Jerry Miller is the presenter and has over 33 years of experience in EMS and fire. He will discuss ambulance accreditation from CAAS and CAMTS and how it may impact reimbursement. Currently, CAAS does not emphasize accreditation for reimbursement but CAMTS is working with CMS to potentially tie reimbursement to accreditation. Over the next 5 years, accreditation may impact air ambulance reimbursement. MedPAC is studying ambulance reimbursement and larger reform that could include quality issues. Upcoming reimbursement challenges include sequestration cuts, expiration of temporary rate increases, and potential 3.5% loss in Medicare rates.
PSOW 2016 - Community Paramedicine in WisconsinPSOW
This document discusses the community paramedicine program in Wisconsin. It provides an overview of community paramedicine and how it can help improve healthcare access, coordination of care, and reduce costs. It then summarizes pilot programs in Wisconsin that showed reductions in emergency department visits and hospital admissions for patients engaged with community paramedics. The document concludes by outlining the legislative process to establish community paramedicine in Wisconsin law and lists some pioneering community paramedicine programs already operating in the state.
The document discusses fraud and Medicare compliance. It provides an overview of the legal framework around governmental oversight of Medicare fraud by agencies like OIG, DOJ, and CMS. It also discusses additional oversight groups like ZPICs and RACs. Laws around fraud are explained, including the Anti-Kickback Statute and False Claims Act. Recent fraud cases are summarized involving ambulance companies billing Medicare for unnecessary transports. The presentation concludes with guidance on developing an effective compliance program with basic elements like training, monitoring, and responding to detected issues.
This document summarizes the Wisconsin EMS system and recent updates. There are over 16,000 EMS professionals in Wisconsin, serving 772 EMS services. Statewide call volume has increased yearly between 2013-2015. The EMS section oversees EMS licensure and provides resources through its website. National EMS practice transitions are underway, and the state is working to update rules and statutes to align with national standards.
The document discusses how healthcare reform will impact ambulance services and individuals. It outlines both positive and negative effects. Positively, more people will gain health insurance coverage. However, ambulance services face potential reductions in Medicare reimbursement rates through measures like productivity adjustments. The document provides an overview of major provisions and recommends steps like improving Medicaid rates and compliance to address the changes.
This document discusses how a community paramedic program supports the goals of accountable care organizations (ACOs) in achieving the "Triple Aim" of improving patient care, improving population health, and reducing costs. It provides examples of how community paramedics can coordinate care between primary care, hospitals, and other partners to reduce emergency department visits and hospital readmissions. The document also outlines various payment models that reimburse for services like care coordination that community paramedic programs provide.
This document discusses the potential for community paramedics to help address various healthcare issues in rural communities. It summarizes the goals of establishing a community paramedic program, including decreasing hospital readmissions and non-essential emergency department visits while improving patient outcomes and reducing overall healthcare costs. The document also outlines some of the challenges faced in establishing community paramedic programs and next steps for the future, including pursuing legislative initiatives and permanent funding models.
The document provides an update from the Wisconsin Department of Health Services Emergency Medical Services program. It summarizes the program's mission to ensure high quality pre-hospital emergency care statewide. It also provides statistics on the number of EMS services, personnel, and calls in Wisconsin. Additionally, it reviews the program's activities over the past year, upcoming renewals, and future plans.
Entering the Final Stretch - Preparing for New Affordable Care Act ObligationsPSOW
This document summarizes a presentation on how the Affordable Care Act will affect emergency medical organizations as employers and providers. Key points include:
- As employers, emergency organizations with 50 or more full-time employees must comply with "pay or play" rules starting in 2015, which require offering affordable health insurance or paying penalties.
- As providers, emergency organizations will face increased fraud enforcement from expanded oversight and penalties under the ACA. The Office of Inspector General will examine Medicare claims data and review transports for medical necessity.
- All non-grandfathered health plans must cover essential health benefits, including emergency transport services. Presenters advise emergency organizations to understand and prepare for new ACA obligations and opportunities.
PSOW 2016 - Community Paramedicine in WisconsinPSOW
This document discusses the community paramedicine program in Wisconsin. It provides an overview of community paramedicine and how it can help improve healthcare access, coordination of care, and reduce costs. It then summarizes pilot programs in Wisconsin that showed reductions in emergency department visits and hospital admissions for patients engaged with community paramedics. The document concludes by outlining the legislative process to establish community paramedicine in Wisconsin law and lists some pioneering community paramedicine programs already operating in the state.
The document discusses fraud and Medicare compliance. It provides an overview of the legal framework around governmental oversight of Medicare fraud by agencies like OIG, DOJ, and CMS. It also discusses additional oversight groups like ZPICs and RACs. Laws around fraud are explained, including the Anti-Kickback Statute and False Claims Act. Recent fraud cases are summarized involving ambulance companies billing Medicare for unnecessary transports. The presentation concludes with guidance on developing an effective compliance program with basic elements like training, monitoring, and responding to detected issues.
