The document discusses components of the revenue cycle in healthcare, including pre-claims submission, claims processing, accounts receivable, claims reconciliation, and collections. It describes the charge description master which houses billing information for healthcare services and supplies. Effective revenue cycle management is important for a provider's financial stability. The revenue cycle involves coordination between many departments to accurately capture and bill for services provided to patients.
This document discusses value-based purchasing and pay-for-performance programs implemented by the Centers for Medicare and Medicaid Services (CMS). It provides an overview of key CMS value-based programs for hospitals, home health agencies, skilled nursing facilities, end-stage renal disease facilities, and physicians. The goals are to improve quality of care, patient outcomes, and reduce healthcare costs through linking provider payments to performance and quality measures. The document describes the measures, payment adjustments, and potential incentives/penalties associated with each program.
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.
The Evolving Role of the Compliance Officer in the Age of Accountable CarePYA, P.C.
Much has been written about new competencies physicians must develop in the face of payment and delivery system reform. But providers are not the only ones seeing their roles change. Compliance officers, who serve as organizations’ internal police officers, will have many new challenges. PYA Principal Martie Ross presented a national Health Care Compliance Association (HCCA) webinar entitled “The Evolving Role of the Compliance Officer In the Age of Accountable Care.”
This document discusses various aspects of revenue management in healthcare, including the revenue cycle, payment methodologies like Medicare and commercial insurance, and strategies for contract negotiation. It describes the front-end, middle, and back-end of the revenue cycle. It explains payment systems like MS-DRGs, APCs, and fee schedules used by Medicare and common commercial insurers. It also covers topics like contractual allowances, prospective versus retrospective payment, and value-based purchasing.
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.
The CMS Innovation Center hosted a special webinar featuring Dr. Patrick Conway, CMS Deputy Administrator for Innovation and Quality and CMS Chief Medical Officer, on Monday, November 10, 2014 from 10:30am – 11:30 am ET. Dr. Conway will provided an update about the work of the CMS Innovation Center and the models being tested to improve better care for patients, better health for our communities, and lower costs through improvement for our health care system. Opportunities for questions were provided.
- - -
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
Sustainable Growth Rate? Goodbye for Good!PYA, P.C.
PYA Staff Consultant Aaron Elias spoke to attendees of the Georgia Healthcare Financial Management Association’s (HFMA) Spring Institute May 6, 2015, on the implications of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).
The Evolving Role of the Compliance Officer in the Age of Accountable CarePYA, P.C.
PYA Consulting Principals Jeff Ellis and Martie Ross presented at the Health Care Compliance Association 2013 Midwest Regional Compliance Conference in Overland Park, Kansas. Ellis and Ross teamed up to explore, “The Evolving Role of the Compliance Officer in the Age of Accountable Care.”
This document discusses value-based purchasing and pay-for-performance programs implemented by the Centers for Medicare and Medicaid Services (CMS). It provides an overview of key CMS value-based programs for hospitals, home health agencies, skilled nursing facilities, end-stage renal disease facilities, and physicians. The goals are to improve quality of care, patient outcomes, and reduce healthcare costs through linking provider payments to performance and quality measures. The document describes the measures, payment adjustments, and potential incentives/penalties associated with each program.
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.
The Evolving Role of the Compliance Officer in the Age of Accountable CarePYA, P.C.
Much has been written about new competencies physicians must develop in the face of payment and delivery system reform. But providers are not the only ones seeing their roles change. Compliance officers, who serve as organizations’ internal police officers, will have many new challenges. PYA Principal Martie Ross presented a national Health Care Compliance Association (HCCA) webinar entitled “The Evolving Role of the Compliance Officer In the Age of Accountable Care.”
This document discusses various aspects of revenue management in healthcare, including the revenue cycle, payment methodologies like Medicare and commercial insurance, and strategies for contract negotiation. It describes the front-end, middle, and back-end of the revenue cycle. It explains payment systems like MS-DRGs, APCs, and fee schedules used by Medicare and common commercial insurers. It also covers topics like contractual allowances, prospective versus retrospective payment, and value-based purchasing.
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.
The CMS Innovation Center hosted a special webinar featuring Dr. Patrick Conway, CMS Deputy Administrator for Innovation and Quality and CMS Chief Medical Officer, on Monday, November 10, 2014 from 10:30am – 11:30 am ET. Dr. Conway will provided an update about the work of the CMS Innovation Center and the models being tested to improve better care for patients, better health for our communities, and lower costs through improvement for our health care system. Opportunities for questions were provided.
- - -
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
Sustainable Growth Rate? Goodbye for Good!PYA, P.C.
PYA Staff Consultant Aaron Elias spoke to attendees of the Georgia Healthcare Financial Management Association’s (HFMA) Spring Institute May 6, 2015, on the implications of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).
The Evolving Role of the Compliance Officer in the Age of Accountable CarePYA, P.C.
