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.
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
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.
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: 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.
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: “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.
“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
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.
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
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.
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: 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.
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: “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.
“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
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.
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.
This presentation defined the disconnect between productivity-based physician compensation models and the demands of value-based payment models; identified and evaluated alternative physician compensation models; addressed the challenges in transitioning from volume-based to value-based compensation; studied how current fraud and abuse laws conflict with strategies related to value-based compensation, and explore potential solutions.
Medical Necessity-- What it Means and 2018 UpdatePYA, P.C.
This presentation addresses the concerns for instituting best practices in tackling medical necessity denials. Including what it means and what it affects, an update on 2018 CMS medical necessity determinations and new initiatives, and details regarding the types of, and criteria for, medical necessity determinations. Admission criteria for skilled nursing facilities and inpatient rehabilitation facilities, as well as the use of Advanced Beneficiary Notification and Hospital-Issued Notice of Non-Coverage (including the outcomes and penalties for not using ABNs or HINNs) are also discussed.
Alternative Payment Models: The Good, the Bad, and the Ugly from an Operation...PYA, P.C.
This presentation describes alternative payment models (APMs) and how their evolution is a catalyst for innovation and change within the healthcare delivery system. With an industry goal of improving healthcare quality and payment outcomes while reducing total costs of care, payers are increasingly promoting the use of APMs, which compensate providers based on the value of care they deliver, rather than the volume of services performed.
This presentation presents the challenges to swing bed reimbursement and discusses swing beds vs. SNFs; readmissions; length of stay; disposition; and transitions of care programs
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.
How HIM Supports the Seven Elements of an Effective Compliance ProgramPYA, P.C.
•An understanding of the seven elements of a robust compliance program.
This presentation offers a review of the regulatory guidance surrounding compliance programs, an identification of HIM’s role in organization compliance, and a discussion of the intersection between HIM and compliance.
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
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: “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.
Practical Steps for Managing Provider Relief Fund DistributionsCitrin Cooperman
Our Healthcare Practice professionals participated in a webinar discussion, "Practical Steps for Managing Provider Relief Fund Distributions," for healthcare organizations.
Topics included: Provider Relief Fund Overview Managing Provider Relief Funds Eligibility Fund Usage & Risk Management Tracking, Documentation, and Reporting Tax and Audit Considerations Sector-Specific Considerations Post-Acute Providers Dental Providers
This is the PowerPoint presentation from Kegler Brown's "2011 Managing Labor and Employee Relations Seminar," held on March 1, 2011, at the Fawcett Center on the campus of The Ohio State University. Topics included recent case law updates, social media in the workplace, distracted driving policies, an update on workers' compensation from ODJFS, an update on complying with healthcare reform and much more.
COVID-19 Emergency Financial Relief: Gas Pedal to the Floor, No Steering Wheel?Health Catalyst
Since the early stages of the COVID-19 pandemic, Congress and the federal government have committed massive amounts of money to economic recovery across affected industries, with healthcare receiving hundreds of billions of dollars in emergency funding. Despite this push to inject capital into a shuttered economy, healthcare organizations have gotten surprisingly little in the way of direction on how they could spend these monies. Providers—a few of which are flush with cash and many struggling with a lack of working capital—now grapple with questions about how to spend sizeable sums of stimulus money legally and how to get their organizations on the road to recovery. Meanwhile, they wait for more guidance, knowing the inevitable waves of audits and enforcement are coming.
During this webinar, you will learn the following:
- How to appropriately receive and optimize COVID-19 relief funding.
- How to utilize relief funding in a compliant way.
- How to proactively prepare for audit and oversight.
- How to make data-informed decisions to prepare, prevent, recover, and plan during a global pandemic.
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.
This presentation defined the disconnect between productivity-based physician compensation models and the demands of value-based payment models; identified and evaluated alternative physician compensation models; addressed the challenges in transitioning from volume-based to value-based compensation; studied how current fraud and abuse laws conflict with strategies related to value-based compensation, and explore potential solutions.
Medical Necessity-- What it Means and 2018 UpdatePYA, P.C.
