Since the inception of the Coverage Gap Discount Program (CGDP), Manufacturers have been presented with challenges in managing the CGDP. There are operational, financial, compliance and legal challenges that fall across the organization.
This webcast will highlight those challenges and provide insight into practical solutions Manufacturers have employed to help mitigate these challenges.
What you can expect to learn from the webcast:
- High-Level Process Requirements needed to efficiently manage CGDP
- Practical Solutions that have been applied to mitigate challenges and risks
- How to manage the Negative Balance Solution
- Tips for preparing for the Dispute Resolution Process
- How to maximize data for Financial Analytics
Pega, Capgemini and partner DLA Piper (a global law firm with extensive experience on FATCA regulations) explore how global financial institutions can fulfill their legal obligations to become FATCA compliant and navigate operational issues and technology requirements.
Presenter Information:
Alan W. Granwell, FATCA Team Leader, of Counsel, DLA Piper LLP
Gerald Francese, Partner, DLA Piper LLP
Reetu Kholsa, Global Director, Risk, Fraud and Compliance, Pegasystems
Erick Christensen, Vice President, Head of Compliance Practice Financial Services BU, Capgemini
This presentation was used as part of a live webcast. You can watch the full recording (with audio) at: http://www.pega.com/resources/webcast-the-state-of-fatca-compliance?utm_source=ss
This document provides an overview of Newgen's presentation on FATCA compliance challenges and solutions. Some key points:
1. FATCA compliance is complex and time is critical as the deadline is approaching. Ensuring compliance requires tools for rules, case management, reporting, and document management.
2. Banks face challenges related to different regions and regulations, unpredictable changes, and complicated FATCA procedures. An agile platform is needed to adapt to changes.
3. Newgen's FATCA solution includes pre-configured templates, rules engine, case management, reporting, and document management to help financial institutions achieve compliance.
4. Newgen conducted surveys that found banks need time-critical templates, agile systems
A telecom company named as Bad Idea is expecting for fraudsters.
They designed a weird rate plan called Praxis plan where only four calls are allowed during a day.
Bad Idea has their call logs spanning over one and half months.We are using the Naive Bayesian Classification rule to predict the fraudsters for telecom company.
How Imprivata Combines External Data Sources for Business InsightsPat Patterson
Imprivata is a healthcare-focused IT security company. Using data integration tools from StreamSets, they built a pipeline to consolidate data from NetSuite, Salesforce, and Oracle in a cloud-based PostgreSQL data warehouse. Hear how their analytics team combined transaction, product, and support data in Einstein Analytics to support decision-making across their business functions: sales, marketing operations, product owners, and CxOs.
Supplier Information and Lifecycle ManagementTradeshift
This document discusses supplier information management (SIM) and the importance of robust management of supplier master data to enable supply analytics and intelligence. It notes that leading organizations are evolving their SIM capabilities from a vendor master file focus to supplier lifecycle management by tying supplier information to knowledge, intelligence, and analytics. Effective SIM requires clear governance, collaboration between procurement and other functions, and principles like risk management and performance management to be built into the supplier onboarding process.
J.P. Morgan 5th Annual U.S. All Stars Conference, at the J.P. Morgan Office in London, on Tuesday, September 16, 2014.
Morningstar Management Behind the Moat Conference, at Morningstar, Inc.’s global headquarters in Chicago, on Wednesday, September 17, 2014
The presentation provides an overview of Symantec's business for investors. It discusses Symantec's competitive advantages in security and information management due to its large civilian cyber intelligence network. The presentation also reviews Symantec's 3Q15 financial results, noting growth in operating margins and revenues for both its security and information management segments. Finally, it outlines Symantec's strategies to continue winning in security and information management by simplifying its security portfolio, expanding its information management offerings, and delivering new solutions.
Iron Mountain Investor Meeting in AustraliaIronMInc
- Iron Mountain is a global records and information management company with $3 billion in annual revenues. It has over 155,000 customers, including 95% of the Fortune 1000, and operates over 1,000 facilities across 67 million square feet worldwide.
- The presentation discusses Iron Mountain's transition to a real estate investment trust (REIT) structure and how this will support value creation through acquiring leased facilities and enhancing returns. It also outlines the company's stable storage rental business fundamentals and growth opportunities.
Pega, Capgemini and partner DLA Piper (a global law firm with extensive experience on FATCA regulations) explore how global financial institutions can fulfill their legal obligations to become FATCA compliant and navigate operational issues and technology requirements.
Presenter Information:
Alan W. Granwell, FATCA Team Leader, of Counsel, DLA Piper LLP
Gerald Francese, Partner, DLA Piper LLP
Reetu Kholsa, Global Director, Risk, Fraud and Compliance, Pegasystems
Erick Christensen, Vice President, Head of Compliance Practice Financial Services BU, Capgemini
This presentation was used as part of a live webcast. You can watch the full recording (with audio) at: http://www.pega.com/resources/webcast-the-state-of-fatca-compliance?utm_source=ss
This document provides an overview of Newgen's presentation on FATCA compliance challenges and solutions. Some key points:
1. FATCA compliance is complex and time is critical as the deadline is approaching. Ensuring compliance requires tools for rules, case management, reporting, and document management.
2. Banks face challenges related to different regions and regulations, unpredictable changes, and complicated FATCA procedures. An agile platform is needed to adapt to changes.
3. Newgen's FATCA solution includes pre-configured templates, rules engine, case management, reporting, and document management to help financial institutions achieve compliance.
4. Newgen conducted surveys that found banks need time-critical templates, agile systems
A telecom company named as Bad Idea is expecting for fraudsters.
They designed a weird rate plan called Praxis plan where only four calls are allowed during a day.
Bad Idea has their call logs spanning over one and half months.We are using the Naive Bayesian Classification rule to predict the fraudsters for telecom company.
How Imprivata Combines External Data Sources for Business InsightsPat Patterson
Imprivata is a healthcare-focused IT security company. Using data integration tools from StreamSets, they built a pipeline to consolidate data from NetSuite, Salesforce, and Oracle in a cloud-based PostgreSQL data warehouse. Hear how their analytics team combined transaction, product, and support data in Einstein Analytics to support decision-making across their business functions: sales, marketing operations, product owners, and CxOs.