PYA Consulting Principals Jeff Ellis and Martie Ross presented at the Health Care Compliance Association 2013 Midwest Regional Compliance Conference in Overland Park, Kansas. Ellis and Ross teamed up to explore, “The Evolving Role of the Compliance Officer in the Age of Accountable Care.”
Affiliation Strategies for At-Risk Community HospitalsPYA, P.C.
PYA Senior Healthcare Consulting Manager Michael Ramey presented “Affiliation Strategies for At-Risk Community Hospitals” with Jay Hardcastle, partner at Bradley Arant Boult Cummings at the AHLA Health Care Transactions Program. The presentation helped:
1. Identify factors affecting the continued financial viability of community hospitals.
2. Introduce the importance of board/management being proactive in evaluating potential affiliation alternatives before reaching a dire state.
3. Discuss the request-for-proposal process.
4. Explore legal structures to retain the best value for the community via appropriate models (i.e., management agreement, lease, acquisition, joint operating agreement, joint venture, affiliation).
5. Provide lessons learned from recent hospital transactions.
Big Data: Implications of Data Mining for Employed Physician Compliance Manag...PYA, P.C.
PYA Principal Denise Hall presented “Big Data: Implications of Data Mining for Employed Physician Compliance Management” at Becker’s Annual CEO & CIO Strategy Roundtables, November 18-19, 2015.
The presentation explored:
Data being aggregated by the government, as well as new approaches by regulators.
Public relations and litigation risk from the public dissemination of data by the government.
Big data connections to payment through quality metrics and the potential for new theories of False Claims Act (FCA) suits.
Internal use of broad spectrum analytics in employed physician compliance management.
Determination of risk tolerance and the customization of “outside the box” analytics.
Benchmarking, monitoring, and defining physician-focused risk area reviews.
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.
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.
Kindred Healthcare and Gentiva Health Services reached a definitive agreement to merge, creating an integrated care delivery system. The combined company will serve over 1 million patients annually across 47 states and over 2,800 locations. It will employ over 109,000 people, making it the 4th largest healthcare employer in the US. The merger accelerates Kindred's "Continue The Care" strategy of providing coordinated care across all points of the healthcare continuum.
Larry Wolf, Kindred’s Health Information Technology Strategist, addressed the importance of information technology as one component for improving care at the Alliance for Home Health Quality and Innovation Symposium.
During this webinar the Direct Contracting Model Options team hosted a webinar on Wednesday, December 18, 2019 from 1:30 p.m.- 3:00 p.m. EST. During this webinar, presenters provided information about benefit enhancements for the Direct Contracting Model Options.
- - -
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
“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.
Presentation Explores Many Contexts of Community BenefitPYA, P.C.
PYA Principal David McMillan gets to the bottom of the definition of community benefit in “Community Benefit: One Term, Many Contexts,” a presentation given at the 2013 AICPA Healthcare Industry Conference.
Big Data: Implications of Data Mining for Employed Physician Compliance Manag...PYA, P.C.
PYA Principal Denise Hall, along with King & Spalding’s Michael Paulhus, co-presented “Big Data: Implications of Data Mining for Employed Physician Compliance Management” at the Health Care Compliance Association’s (HCCA) 19th Annual Compliance Institute.
Forensic and Valuation Issues in HealthcarePYA, P.C.
PYA Principal Carol Carden co-presented “Forensic and Valuation Issues in Healthcare” at the AICPA Forensic & Valuation Services Conference in New Orleans, LA, November 10, 2014.
The document discusses the history and future of "doc fixes" - legislative actions to prevent cuts to Medicare physician payments resulting from the Sustainable Growth Rate (SGR) formula. It notes that while the SGR failed to control costs, doc fixes have led to over $165 billion in deficit reduction through offsets. It describes the bipartisan "Tricommittee" reform package and proposes a "PREP Plan" to permanently replace SGR with value-based payments while fully offsetting costs through delivery system and beneficiary reforms estimated to save over $200 billion.
This document outlines a sample claims management process for a physician practice with 14 steps. The process begins with patient registration, verification of insurance benefits, and check-in. It continues with clinical documentation of services, assigning codes, patient check-out, coding review, pre-authorization if needed, claim generation, claim review, processing by the health insurer, collections if needed, posting payments, appeals if claims are denied, and ends with a glossary. Implementing this detailed process is intended to increase efficiency, submit clean claims, reduce denials, and ensure timely payments from health insurers.
The ET3 Model team hosted a tutorial webinar on Thursday, August 8th, 2019 from 12:00 p.m.-1:30 p.m. EDT, to provide an overview of the Application Portal. During the session, the ET3 Model team reviewed key functionality of the Portal as well as provided guidance and tips for ambulance suppliers and providers to submit a complete application to participate in the Model. The webinar also provided an opportunity for Q & A with the ET3 Model team.
- - -
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
This document summarizes the findings from the first year of the Medicare Advantage Value-Based Insurance Design Model (MA VBID). Nine parent organizations tested innovative benefit designs focused on seven conditions. Most commonly, they offered reduced cost sharing for services conditional on participating in care management. While implementation required new workflows, participants saw potential for improving health and reducing costs. Further evaluation will assess impacts on outcomes.
