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In this episode of Cascade Conversations, Cascade Managing Director Rajesh Kothari, CFA, is joined by McDonald Hopkins Health Care Practice Chair Elizabeth Sullivan to take a deeper look at compliance concerning mergers and acquisitions. Learn why it is vital to have expert legal and financial counsel as early as possible to help navigate the transaction and help advise on various options and their impacts when considering a transaction.

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Transcipt

00:00:00:11 – 00:00:16:19
Announcer
Welcome to Cascade Conversations, joining the team at Cascade Partners and their network of trusted advisers as they work to demystify details, terminology and strategies in the world of acquisitions, divestitures and financings.

00:00:16:21 – 00:00:46:13
Rajesh Kothari – Founder, Managing Director – Cascade Partners
So welcome to another cascade conversation. Joining me today is Liz Sullivan, partner with MdDonald Hopkins, and she leads the health care and their health care compliance effort. So, Liz, thanks for joining us. And in our conversation today, we want to spend a little bit of time with everybody’s favorite topic, compliance and regulatory matters. But it’s so important when folks are looking at what are they going to do, that’s how are they going to grow, whether it’s acquiring another practice, right?

00:00:46:15 – 00:01:06:09
Rajesh Kothari – Founder, Managing Director – Cascade Partners
Building out your own clinical operations or even potentially exploring a sale. Many times people are thinking about this and that. And I know you’re a huge advocate, a strong proponent of doing that work up front, but what where do you think practically, if someone’s beginning to look on that next day, where are we going to go from here?

00:01:06:11 – 00:01:12:01
Rajesh Kothari – Founder, Managing Director – Cascade Partners
Where do they really need to focus from a compliance and regulatory perspective on the health care side?

00:01:12:03 – 00:01:50:18
Elizabeth Sullivan – Healthcare Practice Chair – McDonal Hopkins
Sure. Well, thank you for having me. I’m glad to be glad to be here chatting about this topic, which is one of my favorite topics. I think it’s really important to for any organization that’s thinking about potentially growth, whether that’s their own growth or through acquisition or a transaction, to really think about what the implications could be of an on recognized compliance issue and a claims this you could be we could be talking about a bullying issue maybe it’s a manner of bullying whether it’s what I think about compliance.

00:01:50:18 – 00:02:18:24
Elizabeth Sullivan – Healthcare Practice Chair – McDonal Hopkins
I’m thinking about some error that’s over into overpayments that they’re receiving over payments. But I think as a practical matter, can certainly be a bill here that’s an underpayment that might be to the benefit of the organization. It can also be business arrangements, how they’re set up and it may be something completely innocent, but the documentation is not consistent with what would be expected from a staff perspective or a kickback perspective.

00:02:18:26 – 00:02:47:14
Elizabeth Sullivan – Healthcare Practice Chair – McDonal Hopkins
And those are probably the most significant areas that we see come up in diligence of a transaction or we see when an organization gets large or maybe they’re having a wonderful year and there’s a lot of significant billing and they end up on the radar of a payer or they end up on the radar of the government. And so I would say those are probably the two areas that we recommend focusing on.

00:02:47:21 – 00:03:27:24
Elizabeth Sullivan – Healthcare Practice Chair – McDonal Hopkins
They’re certainly permitting and all sorts of other compliance. Right? It’s a highly regulated industry. So there’s no question that there’s many, many areas that I think those are probably the most significant areas. And there are two areas that can be really intimidating for organizations. So sometimes those those areas aren’t provided maybe as much attention as others because they are intimidating Data privacy is another area that’s important for compliance, and I think there are a lot of solutions out there that organizations can utilize and help them get their arms around their current operations, maybe where they have some exposure.

00:03:27:27 – 00:03:42:17
Elizabeth Sullivan – Healthcare Practice Chair – McDonal Hopkins
But those are probably the areas that we think about the most when we’re working with an organization, whether they’re operating, looking to look into grow or maybe getting ready for a transaction or thinking about.