Supplier Information and Lifecycle ManagementTradeshift
This document discusses supplier information management (SIM) and the importance of robust management of supplier master data to enable supply analytics and intelligence. It notes that leading organizations are evolving their SIM capabilities from a vendor master file focus to supplier lifecycle management by tying supplier information to knowledge, intelligence, and analytics. Effective SIM requires clear governance, collaboration between procurement and other functions, and principles like risk management and performance management to be built into the supplier onboarding process.
J.P. Morgan 5th Annual U.S. All Stars Conference, at the J.P. Morgan Office in London, on Tuesday, September 16, 2014.
Morningstar Management Behind the Moat Conference, at Morningstar, Inc.’s global headquarters in Chicago, on Wednesday, September 17, 2014
The presentation provides an overview of Symantec's business for investors. It discusses Symantec's competitive advantages in security and information management due to its large civilian cyber intelligence network. The presentation also reviews Symantec's 3Q15 financial results, noting growth in operating margins and revenues for both its security and information management segments. Finally, it outlines Symantec's strategies to continue winning in security and information management by simplifying its security portfolio, expanding its information management offerings, and delivering new solutions.
Iron Mountain Investor Meeting in AustraliaIronMInc
- Iron Mountain is a global records and information management company with $3 billion in annual revenues. It has over 155,000 customers, including 95% of the Fortune 1000, and operates over 1,000 facilities across 67 million square feet worldwide.
- The presentation discusses Iron Mountain's transition to a real estate investment trust (REIT) structure and how this will support value creation through acquiring leased facilities and enhancing returns. It also outlines the company's stable storage rental business fundamentals and growth opportunities.
Studies show that top performing companies are using “touchless” (or straight-through) processing to process invoices in 1-3 days, compared to more than 15 days for the average company. This enables them to maximize discount capture and “best pricing” through spend analysis and contract management.
Every invoice that is processed in a touchless manner saves a tremendous amount of time, resources and money. Many top performing companies have implemented touchless processing and they continue to reap the benefits and improve year after year.
This 45-minute session with industry expert David Hay will discuss:
-How touchless processing can be achieved
-Process change and automation
-Collaborating with procurement to achieve touchless transactions
-Usage of cloud and mobile technologies
Revenue assurance (RA) is a niche business activity most commonly undertaken within businesses that provide telecommunication services. The activity is the use of data quality and process improvement methods that improve profits, revenues and cash flows without influencing demand.
2017 07-26 Demystify the Government Contracting Challenges and Opportunities ...Raffa Learning Community
This document provides an overview of a seminar for non-profits on addressing challenges with government contracting. It introduces the presenters and provides an agenda for topics to be covered, including managed accounting services, keys for a successful DCAA audit, an ERP software called JAMIS Prime, an overview of Uniform Guidance versus FAR, cost accounting and indirect rates, and a Q&A session. Background is provided on Raffa as the hosting firm and their services. The document contains various slides with more details on the agenda items, such as differences between Uniform Guidance and FAR, areas with the most common findings in federal grants audits, and how Raffa can help with ensuring compliance with various requirements
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Top 10 Medical Billing KPIs That Show You Where You’re Losing MoneyKareo
This webinar discussed key performance indicators (KPIs) for medical billing processes. It began with introducing the speaker and agenda. Essential KPIs were then reviewed, including first pass acceptance rate, first pass resolution rate, days in accounts receivable, and net collections. Common billing issues like denials, rejections, and under/over-coding were also addressed. The webinar provided tips to improve patient statements and audit medical records. Finally, it described how the Kareo medical billing platform can help practices enhance their billing processes by analyzing billing data and benchmarks.
Inforum 2013: Get Tighter Controls with EfficiencyDan French
April 22nd, 2013 - Inforum Conference in Orlando
This presentation comes at a time when both companies and public sector organizations face increased scrutiny from regulators, auditors, shareholders, and trading partners to assure the integrity of their business processes and safeguard sensitive information. This makes it ever more important for organisations to keep track of the advances in continuous monitoring of business processes
The discussion explores best practice approaches, case studies and business benefits of continuous monitoring. Recent experiences shared in it showcase how effective monitoring of risk and control can drive substantial business value and operational cost reduction.The main focus is placed on ways of ensuring business process optimisation and on key examples from areas such as P2P, O2C, T&E and R2R.
This document summarizes a webcast about improving working capital through various payment strategies. It discusses 5 proven strategies: 1) faster invoice approval through automation, 2) improving payment terms through supplier onboarding, 3) enabling more early payment discounts through dynamic discounting, 4) capturing rebates through buyer-initiated payments, and 5) expanding available cash through supply chain financing. Technology plays a key role in enabling these strategies through features like collaborative workflows, financial solutions, and connecting all parties. The webcast highlights how these strategies can save millions through increased working capital compared to traditional AP automation alone.
ASC 606: Accounting for Contracts with Customers, transforms the way all companies recognize revenue for the sale of goods and services. The implementation of the new standard impacts processes, people and systems for all sectors of the organization from the accounting and finance team to legal and human resources.
Justine Jacob, Senior Manager and Jordan Scheiderer, Director from MorganFranklin Consulting, have spent the last three years assisting public and private companies assess and implement ASC 606 and transform their revenue recognition processes. In this webinar they'll discuss the new standard, share lessons learned from previous implementations and identify the key areas of impact throughout the organization.
1) The bank needed to comply with FATCA regulations by updating its IT systems. It hired TGSL as a testing partner to help with compliance testing and implementation.
2) TGSL developed a framework to identify high-risk areas impacted by FATCA, design test scenarios, and ensure functional coverage. This included testing new customer fields, tax withholding, and report generation.
3) Testing found 25% high severity and 40% medium severity defects. 35% of defects were in critical areas, avoiding post-production issues. All testing was completed on schedule.
Contract Management Best Practices: Tips to Maximize ReimbursementPMMC
This document provides tips and best practices for contract management and maximizing reimbursement. It discusses the purpose and benefits of a contract management system, common issues that can cause delays in reimbursement like billing errors and denials, and strategies for analyzing reimbursement data and negotiating new contracts. Key recommendations include regularly reviewing payer contracts and reimbursement changes, analyzing denial trends, ensuring accurate billing setup and coding, and using contract modeling tools to prepare for negotiations and industry shifts.