The Center for Medicare & Medicaid Innovation (CMS Innovation Center) hosted an open door forum covering population based payments and all inclusive population based payments for the 2017 Next Generation Accountable Care Organization Model. The open door forum was held on Tuesday, April 26 from 4:00pm – 5:00pm EDT.
- - -
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
Healthcare Valuations in an Era of Reform and UncertaintyPYA, P.C.
PYA Principal Jim Lloyd's AICPA Health Care Industry Conference presentation explored reform and current environment highlights, healthcare transactions and affiliations, valuation considerations, and regulatory issues.
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.
- - -
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
Don’t Stumble Coming Out of the Gate –Top Ten Issues to Address When Acquirin...PYA, P.C.
PYA Consulting Principal Carol Carden co-presented with Charlene McGinty of McKenna Long. They examined the top issues to address when acquiring a physician practice and some of the common and more complex issues hospitals face during the acquisition.
This document discusses clinical coding and coding compliance. It defines approved code sets under HIPAA including ICD-10-CM/PCS for diagnoses and procedures, CPT for procedures, and HCPCS Level II. Risk adjustment coding uses diagnosis codes to determine reimbursement. Coding must comply with guidelines to ensure accurate reimbursement. Various government programs audit claims and conduct reviews to identify improper payments and provide education to reduce errors. Coding compliance plans include policies, education, auditing, and monitoring correct coding practices.
The resource-based relative value scale (RBRVS) is used to determine reimbursement for professional services under Medicare Part B. RBRVS assigns relative value units (RVUs) to codes based on physician work, practice expense, and malpractice insurance. RVUs are adjusted by geographic practice cost indexes and multiplied by a conversion factor to calculate payment amounts. Correct coding and documentation are essential for full and accurate RBRVS reimbursement. Unnecessary administrative costs associated with health plan management can significantly impact provider revenues.
Affiliation Strategies for At-Risk Community HospitalsPYA, P.C.
PYA Senior Healthcare Consulting Manager Michael Ramey presented “Affiliation Strategies for At-Risk Community Hospitals” with Jay Hardcastle, partner at Bradley Arant Boult Cummings at the AHLA Health Care Transactions Program. The presentation helped:
1. Identify factors affecting the continued financial viability of community hospitals.
2. Introduce the importance of board/management being proactive in evaluating potential affiliation alternatives before reaching a dire state.
3. Discuss the request-for-proposal process.
4. Explore legal structures to retain the best value for the community via appropriate models (i.e., management agreement, lease, acquisition, joint operating agreement, joint venture, affiliation).
5. Provide lessons learned from recent hospital transactions.
Big Data: Implications of Data Mining for Employed Physician Compliance Manag...PYA, P.C.
PYA Principal Denise Hall presented “Big Data: Implications of Data Mining for Employed Physician Compliance Management” at Becker’s Annual CEO & CIO Strategy Roundtables, November 18-19, 2015.
The presentation explored:
Data being aggregated by the government, as well as new approaches by regulators.
Public relations and litigation risk from the public dissemination of data by the government.
Big data connections to payment through quality metrics and the potential for new theories of False Claims Act (FCA) suits.
Internal use of broad spectrum analytics in employed physician compliance management.
Determination of risk tolerance and the customization of “outside the box” analytics.
Benchmarking, monitoring, and defining physician-focused risk area reviews.
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.
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.
Kindred Healthcare and Gentiva Health Services reached a definitive agreement to merge, creating an integrated care delivery system. The combined company will serve over 1 million patients annually across 47 states and over 2,800 locations. It will employ over 109,000 people, making it the 4th largest healthcare employer in the US. The merger accelerates Kindred's "Continue The Care" strategy of providing coordinated care across all points of the healthcare continuum.
Larry Wolf, Kindred’s Health Information Technology Strategist, addressed the importance of information technology as one component for improving care at the Alliance for Home Health Quality and Innovation Symposium.
During this webinar the Direct Contracting Model Options team hosted a webinar on Wednesday, December 18, 2019 from 1:30 p.m.- 3:00 p.m. EST. During this webinar, presenters provided information about benefit enhancements for the Direct Contracting Model Options.
- - -
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
“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.
Presentation Explores Many Contexts of Community BenefitPYA, P.C.
PYA Principal David McMillan gets to the bottom of the definition of community benefit in “Community Benefit: One Term, Many Contexts,” a presentation given at the 2013 AICPA Healthcare Industry Conference.
Big Data: Implications of Data Mining for Employed Physician Compliance Manag...PYA, P.C.
PYA Principal Denise Hall, along with King & Spalding’s Michael Paulhus, co-presented “Big Data: Implications of Data Mining for Employed Physician Compliance Management” at the Health Care Compliance Association’s (HCCA) 19th Annual Compliance Institute.
Forensic and Valuation Issues in HealthcarePYA, P.C.