This document summarizes the Wisconsin EMS system and recent updates. There are over 16,000 EMS professionals in Wisconsin, serving 772 EMS services. Statewide call volume has increased yearly between 2013-2015. The EMS section oversees EMS licensure and provides resources through its website. National EMS practice transitions are underway, and the state is working to update rules and statutes to align with national standards.
The document discusses how healthcare reform will impact ambulance services and individuals. It outlines both positive and negative effects. Positively, more people will gain health insurance coverage. However, ambulance services face potential reductions in Medicare reimbursement rates through measures like productivity adjustments. The document provides an overview of major provisions and recommends steps like improving Medicaid rates and compliance to address the changes.
This document discusses how a community paramedic program supports the goals of accountable care organizations (ACOs) in achieving the "Triple Aim" of improving patient care, improving population health, and reducing costs. It provides examples of how community paramedics can coordinate care between primary care, hospitals, and other partners to reduce emergency department visits and hospital readmissions. The document also outlines various payment models that reimburse for services like care coordination that community paramedic programs provide.
This document discusses the potential for community paramedics to help address various healthcare issues in rural communities. It summarizes the goals of establishing a community paramedic program, including decreasing hospital readmissions and non-essential emergency department visits while improving patient outcomes and reducing overall healthcare costs. The document also outlines some of the challenges faced in establishing community paramedic programs and next steps for the future, including pursuing legislative initiatives and permanent funding models.
The document provides an update from the Wisconsin Department of Health Services Emergency Medical Services program. It summarizes the program's mission to ensure high quality pre-hospital emergency care statewide. It also provides statistics on the number of EMS services, personnel, and calls in Wisconsin. Additionally, it reviews the program's activities over the past year, upcoming renewals, and future plans.
Entering the Final Stretch - Preparing for New Affordable Care Act ObligationsPSOW
This document summarizes a presentation on how the Affordable Care Act will affect emergency medical organizations as employers and providers. Key points include:
- As employers, emergency organizations with 50 or more full-time employees must comply with "pay or play" rules starting in 2015, which require offering affordable health insurance or paying penalties.
- As providers, emergency organizations will face increased fraud enforcement from expanded oversight and penalties under the ACA. The Office of Inspector General will examine Medicare claims data and review transports for medical necessity.
- All non-grandfathered health plans must cover essential health benefits, including emergency transport services. Presenters advise emergency organizations to understand and prepare for new ACA obligations and opportunities.
Navigating the Post-Health Care Reform LandscapePSOW
The document discusses several changes occurring in the post-Affordable Care Act healthcare landscape. It describes the rise of Accountable Care Organizations which integrate hospitals and physicians to coordinate patient care. It also notes the trend of hospitals acquiring physician practices, making hospitals the dominant player. Health systems are merging into larger organizations and acquiring ancillary services like rehabilitation facilities. The document outlines the establishment of health insurance exchanges and details the availability of premium subsidies and cost-sharing reductions for lower-income individuals. It provides data on enrollment in exchanges and Medicaid expansion.
The document summarizes a presentation on fraud and abuse compliance in healthcare. It discusses the legal framework around laws like the Anti-Kickback Statute and False Claims Act. It outlines recent government enforcement actions and cases involving ambulance companies allegedly engaging in fraudulent billing practices like upcoding transports. It recommends strategies for healthcare providers to develop strong compliance programs to avoid violations like internal auditing, training, and disciplinary guidelines.
PSOW 2016 - HIPAA Compliance for EMS CommunityPSOW
The document discusses changes to HIPAA regulations and compliance requirements for emergency medical services organizations. Key points include:
- Major changes from HIPAA/HITECH include an expanded definition of business associates, new requirements for business associate agreements and breach notification, and increased civil penalties.
- Non-compliance can result in significant fines from audits by the Office for Civil Rights. Fines have been issued in the millions for violations like unencrypted devices being stolen.
- Third party assistance can help EMS organizations establish HIPAA compliance programs and avoid "willful neglect" violations that carry mandatory minimum fines. Regular risk analysis and security practices are important to maintain compliance.
This document discusses the importance of compliance programs for ambulance services. It outlines key federal agencies and regulations related to compliance, including CMS, OIG, ACA, FCA and AKS. The OIG requires ambulance services to implement a seven-element compliance program. Non-compliance can result in fines and penalties. The document urges services to conduct internal audits, ensure documentation like PCRs support medical necessity and billing, and check that billing companies follow proper coding methods. Maintaining a strong compliance program is necessary to avoid issues with regulators and ensure ambulance services are paid appropriately.