00:03:42:20 – 00:04:05:21
Rajesh Kothari – Founder, Managing Director – Cascade Partners
Well, I know a billing audit. We chatted about doing audits that they’re a really important tool, whether you’re considering a transaction or not, how often are you seeing your clients actually kind of as a normal part of their operation, doing a periodic billing review, and why can that be advantageous to them regardless if they’re looking to grow or transact or what have you?

00:04:05:28 – 00:04:26:26
Elizabeth Sullivan – Healthcare Practice Chair – McDonal Hopkins
It’s a great question. I mean, I will say honestly, I wish that we saw more billing on it. But that said, I mean, we do have some we have some clients that are you know, they’re large enough that they may take on the expense of a third party audit. We have a lot of organizations that do internal audits, which is great.

00:04:26:26 – 00:05:00:23
Elizabeth Sullivan – Healthcare Practice Chair – McDonal Hopkins
I mean, the gold standard is always going to be that independent audit for a number of reasons, partially just because you’ve got somebody who is for a set of eyes also doesn’t necessarily have the same historical perspective. So they might be able to identify things that maybe the rest of the organization has an internal audit. And then depending on what the results of the audit are, that third party audit can sort of standalone is viewed differently when you’re looking at payer or you’re looking at a government entity to say, Well, this was a third party.

00:05:00:25 – 00:05:08:09
Rajesh Kothari – Founder, Managing Director – Cascade Partners
We thought we were doing it right. We had somebody else help us tell us where we might have got it wrong, but that we did all the right things and try to do it the right way.

00:05:08:09 – 00:05:38:03
Elizabeth Sullivan – Healthcare Practice Chair – McDonal Hopkins
Absolutely committed to compliance, really in tune with trying to do the right thing. And I think those are all additional factors from the standpoint that are helpful. If for some reason that audit comes back with something that is not not ideal. Again, I would also say, I mean, you know, we always are going to encourage providers to do that third party audit maybe every few years, do your internal audit, utilize your internal team to do those audits on a more regular basis.

00:05:38:06 – 00:06:01:04
Elizabeth Sullivan – Healthcare Practice Chair – McDonal Hopkins
But we do have some organizations that are smaller and maybe we just haven’t thought about it. And there really is a benefit as we were chatting about the business benefits to doing it right, because you may find out you need and it’s great, but maybe there’s something that can be improved or maybe there was something that was overlooked and you can also get with it.

00:06:01:11 – 00:06:03:15
Elizabeth Sullivan – Healthcare Practice Chair – McDonal Hopkins
You can find out that maybe.

00:06:03:21 – 00:06:07:03
Rajesh Kothari – Founder, Managing Director – Cascade Partners
Your other billing exactly is an opportunity to improve and capture.

00:06:07:03 – 00:06:23:04
Elizabeth Sullivan – Healthcare Practice Chair – McDonal Hopkins
More revenue. Right. And we talked about that as we were talking about billing. I mean, it sounds like you’ve seen that where there are groups that could actually increase their productivity in what they’re doing just by changing how they’re building.

00:06:23:06 – 00:06:41:22
Rajesh Kothari – Founder, Managing Director – Cascade Partners
And given the complexity, I mean, health care is extremely complex. Regulatory environment, when you’ve seen issues come up, is that the end of the world? I mean, is it killing deals? I mean, I know we’ve worked through it, but I love your perspective on helping kind of assure that it’s it’s not the end of the world.

00:06:41:22 – 00:07:10:25
Elizabeth Sullivan – Healthcare Practice Chair – McDonal Hopkins
Yes, absolutely. I mean, that’s a great question. I’m glad that you asked that. So we can talk about it. It’s not the end of the world. And every transaction where we’ve identified a billing issue and I know we’ve talked a little bit more focused on compliance issues, if it is not something that has been a deal filler, you know, there’s the chance that it could change the valuation in the deal, which is why it’s so important to do it, be proactive about it, because you want to know.