PYA Principal Carol Carden co-presented “Forensic and Valuation Issues in Healthcare” at the AICPA Forensic & Valuation Services Conference in New Orleans, LA, November 10, 2014.
The document discusses the history and future of "doc fixes" - legislative actions to prevent cuts to Medicare physician payments resulting from the Sustainable Growth Rate (SGR) formula. It notes that while the SGR failed to control costs, doc fixes have led to over $165 billion in deficit reduction through offsets. It describes the bipartisan "Tricommittee" reform package and proposes a "PREP Plan" to permanently replace SGR with value-based payments while fully offsetting costs through delivery system and beneficiary reforms estimated to save over $200 billion.
This document outlines a sample claims management process for a physician practice with 14 steps. The process begins with patient registration, verification of insurance benefits, and check-in. It continues with clinical documentation of services, assigning codes, patient check-out, coding review, pre-authorization if needed, claim generation, claim review, processing by the health insurer, collections if needed, posting payments, appeals if claims are denied, and ends with a glossary. Implementing this detailed process is intended to increase efficiency, submit clean claims, reduce denials, and ensure timely payments from health insurers.
The ET3 Model team hosted a tutorial webinar on Thursday, August 8th, 2019 from 12:00 p.m.-1:30 p.m. EDT, to provide an overview of the Application Portal. During the session, the ET3 Model team reviewed key functionality of the Portal as well as provided guidance and tips for ambulance suppliers and providers to submit a complete application to participate in the Model. The webinar also provided an opportunity for Q & A with the ET3 Model team.
- - -
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
This document summarizes the findings from the first year of the Medicare Advantage Value-Based Insurance Design Model (MA VBID). Nine parent organizations tested innovative benefit designs focused on seven conditions. Most commonly, they offered reduced cost sharing for services conditional on participating in care management. While implementation required new workflows, participants saw potential for improving health and reducing costs. Further evaluation will assess impacts on outcomes.
The Center for Medicare & Medicaid Innovation (CMS Innovation Center) hosted an open door forum covering population based payments and all inclusive population based payments for the 2017 Next Generation Accountable Care Organization Model. The open door forum was held on Tuesday, April 26 from 4:00pm – 5:00pm EDT.
- - -
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
Healthcare Valuations in an Era of Reform and UncertaintyPYA, P.C.
PYA Principal Jim Lloyd's AICPA Health Care Industry Conference presentation explored reform and current environment highlights, healthcare transactions and affiliations, valuation considerations, and regulatory issues.
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.
- - -
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
Don’t Stumble Coming Out of the Gate –Top Ten Issues to Address When Acquirin...PYA, P.C.
PYA Consulting Principal Carol Carden co-presented with Charlene McGinty of McKenna Long. They examined the top issues to address when acquiring a physician practice and some of the common and more complex issues hospitals face during the acquisition.
This document discusses clinical coding and coding compliance. It defines approved code sets under HIPAA including ICD-10-CM/PCS for diagnoses and procedures, CPT for procedures, and HCPCS Level II. Risk adjustment coding uses diagnosis codes to determine reimbursement. Coding must comply with guidelines to ensure accurate reimbursement. Various government programs audit claims and conduct reviews to identify improper payments and provide education to reduce errors. Coding compliance plans include policies, education, auditing, and monitoring correct coding practices.
The resource-based relative value scale (RBRVS) is used to determine reimbursement for professional services under Medicare Part B. RBRVS assigns relative value units (RVUs) to codes based on physician work, practice expense, and malpractice insurance. RVUs are adjusted by geographic practice cost indexes and multiplied by a conversion factor to calculate payment amounts. Correct coding and documentation are essential for full and accurate RBRVS reimbursement. Unnecessary administrative costs associated with health plan management can significantly impact provider revenues.
The document provides an overview of key topics for understanding and completing the Medicare HHA Cost Report, including:
- Regulations and manuals that provide guidance on allowable costs, cost reporting requirements, and definitions.
- Types of cost reports that may be filed depending on utilization levels.
- Data sources and documentation needed to complete the cost report, including statistical, financial, and Medicare utilization data.
- Terminology used in cost reporting, such as cost centers, step-down method, and definitions of visits and episodes.
- An overview of the main worksheets in the CMS Form 1728-94 cost report, including Worksheets S-3 for statistical data, and Worksheet A for financial data.
The document discusses the outpatient prospective payment system (OPPS) for Medicare reimbursement. It provides an overview of key aspects of OPPS including: the use of ambulatory payment classifications (APCs) to group similar procedures and services; partially packaged and bundled payment methodologies; payment status indicators (SIs) that determine payment rules; and adjustments for factors like rural hospitals, cancer centers, and outlier cases. Multiple payment categories and rules are covered to demonstrate the complexity of accurately calculating OPPS reimbursement amounts.
