PYA Principal Martie Ross and Senior Manager Graham Fox presented, “Mastering MIPS" at the American College of Healthcare Executives’ Congress on Healthcare Leadership.
Learning objectives included:
Gaining an understanding of MIPS—why it was implemented and how it will impact reimbursement, governance, and strategic planning for healthcare organizations.
Identifying questions organizations must consider during MIPS implementation that will lead to financial and operational success.
The Changing Healthcare System and Impact of MACRAPYA, P.C.
PYA Principal Lori Foley and Consulting Senior Aaron Elias co-presented “The Changing Healthcare System and Impact of MACRA” at the Physician Insurers Association of America’s CEO/COO Meeting.
The Medicare Access & CHIP Reauthorization Act (MACRA) dramatically affected Medicare reimbursements to healthcare providers, as well as provided a new framework for rewarding quality care and reporting on quality measurements. This incentive-based system has the potential not only to change how medicine is practiced, but influence patient perception of care. The presentation will provide the latest information on MACRA implementation, and will detail how the aforementioned changes will impact miscellaneous professional liability insurers.
The document summarizes the Quality Payment Program (QPP) established by the Medicare Access and CHIP Reauthorization Act (MACRA). It outlines two tracks for physician payment under MACRA - the Merit-based Incentive Payment System (MIPS) and Advanced Alternative Payment Models (APMs). MIPS consolidates existing quality programs and adds a cost component, with payment adjustments starting at -4% to +12% in 2019. Advanced APMs offer higher payment updates and bonuses for bearing more than nominal risk. The document provides details on participation requirements, payment adjustments, and strategic considerations for physicians to succeed under the new program.
PYA Principal Martie Ross joined University of Kansas Medical Center’s Robert Moser, MD, and CIO Chris Hansen for the keynote presentation at the joint symposium by Heart of America Healthcare Information and Management Systems Society and Missouri Health Information Management Association, September 14, 2016, at Johnson County Community College in Overland Park, Kansas. They discussed insights related to the role of advanced analytics and technology in transforming and transitioning to new payment models.
The Vicissitudes of Valuing Value--Legal and Valuation Issues Associated with...PYA, P.C.
PYA Principal Carol Carden co-presented “The Vicissitudes of Valuing Value--Legal and Valuation Issues Associated with Value-Based Payment Models” at the 2017 American Health Lawyers Association Physician and Hospitals Law Institute, February 1-3, 2017, in Orlando, Florida.
The presentation addressed:
Emerging alternative payment models (APMs)
The application of fraud and abuse laws and IRS rules to provider network payments
Existing market data and regulatory guidance
Considerations in determining fair market value and commercial reasonableness
Risk-Based Contracting: Background, Assessment, and ImplementationPYA, P.C.
PYA Principal Bob Paskowski presented “Risk-Based Contracting: Assessments and Implementation,” at the National Association of Managed Care Physicians Fall Managed Care Forum, November 10-11, 2016. The presentation allows participants to:
Understand the different types and core elements of risk-based contracting (RBC).
Prepare for additional discussions with key stakeholders regarding RBC assessment and readiness.
Make informed decisions as to next steps while evaluating associated financial risks.
PYA Principal Martie Ross presented the keynote address, “The March to MIPS: The Merit-Based Payment System,” at the Kansas Medical Group Management Association 2016 Fall Conference, September 21-23, 2016, at the Overland Park Marriott in Overland Park, Kansas.
The presentation will include:
An introduction to the Medicare Merit-Based Incentive Payment System (MIPS).
A discussion of the four components of the MIPS composite score.
An exploration of the penalties and bonuses associated with the MIPS composite score, as well as the reputational impact of the publicly reported MIPS composite score.
Surviving the Healthcare World of Risk AdjustmentPYA, P.C.
PYA Principal Bob Paskowski and Senior Staff Consultant Carine Leslie presented a webinar for the Georgia chapter of the Healthcare Financial Management Association Friday, December 16, 2016.
The presentation is tailored for coders in ambulatory/Medicare Advantage settings, providers participating in Medicare Advantage or other risk-based healthcare plans, and leaders in providers’ managed care contracting departments. The webinar is titled “Surviving the Healthcare World of Risk Adjustment.”
The webinar addresses:
• Principles of the Medicare Advantage risk-adjustment model from Medicare Advantage Hierarchical Condition Categories and other risk-based healthcare plans;
• Strategies for reducing compliance risks;
• Methods for accurately, completely, and consistently capturing and documenting a patient’s disease burden to promote effective care management and to reflect the proper risk score.
This document discusses risk-based coding and reimbursement. It explains that risk-based coding uses diagnosis codes and other patient data to adjust payments to health plans based on patients' expected healthcare costs. Accurately capturing patients' conditions through coding affects future reimbursement amounts and health plans' ability to care for patients. The document provides information on common risk adjustment models and recommends practices improve documentation, evaluate coding processes, obtain physician buy-in for accurate coding, and monitor progress to maximize reimbursement under risk-based payment systems.
The Changing Healthcare System and Impact of MACRAPYA, P.C.
PYA Principal Lori Foley and Consulting Senior Aaron Elias co-presented “The Changing Healthcare System and Impact of MACRA” at the Physician Insurers Association of America’s CEO/COO Meeting.
The Medicare Access & CHIP Reauthorization Act (MACRA) dramatically affected Medicare reimbursements to healthcare providers, as well as provided a new framework for rewarding quality care and reporting on quality measurements. This incentive-based system has the potential not only to change how medicine is practiced, but influence patient perception of care. The presentation will provide the latest information on MACRA implementation, and will detail how the aforementioned changes will impact miscellaneous professional liability insurers.
The document summarizes the Quality Payment Program (QPP) established by the Medicare Access and CHIP Reauthorization Act (MACRA). It outlines two tracks for physician payment under MACRA - the Merit-based Incentive Payment System (MIPS) and Advanced Alternative Payment Models (APMs). MIPS consolidates existing quality programs and adds a cost component, with payment adjustments starting at -4% to +12% in 2019. Advanced APMs offer higher payment updates and bonuses for bearing more than nominal risk. The document provides details on participation requirements, payment adjustments, and strategic considerations for physicians to succeed under the new program.
PYA Principal Martie Ross joined University of Kansas Medical Center’s Robert Moser, MD, and CIO Chris Hansen for the keynote presentation at the joint symposium by Heart of America Healthcare Information and Management Systems Society and Missouri Health Information Management Association, September 14, 2016, at Johnson County Community College in Overland Park, Kansas. They discussed insights related to the role of advanced analytics and technology in transforming and transitioning to new payment models.
The Vicissitudes of Valuing Value--Legal and Valuation Issues Associated with...PYA, P.C.
PYA Principal Carol Carden co-presented “The Vicissitudes of Valuing Value--Legal and Valuation Issues Associated with Value-Based Payment Models” at the 2017 American Health Lawyers Association Physician and Hospitals Law Institute, February 1-3, 2017, in Orlando, Florida.
The presentation addressed:
Emerging alternative payment models (APMs)
The application of fraud and abuse laws and IRS rules to provider network payments
Existing market data and regulatory guidance
Considerations in determining fair market value and commercial reasonableness
Risk-Based Contracting: Background, Assessment, and ImplementationPYA, P.C.
PYA Principal Bob Paskowski presented “Risk-Based Contracting: Assessments and Implementation,” at the National Association of Managed Care Physicians Fall Managed Care Forum, November 10-11, 2016. The presentation allows participants to:
Understand the different types and core elements of risk-based contracting (RBC).
Prepare for additional discussions with key stakeholders regarding RBC assessment and readiness.
Make informed decisions as to next steps while evaluating associated financial risks.
PYA Principal Martie Ross presented the keynote address, “The March to MIPS: The Merit-Based Payment System,” at the Kansas Medical Group Management Association 2016 Fall Conference, September 21-23, 2016, at the Overland Park Marriott in Overland Park, Kansas.
The presentation will include:
An introduction to the Medicare Merit-Based Incentive Payment System (MIPS).
A discussion of the four components of the MIPS composite score.
An exploration of the penalties and bonuses associated with the MIPS composite score, as well as the reputational impact of the publicly reported MIPS composite score.
Surviving the Healthcare World of Risk AdjustmentPYA, P.C.
PYA Principal Bob Paskowski and Senior Staff Consultant Carine Leslie presented a webinar for the Georgia chapter of the Healthcare Financial Management Association Friday, December 16, 2016.
The presentation is tailored for coders in ambulatory/Medicare Advantage settings, providers participating in Medicare Advantage or other risk-based healthcare plans, and leaders in providers’ managed care contracting departments. The webinar is titled “Surviving the Healthcare World of Risk Adjustment.”
The webinar addresses:
• Principles of the Medicare Advantage risk-adjustment model from Medicare Advantage Hierarchical Condition Categories and other risk-based healthcare plans;
• Strategies for reducing compliance risks;
• Methods for accurately, completely, and consistently capturing and documenting a patient’s disease burden to promote effective care management and to reflect the proper risk score.