00:07:10:25 – 00:07:31:29
Elizabeth Sullivan – Healthcare Practice Chair – McDonal Hopkins
You want to try and correct that and you want to know what you’re going into and sort of not be caught flat footed when you’re in the middle of a transaction. But at the end of the day, it’s something that, you know, we’ve never been in the situation where it’s no big deal. It might make things take a little bit longer, it might create a lot of frustration for everyone.

00:07:32:00 – 00:07:47:18
Elizabeth Sullivan – Healthcare Practice Chair – McDonal Hopkins
It may create more duplication if that’s when it’s recognized, is you’ve got all of these parties involved that are now looking at it as a question coming up with different perspectives. But it’s it is not something that we see much easier.

00:07:47:21 – 00:07:56:17
Rajesh Kothari – Founder, Managing Director – Cascade Partners
Less easier to handle if you figure it out before it’s just you and your attorney working through it as opposed to you, your attorney, the buyer, the buyers, which are.

00:07:56:20 – 00:07:57:10
Elizabeth Sullivan – Healthcare Practice Chair – McDonal Hopkins
Absolutely.

00:07:57:12 – 00:08:23:15
Rajesh Kothari – Founder, Managing Director – Cascade Partners
All looking at it because they’re worried about that liability. But again, because it’s so regulated, it is complex. People of all walks of life have violations and issues. It’s just how you manage to address it. But, you know, we can figure it out ahead of time. The scale and scope, there’s no value in getting all the way through a deal process of getting into diligence and then finding out there’s an issue.

00:08:23:17 – 00:08:38:24
Rajesh Kothari – Founder, Managing Director – Cascade Partners
And the issue is so big, you’re on the side, right? Right. You’re kind of talking about the difference between kind of anti-kickback versus start issues of the order of magnitude wasn’t as much an issue, but the length of time to resolve those self disclosures.

00:08:38:24 – 00:08:39:18
Elizabeth Sullivan – Healthcare Practice Chair – McDonal Hopkins
Right.

00:08:39:21 – 00:08:48:22
Rajesh Kothari – Founder, Managing Director – Cascade Partners
Right. Could be make it uneconomical to do a transaction because somebody’s got the liability no matter what.

00:08:48:24 – 00:09:07:22
Elizabeth Sullivan – Healthcare Practice Chair – McDonal Hopkins
Right. That’s such a good point that I was going to come back to this chatting. You made that point. And it’s true. I mean, at the end of the day, right, as an organization, if the seller is doing and whether it’s under payor contracts or whether it’s as a participant in a government program, there are obligations, there are rules.

00:09:07:22 – 00:09:36:14
Elizabeth Sullivan – Healthcare Practice Chair – McDonal Hopkins
And every time you submit a claim, you’re basically certifying that you’re in compliance, which means that maybe this comes out in the context of a transaction through diligence, but that obligation existed either way, right? So whenever it’s discovered, it’s something that needs to be addressed. And if you can do it where it’s you’re not in a position where you’ve got a buyer, you’ve got another party, there’s a lot of attorneys that are looking at it, also have opinions.

00:09:36:16 – 00:09:58:09
Elizabeth Sullivan – Healthcare Practice Chair – McDonal Hopkins
Then That is right. It gives you the opportunity to say, okay, I want to take a step back. I’ve got my third party experts. I’m evaluating the situation. This is what I what we believe the issue to be. This is how we believe we want to correct the issue. And so, you know, even again, focusing on the billing side of things, I mean, is it a repayment?

00:09:58:12 – 00:10:19:08
Elizabeth Sullivan – Healthcare Practice Chair – McDonal Hopkins
Is it a self disclosure there? There are different pathways depending on the fact pattern. And if it’s you and your counselors, you can sort of make that decision outside of the context of the transaction when we are in the middle of a transaction. Exactly. And the buyer may say, hey, if we’re going to go forward, this is how we want you to resolve it.