This document discusses lessons learned from analyzing legal collection experience data. Key points:
1) Analysis of accounts ending up in legal collections showed some business types and lower risk scores were overrepresented, indicating issues with collection and risk management processes.
2) Actions taken included tightening policies for high-risk sectors, accelerating collection processes, ensuring security, and providing data feedback to sales.
3) Reanalysis after changes showed reductions in legal accounts and risk scores, validating the approach. The legal collection process provides valuable data for improving broader processes.
Integrated Order to Cash (O2C) Automation Software for Global Shared Services...Emagia
Integrated Order to Cash (O2C) Automation Software for Global Shared Services
https://www.emagia.com/resources/ebooks/integrated-otc-transformation-for-global-shared-services-organizations/
In this webinar we cover the new and exciting product innovations from the Centricity EDI team. We also share how our customers have improved their A/R and collection rates with the use of these solutions.
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This session covers a wide range of topics, including the latest on audit, accounting, tax, and vat issues, governance, the next Charity SORP, key Charity Commission and Fundraising Regulator updates and the latest topical issues and how these will impact your organisation. In addition, our in house employment law specialists will give an update on important issues affecting the sector.
Session 1 – Audit, Accounting and general sector round up
Are denials and payer audits still impacting your bottom line?Matt Moneypenny
If you are a healthcare provider, it is almost inevitable that you will have to navigate through denials and payer audits. However, there are certain practices that can be implemented to better manage your denials, improve your claim quality, help you manage and track the challenges of audits, and reduce the overall chances of an audit and manage those you must undergo. If you don't know these best practices already, how could you?
On Thursday, June 7th at 11 AM EST, Etactics and Medical Record Associates hosted the webinar, Are Denials and Payer Audits still impacting your bottom line? It featured host Ray Dalessandro, Etactics' Regional Sales Manager, and special guest, Charlie Saponaro, the CEO of Medical Record Associates.
Don’t Miss Out on Money! How to Make Sure Your Credentialing is Done Correctly.Kareo
Credentialing correctly is necessary for all practices (or your clients’ practices) to be able to accept patients and avoid delays in payment. As an independent practice, your staff is most likely facing burnout and staffing shortages are on the rise.
In this informative webinar, Melissa Isham, National Account Executive, Client and Specialty RCM Sales at TriZetto Provider Solutions will explain:
- What is credentialing and why accuracy is paramount to success
- The current state of the industry
- Major pain points and solutions for independent practices
Digital World Class Performance of O2C Shared Services | Order To Cash (O2C) ...Emagia
Digital World Class Performance of O2C Shared Services | Order To Cash (O2C) Automation
https://www.emagia.com/resources/ebooks/digital-world-class-performance-of-o2c-shared-services/
The document discusses managing vendor databases and maintaining accurate vendor information. It describes the typical problems with outdated and inaccurate vendor master files, including duplicate payments, fraud, and non-compliance. It then outlines a three step process for sanitizing, stabilizing, and optimizing the vendor database to reduce risks and costs. Specific strategies covered include using a vendor portal, collecting compliance information, setting up new vendors, and periodically cleansing the database.
The CMS Innovation Center held the second in a series of webinars on Wednesday, July 6, 2016 for the Support and Alignment Networks under the Transforming Clinical Practice Initiative (TCPI). This webinar focused on providing information regarding the application process.
- - -
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
How To Build Yourself Into the Information Governance Champion Your Organiza...Paragon Solutions
The document outlines how to become an effective information governance champion by developing key skills and behaviors. It discusses strategic thinking including defining a program vision and goals. Effective communication is important, such as identifying audiences and developing tailored messages. Socialization involves gaining buy-in from stakeholders through messaging and feedback. Additional skills involve understanding information topology, speaking various business languages, and tailoring the program based on metrics and feedback. The overall aim is to think strategically and enable the right information governance behaviors in the organization.
[WEBINAR] Understanding the 2014 Coverage Gap Discount Program (CGDP) Invoice...Paragon Solutions
Register to watch the recorded webinar: http://goo.gl/YZ6tRT
In January 2014, CMS announced 2014 changes to the Coverage Gap Discount Program (CGDP) related to Negative Invoice Reconciliation and resulting changes to the Quarterly Invoice process. The changes will be in effect for 1Q2014 processing quarter with invoice reports hitting Manufacturers by mid to late April 2014. Quickly reacting to change can cause uncertainty, but with the right awareness, focus, and preparation you can position your organization for a successful transition.
This presentation will enable you to better understand these changes, how they will impact your business process, and what you need to consider and evaluate to prepare for these changes. The change overview and impact considerations will offer insights to companies of all stages.
What you can expect to learn:
- Overview of 2014 CGDP Changes; Negative Invoice Reconciliation and Changes to Quarterly Invoice Process.
- How these changes will impact your business process.
- How to prepare for these changes.
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Studies show that top performing companies are using “touchless” (or straight-through) processing to process invoices in 1-3 days, compared to more than 15 days for the average company. This enables them to maximize discount capture and “best pricing” through spend analysis and contract management.
Every invoice that is processed in a touchless manner saves a tremendous amount of time, resources and money. Many top performing companies have implemented touchless processing and they continue to reap the benefits and improve year after year.
This 45-minute session with industry expert David Hay will discuss:
-How touchless processing can be achieved
-Process change and automation
-Collaborating with procurement to achieve touchless transactions
-Usage of cloud and mobile technologies
Revenue assurance (RA) is a niche business activity most commonly undertaken within businesses that provide telecommunication services. The activity is the use of data quality and process improvement methods that improve profits, revenues and cash flows without influencing demand.