This document discusses risk-based coding and reimbursement. It explains that risk-based coding uses diagnosis codes and other patient data to adjust payments to health plans based on patients' expected healthcare costs. Accurately capturing patients' conditions through coding affects future reimbursement amounts and health plans' ability to care for patients. The document provides information on common risk adjustment models and recommends practices improve documentation, evaluate coding processes, obtain physician buy-in for accurate coding, and monitor progress to maximize reimbursement under risk-based payment systems.
PYA Principal Carol Carden presented “Fundamentals of Healthcare Valuation” at the American Society of Appraisers (ASA) 2015 Advanced Business Valuation Conference. The presentation explored unique characteristics of the healthcare industry, particularly those relevant to appraisers for avoiding common mistakes in assessing risk and projecting cash flow.
Current Trends in Data Protection for Integrated Health, Centralized Peer Rev...PYA, P.C.
A webinar hosted by PYA and the Alliance for Quality Improvement (AQIPS) explored “Current Trends in Data Protection for Integrated Health, Centralized Peer Review Systems, and Other Innovative Programs.” PYA Principal Martie Ross participated in the webinar, which focused on how patient safety organization (PSO) protections can bring value to accountable care organizations and other integrated health systems.
In addition, the webinar provided instruction for using:
Patient Safety and Quality Improvement Act (PSQIA) protections in Medicare Shared Savings Programs, centralized peer review programs, and other collaboratives.
PSQIA protections for new types of clinical analysis, clinical quality reports, and performance tools that contain information that may not be protected under existing state peer review privilege or are shared among an integrated network.
The Heartaches Associated with Billing for Cardiac DevicesPYA, P.C.
PYA Principal Denise Hall-Gaulin and Consulting Manager Joanna Malcolm presented a free webinar for the Georgia chapter of the Healthcare Financial Management Association, on Tuesday, December 6, 2016.
The presentation was geared toward C-suite hospital leaders, compliance officers, in-house counsel, operational leaders, and patient accounting leadership, and covered:
The criteria for implantable cardioverter defibrillators (ICDs), pacemakers, and other devices
The documentation requirements for payment
The prerequisites for a clean audit
Roadmap to the Patient-Centered Medical HomePYA, P.C.
This document provides an overview of the patient-centered medical home (PCMH) model and how to implement it. It defines PCMH and its core standards and requirements for certification. It outlines the benefits of PCMH including improved quality, lower costs, and increased patient satisfaction. It discusses financial and operational considerations for practices transitioning to PCMH, and provides guidance on implementing specific PCMH functions like quality improvement, access to care, transitional care management, referral tracking, pre-visit planning, and population health management. The presentation aims to provide medical practices a roadmap to achieving PCMH recognition and reaping its benefits.
Office of Civil Rights HIPAA Audits Preparing Your Clients and YourselfPYA, P.C.
PYA Consulting Manager Susan Thomas presented “Office of Civil Rights HIPAA Audits – Preparing Your Clients and Yourself” at The Florida Bar’s “Representing the Physician: It Is Harder Than It Looks” conference, February 3, 2017, in Orlando, Florida.
The presentation covered topics that include:
The Health Information Technology for Economic and Clinical Health Act.
Phase 1 audit, privacy, security, and breach notification findings and lessons learned.
Phase 2 audits—scope and recipient selection.
HIPAA audit readiness and steps for preparing.
Personal reflections from an OCR breach investigation.
Audit resources for physician practices.
Addressing Medical Necessity Denials and RecoupmentsPYA, P.C.
With increased denials and recoupments related to medical necessity at the forefront of discussions at this year’s American Health Lawyers Association Institute on Medicare and Medicaid Payment Issues, PYA was prepared to inform and assist providers instituting best practices to address medical necessity denials. PYA Principal Denise Hall-Gaulin co-presented “Medical Status-Current Status/Key Best Practices in Prevention of Medical Necessity Denials and Recoupments” with Michael Spake, VP of External Affairs and Chief Compliance and Integrity Officer at Lakeland Regional Health.
The presentation included:
A discussion of medical necessity—what it means and what it affects
Information regarding medical necessity determinations and criteria for determination
Definitions for categorically excluded services
Criteria for admission (skilled nursing facilities and inpatient rehabilitation facilities included)
PYA Principal Carol Carden and Senior Manager Angie Caldwell presented “Hot Topics in Physician Compensation” at the Kentucky Society of CPAs (KY CPA) Health Care Conference, May 18, 2016. The presentation explored the latest developments in physician compensation structure, as well as considerations related to stacking compensation elements, the role and impact of quality incentives, the latest in affiliation models, and population health initiatives.
PYA Principal J. Michael Keegan, MD, recently presented “Pacing Volume-to-Value Transition” and “The ROI of Avoiding Antibiotic Overuse” at the AlaHA Annual Meeting, June 8-11, 2016. The presentation focused on the importance of antibiotic stewardship programs (ASP) for population health. The presentation explained:
Why the Centers for Medicare & Medicaid Services is proposing a requirement that hospitals implement ASPs to stem the rise of resistant bacteria.
Why PYA is invested in offering hospitals a proven program for improving patient safety while saving costs.
What constitutes a successful ASP.
Chronic Care Management in Post-Acute/LTC SettingPYA, P.C.
PYA Principal Denise Hall and PYA Manager Lori Baker presented an educational session, “Chronic Care Management in Post-Acute/LTC Setting” to members of The Vision Group during The Society for Post-Acute and Long-Term Care Medicine’s (AMDA) Annual Conference.
Healthcare Reform and Physician Compensation— Presentation Examines What’s in...PYA, P.C.
Among the many questions facing physicians in the wake of healthcare reform—how will they get paid? PYA Principal David McMillan recently addressed this question at the PKF Healthcare Fly-In with “Current Reform Initiatives and Their Impact on Physician Compensation.”
PYA Thought Leader Defines Role of Radiation Oncology in Clinical IntegrationPYA, P.C.
PYA Senior Consulting Manager Chris Wilson presented “Clinically Integrated Networks (CIN) and the Role for Radiation Oncology” at the SATRO® 16 Conference, April 24-25, 2014, at the Crowne Plaza Ravinia in Atlanta, Georgia.
PYA Monitors Topics on Healthcare Radar at AlaHAPYA, P.C.
PYA recently presented “Blips on the Radar—Ground Clutter or Looming Crisis?” at the 2014 Alabama Hospital Association Annual Meeting. Topics covered included:
ICD-10—What now?
Hospital-Physician Transactions—The compliance wheel
Value-Based Payments—What’s up with that?
Physician Differentiation—What sets doctors apart?
Modern Physician-Hospital Affiliations in an Era of Increased Fraud and Abuse...PYA, P.C.
PYA Senior Manager Chris Beckham co-presented “Modern Physician-Hospital Affiliations in an Era of Increased Fraud and Abuse Scrutiny” with Ross Burris of Polsinelli at the American Health Lawyer Association’s (AHLA) Physicians and Hospitals Law Institute, February 8-10, 2016.
PYA Highlights Next Steps of Meaningful UsePYA, P.C.
At the 2013 AICPA Healthcare Industry Conference, PYA Principal David McMillan and Senior Manager Chris Wilson recently explored the “new normal” of meaningful use as compliance and strategic standards in new care/reimbursement-model development.
CMS’ Hospital Readmission Reduction Program: What does it mean for your hospi...PYA, P.C.
The document summarizes information presented at an Alabama Hospital Association meeting about the CMS Hospital Readmission Reduction Program. It discusses rising healthcare costs, the shift from fee-for-service to value-based reimbursement, and new programs linking hospital payment to quality metrics like readmission rates. Hospitals face reductions of up to 3% of Medicare reimbursement payments if they have excess readmissions for conditions like heart attacks, heart failure and pneumonia. The presentation provides Alabama-specific data on the financial impacts of readmission adjustments and new billing codes for transitional care management.
Melinda Hancock is Partner at Dixon Hughes Goodman and Chair Elect of HFMA for 2014-2015. She is responsible for developing new financial modeling products and services related to alternative payment models. Edward Stall has over 20 years of healthcare consulting experience providing strategic planning for healthcare clients. The presentation discusses the transition to alternative payment models like accountable care organizations and bundled payments requiring new forms of enterprise intelligence and analytics. It provides an overview of upcoming risk models and payment reforms, and the intelligence needs of organizations to succeed under new models.
CMS Medicare Advantage 2021 Star Ratings: An AnalysisCitiusTech
This report is intended for business, consulting, and technology audience who are actively engaged, or impacted, with the functioning of Medicare Advantage Star ratings, to help them align their star improvement initiatives to the market trends.
As healthcare is a language “all its own,” PYA Principal David McMillan presented “Learning the New Language of Healthcare" at the Georgia Society of CPAs' 2014 Healthcare Conference.
ICD-10 Is Really Here: What Does That Mean To Compliance Officers?PYA, P.C.
This document provides an overview of a presentation for the Tennessee Hospital Association's 2015 Fall Compliance Conference on ICD-10 implementation. The presentation covers the current regulatory status of ICD-10, an overview of industry testing successes and challenges, how ICD-10 will be used for outcome-based and population health data in the future, and what to expect regarding claim denials. It also discusses bills in Congress regarding ICD-10 transition and provides examples of Medicare coverage determination changes.