This presentation addresses the concerns for instituting best practices in tackling medical necessity denials. Including what it means and what it affects, an update on 2018 CMS medical necessity determinations and new initiatives, and details regarding the types of, and criteria for, medical necessity determinations. Admission criteria for skilled nursing facilities and inpatient rehabilitation facilities, as well as the use of Advanced Beneficiary Notification and Hospital-Issued Notice of Non-Coverage (including the outcomes and penalties for not using ABNs or HINNs) are also discussed.
Alternative Payment Models: The Good, the Bad, and the Ugly from an Operation...PYA, P.C.
This presentation describes alternative payment models (APMs) and how their evolution is a catalyst for innovation and change within the healthcare delivery system. With an industry goal of improving healthcare quality and payment outcomes while reducing total costs of care, payers are increasingly promoting the use of APMs, which compensate providers based on the value of care they deliver, rather than the volume of services performed.
This presentation presents the challenges to swing bed reimbursement and discusses swing beds vs. SNFs; readmissions; length of stay; disposition; and transitions of care programs
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.
How HIM Supports the Seven Elements of an Effective Compliance ProgramPYA, P.C.
•An understanding of the seven elements of a robust compliance program.
This presentation offers a review of the regulatory guidance surrounding compliance programs, an identification of HIM’s role in organization compliance, and a discussion of the intersection between HIM and compliance.
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
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: “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.
Practical Steps for Managing Provider Relief Fund DistributionsCitrin Cooperman
Our Healthcare Practice professionals participated in a webinar discussion, "Practical Steps for Managing Provider Relief Fund Distributions," for healthcare organizations.
Topics included: Provider Relief Fund Overview Managing Provider Relief Funds Eligibility Fund Usage & Risk Management Tracking, Documentation, and Reporting Tax and Audit Considerations Sector-Specific Considerations Post-Acute Providers Dental Providers
This is the PowerPoint presentation from Kegler Brown's "2011 Managing Labor and Employee Relations Seminar," held on March 1, 2011, at the Fawcett Center on the campus of The Ohio State University. Topics included recent case law updates, social media in the workplace, distracted driving policies, an update on workers' compensation from ODJFS, an update on complying with healthcare reform and much more.
COVID-19 Emergency Financial Relief: Gas Pedal to the Floor, No Steering Wheel?Health Catalyst
Since the early stages of the COVID-19 pandemic, Congress and the federal government have committed massive amounts of money to economic recovery across affected industries, with healthcare receiving hundreds of billions of dollars in emergency funding. Despite this push to inject capital into a shuttered economy, healthcare organizations have gotten surprisingly little in the way of direction on how they could spend these monies. Providers—a few of which are flush with cash and many struggling with a lack of working capital—now grapple with questions about how to spend sizeable sums of stimulus money legally and how to get their organizations on the road to recovery. Meanwhile, they wait for more guidance, knowing the inevitable waves of audits and enforcement are coming.
During this webinar, you will learn the following:
- How to appropriately receive and optimize COVID-19 relief funding.
- How to utilize relief funding in a compliant way.
- How to proactively prepare for audit and oversight.
- How to make data-informed decisions to prepare, prevent, recover, and plan during a global pandemic.
You’ve Received COVID-19 Related Federal Assistance – Now What?Citrin Cooperman
In this webinar, we discussed the complex web of audit and reporting considerations that organizations who received COVID-19 related federal assistance must consider as they approach year-end planning and look forward to 2021.
In this webinar, CARES Act Funding and Single Audit Update, Withum’s Devin Desmond and Jennifer Stewart discuss recent developments related to Coronavirus Aid, Relief and Economic Security (CARES) Act funding in addition to revisions to Uniform Guidance and Single Audit implications. Viewers are able to identify recent developments related to CARES Act funding and better understand revisions to Uniform Guidance and impact on Single Audits.
This webinar continues the COVID-19 Insights webinar series. Topics include the loans and grants being offered by the government, how they differ, and how they may benefit your practice, including SBA Loans and Grants, HHS Grants, Medicare Advance/Accelerated Payments, and Telehealth Funding. The webinar also goes over the CareOptimize technology developed to assist with streamlining COVID-19 monitoring and reporting.