00:10:19:14 – 00:10:50:09
Elizabeth Sullivan – Healthcare Practice Chair – McDonal Hopkins
And that may mean that may be a different calculation, it may be a different method of repayment or reporting. And so it is really, to your point, it’s best to get out in front of it, able to deal with it sort of independently from that that situation with those additional choices. It just gives more flexibility in a provider organization to feel like they’re sort of in control and those decisions, they’re making the right decision for themselves, not just for purposes of the transaction.

00:10:50:12 – 00:11:24:07
Rajesh Kothari – Founder, Managing Director – Cascade Partners
And then when you help us define it and quantify it right, that gives us the ability to negotiate and structure it into the transaction, whether that’s figuring out how to carve the liability out. And so to decide whether it’s getting insurance and probably fewer cases or creating the indemnification profile that that really manages that risk and what’s at stake obtain, you know, many places we’ve had where we kind of got our clients said, look, if you have a liability, right, right.

00:11:24:09 – 00:11:46:29
Rajesh Kothari – Founder, Managing Director – Cascade Partners
A transaction, even a liability, we’re out of foreclosing as the sellers. What’s after that say now at least you have proceeds I which to pay this right this fee. Otherwise you’d have to come out of pocket. Right. Right. But you got to make sure your structure that your dollars available and I think you said something at the beginning where we got involved.

00:11:47:01 – 00:12:17:09
Rajesh Kothari – Founder, Managing Director – Cascade Partners
So it was all for clients. When you’re doing those audits and you’re keeping that documentation, yeah, it actually gives assurances to the potential buyer. Or if you’re looking at doing an acquisition, being able to compare comparison scratch to know, oh, we’re in compliance is we adapt, how do we get that right, compliance or make sure there is compliance or no, we won’t have a potential liability because we know what our documentation says and what we’re supposed to do.

00:12:17:11 – 00:12:38:10
Rajesh Kothari – Founder, Managing Director – Cascade Partners
And when you’re going to a buyer, it just says, Oh no, we follow the process, right? Yeah. Everything that you give the buyer assurance. But I often remind people, great sellers are optimists. We’re doing everything right and buyers are cynics. They’re doing everything right to prove it. Otherwise. And so this helps create that comfort level and ease around that compensation.

00:12:38:14 – 00:12:59:20
Elizabeth Sullivan – Healthcare Practice Chair – McDonal Hopkins
That’s such a good point. I mean, I think that idea of comfort, trust, positive objects that go with documentation and sort of being proactive, I mean, not only is it helpful in the context of a transaction and sort of giving that comfort to a buyer or knowing what you’re looking for as the buyer when you’re looking at a seller?

00:12:59:22 – 00:13:33:25
Elizabeth Sullivan – Healthcare Practice Chair – McDonal Hopkins
But it’s sort of I mean, it’s essentially the same with payers and with the government, right? Being able to show that work, show your work not look like, oh no, we just figured it out. Deer in the headlights. We’re dealing with it immediately. We’re being reactive and being able to show proactivity, I guess really is beneficial, right? The government expects providers to have compliance plans in place and that those are operating at all times and that things things are always sort of being continuously improved as a practical matter, that’s hard to do, right?

00:13:33:25 – 00:13:58:08
Elizabeth Sullivan – Healthcare Practice Chair – McDonal Hopkins
Everybody’s doing their job, they’re doing their day to day work, they’re caring for patients, they’re giving high quality care, and you have all these other regulation and compliance requirements and responsibilities that are out there. So sometimes it’s hard to maintain that compliance program, but that’s an expectation. So anything you’re doing to document it and have that and be able to show that work is really beneficial not only in the context of a transaction, but with the government as well.

00:13:58:15 – 00:14:20:24
Rajesh Kothari – Founder, Managing Director – Cascade Partners
Right? And that’s what I mean by regulations only get bigger, right? So your ability to stay on top of the. No. You know, the rule that you used to work under five years ago might not be the same rule today. The rules are evolving and they’re changing your ability to stay on top of that. The key for a team like quality of care, right, are standards are changing, right?