USS Value Based—Navigating Old Obstacles in the New WorldPYA, P.C.
A proud supporter of the American Health Lawyers Association (AHLA), PYA joined legal counselors, compliance officers, government representatives, and other attendees October 4-6, at the 2017 Fraud and Compliance Institute, held at the Renaissance Harborplace Hotel, Baltimore, MD. PYA Principal Carol Carden co-presented “USS Value Based—Navigating Old Obstacles in the New World,” with Robert G. Homchick, a partner with Davis Wright Tremaine. The presentation explored: alternative payment models, value-based payments under program waivers, fraud and abuse laws, and IRS rules, as well as valuation and commercial reasonableness of value-based payments.
Alternative Payment Models: The Good, the Bad, and the UglyPYA, P.C.
Real-world examples and case studies related to operationalizing, remaining compliant, valuing APMs and the evolving alternative payment models (APMs) as a catalyst for change and innovation in healthcare delivery are discussed during the presentation, “Alternative Payment Models: The Good, The Bad, and The Ugly.”
Merit-Based Incentive Payment System: Strategic Deployment Within Your Organi...PYA, P.C.
This presentation, “Merit-Based Incentive Payment System: Strategic Deployment Within Your Organization,” outlines the requirements for MIPS participation and scoring in 2018. It also provides strategic guidance for creating an opportunity for positive financial impact for practices.
PYA Principal Carol Carden presented “Fundamentals of Healthcare Valuation” at the American Society of Appraisers (ASA) 2015 Advanced Business Valuation Conference. The presentation explored unique characteristics of the healthcare industry, particularly those relevant to appraisers for avoiding common mistakes in assessing risk and projecting cash flow.
Current Trends in Data Protection for Integrated Health, Centralized Peer Rev...PYA, P.C.
A webinar hosted by PYA and the Alliance for Quality Improvement (AQIPS) explored “Current Trends in Data Protection for Integrated Health, Centralized Peer Review Systems, and Other Innovative Programs.” PYA Principal Martie Ross participated in the webinar, which focused on how patient safety organization (PSO) protections can bring value to accountable care organizations and other integrated health systems.
In addition, the webinar provided instruction for using:
Patient Safety and Quality Improvement Act (PSQIA) protections in Medicare Shared Savings Programs, centralized peer review programs, and other collaboratives.
PSQIA protections for new types of clinical analysis, clinical quality reports, and performance tools that contain information that may not be protected under existing state peer review privilege or are shared among an integrated network.
The Heartaches Associated with Billing for Cardiac DevicesPYA, P.C.
PYA Principal Denise Hall-Gaulin and Consulting Manager Joanna Malcolm presented a free webinar for the Georgia chapter of the Healthcare Financial Management Association, on Tuesday, December 6, 2016.
The presentation was geared toward C-suite hospital leaders, compliance officers, in-house counsel, operational leaders, and patient accounting leadership, and covered:
The criteria for implantable cardioverter defibrillators (ICDs), pacemakers, and other devices
The documentation requirements for payment
The prerequisites for a clean audit
Roadmap to the Patient-Centered Medical HomePYA, P.C.
This document provides an overview of the patient-centered medical home (PCMH) model and how to implement it. It defines PCMH and its core standards and requirements for certification. It outlines the benefits of PCMH including improved quality, lower costs, and increased patient satisfaction. It discusses financial and operational considerations for practices transitioning to PCMH, and provides guidance on implementing specific PCMH functions like quality improvement, access to care, transitional care management, referral tracking, pre-visit planning, and population health management. The presentation aims to provide medical practices a roadmap to achieving PCMH recognition and reaping its benefits.
Office of Civil Rights HIPAA Audits Preparing Your Clients and YourselfPYA, P.C.
PYA Consulting Manager Susan Thomas presented “Office of Civil Rights HIPAA Audits – Preparing Your Clients and Yourself” at The Florida Bar’s “Representing the Physician: It Is Harder Than It Looks” conference, February 3, 2017, in Orlando, Florida.
The presentation covered topics that include:
The Health Information Technology for Economic and Clinical Health Act.
Phase 1 audit, privacy, security, and breach notification findings and lessons learned.
Phase 2 audits—scope and recipient selection.
HIPAA audit readiness and steps for preparing.
Personal reflections from an OCR breach investigation.
Audit resources for physician practices.
Addressing Medical Necessity Denials and RecoupmentsPYA, P.C.
With increased denials and recoupments related to medical necessity at the forefront of discussions at this year’s American Health Lawyers Association Institute on Medicare and Medicaid Payment Issues, PYA was prepared to inform and assist providers instituting best practices to address medical necessity denials. PYA Principal Denise Hall-Gaulin co-presented “Medical Status-Current Status/Key Best Practices in Prevention of Medical Necessity Denials and Recoupments” with Michael Spake, VP of External Affairs and Chief Compliance and Integrity Officer at Lakeland Regional Health.
The presentation included:
A discussion of medical necessity—what it means and what it affects
Information regarding medical necessity determinations and criteria for determination
Definitions for categorically excluded services
Criteria for admission (skilled nursing facilities and inpatient rehabilitation facilities included)
PYA Principal Carol Carden and Senior Manager Angie Caldwell presented “Hot Topics in Physician Compensation” at the Kentucky Society of CPAs (KY CPA) Health Care Conference, May 18, 2016. The presentation explored the latest developments in physician compensation structure, as well as considerations related to stacking compensation elements, the role and impact of quality incentives, the latest in affiliation models, and population health initiatives.
PYA Principal J. Michael Keegan, MD, recently presented “Pacing Volume-to-Value Transition” and “The ROI of Avoiding Antibiotic Overuse” at the AlaHA Annual Meeting, June 8-11, 2016. The presentation focused on the importance of antibiotic stewardship programs (ASP) for population health. The presentation explained:
Why the Centers for Medicare & Medicaid Services is proposing a requirement that hospitals implement ASPs to stem the rise of resistant bacteria.
Why PYA is invested in offering hospitals a proven program for improving patient safety while saving costs.
What constitutes a successful ASP.
Chronic Care Management in Post-Acute/LTC SettingPYA, P.C.
PYA Principal Denise Hall and PYA Manager Lori Baker presented an educational session, “Chronic Care Management in Post-Acute/LTC Setting” to members of The Vision Group during The Society for Post-Acute and Long-Term Care Medicine’s (AMDA) Annual Conference.
Healthcare Reform and Physician Compensation— Presentation Examines What’s in...PYA, P.C.
Among the many questions facing physicians in the wake of healthcare reform—how will they get paid? PYA Principal David McMillan recently addressed this question at the PKF Healthcare Fly-In with “Current Reform Initiatives and Their Impact on Physician Compensation.”
PYA Thought Leader Defines Role of Radiation Oncology in Clinical IntegrationPYA, P.C.
PYA Senior Consulting Manager Chris Wilson presented “Clinically Integrated Networks (CIN) and the Role for Radiation Oncology” at the SATRO® 16 Conference, April 24-25, 2014, at the Crowne Plaza Ravinia in Atlanta, Georgia.
PYA Monitors Topics on Healthcare Radar at AlaHAPYA, P.C.
PYA recently presented “Blips on the Radar—Ground Clutter or Looming Crisis?” at the 2014 Alabama Hospital Association Annual Meeting. Topics covered included:
ICD-10—What now?
Hospital-Physician Transactions—The compliance wheel
Value-Based Payments—What’s up with that?
Physician Differentiation—What sets doctors apart?
Modern Physician-Hospital Affiliations in an Era of Increased Fraud and Abuse...PYA, P.C.
PYA Senior Manager Chris Beckham co-presented “Modern Physician-Hospital Affiliations in an Era of Increased Fraud and Abuse Scrutiny” with Ross Burris of Polsinelli at the American Health Lawyer Association’s (AHLA) Physicians and Hospitals Law Institute, February 8-10, 2016.
PYA Highlights Next Steps of Meaningful UsePYA, P.C.
At the 2013 AICPA Healthcare Industry Conference, PYA Principal David McMillan and Senior Manager Chris Wilson recently explored the “new normal” of meaningful use as compliance and strategic standards in new care/reimbursement-model development.
CMS’ Hospital Readmission Reduction Program: What does it mean for your hospi...PYA, P.C.
The document summarizes information presented at an Alabama Hospital Association meeting about the CMS Hospital Readmission Reduction Program. It discusses rising healthcare costs, the shift from fee-for-service to value-based reimbursement, and new programs linking hospital payment to quality metrics like readmission rates. Hospitals face reductions of up to 3% of Medicare reimbursement payments if they have excess readmissions for conditions like heart attacks, heart failure and pneumonia. The presentation provides Alabama-specific data on the financial impacts of readmission adjustments and new billing codes for transitional care management.
Melinda Hancock is Partner at Dixon Hughes Goodman and Chair Elect of HFMA for 2014-2015. She is responsible for developing new financial modeling products and services related to alternative payment models. Edward Stall has over 20 years of healthcare consulting experience providing strategic planning for healthcare clients. The presentation discusses the transition to alternative payment models like accountable care organizations and bundled payments requiring new forms of enterprise intelligence and analytics. It provides an overview of upcoming risk models and payment reforms, and the intelligence needs of organizations to succeed under new models.
