‒ State and federal survey and certification reports
‒ Complaint and grievance reports
‒ CIAs with similar facilities
Prioritization is key.
Be realistic.
Consider all your potential risks – not just billing/coding.
7
10. ANNUAL AUDIT PLAN
• Utilize your Working Compliance Committee.
• Working Compliance Committee members
should seek assistance from relevant staff.
• Determine the organizations’ specific
strengths and weaknesses within the identified
risk area.
• Develop an improvement plan and audit
methodology to review compliance in areas
of potential weakness.
• Audit compliance and track improvement
monthly/quarterly.
10
11. INVESTIGATIVE AUDITING
• Internal Identification
Annual risk assessment
Compliance Hotline
Compliance reports
Internal department audits
Questions from staff
• External Identification
External auditors (MAC, RAC, ZPIC, OIG, state
Medicaid, OCR)
Being proactive in responding to external audits
heightens chances to minimize penalties and
further scrutiny. 11
12. AUDIT DESIGN & ERROR RATE
• Audit Design
Review Criteria
Universe/Sample Size Determination
Random vs. Risk-Based Sampling
Probe vs. Statistical sample
• Definition of “error”
Financial vs. claim error rate
Net vs. Gross
Internal error rate thresholds
12
14. POTENTIAL IMPACT OF
SIGNIFICANT ERROR RATES
• Self Disclosure
• Significant Overpayment Extrapolation
• Possible Payment Suspension
• Referral to Enforcement Agencies
• Increased External Scrutiny
• Public Perception
14
15. HIDDEN DANGERS
• Overexposure
An improperly defined audit scope can “cast the net too wide.”
Don’t overwhelm yourself or create liability for the organization.
• Invalid Sample Selection
Selecting the sample size requires expertise and familiarity with the types of
services being audited, the patient population, and payer mix.
The sample selection should be performed with potential for extrapolation in mind.
• Error Rate Thresholds
Should be defined ahead of time by the organization.
A conservative error rate threshold is a 5 percent error rate, as this is the rate
typically used in OIG Corporate Integrity Agreements.
• Not Just a Billing Issue
Proper billing and payment is only a piece of the compliance puzzle.
Don’t forget about ADA compliance, HIPAA compliance, EEOC compliance, FDA
compliance, CLIA compliance, etc.
• Conflicts of Interest
The audit should be conducted with independence.
Results must appear reliable to internal and external authorities. 15
17. CONDUCTING THE
INVESTIGATION
• Scope
Define the issues involved.
Establish the relevant time frame.
If reimbursement:
‒ Identify payer sources involved.
‒ Determine “trigger” and universe of potentially affected
claims.
Consider staff interviews, documentation review, claims
audits.
Limit (if possible) to specific individuals involved or
events triggering the investigation.
Keep the scope narrow to design the process around
the key issues as you uncover the “real issue.”
17
18. CONDUCTING THE
INVESTIGATION
• Carefully consider the need to hit the “Panic
Button” to stop the problem immediately.
Document/billing hold
Pre-payment reviews
Repayments/adjustment bills
Don’t over-react!
Don’t under-react!
18
19. CONDUCTING THE
INVESTIGATION
• Attorney-client privilege
Consider for issues with potential high exposure:
‒ Potential dollar amount at stake;
‒ Complexity or severity of the regulatory issue involved;
‒ Number of beneficiaries potentially affected;
‒ Likelihood of uncovering a serious problem requiring a voluntary disclosure
to Medicare or other federal payers;
‒ The government’s likelihood of identifying the issue before repayment can
be made.
‒ Length of potential non-compliance.
Consider outside legal counsel.
‒ Independence
‒ Develop a strong working relationship
‒ Mark all documentation including investigative notes and
correspondence: “CONFIDENTIAL / ATTORNEY-CLIENT PRIVILEGED /
ATTORNEY WORK PRODUCT” 19
20. CONDUCTING THE
INVESTIGATION
• Identify the investigative team considering:
The workloads of internal compliance staff and the
availability of other internal resources;
The complexity or specialization of the issue;
The scope of the investigation (e.g. the universe of
claims and mass of documentation to be reviewed);
The dollar amount potentially at stake; and
The sensitivity of the issue being investigated.