00:14:21:01 – 00:14:46:01
Rajesh Kothari – Founder, Managing Director – Cascade Partners
If physician teams are staying on top of that, you’ve got to have your operational team staying on top of what’s the best practice in reporting and tracking and reporting so often? You know, we get a lot of when we’re working with more out of rural physician practices and other entrepreneurial clinical operations, oftentimes they’re coming to us going, well, why do we need all this?

00:14:46:03 – 00:15:04:25
Rajesh Kothari – Founder, Managing Director – Cascade Partners
We’ve been operating just fine for all these years now. An issue. Why are we also the buyer making an issue? What is what are some of the driver? Why are folks you know, why are the buyers looking at this? Why is it such a big issue when these folks are thinking, hey, this was an aberration?

00:15:04:27 – 00:15:28:29
Elizabeth Sullivan – Healthcare Practice Chair – McDonal Hopkins
Yeah, I mean, I think we’ve always done it this fine. Everything’s been fine. Also, everybody else in the industry is doing it and we can’t keep up and listen to it. I mean, we hear that so frequently. That’s probably one of the biggest challenges of the compliance side of things. And part of our job is saying, you know, just because everybody’s doing it or just because it’s always been done doesn’t mean that it’s going to work.

00:15:28:29 – 00:15:46:29
Elizabeth Sullivan – Healthcare Practice Chair – McDonal Hopkins
And so I think to your point, right, we also have a lot of clients who fail and they say, well, I got paid, so it must be fine. Back to that point that you’re making and generally a payer, if they look at a claim and it’s clean, they’re going to pay it and they’ll just audit later. That’s next.

00:15:47:06 – 00:16:12:03
Elizabeth Sullivan – Healthcare Practice Chair – McDonal Hopkins
So you can’t assume that. And I think when you’re when you’re looking at a situation as the seller might have been, you know, might have been on an organization that you’re joining a larger platform. Right. Or you’re joining a huge organization that sort of has a robust compliance plan. Maybe the reason that that organization has a robust compliance plate is because they’ve already been through this with the government.

00:16:12:05 – 00:16:32:18
Elizabeth Sullivan – Healthcare Practice Chair – McDonal Hopkins
Maybe there are some situations that, you know, you’re actually working with the government on their compliance on an ongoing basis. And so I think for an organization that’s always sort of been able to operate in a certain fashion but is being told now we’d like to see you do it a different way, your expectations are different about how you operate it.

00:16:32:19 – 00:17:07:21
Elizabeth Sullivan – Healthcare Practice Chair – McDonal Hopkins
We view this differently in a buyer situation. That may be it may be because of past experience. And you made a really good point as we were chatting. It could very well be just because the platform’s bigger, which means the chart is bigger, right? There’s more chance, whether it’s just the size of the organization, the amount of services provided, the dollars that are being paid to the organization or associated with the various providers within the organization, all of those things are going to increase the potential for an audit, private or government audit or even a government investigation.

00:17:07:21 – 00:17:35:02
Elizabeth Sullivan – Healthcare Practice Chair – McDonal Hopkins
Any kind of focus on the billing side of the auditing. But there is there’s investigation side of things too, which can be civil, can be criminal, and that’s all of those things that everyone is sort of tasked with looking for fraud, waste, abuse, whether they’re in private payer or whether they’re in the government. The larger you are, the more opportunity there is for something to something to go wrong.

00:17:35:10 – 00:18:06:10
Rajesh Kothari – Founder, Managing Director – Cascade Partners
And it’s, you know, the impact on a large organization is a larger mistake. So, you know, we often I think that’s also we felt like a single practice might not be on the radar screen, but, you know, safety practices, it’s got a greater shot of being on the radar screen, whoever is going to audit. And when we have these complex arrangements that exist between ancillary services and different groups, and then you start crossing state lines, right.

00:18:06:11 – 00:18:30:14
Rajesh Kothari – Founder, Managing Director – Cascade Partners
The level of scrutiny goes up. And so absolutely. What might have been great for you operating in the last 15 years or as part of a much, much, much larger platform is we’re often trying to tag clients through that dynamic of here are the rules. You got to follow the rules even though they can never had an issue in the past that ends up being something that.