CMS Medicare Advantage 2021 Star Ratings: An AnalysisCitiusTech
This report is intended for business, consulting, and technology audience who are actively engaged, or impacted, with the functioning of Medicare Advantage Star ratings, to help them align their star improvement initiatives to the market trends.
As healthcare is a language “all its own,” PYA Principal David McMillan presented “Learning the New Language of Healthcare" at the Georgia Society of CPAs' 2014 Healthcare Conference.
ICD-10 Is Really Here: What Does That Mean To Compliance Officers?PYA, P.C.
This document provides an overview of a presentation for the Tennessee Hospital Association's 2015 Fall Compliance Conference on ICD-10 implementation. The presentation covers the current regulatory status of ICD-10, an overview of industry testing successes and challenges, how ICD-10 will be used for outcome-based and population health data in the future, and what to expect regarding claim denials. It also discusses bills in Congress regarding ICD-10 transition and provides examples of Medicare coverage determination changes.
USS Value Based—Navigating Old Obstacles in the New WorldPYA, P.C.
A proud supporter of the American Health Lawyers Association (AHLA), PYA joined legal counselors, compliance officers, government representatives, and other attendees October 4-6, at the 2017 Fraud and Compliance Institute, held at the Renaissance Harborplace Hotel, Baltimore, MD. PYA Principal Carol Carden co-presented “USS Value Based—Navigating Old Obstacles in the New World,” with Robert G. Homchick, a partner with Davis Wright Tremaine. The presentation explored: alternative payment models, value-based payments under program waivers, fraud and abuse laws, and IRS rules, as well as valuation and commercial reasonableness of value-based payments.
Alternative Payment Models: The Good, the Bad, and the UglyPYA, P.C.
Real-world examples and case studies related to operationalizing, remaining compliant, valuing APMs and the evolving alternative payment models (APMs) as a catalyst for change and innovation in healthcare delivery are discussed during the presentation, “Alternative Payment Models: The Good, The Bad, and The Ugly.”
Merit-Based Incentive Payment System: Strategic Deployment Within Your Organi...PYA, P.C.
This presentation, “Merit-Based Incentive Payment System: Strategic Deployment Within Your Organization,” outlines the requirements for MIPS participation and scoring in 2018. It also provides strategic guidance for creating an opportunity for positive financial impact for practices.
MACRA, MIPS, & APMs: Considerations for 2018 and BeyondPYA, P.C.
Providing an overview of QPP’s second performance year finalized in the 2018 Centers for Medicare & Medicaid Services’ QPP and Medicare Physician Fee Schedule, this presentation highlights changes from last year’s program requirements, identifies key areas of immediate focus relevant to financial risks and outcomes, and provides insights into 2019 planning.
Valuing Value: Issues Associated with the Valuation of Alternative Payment Mo...PYA, P.C.
Many providers face challenges when transitioning from fee-for-service payments to value-based reimbursement. In this presentation, existing market data and regulatory guidance will be discussed, and considerations for the determination of fair market value and commercial reasonableness for such models will be explored.
MACRA and the Merit-Based Incentive Payment System (MIPS)PYA, P.C.
This document provides an overview of the Merit-based Incentive Payment System (MIPS) under the Medicare Access and CHIP Reauthorization Act (MACRA). MIPS replaces previous quality reporting programs and includes four components that determine a Composite Performance Score: Quality, Resource Use, Clinical Practice Improvement Activities, and Advancing Care Information. Scores will determine payment adjustments beginning in 2019, with the potential for bonuses or penalties up to 9% by 2022 based on performance compared to benchmarks and thresholds. The document reviews the scoring methodology and reporting requirements for each MIPS component.
Year 2 of the Quality Payment Program: MIPS and APMsPYA, P.C.
The transition to value-based payment models continues to grow. A recent report found nearly 30% of all payments for healthcare services—more than $350 billion—flowed through APMs in 2016. In order to remain relevant in today’s healthcare environment, providers are seeking strategies to position themselves for value-based care transformation.
PYA to Tackle Organizational Risks, Alternative Payment Models, and HIPAA Aud...PYA, P.C.
PYA Principal Martie Ross and Senior Consultant Aaron Elias conducted a session at the Association of Healthcare Internal Auditors (AHIA) 36th Annual Conference. The presentation was titled: “The Times, They Are A- Changin’: Alternative Payment Models Panel Presentation.”
Areas of focus included:
•Discussing new payment models available to providers, including the Merit-Based Incentive Payment System and Advanced Alternative Payment Models.
•Exploring CMS’ progress toward goals related to payment reform.
•Understanding alternative payment models and pay-for-performance programs—which components require auditing and recommendations for potential auditing processes.
Regulatory Outlook: Knock MACRA Out of the ParkKareo
Review the latest changes to the regulatory landscape, including HIPAA, MACRA, and the NC HIE. Learn how these changes impact your clients and your business.
Medicare Access and Chip Reauthorization Act (MACRA) is the law that changes how Providers are to be reimbursed. One of the key characteristics is that it rewards Providers based on value and not volume.
The Primary Care First Model Options team hosted a payment webinar on Thursday, June 27, 2019 from Noon - 1:00 p.m. EDT. Topics discussed included what the Primary Care First Total Primary Care Payment and the quality measures used to calculate the Performance-Based Adjustment, beneficiary attribution, policies on overlap with other CMS models, and the timeline for receiving model payments.
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The document discusses the Medicare Access and CHIP Reauthorization Act (MACRA) and its Quality Payment Program. Some key points:
- MACRA rolled several existing programs (PQRS, Meaningful Use, Value Modifier) into a single program with two tracks: MIPS and Advanced APMs. MIPS assesses clinicians on quality, cost, improvement activities, and advancing care information.
- Most clinicians will be subject to MIPS based on Medicare billing amounts and patient volumes. MIPS scoring is based on a composite of these categories, with financial incentives or penalties applied after a two-year delay.
- The categories have different measures and reporting methods. Quality makes up 30% of
MIPS APM for ACOs: A Hybrid Reimbursement ModelCitiusTech
This document discusses MIPS APM scoring for ACOs that do not meet the patient and payment thresholds to be classified as Advanced APMs. It provides an overview of MIPS APM reporting requirements and timelines, the measures ACOs can report through various methods like surveys and claims, and how payment adjustments will be determined based on a composite performance score. Key advantages of MIPS APM scoring include reduced reporting burdens and greater weight given to quality over cost measures.
The Direct Contracting Model Options team hosted a webinar on January 22, 2020 to provide additional information on the Direct Contracting model's payment methodology following the Payment Part 1 Webinar on January 15th. The team presented on additional aspects of the financial model not covered during the Payment Part 1 Webinar, such as its risk adjustment, benchmark methodologies, and quality measures. The forum also provided an opportunity for potential applicants to ask the team questions regarding these topics and other topics related to the model application.
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This slideshow is about P4P model in health care and how it can transform the health care sector. It also talks about what is P4P it origin, budgeting methods, and how can it transform health care
MACRA will help us move more quickly towards our goal of value-based care. MIPS combines parts of the Physician Quality Reporting System (PQRS), the Value Modifier (VM or Value-based Payment Modifier), and the Medicare Electronic Health Record (EHR) incentive program into one single program. Have a look at the objectives & measures, quality scoring methodology, clinical practice improvements and other pertinent details.
The document discusses how physicians can prepare for the Medicare Access and CHIP Reauthorization Act (MACRA) Quality Payment Program, which incorporates quality measurements into Medicare payments. It provides a 5-step guide to transition successfully to the Merit-based Incentive Payment System (MIPS) in 2017. The steps include: determining eligibility and reporting status; reviewing current performance under programs like PQRS; selecting a pace of participation in MIPS; choosing quality measures; and identifying gaps to address in order to improve performance scores.
Quality Payment Program (MACRA) Proposed RuleMick Brown
The Quality Payment Program, established under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), began in 2017, known as the transition year. The Program’s main goals are to:
Improve health outcomes.
Spend wisely.
Minimize burden of participation.
Be fair and transparent.
The Quality Payment Program has 2 tracks: (1) The Merit-based Incentive Payment System (MIPS) and (2) Advanced Alternative Payment Models (Advanced APMs).
Because the Quality Payment Program brings significant changes to how clinicians are paid within Medicare, the Centers for Medicare & Medicaid Services (CMS) is continuing to go slow and use stakeholder feedback to find ways to streamline and reduce clinician burden. CMS has engaged more than 100 stakeholder organizations and over 47,000 people since January 1, 2017 to raise awareness, solicit feedback, and help clinicians prepare to participate. Based on stakeholder feedback, CMS established transition year policies from the clinician perspective, such as:
Giving clinicians the option to choose how they’ll participate (also known as Pick Your Pace).
Having a low-volume threshold that exempts many clinicians with a low volume of Medicare
Part B payments or patients.
Allowing flexibilities for clinicians who are considered hospital-based or have limited face-to-
face encounters with patients (referred to as non-patient facing clinicians).
As the Quality Payment Program moves into the second year, CMS wants to ensure that there is meaningful measurement and the opportunity for improved patient outcomes while minimizing burden, improving coordination of care for patients, and supporting a pathway to participation in Advanced APMs.