The ability of the staff to exercise independence.
When is it appropriate to escalate to executive team /
Board.
20
21. CONDUCTING THE
INVESTIGATION
• Interviewing
Time is of the essence, but don’t rush.
Confidentiality is key.
Awareness and enforcement of non-retaliation
policy is imperative.
Corporate attorney represents the organization, not
the individual.
Consider environment / tone / possible demeanor
of the witness (cooperative / defensive / veracity).
“Who’s the best man [or woman] for the job?”
21
22. HIDDEN DANGERS
• Whistleblowers
Employers cannot retaliate against whistleblowers.
Consider exit interviews / severance agreements.
• Attorney-client privilege
Must document appropriately.
Document the scope of the engagement in writing
• Conflicts of Interest
Make sure you have the right
people conducting the investigation.
• Jumping to Conclusions
Keep an open-mind and don’t overreact. 22
24. CORRECTIVE ACTION
“Next to doing the right thing, the most
important thing is to let people know you
are doing the right thing.”
- John D. Rockefeller
24
25. CORRECTIVE ACTION
PLANS
• Document, document, document – but consider whether
the information is protected;
• Description of the compliance issue;
• Description of the investigative audit findings;
• Summary of the applicable regulation or policy at issue;
• Identification of the cause of the non-compliant practice;
• A list of steps taken by the provider to correct the issue:
Immediate cessation of the problem;
Retrospective corrective action (e.g. repayment)
Prospective corrective action (e.g. education of staff, revisions to
processes, etc.); and
• A plan for future compliance monitoring of the issue to
ensure that the corrective actions have remedied the
problem permanently (recidivism is a big issue).
25
26. CORRECTIVE ACTION
PLANS
• Organizational Culture
Internal communications
Potential relator considerations
• Having all the right parties involved in this step
• Must have support from all levels – staff to
organizational leadership
• Putting it in writing – nature, purpose and
design
• Having responsible parties dedicated to
taking the corrective steps 26
28. FALSE CLAIMS ACT
LIABILITY
• PPACA expanded False Claims Act (FCA) liability to
include “identified” overpayments not returned to
federal health care programs within 60 days.
• “Identified” = the provider “has actual knowledge of
the existence of the overpayment or acts in reckless
disregard or deliberate ignorance of the existence of
the overpayment.”
• Required to act “with all deliberate speed” to
conduct a “reasonable inquiry” to determine
whether an overpayment exists
• CMS proposed to implement a 10-year look-back
period for purposes of making repayments under the
60-day rule.
28
29. FALSE CLAIMS ACT
LIABILITY
• CMS’ Examples of “Identified” Overpayments
A provider reviews billing or payment records and learns that it
incorrectly coded certain services, resulting in increased
reimbursement.
A provider learns that a patient death occurred prior to the
service date on a claim that has been submitted for payment.
A provider learns that services were provided by an unlicensed or
excluded individual on its behalf.
A provider performs an internal audit and discovers that
overpayments exist.
A provider is informed by a government agency of an audit that
discovered a potential overpayment and the provider or supplier
fails to make a reasonable inquiry.
A provider supplier experiences a significant increase in
Medicare revenue with no apparent reason (such as a new
partner added to a group practice or a new focus on a
particular area of medicine) and fails to make a reasonable
inquiry.
29
30. EXTRAPOLATION
• OIG Corporate Integrity Agreement standard:
The sample should be designed to estimate the
overpayment with a 90% confidence level and with
a maximum relative precision of 25% of the point
estimate.
• Use OIG RAT-STATS software.
• Consider use of expert statistician to perform
extrapolation for higher likelihood of
acceptance by payer.
30
31. REPAYMENT LETTERS
• Voluntary Repayment process outlined in Chapter 4
of the Medicare Financial Management Manual.
Use form on MAC websites.
• The repayment letter should include:
A summary of how the error was discovered;
A clear outline of the methodology used to quantify the
overpayment (including whether statistical sampling was
used);
What corrective actions were taken as a result of the
discovery; and
Other information necessary to identify the affected claims
(including, when possible, a copy of the audit spreadsheet).