Medical coding is the process of transforming transcribed data into set of numerical codes using a system of numbers to represent various medical problems, (diagnoses), and treatments (procedures
The document provides an overview of revenue cycle management, outlining the various departments and processes involved such as patient access, health information management, patient financial services, and charge capture. It discusses important metrics and challenges in the current healthcare environment like rising insurance premiums, market conditions, and reimbursement methodologies. The document also examines the roles of auditors, strategies for improving revenue cycle performance, and considerations around charity care.
Administrative information systems manage the business aspects of healthcare, such as finances and human resources. These systems include the financial information system, human resources information system, decision support system, and master patient index. The master patient index serves as a central patient directory and is important for maintaining accurate patient records. Administrative systems impact health information management practices by providing data for coding, billing, and other revenue cycle functions.
Provides an overview of the current revenue cycle management and its processes and offers a point-of-view on today’s RCM trends and areas of transformation.
This document provides strategies for physicians to successfully participate in the 2007 Physician Quality Reporting Initiative (PQRI) program, which provides bonus payments for reporting on quality of care measures. It discusses selecting quality measures, defining team roles, modifying workflows to capture quality data, reporting the data using claims codes, and understanding how satisfactory reporting and bonus payments will be determined. The goal is to help integrate quality data reporting into clinical practices to improve care and prepare for future pay-for-performance programs.
This presentation was shared with an audience at the AHLA Fundamentals of Health Law program in November 2008.
It contains some basic coding and compliance information to introduce health lawyers to the coding world including recent hot topics under scrutiny.
Being a healthcare provider, you know how crucial it is to understand the ins and outs of billing procedures. However, Medicare billing comes with its own set of rules and guidelines that set it apart from other billing processes.
Medicare is a federal health insurance program that primarily serves individuals aged 65 and older, as well as some younger people with disabilities. As one of the largest payers in the healthcare industry, Medicare billing plays a significant role in how providers are reimbursed for the services they render to eligible beneficiaries.
Read detailed blog : https://www.247medicalbillingservices.com/blog/medicare-billing-guide/
But Medicare billing isn’t just about submitting a bill and waiting for payment. It involves navigating a complex system of codes, forms, and regulations that must be followed to ensure accurate reimbursement. Unlike other insurance plans, Medicare has specific billing requirements that providers must adhere to in order to avoid claim denials and payment delays.
In this blog, we’ll break down the Medicare billing process step-by-step, providing easy-to-understand explanations and practical tips for healthcare providers. Let’s break down the steps to streamline the billing process:
This webinar provided an overview on the Medicare Diabetes Prevention Program (MDPP) Expanded Model Billing and Claims process. During this webinar, participants were familiarized with the key terms and entities involved in the billing and claims process, MDPP payment structure and how it applies to billing, and learned how to successfully submit claims to Medicare for MDPP services.
- - -
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
Being a healthcare provider, you know how crucial it is to understand the ins and outs of billing procedures. However, Medicare billing comes with its own set of rules and guidelines that set it apart from other billing processes.
Medicare is a federal health insurance program that primarily serves individuals aged 65 and older, as well as some younger people with disabilities. As one of the largest payers in the healthcare industry, Medicare billing plays a significant role in how providers are reimbursed for the services they render to eligible beneficiaries.
Read detailed blog : https://www.247medicalbillingservices.com/blog/medicare-billing-guide/
Learn how to identify and track indicators of your company's financial health. Dave Justus, Kareo's Chief Financial Officer, and Ted Stack, founder of Falcon Capital Partners, will discuss the key performance benchmarks and insights you should pay attention to when working to optimize your billing company business.
This document discusses budgets in healthcare, including types of budgets like operating, capital, and flexible budgets. It covers budget tools like accounting systems and historical data used in budgeting. Traditional, flexible, and zero-based budgets are defined. The document explains how to develop operating budgets including revenue, expenses, costs, labor costs, and allocation of indirect costs. Methods like direct and step-down allocation of overhead costs are compared. Budget variances and management reporting on variances are also summarized.
The document discusses how hospitals and health systems can prepare for bundled payments and pay-for-performance contracting. It outlines challenges such as fluctuating profits, rising costs, and shifting to outpatient care. It also discusses the need for data aggregation and business intelligence tools to track costs, utilization, and quality measures in order to succeed under new payment models.
The document defines revenue cycle management and its key components. It begins by providing the Healthcare Financial Management Association's definition of revenue cycle as encompassing all administrative and clinical functions from creating a patient account through payment collection. It describes revenue cycle processes as interdependent and notes that early errors can significantly impact revenue recovery costs. The rest of the document provides more details on the various components and goals of revenue cycle management.
Sentry Data Systems offers a Revenue Cycle Management (RCM) business intelligence (BI) application called Sentinel RCM that aggregates and analyzes hospital data without requiring additional IT resources. The application includes Claims Guardian which provides financial benchmarking, volume management, charge master coding updates, and billing/denial analysis. Reports include track and trend options with an alert engine. The non-intrusive cloud-based solution is competitively priced with no added fees or costs. Upcoming regulatory changes will greatly impact hospital reimbursements, requiring data analytics to improve outcomes and cost controls. Sentry's application allows hospitals to effectively manage these changes by aggregating diverse data sources to monitor performance, contracts, and financial risks in order to make
ASC CODING AND BILLING: KNOWING WHAT’S IMPORTANTJessica Parker
The basics of the ambulatory surgery center (ASC) coding and billing aren’t hard to master, but they do differ from physician and facility requirements. The following overview will help you know what’s most important in the ASC setting. ASCs use a combination of hospital and physician billing.