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This document provides an overview of a seminar for non-profits on addressing challenges with government contracting. It introduces the presenters and provides an agenda for topics to be covered, including managed accounting services, keys for a successful DCAA audit, an ERP software called JAMIS Prime, an overview of Uniform Guidance versus FAR, cost accounting and indirect rates, and a Q&A session. Background is provided on Raffa as the hosting firm and their services. The document contains various slides with more details on the agenda items, such as differences between Uniform Guidance and FAR, areas with the most common findings in federal grants audits, and how Raffa can help with ensuring compliance with various requirements
Top 10 Medical Billing KPIs That Show Where Your Practice is Losing MoneyKareo
Kareo’s Billing Subject Matter Expert, Terri Joy, MBA, CPC, CGSC, COC, CPC-I, shares the 10 medical billing KPIs you need to know to prevent your practice from losing money.
Top 10 Medical Billing KPIs That Show You Where You’re Losing MoneyKareo
This webinar discussed key performance indicators (KPIs) for medical billing processes. It began with introducing the speaker and agenda. Essential KPIs were then reviewed, including first pass acceptance rate, first pass resolution rate, days in accounts receivable, and net collections. Common billing issues like denials, rejections, and under/over-coding were also addressed. The webinar provided tips to improve patient statements and audit medical records. Finally, it described how the Kareo medical billing platform can help practices enhance their billing processes by analyzing billing data and benchmarks.
Inforum 2013: Get Tighter Controls with EfficiencyDan French
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This presentation comes at a time when both companies and public sector organizations face increased scrutiny from regulators, auditors, shareholders, and trading partners to assure the integrity of their business processes and safeguard sensitive information. This makes it ever more important for organisations to keep track of the advances in continuous monitoring of business processes
The discussion explores best practice approaches, case studies and business benefits of continuous monitoring. Recent experiences shared in it showcase how effective monitoring of risk and control can drive substantial business value and operational cost reduction.The main focus is placed on ways of ensuring business process optimisation and on key examples from areas such as P2P, O2C, T&E and R2R.
This document summarizes a webcast about improving working capital through various payment strategies. It discusses 5 proven strategies: 1) faster invoice approval through automation, 2) improving payment terms through supplier onboarding, 3) enabling more early payment discounts through dynamic discounting, 4) capturing rebates through buyer-initiated payments, and 5) expanding available cash through supply chain financing. Technology plays a key role in enabling these strategies through features like collaborative workflows, financial solutions, and connecting all parties. The webcast highlights how these strategies can save millions through increased working capital compared to traditional AP automation alone.
ASC 606: Accounting for Contracts with Customers, transforms the way all companies recognize revenue for the sale of goods and services. The implementation of the new standard impacts processes, people and systems for all sectors of the organization from the accounting and finance team to legal and human resources.
Justine Jacob, Senior Manager and Jordan Scheiderer, Director from MorganFranklin Consulting, have spent the last three years assisting public and private companies assess and implement ASC 606 and transform their revenue recognition processes. In this webinar they'll discuss the new standard, share lessons learned from previous implementations and identify the key areas of impact throughout the organization.
1) The bank needed to comply with FATCA regulations by updating its IT systems. It hired TGSL as a testing partner to help with compliance testing and implementation.
2) TGSL developed a framework to identify high-risk areas impacted by FATCA, design test scenarios, and ensure functional coverage. This included testing new customer fields, tax withholding, and report generation.
3) Testing found 25% high severity and 40% medium severity defects. 35% of defects were in critical areas, avoiding post-production issues. All testing was completed on schedule.
Contract Management Best Practices: Tips to Maximize ReimbursementPMMC
This document provides tips and best practices for contract management and maximizing reimbursement. It discusses the purpose and benefits of a contract management system, common issues that can cause delays in reimbursement like billing errors and denials, and strategies for analyzing reimbursement data and negotiating new contracts. Key recommendations include regularly reviewing payer contracts and reimbursement changes, analyzing denial trends, ensuring accurate billing setup and coding, and using contract modeling tools to prepare for negotiations and industry shifts.
This document discusses lessons learned from analyzing legal collection experience data. Key points:
1) Analysis of accounts ending up in legal collections showed some business types and lower risk scores were overrepresented, indicating issues with collection and risk management processes.
2) Actions taken included tightening policies for high-risk sectors, accelerating collection processes, ensuring security, and providing data feedback to sales.
3) Reanalysis after changes showed reductions in legal accounts and risk scores, validating the approach. The legal collection process provides valuable data for improving broader processes.
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This session covers a wide range of topics, including the latest on audit, accounting, tax, and vat issues, governance, the next Charity SORP, key Charity Commission and Fundraising Regulator updates and the latest topical issues and how these will impact your organisation. In addition, our in house employment law specialists will give an update on important issues affecting the sector.
Session 1 – Audit, Accounting and general sector round up
Are denials and payer audits still impacting your bottom line?Matt Moneypenny
If you are a healthcare provider, it is almost inevitable that you will have to navigate through denials and payer audits. However, there are certain practices that can be implemented to better manage your denials, improve your claim quality, help you manage and track the challenges of audits, and reduce the overall chances of an audit and manage those you must undergo. If you don't know these best practices already, how could you?
On Thursday, June 7th at 11 AM EST, Etactics and Medical Record Associates hosted the webinar, Are Denials and Payer Audits still impacting your bottom line? It featured host Ray Dalessandro, Etactics' Regional Sales Manager, and special guest, Charlie Saponaro, the CEO of Medical Record Associates.
Don’t Miss Out on Money! How to Make Sure Your Credentialing is Done Correctly.Kareo
Credentialing correctly is necessary for all practices (or your clients’ practices) to be able to accept patients and avoid delays in payment. As an independent practice, your staff is most likely facing burnout and staffing shortages are on the rise.
In this informative webinar, Melissa Isham, National Account Executive, Client and Specialty RCM Sales at TriZetto Provider Solutions will explain:
- What is credentialing and why accuracy is paramount to success
- The current state of the industry
- Major pain points and solutions for independent practices
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The document discusses managing vendor databases and maintaining accurate vendor information. It describes the typical problems with outdated and inaccurate vendor master files, including duplicate payments, fraud, and non-compliance. It then outlines a three step process for sanitizing, stabilizing, and optimizing the vendor database to reduce risks and costs. Specific strategies covered include using a vendor portal, collecting compliance information, setting up new vendors, and periodically cleansing the database.