Congress Gave Hospitals and Providers $100B in the Coronavirus Stimulus Packa...Health Catalyst
The COVID-19 pandemic has caused immense financial strain on healthcare systems across the nation. As a result, Congress passed a $3 trillion stimulus package that includes $100 billion for hospitals and other healthcare providers. While this relief for healthcare organizations is much needed, it can also add confusion. What can organizations use these stimulus funds for? What are the risks and compliance requirements?
Bobbi Brown, Senior Vice President of Professional Services, and Dan Orenstein, General Counsel at Health Catalyst, discuss answers to these questions and more. With over thirty years of experience in healthcare financial planning and analysis, Bobbi shares her unique perspective on the stimulus package and how providers can use these funds in their recovery planning. Dan has over two decades of legal experience in healthcare and discusses the specifics of compliance requirements.
In this webinar, Bobbi and Dan address the following:
-Explain significant sections of the four laws passed, including the CARES Act.
-Review program details of the Provider Relief Fund.
-Explore the use of the funds and compliance with terms and conditions.
-Discuss policy changes to better prepare for healthcare emergencies.
As Operational Site Visits (OSVs) resume virtually, it is important for Community Health Centers to maintain continuous compliance. Compliatric is excited to continue their “Compliance Webinar Series” where each month, program requirements are reviewed to assist health centers in understanding various elements. Participants will be able to utilize these webinars to increase their knowledge of the requirements, and also take compliance to the next level.
This month’s webinar will focus on the following chapter:
Chapter 16: Billing and Collections
Webinar attendee takeaways will include:
· Understanding the requirements and why they are important
· Methods to maintain continuous compliance (without addressing it last minute or only during an OSV)
· How to use the requirement in everyday practice to improve your Community Health Center
This episode continues our COVID-19 COVID-19 Insights Webinar discussing CMS changes, available grants and loans, existing opportunities in telehealth, and more state openings for elective surgeries.
Does it feel like you’re falling behind on the latest CMS regulatory updates? You’re not alone. The CareOptimize COVID-19 Insights webinar is designed to keep you informed of everything going on with CMS as healthcare practices continue to adjust. Along with CMS updates, this webinar goes over SBA loans and Fee-for-service Advance/Accelerated Medicare payments.
During this webinar the Direct Contracting Model Options team hosted a webinar on Tuesday, January 7, 2020 from 1:00 p.m.- 2:30 p.m. EST. During this webinar, presenters provided an overview and demonstration of the Direct Contracting application portal and answered questions about the portal from the audience.
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CMS Innovation Center
http://innovation.cms.gov
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http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
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.
The CMS Innovation Center hosted a webinar on Monday, March 3, 2014 to provide information on how to calculate budget neutrality for the five prongs in the Frontier Community Health Integration Project Demonstration. CMS also provided examples of ways that applicants can respond to the solicitation. Subject matter experts from the CMS Innovation Center and the Health Resources Services Administration (HRSA) provided details and answered questions.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
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.
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.
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: “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.
Webinar: “Getting Online with Telehealth: Practical Guidance for Physician Pr...PYA, P.C.
Medicare’s decision to reimburse for telehealth services, concerns for patient and staff safety, and the loss of revenue from canceled elective procedures are leading many physician practices to consider providing or expanding telehealth services.
During this webinar, PYA’s panel of heavy-hitting experts provided guidance physician practices can use to rollout, or further tap into, the telehealth opportunity. The presenters discussed:
Technology options and speed-to-implementation.
Solutions to internal process challenges.
Patient engagement in telehealth.
PYA hosted this one-hour webinar Thursday, March 26, 2020, at 4 p.m. EDT.
PYA hosted a complimentary one-hour webinar aimed at helping independent medical group owners, partners and practice executives, law firms, and financial advisors by offering strategies for physician practice survival. Practices are exploring every avenue to remain solvent while health systems express concerns about the survival of the independent groups in their communities.
PYA Principals Lori Foley and Jeff Bushong, along with Consultant Katie Ray, discussed:
Cash flow support, including the CARES Act Paycheck Protection Program and Medicare Advance Payments.
Staffing considerations, including the Families First Coronavirus Response Act (FFCRA), pay reductions, and furloughs.
Operations during crisis management, including topline revenue preservation and expense reductions.
The webinar took place Monday April 6, 2020, at 11:00 am EDT.