The document discusses the drivers and pressures for organizational change. It identifies that change comes from both external environmental pressures such as competition, regulations and technological changes as well as internal pressures like growth, leadership changes, and politics. Some of the key external pressures mentioned are globalization, hypercompetition, and reputation concerns. The document also examines why organizations may not change in response to environmental pressures or after crises, citing factors such as organizational learning difficulties and defensive priorities over innovation.
This document discusses evolutionary developmental biology and how changes in development can lead to evolutionary changes. It provides examples of modularity and molecular parsimony which help explain this. Modularity means parts of the body and DNA can develop differently. Molecular parsimony means organisms share developmental toolkit genes. The document then discusses specific examples like stickleback fish pelvic spines being due to different Pitx1 expression, and Darwin's finches having beak shape variations due to differing Bmp4 and Calmodulin expression levels. Mechanisms of evolutionary change include changes in location, timing, amount, or kind of gene expression.
Developmental plasticity allows an organism's phenotype to change in response to environmental conditions during development. There are two main types of phenotypic plasticity: reaction norms, where the environment determines the phenotype from a continuum of genetic possibilities, and polyphenisms, where discrete alternative phenotypes are produced. Examples include caterpillars changing appearance to match plant growth stages, frogs hatching early in response to vibrations, and temperature determining sex in crocodiles. Stressors like water levels can also influence development, as seen in spadefoot toads. Symbiotic relationships between organisms, like nitrogen-fixing bacteria in plant roots, are important to development and often involve vertical transmission from parents. Gut bacteria are also necessary for
This document discusses several genetic and environmental factors that can influence human development. Genetic factors like pleiotropy and mosaicism can result in syndromes with multiple abnormalities. The same genetic mutation can also produce different phenotypes depending on gene interactions. Environmental teratogens during critical periods of embryonic development can irreversibly damage organ formation, with alcohol, retinoic acid, and endocrine disruptors like bisphenol A and atrazine posing particular risks like fetal alcohol syndrome, cleft palate, lower sperm counts, and cancer. Both genetic and environmental heterogeneity contribute to the complexity of human development.
The endoderm forms the epithelial lining of the digestive and respiratory systems. It gives rise to tissues like the notochord, heart, blood vessels, and parts of the mesoderm. The endoderm comes from two sources - the definitive endoderm and the visceral endoderm. The transcription factor Sox17 marks and regulates the formation of the endoderm. The endoderm lines tubes in the body and gives rise to organs like the liver, pancreas, lungs and digestive system through the formation of buds and pouches along the foregut.
The document summarizes the development of the intermediate mesoderm and lateral plate mesoderm. The intermediate mesoderm forms the urogenital system including the kidneys, ureters, ovaries, fallopian tubes, testes and vas deferens. Kidney development occurs through the pronephros, mesonephros and metanephros stages. The lateral plate mesoderm splits into somatic and splanchnic layers and forms the heart through the merging of cardiac progenitor cells from both sides of the embryo. The heart tube loops to the right to begin resembling the four-chambered adult heart.
The paraxial mesoderm lies just lateral to the notochord and gives rise to vertebrae, skeletal muscles, and skin connective tissue. It is divided into somites which then form dermomyotomes and sclerotomes. Dermomyotomes develop into dermatomes that make dermis and myotomes that form back, rib, and body wall muscles. Sclerotomes form the vertebrae and rib cage. Somitogenesis occurs through a clock-wavefront model where somites sequentially segment from cranial to caudal regions under the influence of signaling molecules like retinoic acid and FGF.
The document summarizes ectodermal placodes and the epidermis. It discusses how placodes give rise to sensory structures like the eye lens, inner ear, and nose. It describes the different cranial placodes that form sensory tissues and nerves, including the anterior placodes that form the pituitary gland and eye lens. The intermediate placodes form nerves involved in sensation of the face and hearing/balance. The epidermis derives from surface ectoderm under the influence of BMPs and forms the protective outer layer of skin and its appendages like hair, sweat glands, and teeth.
- The neural plate transforms into a neural tube through a process called neurulation regulated by proteins like BMP and transcription factors like Sox1, 2, and 3.
- Primary neurulation involves the elongation, bending, and convergence of the neural folds before their closure at the midline to form the neural tube. Key regulation events involve hinge points at the midline and dorsolateral edges.
- Neural tube defects can occur if closure fails, as in spina bifida where the posterior neuropore remains open, preventing proper spinal cord development.