The CMS Innovation Center held the second in a series of webinars on Wednesday, July 6, 2016 for the Support and Alignment Networks under the Transforming Clinical Practice Initiative (TCPI). This webinar focused on providing information regarding the application process.
- - -
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
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The document outlines how to become an effective information governance champion by developing key skills and behaviors. It discusses strategic thinking including defining a program vision and goals. Effective communication is important, such as identifying audiences and developing tailored messages. Socialization involves gaining buy-in from stakeholders through messaging and feedback. Additional skills involve understanding information topology, speaking various business languages, and tailoring the program based on metrics and feedback. The overall aim is to think strategically and enable the right information governance behaviors in the organization.
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Register to watch the recorded webinar: http://goo.gl/YZ6tRT
In January 2014, CMS announced 2014 changes to the Coverage Gap Discount Program (CGDP) related to Negative Invoice Reconciliation and resulting changes to the Quarterly Invoice process. The changes will be in effect for 1Q2014 processing quarter with invoice reports hitting Manufacturers by mid to late April 2014. Quickly reacting to change can cause uncertainty, but with the right awareness, focus, and preparation you can position your organization for a successful transition.
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IMPACT Silver is a pure silver zinc producer with over $260 million in revenue since 2008 and a large 100% owned 210km Mexico land package - 2024 catalysts includes new 14% grade zinc Plomosas mine and 20,000m of fully funded exploration drilling.
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The Strategy Implementation System offers a structured approach to translating stakeholder needs into actionable strategies using high-level and low-level scorecards. It involves stakeholder analysis, strategy decomposition, adoption of strategic frameworks like Balanced Scorecard or OKR, and alignment of goals, initiatives, and KPIs.
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BriansClub.cm, a famous platform on the dark web, has become one of the most infamous carding marketplaces, specializing in the sale of stolen credit card data.
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2. Shannon
Bermudez
Principal Consultant,
Life Sciences
http://www.linkedin.com/pub/shannon-bermudez/b/541/695
sbermudez@consultparagon.com
3. Coverage Gap Discount Program History
The Affordable Care Act stipulated that the Coverage Gap or
Donut Hole will be closed by 2020.
• In 2010, CMS provided a $250 rebate to all Part D
beneficiaries who entered the Coverage Gap.
• As of January 1 2011, Part D beneficiaries who reached the
Coverage Gap received a 50% discount on brand name
drugs provided by the brand name drug manufacturers while
in the Coverage Gap. This program is known as the
Coverage Gap Discount Program (“CDGP”).
• Through 2020, CMS will gradually phase in additional
subsidies for generic and brand name drugs which will
reduce Medicare Part D beneficiaries’ co-insurance rate in
the “donut hole” from 100% to 25%.
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4. Closing the “Donut Hole” 2011 - 2020
By 2020, the “donut hole” will be
effectively eliminated and Medicare Part
D beneficiaries will pay only a 25%
cost-sharing for all drugs until reaching
the Catastrophic Coverage threshold.
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Benefit Year Beneficiary Part D Plan Manufacturer
2011 50% - 50%
2012 50% - 50%
2013 47.50% 2.50% 50%
2014 47.50% 2.50% 50%
2015 45% 5% 50%
2016 45% 5% 50%
2017 40% 10% 50%
2018 35% 15% 50%
2019 30% 20% 50%
2020 25% 25% 50%
5. Coverage Gap Discount
The Affordable Care Act mandated that manufacturers of Branded
Drugs, Biologics and Authorized Generics provide Part D beneficiaries
50% discounts of the “negotiated price” of such drugs dispensed in the
Coverage Gap (“Donut Hole”) in order for such drugs to be covered
under Medicare Part D.
• Based on “negotiated price,” minus dispensing fees and vaccine
administrative fees.
• Does not apply to Low Income Subsidy Beneficiary utilization, whose
Donut Hole costs are paid by CMS.
• Paid after a Part D Plan’s supplemental benefits
• CMS can waive this requirement in its discretion
• The product must be on the Part D Plan’s formulary, or approved
under an exception.
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6. Prominent Differences between CGDP & MDRP
CGDP Pay and chase
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Not a guarantee of coverage
Hundreds of plans vs. 50 states
Rigid appeals process
Payment level detail only available on audit
No challenges for duplicate rebates (e.g.,
commercial, 340B)
No price reporting
No CPI-U inflation consideration
8. Who’s impacted by CGDP in your organization?
Visit us: http://www.consultparagon.com
Cross Functional Impact
Contract
Operations
Responsible
for overall
CGDP
admin.
Finance
Forecasting
accruals
and liability
Managed
Markets
Negotiation
of standard
Part D
agreements
Potential
terms
around
duplicate
discounts
Product
Management
Interest on
cost to
determine
effects on
product
specific
profitability
Accounts
Payable
Sending EFT
payments
Maintenance
of EFT
information
Accounts
Receivable
Track
receipt of
EFT
payments
for negative
invoices
from Plan
Sponsors
Information
Technology
Infrastructure
to support
CGDP
admin.
9. CGDP High-Level Process Requirements
The figure to the right illustrates
the minimum high level
requirements Manufacturers
should have in place to support
the administration & processing
of CGDP payments.
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Data
Management
Requirements
Data Receipt
Invoice Data
Management
Detail Data
Management
EFT File
Management
Payment
Requirements
Maintain EFT
banking info for
600+ contracts
38 day processing
deadline
Send EFT
payments for
600+ contracts
Reporting
Requirements
Payment
Confirmation
report
Operational
Reports
Financial & Trend
Reports
Retain data for 17
quarters
Negative
Balance
Solution
Negative Invoice
Reconciliation
Report
Maintain EFT info
for receipt of
Negative Invoice
payments
Receive EFT
payments
(Negative
Invoices)
Confirm receipt of
negative invoice
payments
Dispute
Resolution
Mechanism to
scrub & validate
detail claims data
Determine data
elements to
dispute
Develop Dispute
internal
guidelines &
polices
10. Operational Challenges
Practical Solutions
• Dedicate resources to specially manage CGDP
operations
• Define detailed process & timeline from receipt of
data to payment due date
• Automate processes as much as possible
• Promote Cross functional Awareness,
Involvement & Collaboration
• Data storage & data repository
• Build operational reporting capabilities
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Operational
• Strict Mandated
timelines
• Resource Constraints
• Maintenance of EFT
information
• Mgmt. of Negative
Invoices
11. Financial Challenges
Practical Solutions
• Adhere to detailed process timeline to avoid payment
penalty
• Data storage & data repository
– Build financial reporting capabilities to support
financial analysis
– Negotiate with Part D Plans to limit double dipping
concerns
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Financial
• 25% late payment
penalty
• Cash Flow
• Forecasting limitations
• Potential for double
dipping
12. Compliance Challenges
Practical Solutions
• Define business rules, processes, and SOPs with
control points for the overall operational process
• Develop Dispute Business Rules & Process
• Perform reasonability checks on data to support
payment justification & additional financial analysis.