• Understand differences in government and private
payer processes.
31
33. REBILLING
• For most Medicare claims, the timely filing limit
is 12 months from the date of service.
• If an audit identifies improperly billed claims
within the timely filing period, the claims can
typically be re-billed or adjusted with the
MAC.
• CMS has implemented a new process for
rebilling improper Part A inpatient hospital
claims under Part B.
Payment Policies Related to Patient Status, 78 Fed.
Reg. 50495 (August 19, 2013).
33
34. HIDDEN DANGERS
• 60-Day Rule
The date of “identification” is often hard to determine.
Must clearly identify any overpayments – the clock starts
running at identification.
• Documentation
Consider attorney-client privilege
Compliance documents are not automatically protected
• Excessive Rebilling
Can raise red flags
• Beneficiary Repayment and Collection
Responsibility to repay copayments to beneficiaries.
Providers must also collect from beneficiaries if they rebill
claims and a copay or deductible is owed. 34
36. MONITORING
• Where do you start?
• Who is responsible?
• How do you keep track of it all?
• Is there available technology?
• Are we tracking all corrective action plans? How often?
• Are we tracking all governmental pre- and post- payment
activity?
• Did we miss any response to inquiry deadlines?
• What percentage of repayment requests are appealed?
(ex. RAC Appeals)
• Are we reviewing denial activity and determining root
cause?
• Do we have corrective action plans developed for our
unique root cause(s)? 36
37. DEFINE YOUR
MONITORING PROCESS
• Obtain leadership buy-in
• Must eliminate silos/protective behavior
• Communicate expected outcomes and
financial risk
• Define which regulatory requirements are
relevant to the organization
• Establish Risk Tolerance
• Establish Risk Ownership
37
38. QUESTIONS LEADERSHIP
MAY ASK
• What regulations changed in FY2013/anticipated
to change in FY2014 and what new processes
are needed to address?
• What is the impact of regulatory activities?
• How effective is our monitoring process?
• How do we know our internal efforts are working?
• What should we expect for remainder of our
fiscal year?
Consider a dashboard to report and monitor.
38
39. HIDDEN DANGERS
• Failing to Monitor
The compliance department should add any identified
compliance concerns to the organization’s Audit Plan and
create a schedule for follow up audits to ensure ongoing
compliance.
Inevitably, staff and processes revert to their “old habits.”
• Failing to Follow CAP
Failing to abide by a CAP can increase risk for FCA liability for
future overpayments because the provider was already on
notice of the issue.
Particularly critical when promised in a repayment letter.
• Culture / Buy-in
Resources are slim for everyone
39
41. SCENARIO 1
• Issue: Employee performing a daily task of up-
coding on very expensive DRGs on I/P with all
payers.
The CCO received an Alertline report that the caller was instructed by
their supervisor to bill a higher level of service then is recorded on the
documentation and told if they did not do it they would be fired and the
supervisor would find another sucker to do it. They up-coded for several
months and then decide to report to the CCO. They placed their
concern through the Compliance AlertLine and felt that way they could
stay anonymous and not lose their job.
• What is the next step?
Once reported to the Compliance Dept/CCO, the investigation begins;
initially an internal review is conducted on what is known at this point,
which was assumed to be only one employee doing this. With the
volume discovered from the baseline audit, it was decided to expand
the audit to include 2 other coders, which uncovered they were also up-
coding. This opens up an unknown timeframe, number of personnel and
finance impact to the organization.
• What do you do now? 41
42. SCENARIO 2
• Issue: Wound care services investigation
Compliance auditors express concerns to
Compliance Office regarding physician
documentation and quality of care.
• Considerations
Closed community with physician being heavy
admitter.
How far do you take this investigation before
involving counsel?
How do you adequately prove or disprove quality
of care issues?
How do you protect your organization given the
community culture? 42
43. THANK YOU
We are happy to answer any questions.
Michelle Calloway
HDJN
(804) 967-9604
mcalloway@hdjn.com
Denise Hall
PYA
(404) 266-9876
Dhall@pyapc.com
43