Similar to Deployment of the Medicare Access and CHIP Reauthorization Act (20)
“CARES Act Provider Relief Fund: Opportunities, Compliance, and Reporting”PYA, P.C.
PYA Principal Martie Ross spoke at the virtual North Carolina Healthcare Association Critical Access Hospital Statewide Meeting. The two-day event, “Quality Focus is a Finance Focus,” provided critical access hospital leaders with the opportunity to network and review data-informed strategies as well as updates to the Medicare Flexibility Program Project. It also provided guidance on federal compliance and tracking of Provider Relief Funds.
In “CARES Act Provider Relief Fund: Opportunities, Compliance, and Reporting,” Martie gave an overview of the history of distribution of those funds as well as regulations and guidelines including:
Statutory Language
Reporting Requirements
Use of Funds Calculation
Expenses
Risk Management
Martie presented Thursday, March 4, 2021.
If you would like guidance related to Provider Relief Fund regulations, or for assistance with any matter related to strategy and integration, compliance, or valuation, contact one of our PYA executives at (800) 270-9629.
PYA Presented on 2021 E/M Changes and a CARES Act Update During GHA Complianc...PYA, P.C.
The Georgia Hospital Association (GHA) Compliance Officers Roundtable, an active GHA group that meets quarterly and includes educational sessions featuring government representatives, industry experts, and other thought leaders speaking about compliance-related issues, conducted their latest meeting virtually. PYA Principals Lori Foley, Tynan Kugler, and Valerie Rock were among the presenters at this quarter’s event. In their session, they:
Described key elements associated with 2021 E/M changes, and strategies for preparation and implementation.
Explained the impact of 2021 E/M changes on physician compensation and contracting, including potential mitigation approaches.
Presented key components of Stark Law and Anti-Kickback Statute final rules.
Provided an update on the CARES Act.
The Compliance Certification Board offered CEUs for this event, which took place on Friday, December 4, 2020.
Webinar: “Trick or Treat? October 22nd Revisions to Provider Relief Fund Repo...PYA, P.C.
On October 22nd, the Department of Health and Human Services released revised Provider Relief Fund (PRF) reporting requirements. Under HHS’ September 19 directive, “lost revenue” was defined narrowly as a negative change in year-over-year patient care operating net income. Now, HHS will permit providers to use PRF funds to cover the difference between their 2019 and 2020 actual patient care revenue with some adjustments for COVID-related expenses. The October 22nd notice is available here.
PYA Principals Martie Ross and Michael Ramey hosted a complimentary 30-minute webinar, “Trick or Treat? October 22nd Revisions to Provider Relief Fund Reporting Requirements” on Thursday, October 29th.
“Regulatory Compliance Enforcement Update: Getting Results from the Guidance” PYA, P.C.
PYA Principal and Chief Compliance Officer Shannon Sumner and Consulting Senior Manager Susan Thomas presented “Regulatory Compliance Enforcement Update: Getting Results from the Guidance” at the virtual 2020 Montana Healthcare Conference. They reviewed the sources of regulatory enforcement and investigation information—guidelines, statutory updates, best practices, settlements, case studies, etc.—available to healthcare organizations. They will also discuss how to interpret and implement the guidance in order to strengthen the compliance function and protect the organization. The presentation covered:
Compliance regulatory requirements for healthcare organizations.
Guidance available for consideration in organizational compliance programs.
Internal and external reporting to ensure regulatory requirements are met.
Best practices for implementation of guidance.
Case studies for illustration of guidance implementation.
“Federal Legislative and Regulatory Update,” Webinar at DFWHCPYA, P.C.
The Dallas Fort Worth Hospital Council (DFWHC) and PYA co-hosted an exclusive complimentary webinar, “Federal Legislative and Regulatory Update,” on Wednesday, September 23.
DFWHC President/CEO Stephen Love hosted a discussion with PYA Senior Manager Kathy Reep about concerns that have dropped from the radar during the last four months of COVID-19, addressing issues for which hospitals must prepare in approaching 2021. This session focused on these key areas:
Appropriate use criteria
Transparency
Site neutral payments
The future of the Medicare Trust Fund
The federal budget
Key provisions of the final rule for the inpatient prospective payment system for FY2021 and the proposed outpatient rule for CY2021
On-Demand Webinar: Compliance With New Provider Relief Funds Reporting Requir...PYA, P.C.
On September 19, the Department of Health and Human Services (HHS) published its Post-Payment Notice of Reporting Requirements. The Notice details the reporting requirements for all Provider Relief Fund (PRF) recipients that have received $10,000 or more in aggregate payments.
Under the PRF Terms and Conditions, a recipient may use the funds only for healthcare-related expenses and lost revenue attributable to coronavirus. The Notice provides the clearest direction to date regarding permissible uses of PRF funds.
PYA offered a 45-minute complimentary webinar that explained the new reporting requirements and delved into permissible uses. While many questions remain, we provided practical advice on the next steps in the reporting process.
The webinar took place Monday, October 5 at 11 a.m. EDT.
Webinar: “While You Were Sleeping…Proposed Rule Positioned to Significantly I...PYA, P.C.
The proposed rule would significantly impact physician compensation by re-valuing outpatient E/M services. It increases reimbursement for E/M codes but reduces the conversion factor, resulting in higher payments for some specialties and lower payments for others. This redistribution could increase revenue for specialists providing many E/M services but decrease revenue for proceduralists. Employers may need to adjust physician contracts to account for these changes. The rule also introduces new E/M guidelines and codes effective 2021, requiring preparation from medical practices.
Webinar: “Cybersecurity During COVID-19: A Look Behind the ScenesPYA, P.C.
Cybersecurity breaches have been in the news almost daily for some time now. COVID-19 has amplified the problem, as “bad actors” seize upon the opportunity to take advantage of hospitals at their most vulnerable time. Given this climate and an aging HIPAA rule, it is difficult to anticipate and prepare for the future.
PYA Principal Barry Mathis presented “Cybersecurity During COVID-19: A Look Behind the Scenes,” on Wednesday, August 12, 2020. This one-hour, complimentary webinar was hosted by PYA in conjunction with the Montana Hospital Association as Part 2 of the Frontier States Town Hall Meeting.
Barry covered information related to HIPAA, cybersecurity, and a special behind-the-scenes view into the tradecraft of bad actors. This unique presentation included:
Recent enforcement trends by the Office for Civil Rights.
The current environment for ransomware.
An opportunity to watch as Barry logs onto the Dark Web and shows you first-hand how bad actors operate.
Ideas for managing cybersecurity threats.
On Friday, August 21, 2020, a webinar co-hosted by PYA prepared hospitals for a new rule taking effect on January 1, 2021, to address price transparency in healthcare. The Centers for Medicare & Medicaid Services published a rule in November 2019 requiring hospitals to establish, update, and make public a list of their standard charges for items and services they provide. In addition to the current requirement to post standard charges on their websites, the Final Rule requires hospitals to publish online, in a machine-readable format, their payer-specific negotiated rates for 300 “shoppable” services and their standard charges for all items and services provided, defined as the gross charge, payer-specific negotiated charges, discounted cash price, and the de-identified minimum and maximum charges.
As we approach January 2021, it is vital that hospitals understand the requirements of the pricing transparency rule and options for compliance. It is unlikely that this rule will “go away”–court decisions are always subject to appeal, and there is even concern that Congress is considering action that would transform these requirements from regulation to legislation.
During the complimentary webinar, PYA Senior Manager Kathy Reep discussed hospital requirements related to pricing transparency, and Chris Kenny, Partner in the Washington, D.C., office of King & Spalding, addressed concerns related to compliance and the legal challenges associated with the final transparency rule.
This webinar was presented in conjunction with:
Dallas-Fort Worth Hospital Council
Florida Hospital Association
Georgia Hospital Association
Kansas Hospital Association
Louisiana Hospital Association
Montana Hospital Association
Not a surprise to most — healthcare is making headlines on an international level. Though not front and center, still of importance to the hospital community are issues working their way through government agencies and the legislature.
As one of the keynote speakers of this year’s virtual Florida Institute of CPAs Health Care Industry Conference, PYA Senior Manager Kathy Reep presented a “Federal Legislative and Regulatory Update.” She covered a number of current issues affecting healthcare providers, including:
Price transparency.
Congressional action on surprise billing.
The Administration’s budget for 2021.
Medicare proposed rules related to hospital inpatient payments and post-acute care for FY2021.
The virtual event took place June 23-24, 2020.
Webinar: Post-Pandemic Provider Realignment — Navigating An Uncertain MarketPYA, P.C.
The COVID-19 pandemic will materially affect U.S. provider industry structure, as financial weaknesses are exposed, risk tolerances are tested, and uncertainties persist. As a result, provider mergers-and-acquisitions (M&A) activities across industry sectors will likely spike in the short- to medium-term future. Providers of all types need to be aware of, and prepared for, the changes they will face.
In this 45-minute joint webinar, PYA Principal Brian Fuller and Juniper Advisory Managing Director Jordan Shields provided a real-time assessment of the COVID-19 pandemic, as well as shared predictions for what the extending crisis means in coming years for M&A activity in the provider space.