Mammalian development begins with fertilization and cleavage of the egg. The egg develops membranes that allow development outside of water. In mammals, the placenta exchanges gases and nutrients between the embryo and mother. Cleavage is rotational, with zygotic genes activating later than other animals. Cells compact and the morula forms an inner cell mass and trophoblast cells. The trophoblast secretes fluid to form a blastocyst cavity. The inner cell mass forms the epiblast and hypoblast, which generate the embryo and extraembryonic tissues through gastrulation. Axis formation is guided by gradients of genes like HOX and left/right asymmetries are regulated by proteins including Nodal.
- Drosophila melanogaster is a useful model organism for studying development due to its short life cycle, fully sequenced genome, and ease of breeding.
- Early Drosophila development involves syncytial cleavage where nuclei divide without cell division, specifying the dorsal/ventral and anterior/posterior axes.
- Fertilization occurs when sperm enters an egg that has already begun specifying axes; maternal and paternal chromosomes remain separate during early divisions.
This document summarizes key patterns in animal development. It describes that animals undergo gastrulation where cells migrate to form germ layers and axes. Animals are categorized into 35 phyla based on features like germ layers, organ formation, and cleavage patterns. It describes that diploblastic animals have two germ layers while most are triploblastic with three germ layers. Triploblastic animals are further divided into protostomes and deuterostomes based on mouth formation. The document also provides examples of cleavage patterns in snails which are spirally arranged in either a dextral or sinistral pattern determined by maternal factors.
1) Sex determination in mammals is primarily determined by the XY sex determination system, with females having XX and males having XY. The SRY gene on the Y chromosome causes the development of testes.
2) The gonads are initially bipotential but develop into either ovaries or testes based on the sex chromosomes. Testes secrete AMH and testosterone to direct male development while ovaries secrete estrogens for female development.
3) Gametogenesis includes the process of meiosis which produces haploid gametes from diploid germ cells in the gonads. In females, oogenesis begins in the embryo but arrests until puberty while spermatogenesis only occurs at puberty in males.
Stem cells are unspecialized cells that can divide and differentiate into specialized cell types. There are several types of stem cells defined by their potency, including totipotent stem cells found in early embryos, pluripotent stem cells in the embryo, and multipotent adult stem cells. Stem cell regulation is controlled through extracellular signals from the stem cell niche and intracellular factors that influence gene expression and cell fate. Researchers have also induced pluripotency in adult cells by introducing genes that code for key transcription factors.
This document discusses cell-to-cell communication and how it allows for the development of specialized tissues and organs through three main mechanisms: cell adhering, cell shape changing, and cell signaling. It describes how cells interact at the cell membrane through various receptor and ligand proteins. These interactions can be homophilic or heterophilic, and occur through direct contact between neighboring cells (juxtacrine signaling) or over short distances (paracrine signaling). Differential adhesion and cadherins allow cells to sort themselves into tissues based on adhesion strengths. The extracellular matrix and integrins also influence cell communication and development.
Differential gene expression refers to the process where different genes are activated in different cell types, leading to cellular specialization. While all cells contain the full genome, only a small percentage of genes are expressed in each cell. Gene expression is regulated at multiple levels, including differential transcription, selective pre-mRNA processing, selective mRNA translation, and posttranslational protein modification. The most common mechanisms involve regulating transcription through epigenetic modifications of chromatin and the use of transcription factors.
The document summarizes key stages in animal development from fertilization through organogenesis. It begins with fertilization and cleavage, followed by gastrulation where the three germ layers (endoderm, mesoderm, ectoderm) are formed. During organogenesis, organs develop from the germ layers. Metamorphosis may also occur to transition organisms like frogs from immature to sexually mature forms. Examples are provided of developmental processes in frogs and other model organisms like fruit flies and plants. Cell behavior and patterning during these stages are also discussed.
The document discusses considerations for small businesses when hiring employees. It covers deciding when to hire an employee, defining job roles, writing job descriptions, attracting and evaluating candidates, selecting the right hire, training employees, rewarding and compensating employees, and managing ownership and dividends when there are family business partners involved. The key aspects of setting up an employee program for a small business are planning job roles, writing thorough job descriptions, developing fair hiring and review processes, providing training, and establishing clear compensation and ownership structures.
This document discusses various legal issues that small business owners should be aware of, including:
- Understanding the different types of laws (federal, state, local) that may apply to a small business.
- Hiring an experienced small business attorney to provide legal advice and represent the business as needed.
- Choosing an appropriate legal structure for the business, such as a sole proprietorship, partnership, corporation, or LLC.
- Protecting the business name as intellectual property and complying with regulations regarding contracts, liability, taxation and other legal matters.
This document discusses risk management and insurance for small businesses. It begins by defining risk for business owners and identifying common sources of risk such as financial investments, theft, nonpayment of debts, and natural disasters. It then examines risks related to a business's property, personnel, customers, and intangible property. The document provides strategies for managing these risks, such as developing policies and procedures, securing valuable assets, and obtaining different types of insurance. It concludes by discussing ways for businesses to share risk through joint ventures, industry groups, and government funding programs.