• Monitor compliance with business rules, processes,
and SOPs
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Compliance
• Dispute process is pay
and chase
• Lack of data visibility
• Challenge verifying CG
Discount invoiced is correct
• Strict Audit Guidelines
13. Legal Challenges
Practical Solutions
• Exhibit C of the Manufacturer Agreement with CMS restricts
the use of claims-level data.
• Permitted use- financial statement forecasting and
accounting purposes.
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Legal
• Restrictions on use
of data
• HIPAA Confidentially
• Appeal Process
14. CGDP Risks to Manufacturer
Operational
• Strict Mandated
timelines
• Resource Constraints
• Maintenance of EFT
information
• Mgmt. of Negative
Invoices
Visit us: http://www.consultparagon.com
Financial
• 25% late payment
penalty
• Cash Flow
• Forecasting limitations
• Potential for double
dipping
Compliance
• Dispute process is pay
and chase
• Lack of data visibility
• Strict Audit Guidelines
Legal
• Restrictions on use
of data
• HIPAA Confidentially
• Appeal Process
Risks across the organization
15. CGDP Primary Pain Points
• Negative Balance Solution
• Pay & Chase Dispute Resolution Process
• Negotiating with Part D Plans to limit double dipping
• Financial Forecasting & Predictive Analytics
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17. Negative Balance Solution Impact on Business Process
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• Multiple reports
• Manual Updates
• Confirming payments
in and out
• Additional Processing
• Same 38 day
timeframe
• Tracking Funds
coming in
• Tracking funds going
out
• Phase 1 &
Phase2/Qtrly Invoice
Process
• Phase 2 & Standard
Qtrly Invoice Process
Processing
Overlap
EFT Funds
Tracking
Payment
Confirmation
Reports
Resource &
Time
Constraints
18. How to manage the Negative Balance Solution
Implement process to receive & translate Negative Balance Reports
Evaluate file formats Determine process and/or system changes Implement applicable changes
Implement process to receive funds
Set–up account to receive funds from
Provide applicable EFT banking
information to TPA
Ensure A/R system is equipped to receive
EFT funds for CGDP payments
Implement A/R process to track receipt of funds
Sponsors via EFT
Identify & allocate A/R resources Create reports to support tracking
Define overall A/R process, process
timeline & SLA to track receipt of funds
Implement process to Confirm receipt of funds
Confirm payments received for negative
invoices
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Confirm payments not received for
negative invoices
Confirm payments made for positive
invoices
Implement Reconciliation Process
Funds expected vs. actual funds received Internal tracking vs. TPA tracking Summarize & report variances
20. Tips for Preparing for the Dispute Resolution Process
• Must have mechanism to scrub & validate data for
disputes
• Determine data elements & validations to dispute
• Develop Dispute internal guidelines & polices
• Ability to prepare dispute report in CMS defined format
• Understand Dispute Process Timeline & Audit Rights
• Time exercise of audit right to maximize chances of
success during appeal
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21. Data Items Eligible for Dispute per CMS
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Pay & Chase Dispute Items
• Duplicate Invoice Item (D01)
• Closed Pharmacy (D02)
• Not Part D Covered Drug (D03)
• Excessive Quantity (D04)
• Days’ Supply (D05)
• High Price of the Drug (D06)
• Last Lot Expiration Date (D07)
• Early Fill (D08)
• Marketing Category is Not NDA or BLA (D09)
• Date of Service Prior to 1/1/2011 (D10)
• PDE Improperly Invoiced Beyond Manufacturer
Agreement Invoice Period (D11)
• Invalid Prescription Service Reference Number (D12)
• Other (D99)
340B Pharmacy Disputes
Maximum Gap Discount Disputes
Employer Group Waiver Plans (EGWPs)
Invoice corrections for incorrect
labeler billings can be submitted
within 5 days of receipt of invoices. All
other disputes items are pay & chase.
22. Dispute Resolution Timeline
Extensive Dispute Resolution Timeline in upwards of 210
days.
• Disputes must be submitted to the TPA in writing within
60 days of receipt of the applicable invoice.
• The TPA must use its best efforts to work with the
Manufacturer to resolve these disputes within 60 days
of the notice.
• If the TPA and the manufacturer fail to resolve the
dispute within 60 days of the notice, CMS will specify
an entity to perform an independent review of the
dispute.
• This review will be completed within 90 days of receipt
of request by manufacturer for an independent review.
• Upon an unfavorable decision, manufacturer may
request CMS Administrator review w/I 30 days after
receipt of such determination.
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23. Manufacturer Audit Rights
Manufacturer can audit TPA’s data annually.
• Audit commenced on 60 days notice.
Must include:
• Reasonable basis for the audit; and
• Description of the information required for the audit.
• Review limited to a “statistically significant sample size of
PDEs.”
• No audit of CMS records.
• Records are confidential and reviewed on-site.
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Data elements subject to audit are:
• Contract Number
• Plan Benefit Package Identifier
• Ingredient Cost Paid
• Dispensing Fee Paid
• Total Amount Attributed to Sales Tax
• Low-Income Cost Sharing Amount
• Non-covered Plan Paid Amount
• Vaccine Administration Fee
• Total Gross Covered Drug Cost Accumulator
• True Out-of-Pocket Accumulator
25. Limit Double Dipping by Negotiating with Part D Plans
Data Requirements
• Consider a clause requiring Part D Plan cooperation in
gathering information that could be useful in a dispute
(subject to HIPAA limitations).