The PPS [Prospective Payment System] to PDPM Pendulum: An Analysis of PDPM Co...PYA, P.C.
The Skilled Nursing Facility (SNF) industry has faced disruption with Medicare Part A’s transition to the Patient Driven Payment Model (PDPM) in the fall of 2019. Providers seeking additional guidance to further develop and shape their compliance programs are encouraged to view the presentation given by join PYA at the AHLA Long Term Care and the Law program in March of 2020.
PYA Post-Acute Service Line Manager Amy Dalton co-presented with Liz Steffen, MJ CHC CPHRM MBA HCM MA CCC-SLP, Senior Divisional Corporate Compliance Officer of Promedica Health System. “The PPS [Prospective Payment System] to PDPM Pendulum: An Analysis of PDPM Compliance Matters Post Go-Live” covers the following topics:
• Trends in care provision related to value-based outcomes and quality of care.
• Relevant compliance updates from the Department of Health and Human Services, Department of Justice, and Office of Inspector General.
• Clinical operational and compliance-related hurdles for SNFs post-PDPM go-live.
• How PDPM fits into the larger context of a SNF compliance program.
• PDPM recommendations and best practices going forward.
HIPAA Security Trends and Future ExpectationsPYA, P.C.
PYA Principal Barry Mathis, a former CIO, CTO, senior IT audit manager, and IT risk management consultant, presented at teh TSCPA Health Care Conference. His presentation, “HIPAA Security Trends and Future Expectations” will focuses on:
- Current HIPAA enforcement activities and future developments.
- Case studies that highlight the changing HIPAA landscape.
- Cyber threats that impact covered entities and business associates.
Medicare Advantage plans are gaining in popularity. PYA Principal Robert Paskowski, CPA will provided an overview, discussed the business model, and offered contracting strategies at the South Carolina Hospital Association Managed Care Conference.
PYA Managing Principal David McMillan presented “Risk-Based Payment Models,” which discusses:
-The transition from fee-for-service reimbursement to value-based payments.
-Several new models, including pay-for-performance, episodic payments, shared savings arrangements, and global budgets.
Transparency: Current Requirements, Proposed Rules, and Implications for Hosp...PYA, P.C.
PYA Principal and Chief Compliance Officer Shannon Sumner and Consulting Manager Susan Thomas will present sessions that address a range of compliance program needs. They will use their decades of experience and insight to offer concrete, practical information and support:
“Compliance Program Essentials”
“Compliance Program Reporting and Governance”
“The Role of Compliance in Government Enforcement & Compliance Resources”
PYA Principal Barry Mathis presented “The IT Analysis Paralysis,” in which attendees:
Received a compressive review of the many IT frameworks that can be used to develop effective internal audit programs.
Learned the differences between commercial, federal, and industry frameworks.
Received tips, tools, and techniques for creating an effective framework based on risk assessment and identified risks.
The Opioid Epidemic: An Important Auditor UpdatePYA, P.C.
PYA Tampa Office Managing Principal Angie Caldwell and Consulting Senior Manager Sarah Bowman addressed “The Opioid Epidemic: An Important Auditor Update” in their presentation. They:
Provided an overview of the scope of the opioid crisis, emerging trends in opioid abuse, and recent regulatory activity.
Analyzed key internal control risk areas to prevent drug diversion.
Reviewed specific examples of monitoring for fraud and abuse related to the opioid epidemic.
The Current Regulatory Environment and Auditing Urine Drug TestingPYA, P.C.
PYA Consulting Seniors Jennifer Bridgeforth and Jennifer Kastner also presented “The Current Regulatory Environment and Auditing Urine Drug Testing.” Attendees:
Learned the history of urine drug test (UDT) billing changes.
Understood current requirements of UDT coding and documentation.
Learned common compliance issues.
Became familiar with best practice recommendations.
Auditing Healthcare Focus Arrangements for Regulatory CompliancePYA, P.C.
PYA Principal Tynan Kugler and Consulting Manager Susan Thomas presented “Auditing Healthcare Focus Arrangements for Regulatory Compliance: Physicians, Management Services, Post-Discharge Care, Ambulance Services, and Specialty Care.” Their presentation:
- Describes what constitutes a focus arrangement for healthcare organizations.