The webinar took place Thursday, August 6, 2020, at 11 a.m. EDT.
Since March, PYA experts have closely tracked and carefully evaluated the pandemic’s impact on employed physician compensation. During this complimentary one-hour webinar, PYA Principals Angie Caldwell and Martie Ross highlighted five immediate considerations for hospitals and health systems to manage the storm. They also explored five longer-term considerations impacting future planning.
This webinar took place Friday, July 24, 2020, at 11 a.m. EDT, and was held in conjunction with:
Dallas-Fort Worth Hospital Council
Florida Hospital Association
Kansas Hospital Association
Montana Hospital Association
The COVID-19 pandemic has exposed organizational and industry weaknesses. To build a more resilient delivery system, leaders now must engage their governing boards in re-calibrating strategic plans, re-evaluating investments, and re-imagining hospitals’ and health systems’ roles in their communities.
In this 45-minute webinar, PYA Principals Martie Ross and Brian Fuller provided a framework for these critical discussions including root-cause analysis, market assessment, new realities, guiding principles, and strategic and operational priorities.
This webinar originally took place on Wednesday, June 24, 2020.
Webinar: Free Money with Strings Attached – Cares Act Considerations for Fron...PYA, P.C.
PYA, in conjunction with the Montana Hospital Association, recently co-hosted a Frontier States Town Hall Meeting webinar, “Free Money With Strings Attached: CARES Act Considerations for Frontier States’ Healthcare Provider Organizations.” Principals Lori Foley, Martie Ross, and David McMillan introduced the CARES Act Provider Relief Fund including distribution formulas, the attestation process, the verification and application process, and ongoing recordkeeping requirement. They also answered attendees’ numerous questions regarding these matters.
Webinar: “Got a Payroll? Don’t Leave Money on the Table”PYA, P.C.
Under the CARES Act, every employer with a payroll has an opportunity to retain cash–whether they have a PPP loan or not. What employers need to know right now.
The Coronavirus Aid, Relief, and Economic Security Act (CARES Act) along with the Payroll Protection Program (PPP) offer all business owners relief, but the details can be confusing or overlooked.
Perhaps you don’t fully understand how the deferral of the employer’s share of Social Security taxes works. Maybe you wonder if the deferral even applies to you—good news, it does if you have a payroll!
Failure to fully understand your options could cost you money, at a time when “cash is king.”
As part of PYA’s ongoing commitment to sharing helpful guidance, Tax Principals Debbie Ernsberger and Mark Brumbelow outlined issues and opportunities within the CARES Act, and answered questions during a one-hour webinar that originally aired on Wednesday, May 20, 2020.
Webinar: So You Have a PPP Loan. Now What?PYA, P.C.
The CARES Act provides relief to small businesses through Paycheck Protection Program (PPP) loans, but receiving the loan is only the first part of the equation. PYA discussed what businesses need to know and do next.
Failure to fully understand the requirements for PPP loan forgiveness could cost employers money, at a time when every penny counts. Employers need to stay up-to-date on recent activities regarding the PPP loan forgiveness application, necessary documentation, and other best practices to ensure they are well-prepared for the next steps under the PPP.
As part of PYA’s ongoing commitment to sharing helpful guidance, Tax Principals Debbie Ernsberger and Mark Brumbelow outlined PPP loan forgiveness requirements and answered questions during a one-hour webinar on Wednesday, June 3, 2020.
Webinar: “Making It Work—Physician Compensation During the COVID-19 Pandemic”PYA, P.C.
What to do with your physician compensation plan in the face of the COVID-19 pandemic? It’s a question that leaves administrators searching for answers.
PYA Principal Angie Caldwell and Senior Manager Katie Culver introduced several key considerations for provider compensation during and after the COVID-19 pandemic. In PYA’s complimentary webinar, they:
Summarized the current environment impacting physician compensation associated with the pandemic.
Provided an overview of the Stark Blanket Waivers and opportunities created for physician compensation.
Described restoration and recovery strategies for physician resources.
PYA hosted this one-hour webinar Tuesday, April 28, 2020, at 11 a.m. EDT in conjunction with the Florida Hospital Association.
Webinar: “Provider Relief Fund Payments – What We Know, What We Don’t Know, W...PYA, P.C.
The document provides information on the $100 billion Provider Relief Fund established by the CARES Act to reimburse healthcare providers for expenses or lost revenues attributable to COVID-19. It summarizes that $30 billion has been distributed based on providers' 2019 Medicare billings, with no repayment obligation. It outlines the attestation process to accept funds within 30 days and confirms that providers must comply with terms including using funds only for COVID-19 care and not balance billing uninsured patients. The document advises on accounting, compliance, and tax implications of the relief funds.
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.
Let's Talk About It: Breast Cancer (What is Mindset and Does it Really Matter?)bkling
Your mindset is the way you make sense of the world around you. This lens influences the way you think, the way you feel, and how you might behave in certain situations. Let's talk about mindset myths that can get us into trouble and ways to cultivate a mindset to support your cancer survivorship in authentic ways. Let’s Talk About It!
Unlocking the Secrets to Safe Patient Handling.pdfLift Ability
Furthermore, the time constraints and workload in healthcare settings can make it challenging for caregivers to prioritise safe patient handling Australia practices, leading to shortcuts and increased risks.
Exploring the Benefits of Binaural Hearing: Why Two Hearing Aids Are Better T...Ear Solutions (ESPL)
Binaural hearing using two hearing aids instead of one offers numerous advantages, including improved sound localization, enhanced sound quality, better speech understanding in noise, reduced listening effort, and greater overall satisfaction. By leveraging the brain’s natural ability to process sound from both ears, binaural hearing aids provide a more balanced, clear, and comfortable hearing experience. If you or a loved one is considering hearing aids, consult with a hearing care professional at Ear Solutions hearing aid clinic in Mumbai to explore the benefits of binaural hearing and determine the best solution for your hearing needs. Embracing binaural hearing can lead to a richer, more engaging auditory experience and significantly improve your quality of life.
R3 Stem Cell Therapy: A New Hope for Women with Ovarian FailureR3 Stem Cell
Discover the groundbreaking advancements in stem cell therapy by R3 Stem Cell, offering new hope for women with ovarian failure. This innovative treatment aims to restore ovarian function, improve fertility, and enhance overall well-being, revolutionizing reproductive health for women worldwide.
TEST BANK For Accounting Information Systems, 3rd Edition by Vernon Richardso...rightmanforbloodline
TEST BANK For Accounting Information Systems, 3rd Edition by Vernon Richardson, Verified Chapters 1 - 18, Complete Newest Version
TEST BANK For Accounting Information Systems, 3rd Edition by Vernon Richardson, Verified Chapters 1 - 18, Complete Newest Version
TEST BANK For Accounting Information Systems, 3rd Edition by Vernon Richardson, Verified Chapters 1 - 18, Complete Newest Version
Comprehensive Rainy Season Advisory: Safety and Preparedness Tips.pdfDr Rachana Gujar
The "Comprehensive Rainy Season Advisory: Safety and Preparedness Tips" offers essential guidance for navigating rainy weather conditions. It covers strategies for staying safe during storms, flood prevention measures, and advice on preparing for inclement weather. This advisory aims to ensure individuals are equipped with the knowledge and resources to handle the challenges of the rainy season effectively, emphasizing safety, preparedness, and resilience.
This particular slides consist of- what is Pneumothorax,what are it's causes and it's effect on body, risk factors, symptoms,complications, diagnosis and role of physiotherapy in it.
This slide is very helpful for physiotherapy students and also for other medical and healthcare students.
Here is a summary of Pneumothorax:
Pneumothorax, also known as a collapsed lung, is a condition that occurs when air leaks into the space between the lung and chest wall. This air buildup puts pressure on the lung, preventing it from expanding fully when you breathe. A pneumothorax can cause a complete or partial collapse of the lung.
LGBTQ+ Adults: Unique Opportunities and Inclusive Approaches to CareVITASAuthor
This webinar helps clinicians understand the unique healthcare needs of the LGBTQ+ community, primarily in relation to end-of-life care. Topics include social and cultural background and challenges, healthcare disparities, advanced care planning, and strategies for reaching the community and improving quality of care.
Michigan HealthTech Market Map 2024. Includes 7 categories: Policy Makers, Academic Innovation Centers, Digital Health Providers, Healthcare Providers, Payers / Insurance, Device Companies, Life Science Companies, Innovation Accelerators. Developed by the Michigan-Israel Business Accelerator
At Apollo Hospital, Lucknow, U.P., we provide specialized care for children experiencing dehydration and other symptoms. We also offer NICU & PICU Ambulance Facility Services. Consult our expert today for the best pediatric emergency care.