• Require Benefit Stage Qualifier of NCPDP standard be
valued in standard Part D rebate submissions.
Terms
• Pursue terms to carve out double rebates, but Part D
Plans not required to agree.
• Negotiate terms that will allow for the scrubbing out of
claims that are identified as falling in the Coverage Gap
Benefit Stage.
Visit us: http://www.consultparagon.com
27. Maximizing CGDP Data for Financial Analytics
What’s my total CGDP
liability overtime
qtr/qtr & yr/yr ?
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What’s my CGDP
liability by product &
how’s it trending?
How are Part D lives
growing?
What am I owed for
negative invoices?
28. Maximizing CGDP Data for Financial Analytics
How to get there?
• Understand all aspects of Coverage Gap data
you are receiving
• Create data repository for data storage for
reporting & trend analysis overtime.
• Build Operational & Financial Reporting
capabilities
• Build Scrubbing capabilities
Visit us: http://www.consultparagon.com
29. Maximizing CGDP Data for Financial Analytics
What to look for?
• Perform validation checks and review data for
applicable disputes acceptable by CMS.
• Use detail data to report by NDC to provide visibility to
finance for forecasting, accruals ,GTN purposes and
breakout of U.S. vs. Puerto Rico.
• Perform additional analysis on detail data using
calculation algorithms to evaluate for reasonableness.
• Innovative approaches to evaluating data that is
available to do more advanced analysis.
• Link data between EFT file and invoice file to
summarize estimate by plan sponsor and region.
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30. CGDP Business & Technical Process Flow
Visit us: http://www.consultparagon.com
31. For information, visit:
http://www.consultparagon.com
s b e rmu d e z@c o n s u l t p a r a g o n . c om
Editor's Notes
Speaker: Jim Kane
This slide covers all the pieces of SharePoint. SharePoint exists on premises as well as in the cloud. Regardless of the path you choose these functions are available in either scenario.
**Change Slide**
Speaker: Robert Heiden
In order to properly put your arms around your projects, programs or portfolio there are three key pillars which need to be addressed right out of the gate. These pillars function as the basic girders by which you will build future success. That is not to say that these items will not change and evolve as your organization matures, they will.
These pillars address the following:
Why are we working on this? – strong business case to obtain agreement on what you are doing
How are we doing? – Status Reporting to track progress
What are we doing? – The ability to manage change against the agreed upon scope
All of the features, improvements and functionality we find in SharePoint 2013 will be mapped back to supporting these pillars.
**Change Slide**
Speaker: Robert Heiden
There is an evolution and we can use SharePoint to start off with. As you mature with your project management techniques you can use a lot of different tools, but basic SharePoint can help you frame out how to effectively manage your projects, if properly constructed. It is our expertise as a company to help you make those simple choices to ensure that you set yourself up for a successful future.
During the course of this webinar we will be discussing how you can use Microsoft SharePoint 2013 to effectively manage your projects. SharePoint 2013 offers many new options and improvements to increase adoption and allow for a streamlined setup. Most importantly the platform is presented in a way that allows you to mature and grow without throwing away previous work. A simple task list can expand into a fully functional PPM solution.
Some simple analysis is needed to identify key data points. Begin with the end in mind. If you have a project code, for example, that code should be replicated across all of your lists and libraries using a site level custom field. This should be the basis of your taxonomy. As you build out the taxonomy and layer that into the built in SharePoint lists, you start to build out the consistency that is required.
**Change Slide**
Speaker: Robert Heiden
You can manage your documents with versioning, check out, check in. This can function as a central repository for all the documents that manage the business case (i.e., financial calculations). You can leverage content types that represent a standardized business case.
Depending on what schema you use, and this is where the flexibility comes in, you can have one library for all projects or one per project. The security model previously defined would drive your decisions here. SharePoint can be expanded by the scale of your organization and you can take this framework and apply it to the other lists we will discuss in this presentation.
**Change Slide**
Transition slide
Speaker: Robert Heiden
Team members can be notified of task assignments via email, which removes the burden from the Project Manager to notify assignments. Alerts (i.e., notifications) of item changes can let team members know when their assignments have been altered. Also alerts can be used for team broadcasts sending daily or weekly summaries to the entire team of altered tasks.
Animation 1- Task Indentation – now provides a hierarchal view of task relationships
Animation 2- Mark complete with checkbox – quickly enables team members to update status
Animation 3- Strikethrough – provides an “at a glance” view showing anything that is completed
Animation 4- Lync Integration – facilitates communication to quickly gain the latest updates
Animation 5- Date Formatting – offers dates in a friendlier format for end users
The platform is dynamic yet simple enabling users to rapidly add tasks.
**Change Slide**
Speaker: Robert Heiden
The new Project Summary web part flips between the Timeline view and Overdue tasks.
Animation 1- The Project Summary web part shows a carousel easily switching between upcoming/late tasks and the overall project timeline. This can be added to different pages of your SharePoint site
**Change Slide**
Speaker: Robert Heiden
To improve the adoption rate for such a change there are multiple ways to interact with team members. In order to buffer end users from MS Project (which we all know and love) multiple methods exist for communicating task status. Including SharePoint task lists, Outlook, and Excel. This integration can be done without any programming or specialized IT skills. This increases the likelihood of individuals providing the project managers with their task updates since they do not need to interact with Microsoft Project.
**Change Slide**
Speaker: Robert Heiden
So now lets talk about pulling these things together. The taxonomy defined earlier provides us with the framework for grouping or associating the various SharePoint list items with the projects that they are associated with.
Scenario 1 – a single registry for multiple projects we can group a list by project ID and you can see all the risks or issues or changes associated with that particular project
Scenario 2 – an individual registry for a project and group items by priority to view all high priority item, group by assigned to resource.
The foundation is now established for continuous improvement. These lists are now searchable for future projects facilitating lessons learned.