- Explains the implications of Stark Law and Anti-Kickback violations, along with Corporate Integrity Agreement focus arrangement requirements.
- Discusses essential focus arrangement procedures to facilitate regulatory compliance.
- Provides an example design of an audit plan approach for focus arrangements.
One of the most developed cities of India, the city of Chennai is the capital of Tamilnadu and many people from different parts of India come here to earn their bread and butter. Being a metropolitan, the city is filled with towering building and beaches but the sad part as with almost every Indian city
Explore our infographic on 'Essential Metrics for Palliative Care Management' which highlights key performance indicators crucial for enhancing the quality and efficiency of palliative care services.
This visual guide breaks down important metrics across four categories: Patient-Centered Metrics, Care Efficiency Metrics, Quality of Life Metrics, and Staff Metrics. Each section is designed to help healthcare professionals monitor and improve care delivery for patients facing serious illnesses. Understand how to implement these metrics in your palliative care practices for better outcomes and higher satisfaction levels.
India Clinical Trials Market: Industry Size and Growth Trends [2030] Analyzed...Kumar Satyam
According to TechSci Research report, "India Clinical Trials Market- By Region, Competition, Forecast & Opportunities, 2030F," the India Clinical Trials Market was valued at USD 2.05 billion in 2024 and is projected to grow at a compound annual growth rate (CAGR) of 8.64% through 2030. The market is driven by a variety of factors, making India an attractive destination for pharmaceutical companies and researchers. India's vast and diverse patient population, cost-effective operational environment, and a large pool of skilled medical professionals contribute significantly to the market's growth. Additionally, increasing government support in streamlining regulations and the growing prevalence of lifestyle diseases further propel the clinical trials market.
Growing Prevalence of Lifestyle Diseases
The rising incidence of lifestyle diseases such as diabetes, cardiovascular diseases, and cancer is a major trend driving the clinical trials market in India. These conditions necessitate the development and testing of new treatment methods, creating a robust demand for clinical trials. The increasing burden of these diseases highlights the need for innovative therapies and underscores the importance of India as a key player in global clinical research.
Health Education on prevention of hypertensionRadhika kulvi
Hypertension is a chronic condition of concern due to its role in the causation of coronary heart diseases. Hypertension is a worldwide epidemic and important risk factor for coronary artery disease, stroke and renal diseases. Blood pressure is the force exerted by the blood against the walls of the blood vessels and is sufficient to maintain tissue perfusion during activity and rest. Hypertension is sustained elevation of BP. In adults, HTN exists when systolic blood pressure is equal to or greater than 140mmHg or diastolic BP is equal to or greater than 90mmHg. The
Leading the Way in Nephrology: Dr. David Greene's Work with Stem Cells for Ki...Dr. David Greene Arizona
As we watch Dr. Greene's continued efforts and research in Arizona, it's clear that stem cell therapy holds a promising key to unlocking new doors in the treatment of kidney disease. With each study and trial, we step closer to a world where kidney disease is no longer a life sentence but a treatable condition, thanks to pioneers like Dr. David Greene.
Empowering ACOs: Leveraging Quality Management Tools for MIPS and BeyondHealth Catalyst
Join us as we delve into the crucial realm of quality reporting for MSSP (Medicare Shared Savings Program) Accountable Care Organizations (ACOs).
In this session, we will explore how a robust quality management solution can empower your organization to meet regulatory requirements and improve processes for MIPS reporting and internal quality programs. Learn how our MeasureAble application enables compliance and fosters continuous improvement.
2. Page 1
Provider Relief Fund
• CARES Act (March 2020)
$100 billion
• Paycheck Protection Program and Health
Care Enhancement Act (April 2020)
$75 billion
• Consolidated Appropriations Act
(December 2020)
$3 billion
• American Rescue Plan (President Biden’s
proposed COVID-19 stimulus package)
$0
3. Page 2
Distributions To Date
1. General Distribution, Phase I - $50 billion
a. Round I - $30 billion
b. Round II - $20 billion
2. General Distribution, Phase II - $18 billion
3. General Distribution, Phase III - $20 billion
4. Targeted Distributions
a. Rural Providers - $11.3 billion
b. COVID-19 High Impact Hospitals - $22 billion
c. Skilled Nursing Facilities - $4.9 billion
d. Safety Net Hospitals - $14.7 billion
e. Nursing Homes - $2.5 billion
f. Indian Health Services - $500 million
5. Other Allocations
a. Rural Health Clinic Testing Program - $225 million
b. Nursing Home Infection Control Incentive Payments - $2.5 billion
c. COVID Testing and Treatment for Uninsured* - ~$7.4 billion (includes estimated reserve funds)
4. Page 3
What’s Next?