Communicating effectively and consistently with students can help them feel at ease during their learning experience and provide the instructor with a communication trail to track the course's progress. This workshop will take you through constructing an engaging course container to facilitate effective communication.
Chapter wise All Notes of First year Basic Civil Engineering.pptxDenish Jangid
Chapter wise All Notes of First year Basic Civil Engineering
Syllabus
Chapter-1
Introduction to objective, scope and outcome the subject
Chapter 2
Introduction: Scope and Specialization of Civil Engineering, Role of civil Engineer in Society, Impact of infrastructural development on economy of country.
Chapter 3
Surveying: Object Principles & Types of Surveying; Site Plans, Plans & Maps; Scales & Unit of different Measurements.
Linear Measurements: Instruments used. Linear Measurement by Tape, Ranging out Survey Lines and overcoming Obstructions; Measurements on sloping ground; Tape corrections, conventional symbols. Angular Measurements: Instruments used; Introduction to Compass Surveying, Bearings and Longitude & Latitude of a Line, Introduction to total station.
Levelling: Instrument used Object of levelling, Methods of levelling in brief, and Contour maps.
Chapter 4
Buildings: Selection of site for Buildings, Layout of Building Plan, Types of buildings, Plinth area, carpet area, floor space index, Introduction to building byelaws, concept of sun light & ventilation. Components of Buildings & their functions, Basic concept of R.C.C., Introduction to types of foundation
Chapter 5
Transportation: Introduction to Transportation Engineering; Traffic and Road Safety: Types and Characteristics of Various Modes of Transportation; Various Road Traffic Signs, Causes of Accidents and Road Safety Measures.
Chapter 6
Environmental Engineering: Environmental Pollution, Environmental Acts and Regulations, Functional Concepts of Ecology, Basics of Species, Biodiversity, Ecosystem, Hydrological Cycle; Chemical Cycles: Carbon, Nitrogen & Phosphorus; Energy Flow in Ecosystems.
Water Pollution: Water Quality standards, Introduction to Treatment & Disposal of Waste Water. Reuse and Saving of Water, Rain Water Harvesting. Solid Waste Management: Classification of Solid Waste, Collection, Transportation and Disposal of Solid. Recycling of Solid Waste: Energy Recovery, Sanitary Landfill, On-Site Sanitation. Air & Noise Pollution: Primary and Secondary air pollutants, Harmful effects of Air Pollution, Control of Air Pollution. . Noise Pollution Harmful Effects of noise pollution, control of noise pollution, Global warming & Climate Change, Ozone depletion, Greenhouse effect
Text Books:
1. Palancharmy, Basic Civil Engineering, McGraw Hill publishers.
2. Satheesh Gopi, Basic Civil Engineering, Pearson Publishers.
3. Ketki Rangwala Dalal, Essentials of Civil Engineering, Charotar Publishing House.
4. BCP, Surveying volume 1
it describes the bony anatomy including the femoral head , acetabulum, labrum . also discusses the capsule , ligaments . muscle that act on the hip joint and the range of motion are outlined. factors affecting hip joint stability and weight transmission through the joint are summarized.
বাংলাদেশের অর্থনৈতিক সমীক্ষা ২০২৪ [Bangladesh Economic Review 2024 Bangla.pdf] কম্পিউটার , ট্যাব ও স্মার্ট ফোন ভার্সন সহ সম্পূর্ণ বাংলা ই-বুক বা pdf বই " সুচিপত্র ...বুকমার্ক মেনু 🔖 ও হাইপার লিংক মেনু 📝👆 যুক্ত ..
আমাদের সবার জন্য খুব খুব গুরুত্বপূর্ণ একটি বই ..বিসিএস, ব্যাংক, ইউনিভার্সিটি ভর্তি ও যে কোন প্রতিযোগিতা মূলক পরীক্ষার জন্য এর খুব ইম্পরট্যান্ট একটি বিষয় ...তাছাড়া বাংলাদেশের সাম্প্রতিক যে কোন ডাটা বা তথ্য এই বইতে পাবেন ...
তাই একজন নাগরিক হিসাবে এই তথ্য গুলো আপনার জানা প্রয়োজন ...।
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Temple of Asclepius in Thrace. Excavation resultsKrassimira Luka
The temple and the sanctuary around were dedicated to Asklepios Zmidrenus. This name has been known since 1875 when an inscription dedicated to him was discovered in Rome. The inscription is dated in 227 AD and was left by soldiers originating from the city of Philippopolis (modern Plovdiv).
Strategies for Effective Upskilling is a presentation by Chinwendu Peace in a Your Skill Boost Masterclass organisation by the Excellence Foundation for South Sudan on 08th and 09th June 2024 from 1 PM to 3 PM on each day.
How to Setup Warehouse & Location in Odoo 17 InventoryCeline George
In this slide, we'll explore how to set up warehouses and locations in Odoo 17 Inventory. This will help us manage our stock effectively, track inventory levels, and streamline warehouse operations.