**Change Slide**
Speaker: Robert Heiden
One of the most powerful aspects here is the ability to sort and group in the views creating reports that align to the steps of your processes (i.e., creation, status, reporting and lessons learned)
**Change Slide**
Speaker: Robert Heiden
Increase the transparency and insight into the organization is easily done via these views. All of this information can be shared with team members, executives and stakeholders in a manner that they require.
This is the first iteration of the single truth, now you are establishing consistency across the platform that is scalable in that it can easily manage as many projects as you require.
Animation 1- There are a number of different ways to view your data within SharePoint 2013. Whether you are looking at a calendar, single item view, a gantt chart or a timeline the information can be presented to your end users in a meaningful way.
**Change Slide**
Speaker: Robert Heiden
**Animations on this slide are timed with a single click**
Thanks Stephen…
The examples we have shown you throughout this presentation are applicable, to varying degrees, to all stages of your PMO evolution.
An alternative scenario may be to have your project task lists separate but keep your documents, risk issues and changes consolidated. This scenario would allow project managers to sync projects with Microsoft Project Professional to have more robust project schedules.
As you expand or depending on your current size you may want to consider a site per program or a site per business unit. In this scenario you can leverage the foundation described today across these sites. You can then leverage web parts and other techniques to bring that information back together in a single place for reporting. In future webinars we will show you how you can quickly and easily report on tagged items across sites. An example being a view of all high priority lists.
Finally as you move into a more robust scenario you would want to consider a PPM tool such as project server or leverage the foundation to simply have separate project sites. Reporting across those sites and maintaining consistency via list, library and site templates.
**Change Slide**
Speaker: Robert Heiden
Here we see how this approach ties into Microsoft’s PPM journey. We have focused on the task management and project collaboration area. In future webinars we will move along this curve and describe how you can eventually leverage Project Server without your teams keeping the SharePoint front end. In Project Server 2013 you have the ability to import the same SharePoint task list we just demonstrated into the enterprise for visibility in PPM reporting.
**Change Slide**
Transition slide
Speaker: Robert Heiden
Here we see how this approach ties into Microsoft’s PPM journey. We have focused on the task management and project collaboration area. In future webinars we will move along this curve and describe how you can eventually leverage Project Server without your teams keeping the SharePoint front end. In Project Server 2013 you have the ability to import the same SharePoint task list we just demonstrated into the enterprise for visibility in PPM reporting.
**Change Slide**
Speaker: Robert Heiden
Here we see how this approach ties into Microsoft’s PPM journey. We have focused on the task management and project collaboration area. In future webinars we will move along this curve and describe how you can eventually leverage Project Server without your teams keeping the SharePoint front end. In Project Server 2013 you have the ability to import the same SharePoint task list we just demonstrated into the enterprise for visibility in PPM reporting.
**Change Slide**
Transition slide
Speaker: Robert Heiden
Here we see how this approach ties into Microsoft’s PPM journey. We have focused on the task management and project collaboration area. In future webinars we will move along this curve and describe how you can eventually leverage Project Server without your teams keeping the SharePoint front end. In Project Server 2013 you have the ability to import the same SharePoint task list we just demonstrated into the enterprise for visibility in PPM reporting.
**Change Slide**
Speaker: Robert Heiden
Here we see how this approach ties into Microsoft’s PPM journey. We have focused on the task management and project collaboration area. In future webinars we will move along this curve and describe how you can eventually leverage Project Server without your teams keeping the SharePoint front end. In Project Server 2013 you have the ability to import the same SharePoint task list we just demonstrated into the enterprise for visibility in PPM reporting.
**Change Slide**
Speaker: Robert Heiden
Here we see how this approach ties into Microsoft’s PPM journey. We have focused on the task management and project collaboration area. In future webinars we will move along this curve and describe how you can eventually leverage Project Server without your teams keeping the SharePoint front end. In Project Server 2013 you have the ability to import the same SharePoint task list we just demonstrated into the enterprise for visibility in PPM reporting.
**Change Slide**
Speaker: Robert Heiden
Here we see how this approach ties into Microsoft’s PPM journey. We have focused on the task management and project collaboration area. In future webinars we will move along this curve and describe how you can eventually leverage Project Server without your teams keeping the SharePoint front end. In Project Server 2013 you have the ability to import the same SharePoint task list we just demonstrated into the enterprise for visibility in PPM reporting.
**Change Slide**
Transition slide
Speaker: Robert Heiden
Here we see how this approach ties into Microsoft’s PPM journey. We have focused on the task management and project collaboration area. In future webinars we will move along this curve and describe how you can eventually leverage Project Server without your teams keeping the SharePoint front end. In Project Server 2013 you have the ability to import the same SharePoint task list we just demonstrated into the enterprise for visibility in PPM reporting.
**Change Slide**
Transition slide
Speaker: Robert Heiden
Here we see how this approach ties into Microsoft’s PPM journey. We have focused on the task management and project collaboration area. In future webinars we will move along this curve and describe how you can eventually leverage Project Server without your teams keeping the SharePoint front end. In Project Server 2013 you have the ability to import the same SharePoint task list we just demonstrated into the enterprise for visibility in PPM reporting.
**Change Slide**
Speaker: Robert Heiden
Here we see how this approach ties into Microsoft’s PPM journey. We have focused on the task management and project collaboration area. In future webinars we will move along this curve and describe how you can eventually leverage Project Server without your teams keeping the SharePoint front end. In Project Server 2013 you have the ability to import the same SharePoint task list we just demonstrated into the enterprise for visibility in PPM reporting.
**Change Slide**
Speaker: Robert Heiden
Here we see how this approach ties into Microsoft’s PPM journey. We have focused on the task management and project collaboration area. In future webinars we will move along this curve and describe how you can eventually leverage Project Server without your teams keeping the SharePoint front end. In Project Server 2013 you have the ability to import the same SharePoint task list we just demonstrated into the enterprise for visibility in PPM reporting.
**Change Slide**
Speaker: Robert Heiden
Here we see how this approach ties into Microsoft’s PPM journey. We have focused on the task management and project collaboration area. In future webinars we will move along this curve and describe how you can eventually leverage Project Server without your teams keeping the SharePoint front end. In Project Server 2013 you have the ability to import the same SharePoint task list we just demonstrated into the enterprise for visibility in PPM reporting.
**Change Slide**