• As of 02/17/21, 406,322 providers had attested to at least one PRF
distribution; about 50% have received ≥ $10,000
• HHS has yet to allocate $20.2 billion of the $178 billion appropriated by
Congress; estimated $19.4 billion has been returned by providers
• Consolidated Appropriations Act: At least 85% of future allocations (including
returned funds) “shall be for any successor to the Phase 3 General Distribution
allocation to make payments to eligible health care providers based on applications
that consider financial losses and changes in operating expenses occurring in” Q3 of
Q4 of 2020 or Q1 of 2021.
• Legislative action authorizing expanded use of funds?
6. Page 5
Statutory Language – CARES Act
“to reimburse … eligible health care providers for health care related
expenses or lost revenues that are attributable to coronavirus”
“these funds may not be used to reimburse expenses or losses that have been
reimbursed from other sources or that other sources are obligated to
reimburse”
“payments …shall be made in consideration of the most efficient payment
systems practicable to provide emergency payment”
“to be eligible for a payment…an eligible health care provider shall submit… an
application that includes a statement justifying the need … for the payment”
7. Page 6
Parent organization may re-allocate general and targeted
distributions among subsidiary eligible health care providers, but
reporting responsibility remains with original recipient
Lost revenue may be calculated in any reasonable manner
including comparison to budget approved prior to 03/27/20
Statutory Language
Consolidated Appropriations Act
8. Page 7
Terms & Conditions - Reporting
“[S]ubmit reports as the Secretary determines are needed to ensure compliance
with conditions … in such form, with such content, as specified by the Secretary in
future program instructions directed to all.”
“[M]aintain appropriate records and cost documentation [as] required by future
program instructions to substantiate the reimbursement of costs under this award.”
“[P]romptly submit copies of such records and cost documentation upon the request
of the Secretary.”
“[F]ully cooperate in all audits the Secretary, Inspector General, or Pandemic
Response Accountability Committee conducts to ensure compliance with these
Terms and Conditions.”
9. Page 8
Post-Payment
Notice of Reporting Requirements
Updated January 15, 2021
• On-line reporting portal now available for registration only
• Available at https://prfreporting.hrsa.gov/s/ (links to Portal FAQs and Registration User
Guide)
• No announced deadline for registration or reporting use of funds thru 12/31/20
• No announced change to 07/31/21 deadline for reporting use of funds thru 06/31/21
• Reporting Entity
• Parent may report on General Distributions for any subsidiary
• Even if subsidiary signed the Terms and Conditions
• Parent CANNOT report on Targeted Distributions for its subsidiaries
• Every recipient of a Targeted Distribution will need to register as Reporting Entity
• If parent re-allocated subsidiary’s Targeted Distribution, subsidiary reports on that re-
allocation
10. Page 9
Use of Funds Calculation
A. Calculate 2020 unreimbursed expenses attributable to coronavirus
• Necessary if relying solely on 2020 lost revenue?
B. If A is ˂ total PRF distributions, calculate 2020 lost revenue
• Difference between 2019 and 2020 actual net patient care revenue
• Difference between 2020 budget and 2020 actual net patient care revenue
• Any reasonable means of calculating revenue
C.If A + B is ˂ total PRF distributions, calculate:
• First half 2021 unreimbursed expenses attributable to coronavirus
and/or
• Lost revenues in an amount not to exceed the difference between (i) Q1 + Q2 2019
and Q1 + Q2 2021 actual revenue; or (ii) Q1 + Q2 2020 budgeted revenue to Q1 +
Q2 2021 actual revenue.