00:18:30:17 – 00:19:09:07
Elizabeth Sullivan – Healthcare Practice Chair – McDonal Hopkins
Right folks have to look at. Right. And just again, to circle back to where we started, this idea of being proactive, you know, when you think about that situation there, it does impact right? If you do it proactively and you learn, you learn something about your organization or your operations that you want to change, whether it’s billing, whether it’s some other compliance, compliance aspect, whether it’s whether you’re contracting, the way that you’re employing folks or paying folks, whether it’s, you know, different types of business arrangements, whether it’s all of those things, right?

00:19:09:10 – 00:19:24:07
Elizabeth Sullivan – Healthcare Practice Chair – McDonal Hopkins
If you do it on the front end, you figure out kind of what works for you. It’s not a surprise when you go through a transaction say, hey, we need to change a few of your operations, we need to change this, or we need to change that. And so I think that’s helpful too, because we made this point earlier.

00:19:24:08 – 00:19:54:26
Elizabeth Sullivan – Healthcare Practice Chair – McDonal Hopkins
We are knowledge is power, right? Making those decisions is going to help people with some worry control and may be able to give more insight or feedback or think about what does it mean to join, What am I changing or what have I already changed so that my business operations are more consistent? Maybe they won’t be as impacted by that large platform if that ultimately is what an organization is doing.

00:19:54:26 – 00:20:27:21
Rajesh Kothari – Founder, Managing Director – Cascade Partners
Practices and whether I’m joining or becoming a large firm right, I’m creating the super. We often work with with, with physician shareholders as they explore this environment, very active environment. What are their options? So when we talk to them about, you know, you have the ability, they have the ability to execute the exact same plan, the private equity guys do, they have the ability to bring their management team pros and they’re very successful practices, but they have the same scrutiny and the same issues right as they grow.

00:20:27:21 – 00:20:53:27
Rajesh Kothari – Founder, Managing Director – Cascade Partners
And we come back from a single practice with ten or 15 providers to a you know, I a very large group with 100, 250 providers. They are going to get on the radar screen rate of payers and the government of investigators. They have to have good type processes in order to make sure they’re doing current standards, firm requirements, current expectations.

00:20:54:01 – 00:21:26:06
Elizabeth Sullivan – Healthcare Practice Chair – McDonal Hopkins
Absolutely. I mean, that is such a good point. And I, I, I hope in those instances. Right. You’re already starting to think through all of the things that are going to be required to make that form successful, which you’re absolutely right. I mean, we have gone through diligence before where one of the start requirements relates to how you are compensating your physicians, making sure that designated health services, which would be something like a lab, something that the physician can generate the order for, can be done within the practice.

00:21:26:08 – 00:21:48:22
Elizabeth Sullivan – Healthcare Practice Chair – McDonal Hopkins
But you have to be very careful how that is allocated from a compensation standpoint. And we’ll get into diligence. The contract will say we only compensate you on personally performed work. It does not include designating health services, but as we speak with the organization, it might turn out that maybe not everybody appreciated what was D.H.S. What was that designated health service.

00:21:48:29 – 00:22:21:16
Elizabeth Sullivan – Healthcare Practice Chair – McDonal Hopkins
And so it gets maybe into the compensation somewhere. We have to figure that out. And so to your point of this idea of building that platform and having those controls in place, you know, if it’s if it’s if it’s a process, it’s sort of automatic that can be vetted that somebody is looking at it, it’s it’s much more likely to be success and sort of assume that everybody understands the requirements and has the same grasp on those details because it’s just it’s one of those things that you mentioned this when you were talking about sort of shelters.

00:22:21:16 – 00:22:42:03
Elizabeth Sullivan – Healthcare Practice Chair – McDonal Hopkins
Right. We’re doing everything right. I mean, I think that there is a thought often times in a transaction, you know, it’s all positive. It’s like, okay, we’ve got the smartest people, We’re joining two fantastic organizations, three fit, whatever it may be. We’ve all got this figured out. Sky’s the limit. Not everybody with the operating in that same fashion.