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Pediatric Emergency Care for Children | Apollo Hospital
Deployment of the Medicare Access and CHIP Reauthorization Act
1. Martie Ross, JD
Graham Fox, FACHE
Presentation prepared for
ACHE Congress on Healthcare Leadership
Mar. 27-30, 2017
Mastering MIPS
2. Page 1
Learning Objectives
Gain an understanding of MACRA, why it was
implemented, and how it will impact
reimbursement, governance, and strategic
planning for healthcare organizations
Identify questions organizations must consider
during MIPS implementation that will lead to
financial and operational success
3. Page 2
Agenda
MACRA and the QPP
Advanced Alternative Payment
Models
Merit-Based Incentive Payment
System
Game Plan
5. Page 4
VBR Framework
FEE-FOR-SERVICE
(FFS) PAYMENTS
POPULATION-BASED
APMs
ADJUSTED FFS
PAYMENTS
APMs INCORPORATING
FFS PAYMENTS
$
$
Bank
A Pay For
Reporting
B Pay For
Performance
C Pay/Penalty
For
Performance
A Total Cost of
Care Shared
Savings
B Total Cost of
Care Shared
Risk
C Retrospective
Episodic
Payment
A Prospective
Episodic Payment
B Primary Care
Population-
Based
Payments
C Comprehensive
Population-
Based
Payments
A Traditional FFS
B Infrastructure
Incentives
C Care
Management
Payments
6. Page 5
Has VBR Been Trumped?
ObamaCare Repeal
Front half vs. back half of the ACA
Episodic Payment Model (AMI & CABG)
3/20 Federal Register Notice extending start date to
10/1/17
MSSP
3/22 announcement of 2018 application cycle
7. Page 6
Medicare Access and CHIP
Reauthorization Act of 2015
Advanced Alternative
Payment Model
Merit-Based Incentive
Payment System
Quality
Payment
Program
8. Page 7
Transition Period
Through
December 31,
2018
Starting
January 1, 2019
0.5% annual MPFS update (2016-
2019)
Payment adjustments
Potential 2% PQRS reporting penalty
Potential 3% EHR meaningful use
penalty
Up to +/- 4% Value-Based Modifier
bonus/penalty
Annual MPFS update:
0% in 2020 through 2025
0.25% thereafter (0.75% for Advanced
APM participants)
Payment Adjustments
5% bonus for participation in
advanced APMs thru 2024
Up to +/- 9% MIPS bonus/penalty
9. Page 8
Years 1 and 2 Years 3+
Physicians (MD/DO, DPM, OD, DC,
DMD/DDS)
PAs, APRNs, CNSs, CRNA
Physical or occupational therapists,
speech-language pathologists,
audiologists, nurse midwives, clinical
social workers, clinical psychologists,
dieticians/nutritional professionals
Eligible Clinicians
11. Page 10
Advanced APMs (Traditional Medicare)
Definite
Medicare Shared Savings Program
(Tracks 2 & 3 Only)
Next Generation ACO Model
Comprehensive ESRD Care
(LDO arrangement and Two-Sided Risk)
Comprehensive Primary Care Plus
(re-open applications)
Oncology Care Model
(Two-Sided Risk)
In Development
Medicare Shared Savings Program
Track 1+
Comprehensive Care for Joint
Replacement
(CEHRT Track)
Episodic Payment Model
(CEHRT and non-CEHRT Tracks)
Cardiac Rehabilitation
Incentive Payment Model
Medicare Diabetes
Prevention Program
New Voluntary Bundled Payment
Program
Vermont Medicare ACO Initiative
12. Page 11
Qualifying Participant
Qualifying Participant
Higher % of patients or payments
Bonus = 5% of MPFS payments
Partial Qualifying Participant
Lower % of patients or payments
No bonus, no MIPS
Non-Qualifying Participant
Subject to MIPS
Payment Year 2019 2020 2021 2022 2023 2024
QP Threshold 25% 25% 50% 50% 75% 75%
Partial QP Threshold 20% 20% 40% 40% 50% 50%
Payment Year 2019 2020 2021 2022 2023 2024
QP Threshold 25% 25% 50% 50% 75% 75%
Partial QP Threshold 20% 20% 40% 40% 50% 50%
Medicare Option – Payment Amount Threshold
Medicare Option – Patient Count Threshold
13. Page 12
12
Other Payer Advanced APMs
Credit for participation in Other Payer Advanced APMs starting in 2019
Three criteria: (1) Use of CEHRT; (2) Quality measures; and (3) More than nominal
financial risk or medical home model
Submission and approval process
Still requires some level of participation in Advanced APMs
Payment Year 2019 2020 2021 2022 2023 2024
MCR MCR Total MCR Total MCR Total MCR Total MCR
QP Threshold - - 50% 25% 50% 25% 75% 25% 75% 25%
Partial QP Threshold - - 40% 20% 40% 20% 50% 20% 50% 20%
Payment Year 2019 2020 2021 2022 2023 2024
MCR MCR Total MCR Total MCR Total MCR Total MCR
QP Threshold - - 35% 20% 35% 20% 50% 20% 50% 20%
Partial QP Threshold 25% 10% 25% 10% 35% 10% 35% 10%
All Payer Combination Option – Payment Amount Threshold
All Payer Combination Option – Patient Count Threshold
15. Page 14
MIPS Final Score Components
Quality Cost Performance
Improvement
Activities
Advancing Care
Information
60%
0%
15%
25%
50%
10%
15%
25%
30%
30%
15%
25%
2017 Performance Year 2018 Performance Year 2019 Performance Year
Impacts 2019 Payments Impacts 2020 Payments Impacts 2021 Payments
16. Page 15
2017 Final Score Calculation
Quality
Component Score
Cost Performance
Component Score
Improvement
Activities
Component Score
Advancing Care
Information
Component Score
Multiply Each By
Component Weight
Final
Score
17. Page 16
MIPS Payment Adjustments
2019 2022+2020 2021
+4%
-4%
+5%
-5%
+7%
-7%
+9%
-9%
Up to 12% Scaling Factor*
Up to 15% Scaling Factor
Up to 21% Scaling Factor
Up to 27% Scaling Factor
Performance
Threshold**
* Due to budget neutrality, higher bonuses will be paid if total penalties exceed projections, not to exceed 3 times the base bonus percentage.
** Performance Threshold will be adjusted each year based on historical performance.
18. Page 17
March 31, 2018
Deadline for
individual/group to
report on required
measures
Performance-To-Adjustment Cycle
Perform Submit AdjustFeedback
CY 2017
Period of time for
which performance
will be evaluated
2017 only: may elect
90-day continuous
performance period
Q3 2018
CMS reports on prior
year performance,
including calculation
of Final Score and
payment adjustment
for upcoming year
CY 2019
Positive or negative
MPFS payment
adjustments based on
2017 Final Score
19. Page 18
MIPS Participation Election
Final Score assigned to each NPI/TIN
Group reporting must include all NPIs who reassign to
TIN; cannot pick and choose
NPI who reassigns to TIN reporting as a group may
also report individually
20. Page 19
Low-Volume Threshold
For 2017, individual or group exempt from MIPS if:
$30,000 or less in allowable Part B charges; or
See 100 or fewer traditional Medicare beneficiaries
If elect group reporting, NPIs who would be exempt if
reporting individually are NOT exempt
Two determination periods (both with 60-day claims run-out)
September 1, 2015, to August 31, 2016
September 1, 2016, to August 31, 2017
21. Page 20
2017: Pick Your Pace
2017 Reporting Option 2019 Payment Impact
No reporting
4% penalty on all MPFS payments
Report performance for minimum of 90-day continuous
period
One quality measure OR
One clinical practice improvement activity OR
All required measures for advancing care information
No penalty, no bonus
Report performance for minimum of 90-day continuous period
More than one quality measure OR
More than one clinical practice improvement activity OR
More than the required measures for advancing care
information
Eligible for up to 12% bonus on all MPFS payments (amount
varies based on Final Score and budget-neutral scaling factor)
Report performance on all required measures for minimum of 90-
day continuous period.