D. If A + B + C ˂ total PRF distributions, return remaining amount to HHS
11. Page 10
Reporting Requirements - Expenses
General and Administrative Expenses Attributable to Coronavirus
• Mortgage/Rent
• Insurance
• Personnel
• Fringe Benefits
• Lease Payments
• Utilities/Operations
• Other G&A
Healthcare Related Expenses Attributable to Coronavirus
• Supplies (e.g., PPE, hand sanitizer, screening supplies)
• Equipment (e.g., ventilators, updates to HVAC systems)
• IT/interoperability systems (e.g., telehealth infrastructure, increased bandwidth)
• Facilities (e.g., modifications to facilities to accommodate patient treatment practices revised due to coronavirus)
• Other Healthcare Related Expenses (any other actual expenses, not previously captured above, that were paid to prevent,
prepare for, or respond to the coronavirus)
*Reporting Entity must report by sub-category if received ≥ $500,000 in aggregate
12. Page 11
What Qualifies as
“Expense Attributable to Coronavirus?”
• 10/28 FAQ: “[A] broad term that may cover a range of items and services purchased to
prevent, prepare for, and respond to coronavirus, including:
• supplies used to provide healthcare services for possible or actual COVID-19 patients;
• equipment used to provide healthcare services for possible or actual COVID-19 patients;
• workforce training;
• developing and staffing emergency operation centers;
• reporting COVID-19 test results to federal, state, or local governments;
• building or constructing temporary structures to expand capacity for COVID-19 patient care or
to provide healthcare services to non-COVID-19 patients in a separate area from where
COVID-19 patients are being treated; and
• acquiring additional resources, including facilities, equipment, supplies, healthcare practices,
staffing, and technology to expand or preserve care delivery.”
13. Page 12
Capital Equipment (11/14/20 FAQ)
Will the Provider Relief Fund limit qualifying expenses for capital equipment
purchases to 1.5 years of depreciation, or can providers fully expense capital
equipment purchases?
• Expenses for capital equipment and inventory may be fully expensed only in cases
where the purchase was directly related to prevent, prepare for and respond to the
coronavirus.
• Examples of these types of equipment and inventory expenses include:
• Ventilators, CT scanners, and other ICU-related equipment put into use or held in inventory
• Masks, face shields, gloves, gowns
• Biohazard suits
• General personal protective equipment
• Disinfectant supplies
14. Page 13
Capital Facilities Projects (11/14/20 FAQ)
Can providers include the entire cost of capital facilities projects as eligible
expenses, or will eligible expenses be limited to the depreciation expense for
the period?
• Expenses for capital facilities may be fully expensed only in cases where the
purchase was directly related to preventing, preparing for and responding to the
coronavirus.
• Examples of these types of facilities projects include:
• Upgrading HVAC system to support negative pressure units
• Retrofitting a COVID-19 unit
• Enhancing or reconfiguring ICU capabilities
• Leasing or purchasing a temporary structure to screen and/or treat patients
• Leasing a permanent facility to increase hospital or nursing home capacity
15. Page 14
Labor-Related Expenses
• Labor costs not normally incurred (10/28/20 FAQ)
• Additional security personnel (locum tenens, traveling nurses?)
• Hazard pay
• Retention bonuses?
• Re-charge vacation/sick leave?
• Terms and Conditions prohibit use of PRF distributions to pay any salary at
annual rate in excess of Executive Level II ($197,300 in 2020)
• Not including fringe benefits and indirect costs
• May pay amount in excess with non-federal funds
16. Page 15
Expanded Capabilities
• Infection control
• Community engagement
• Patient throughput/efficiencies
• Continuum of care
• Transfers and transportation
• Staff training
17. Page 16
Not Reimbursed By Other Sources
• Post-Payment Notice of Reporting Requirements: “Net of other reimbursed
sources (e.g., payments received from insurance and/or patients, and amounts
received from federal, state or local governments, etc.)”