00:22:42:03 – 00:22:55:24
Elizabeth Sullivan – Healthcare Practice Chair – McDonal Hopkins
So for someone who is for organizations, it’s going to scale. It is important to have those protections in place, make it automatic, and hopefully it’s not anything anybody needs to spend extra time thinking about doing.

00:22:55:27 – 00:23:18:24
Rajesh Kothari – Founder, Managing Director – Cascade Partners
And I think the key is you say details matter. You might have a documented one way, but you’re actually not doing what the documentation says. Yes. Because folks farther down the team, yeah, that’s where. So it’s not just, hey, if we have good documentation, if this is okay, practically pragmatically, what are you really doing that matters just as much?

00:23:18:27 – 00:23:19:18
Elizabeth Sullivan – Healthcare Practice Chair – McDonal Hopkins
Right.

00:23:19:21 – 00:23:21:26
Rajesh Kothari – Founder, Managing Director – Cascade Partners
They’re getting folks through that can be announced.

00:23:21:29 – 00:23:54:11
Elizabeth Sullivan – Healthcare Practice Chair – McDonal Hopkins
Absolutely. I mean, I think dare I go back to being a compliance person and rah rah for being proactive. But that’s a perfect example of an organization. Might get a great document and they spent the time and the effort and somebody spent time away from clinical to learn and understand that area to get that document ready. So when it gets rolled out the first few times, there’s no need to go back to the attorney or, you know, whomever was helping with it.

00:23:54:13 – 00:24:16:11
Elizabeth Sullivan – Healthcare Practice Chair – McDonal Hopkins
But maybe then that person gives that responsibility. So there’s changes in leadership. There’s things happening. And so the next person comes into that role is a physician. Depending on the size of the practice agents, an administrator, they come in, they don’t appreciate necessarily what’s in there. Nobody’s kind of going back to their law firm or their attorney talking through that.

00:24:16:13 – 00:24:35:19
Elizabeth Sullivan – Healthcare Practice Chair – McDonal Hopkins
So it is important to have a dialog and say these are the things that we’re building this is you know, we’re building out this ancillary service line of work with you. We’ve got these new folks joining. We want to tweak this, that or the other about their arrangements. It is important to go back to your counsel or your I will say even any of your.

00:24:35:19 – 00:24:37:03
Rajesh Kothari – Founder, Managing Director – Cascade Partners
Documentation, your function.

00:24:37:03 – 00:24:39:04
Elizabeth Sullivan – Healthcare Practice Chair – McDonal Hopkins
You’re right. Yes. No question.

00:24:39:04 – 00:25:01:24
Rajesh Kothari – Founder, Managing Director – Cascade Partners
And obviously large amount of turnover and changing and staff. If there’s ever a time that folks should go back, what is the environment? Because the team that you had during billing for the team that you had doing all the payroll data, this change, and are they up to speed on the client and what your practices say? This is the right thing?

00:25:01:26 – 00:25:02:14
Rajesh Kothari – Founder, Managing Director – Cascade Partners
Really?

00:25:02:16 – 00:25:25:16
Elizabeth Sullivan – Healthcare Practice Chair – McDonal Hopkins
That’s such a good point. I think you’re right. The practical thing to do right is go back to the documentation if there’s any question about it. If someone doesn’t understand what’s in there, it’s worth asking whatever that billing consultants, whomever, accountants, whatever it is. But make sure that you are going back to the documentation to your point. And if somebody doesn’t understand it or is in charge of it, ask the question.

00:25:25:23 – 00:25:37:09
Elizabeth Sullivan – Healthcare Practice Chair – McDonal Hopkins
It’s worth it. If it can truly save a great deal of money, legal expense, resources, sleep, sleepless nights. So it’s it’s work.

00:25:37:12 – 00:25:46:26
Rajesh Kothari – Founder, Managing Director – Cascade Partners
Well, thank you very much for taking the time and sharing your insight and perspective. And thank you for joining us on another cascade conversation. You.