Eligible for up to 12% bonus on all MPFS payments
(amount varies based on Final Score and budget-
neutral scaling factor)
If Final Score ≥ 70, eligible for additional Exceptional
Performance Bonus (amount varies based on Final Score and
distribution of $500 million annual fund; cannot exceed 10% of
Part B allowed charges)
23. Page 22
Quality Reporting
Manner of
Participation
Reporting Mechanism
Measure
Requirements
Data Completeness
Individual Part B Claims
6 measures (at least 1
outcome measure) OR
specialty-specific
measure set (including
oncology)
50% of Part B patients
(60% in 2018)
Individual or Group
QCDR
Qualified Registry
EHR
6 measures (at least 1
outcome measure) OR
specialty-specific
measure set (including
oncology)
50% of individual’s or
group’s patients who
meet measure
denominator (60% in
2018)
Group CMS Web Interface
(register by 06/30/17)
All measures included
CMS-selected sample
of Part B patients
24. Page 23
Quality Scoring Methodology
Measure No. 7: All-Cause Readmissions
CMS calculates using claims data; minimum 200 cases
Group or NPI/TIN based on participation election
Point conversion – examples to follow
CMS calculates deciles for each measure based on national performance in baseline
period
Compare score to decile breaks and assign corresponding points
Assign zero points for unreported measures
If report more than required number of measures, CMS uses top points to calculate
quality component score
Bonus points
1 extra point for each measure reported using CEHRT for end-to-end electronic
reporting up to 10% of total possible points
2 points for additional outcome/patient experience measure; 1 point for other high
priority measures up to 10% of total possible points
Quality component score
Total points on 7 measures + bonus points
Adjusted based on measures with insufficient # of cases
25. Page 24
Point Assignment Based on Deciles
Measure Name
Submission
Method
Decile 3 Decile 4 Decile 5 Decile 6 Decile 7 Decile 8 Decile 9 Decile 10
Topped
Out
Preventive Care
and Screening:
Influenza
Immunization
(#110)
Claims
22.64 -
31.75
31.76 -
43.13
43.14 -
54.68
54.69 -
66.38
66.39 -
77.47
77.48 -
92.03
92.04 -
99.99
100 No
EHR
11.22 -
18.57
18.58 -
24.99
25.00 -
31.84
31.85 -
38.92
38.93 -
47.86
47.87 -
59.99
60.00 -
79.01
>= 79.02 No
Registry/ QCDR
11.57 -
21.39
21.40 -
31.39
31.40 -
41.31
41.32 -
51.13
51.14 -
62.04
62.05 -
74.27
74.28 -
91.83
>= 91.84 No
Sample Benchmarks for 2017 MIPS Quality Reporting and
Measurement
Source: 2017 MIPS benchmarks as provided by CMS through qpp.cms.gov
Example:
Provider A
Provider B
Claims
EHR
61%
61%
6 points
9 points
Submission
Method
Performance Points Earned
26. Page 25
Point Assignment Based on Deciles
Sample Benchmarks for 2017 MIPS Quality Reporting and
Measurement
Source: 2017 MIPS benchmarks as provided by CMS through qpp.cms.gov
Example:
Provider A
Provider B
Claims
EHR
98.6%
98.6%
4 points
10 points
Submission
Method
Performance Points Earned
Measure Name
Submission
Method
Decile 3 Decile 4 Decile 5 Decile 6 Decile 7 Decile 8 Decile 9 Decile 10
Topped
Out
Preventive Care
and Screening:
Tobacco Use:
Screening and
Cessation
Intervention
(#226)
Claims
95.60 -
97.85
97.86 -
99.25
99.26 -
99.99
-- -- -- -- 100 Yes
EHR
72.59 -
81.59
81.60 -
86.68
86.69 -
90.15
90.16 -
92.64
92.65 -
94.67
94.68 -
96.58
96.59 -
98.51
>= 98.52 No
Registry/ QCDR
76.67 -
85.53
85.54 -
89.87
89.88 -
92.85
92.86 -
95.14
95.15 -
97.21
97.22 -
99.10
99.11 -
99.99
100 No
27. Page 26
Improvement Activities Reporting
90+ Improvement Activities Across 9 Subcategories
Each Graded Medium (10 pts) or High (20 pts)
Expanded Practice Access
Population Management
Care Coordination
Beneficiary Engagement
Patient Safety and Practice Assessment
Participation in an APM
Achieving Health Equity
Integrated Behavioral and Mental Health
Emergency Preparedness and Response
28. Page 27
Improvement Activities Scoring
Improvement Activities Component Score (capped at 100) =
(# of Medium Activities * 10) + (# of High Activities * 20) / 40 possible points
Most Participants
Attest to completion of 4 activities for
minimum of 90 days
Groups (a) with fewer than 15
participants, (b) located in rural area or
HPSA
Attest to completion of 2 activities for
minimum of 90 days
Participants in certified PCMH or
comparable specialty practice
designation
Full credit
Participants in MIPS APM Full credit
Participants in other APMs Half credit
*
29. Page 28
Advancing Care Information Reporting
Base Score (Required) Measures
(10 points each; Y/N or report numerator/
denominator)
Performance Score Measures
(0 to 10 points each based on level of
performance)
Security Risk Analysis Patient-Specific Education
E-Prescribing View, Download, or Transmit
Provide Patient Electronic Access Provide Patient Electronic Access*
Health Information Exchange Health Information Exchange*
Medication Reconciliation
Secure Messaging
Immunization Registry Reporting (Y/N)
Option 1: Clinicians with CEHRT 2014 or CEHRT 2015 (2017 Only)
*Select measures worth up to 20 points toward performance score
30. Page 29
Advancing Care Information Reporting
Base Score (Required) Measures
(10 points each; Y/N or report numerator/
denominator)
Performance Score Measures
(0 to 10 points each based on level of
performance)
Security Risk Analysis Patient-Specific Education
E-Prescribing View, Download, or Transmit
Provide Patient Electronic Access Provide Patient Electronic Access
Send a Summary of Care Send a Summary of Care
Request and Accept Summary of Care Request and Accept Summary of Care
Secure Messaging
Patient-Generated Health Data
Clinical Information Reconciliation
Immunization Registry Reporting (Y/N)
Option 2: Clinicians with CEHRT 2015* (Mandatory in 2018)
*CEHRT 2015 is required for MIPS-Eligible Clinicians to successfully meet ACI requirements in 2018 and beyond
31. Page 30
Advancing Care Information Scoring
50-point Base Score +
0- to 90-point Performance Score +
Up to 15 Bonus Points =
(syndromic surveillance, electronic case, public health registry, and clinical data
registry reporting; reporting improvement activities using CEHRT)
Up to 100 points
32. Page 31
Cost Performance Component
Not included in 2017 Final Score calculation, but feedback
provided
No additional reporting; CMS calculate from claims data
Two categories of measures (attribution)
Two total cost of care measures
Total per capita costs
Medicare Spending Per Beneficiary
Ten episode-based efficiency measures
Reported in 2014 supplemental QRUR
Scored on deciles (like quality component)
33. Page 32
Patient Relationship Categories
MACRA-mandated tools to compare relative cost
performance among eligible clinicians/groups
Begin including codes on claims no later than 01/01/2018
CMS to publish codes in April 2017
Continuing care relationship
Acute care relationship
Care furnished pursuant to order from other practitioner
34. Page 33
Final Score Calculation
Sum of each of the products of each component score and
each component’s assigned weight, multiplied by 100.
Example:
Quality = (55 points / 70 possible points) x 60%
Advancing Care Information = (84 points / 100 possible points) x
25%
Improvement Activities = (40 points / 40 possible points) x 15%
FINAL SCORE = 83.14
35. Page 34
APM Scoring Standard
Applies to those eligible clinicians identified on MIPS APM
participant list
MIPS APM
Advanced APMs
Track 1 MSSP ACO
Oncology Care Model (one-sided model)
Included on participant list as of March 31, June 30, or August 31
of performance year
36. Page 35
Applying the APM Scoring Standard
50% Quality
Based on APM performance measures
20% Improvement Activities
Full Credit
30% Advancing Care Information
Weighted mean average of APM participants’ reported scores
1)
38. Page 37
Public Reporting
Individual profile pages
Participation in APM
Final Score
Component scores
Aggregate data
Range of Final Scores and component scores
40. Page 39
Action Items
Education
Group vs. individual reporting
Pick-Your-Pace
Quality measure selection and corresponding performance
improvement
Improvement activities selection and execution
“Meaningful Use”
Reporting mechanism(s)
Preparation for cost performance measures
Future APM participation
41. Page 40
Faculty Biography & Contact Info
Following a successful two-decade career as a healthcare transactional and regulatory attorney,
Martie Ross now serves as a trusted advisor to providers navigating the ever-expanding maze of
healthcare regulations. Her profound understanding of new payment and delivery systems and
public payer initiatives is an invaluable resource for providers seeking to strategically position
their organizations for the future. Martie identifies opportunities and develops realistic plans of
action where others only see obstacles.
Martie has an uncanny ability to synthesize complex regulatory schemes and explain in
straightforward and practical terms their impact on providers. She has made hundreds of
presentations to professional and community organizations on a broad range of industry topics.
Martie provides dynamic, customized educational and planning sessions for directors, executives,
and managers, as well as employee compliance training programs.
Martie Ross
Principal, PYA
mross@pyapc.com
(913) 748-4604
42. Page 41
Faculty Biography & Contact Info
Graham M. Fox has over 15 years’ experience overseeing the strategic, operational, and
financial growth of physician practices. He specializes in physician practice/health
system integration and has held multiple senior leadership roles in both nonprofit systems
and academic medical centers where he led numerous physician acquisitions and
integrations, as well as practice startups, turnarounds and employment agreement
negotiations. He returned to consulting in 2015 and has since led numerous projects in
revenue cycle efficiency, organizational development, and provider compensation
redesign. Graham is a Fellow of the American College of Healthcare Executives and
currently resides in Dalton, GA with his wife and two daughters.
Graham M. Fox
Consulting Senior Manager, PYA
gfox@pyapc.com
(404) 266-9876 x2156
43. Page 42
Bibliography/References
Medicare Program; Merit-Based Incentive Payment System (MIPS) and
Alternative Payment Model (APM) Incentive Under the Physician Fee Schedule,
and Criteria for Physician-Focused Payment Models (Final Rule)
https://www.federalregister.gov/documents/2016/11/04/2016-25240/medicare-program-
merit-based-incentive-payment-system-mips-and-alternative-payment-model-apm
CMS/Medicare – Physician Compare
https://www.medicare.gov/physiciancompare
PYA White Paper
http://www.pyapc.com/pya-white-paper-helps-providers-master-mips/