• Includes payer reimbursement
• Example: May use PRF funds for vaccine distribution (e.g., “additional refrigerators, personnel
costs to provide vaccinations, and acquiring doses of a vaccine (including transportation costs
not otherwise reimbursed)” but not vaccination of Medicare, Medicaid, CHIP beneficiaries
• Required to report other assistance received
• Federal assistance (e.g., forgiven PPP loan, FEMA, CARES Act Testing) received by
Reporting Entity as of reporting period end date
• State, local, and tribal government assistance received by recipient and its included
subsidiaries as of reporting period end date
• Business insurance - paid claims
• Other assistance - Total amount received by recipient and other TINs included in its
report as of reporting period end date
18. Page 17
Cost-Based Reimbursement (10/28/20 FAQ)
How does cost reimbursement relate to my Provider Relief Fund payment?
“Under cost reimbursement, the payer agrees to reimburse the provider for the costs
incurred in providing services to the insured population.”
“[I]f the full cost was reimbursed based upon this method, there is nothing eligible to
report as an expense attributable to coronavirus because the expense was fully
reimbursed by another source.
“In cases where a ceiling is applied to the cost reimbursement and the reimbursed
amount does not fully cover the actual cost due to unanticipated increases in
providing care attributable to coronavirus, those incremental costs that were not
reimbursed are eligible for reimbursement….”
19. Page 18
Risk Tolerance and Risk Management
• Expenditure of PRF distributions on projects for which funding not otherwise
available (having to repay funds vs. having to return unspent funds)
• Capital equipment and capital facilities projects
• Labor costs
• Considerations
• Directly related to COVID-19 response?
• Commercially reasonable?
• Contemporaneous documentation
20. Page 19
Reporting Relating To Lost Revenue
• All Reporting Entities report revenue/net charges from patient care (prior to netting
with expenses) for CY2020 by quarter and payer mix (include subsidiaries?)
• Medicare Part A and B
• Medicare Advantage
• Medicaid/CHIP
• Commercial Insurance
• Self-pay
• Other
• Include fundraising revenues, grants, or donations “if they contribute to funding patient care
services.” (12/4/20 FAQ)
• Do not include -
• Insurance, retail, real estate values, grant funding, tuition
• Sales of medical supplies, including DME and prescription glasses/contacts (10/28/20 FAQ)
• Savings obtained through enrollment in the 340B Program (6/22/20 FAQ)
• Payments made to third parties relating to care not provided in 2019 or 2020 (11/18/20 FAQ)
21. Page 20
Lost Revenue Option 1
• Difference between 2019 and 2020 actual patient care revenue
• Must report patient care revenue by quarter by payer mix for 2019 and 2020
• Following still true? - “Entity with negative net operating income from patient
care in 2019 may apply PRF amounts to lost revenues up to a net zero
gain/loss in 2020.”
22. Page 21
Lost Revenue Option 2
• Difference between 2020 budgeted and 2020 actual patient care
revenue
• Only available if budget established and approved prior to March 27, 2020
• What if budget covers only a portion of the year (e.g., September 30 year-
end)?
• Must submit –
• 2020 budgeted amount of patient care revenue (by quarter by payer mix?)
• Copy of 2020 budget
• Attestation from the Reporting Entity’s Chief Executive Officer, Chief Financial Officer,
or similar responsible individual, attesting under 18 USC § 1001 that the exact budget
being submitted was established and approved prior to March 27, 2020.
23. Page 22
Lost Revenue Option 3
• Calculate lost revenue using any reasonable method of
estimating revenue
• Must submit -
• Description of methodology
• Calculation of lost revenues using that methodology
• Explanation of why the methodology is reasonable
• Description establishing how lost revenue was in fact loss attributable to coronavirus
(as opposed to loss caused by any other source)
• If HHS determines recipient’s proposed alternate methodology is not
reasonable, recipient must resubmit its report within 30 days of notification
using either (a) 2019 calendar year actual revenue, or (b) 2020 calendar
year budgeted revenue to calculate lost revenues
24. Page 23
Required Reporting – Additional Information
• For each 2020 calendar quarter:
• Personnel Metrics - total personnel by labor category (FT, PT, contract, other), total re-
hires, total new hires, total personnel separations by labor category
• Patient Metrics - total # patient visits (in-person/telehealth), total # patients admitted, total
# resident patients
• Facility Metrics - total available staffed beds for medical/surgical, critical care, other
• Changes in ownership
• If Reporting Entity acquires or divests of related subsidiary, include specified
information regarding transaction
• Amount of interest earned on PRF payments (by what date?)