The Future of OB Hospitalist Programs: The Unexpected DeliverablesEmCare
You might expect that with an OB hospitalist onsite 24/7, hospitals are better equipped to manage obstetric and gynecologic care and emergencies, providing the ultimate in patient safety while reducing liability and risk. That’s true. But there are unexpected benefits as well.
Wayne L. Farley, Jr., D.O., FACOG, presents “The Future of OB Hospitalist Programs: The Unexpected Deliverables.” This webinar was September 21, 2016, hosted by Becker’s Hospital Review.
This episode continues our COVID-19 COVID-19 Insights Webinar discussing CMS changes, available grants and loans, existing opportunities in telehealth, and more state openings for elective surgeries.
An increasing number of states are expanding managed care. This webinar provides a straightforward overview and history of the Medicaid Managed Care program and how it applies to physicians, practices, and patients.
National health service corp presentation to mo rhit may 27 2010learfield
The document summarizes the National Health Service Corps (NHSC), which provides clinicians to work in underserved areas. The NHSC offers scholarship and loan repayment programs to recruit primary care providers to work in Health Professional Shortage Areas (HPSAs). Sites must be located in and provide services to HPSAs to be eligible. The document outlines NHSC programs and funding provided by the American Recovery and Reinvestment Act to recruit additional clinicians and expand access to care.
Providing and Billing Medicare for Transitional and Chronic Care ManagementPYA, P.C.
PYA Principal Martie Ross co-presented “Providing and Billing Medicare for Transitional and Chronic Care Management,” along with Robert Jarrin, Government Affairs Director of Qualcomm Life at the AHLA 2015 Institute on Medicare and Medicaid Payment Issues program. Together they:
Briefly summarized research regarding advantages of care management services.
Explained the history of Medicare policy regarding care management services.
Provided detailed explanation of billing rules for transitional care management and level of reimbursement.
Provided detailed explanation of billing rules for chronic care management and level of reimbursement.
Highlighted unique arrangements for providing centralized care management services.
NYSHIP provides affordable and comprehensive health insurance to over 1.2 million public employees in New York State through two plan options - Empire Plan and Excelsior Plan. It offers low and stable premium increases, negotiated rates with healthcare partners, and a large pool of enrollees. Administration is simple for participating agencies through the Department of Civil Service Employee Benefits Division. NYSHIP delivers periodic reports and support to help agencies manage benefits. The plans provide in-network and out-of-network coverage nationwide with few out-of-pocket costs for preventive services and specific medical care.
1) The Office of Health Information Technology (OHIT) promotes adoption of health IT in safety net providers like community health centers and aims to improve quality of care, reduce costs, and prevent a digital divide.
2) OHIT provides various funding opportunities and technical assistance to support health centers' planning, implementation, and use of electronic health records and other health IT.
3) OHIT collaborates with other agencies and organizations to advance use of health IT and address related policy issues.
Direct Primary Care (DPC) is an alternative payment model that involves a monthly retainer paid by an individual, employer, or health plan directly to a physician for primary care and prevention services, replacing traditional fee-for-service billing. DPC practices have been established in 46 states and have shown better outcomes, patient satisfaction, and savings of approximately 20% for employers, exchanges, and Medicaid. Legislation has been passed in 13 states defining DPC as a medical service outside insurance regulation. Additional legislation has been proposed or passed in several other states and at the federal level to further support DPC.
Accounting Update Overview with a Healthcare SlantPYA, P.C.
PYA Principal and Director of Audit Services Doug Arnold presented during East Tennessee State University’s 38th Annual Accounting, Auditing, and Tax Updating CPE conference. His presentation covered many recent Accounting Standards Updates, but leaned toward their applications in healthcare.
Fair Market Value: What Rural Providers Need to Know PYA, P.C.
PYA Principal Tynan Olechny and Senior Manager Annapoorani Bhat provided important information for rural providers related to fair market value and commercial reasonableness considerations during a National Rural Health Association webinar, “Valuations: What Rural Providers Need to Know."
Improve Employee Health & Control Healthcare Costs with Direct Primary CareMegan Zimmerman
Direct Primary Care is providing employers of all sizes substantial cost savings while improving health outcomes. Learn how telemedicine, occupational health, wholesale medications, direct labs and imagining are working in tandem to create a cost effective and proactive healthcare model for employers.
CVS Caremark partnered with several organizations to raise awareness of colon cancer through a statewide and nationwide campaign in March 2012. The campaign included in-store radio, signs, and receipts to reach 800,000 monthly store customers. A website banner and emails targeted the 9.3 million monthly CVS.com visitors. The campaign aimed to educate the public on colon cancer and the importance of screenings through CVS's extensive consumer touchpoints.
This document provides an overview of community health centers in the United States. It contains sections on who health centers serve (largely low-income, minority, uninsured or publicly insured populations), their growth over time, the access to care they provide, preventive services offered, efforts to reduce health disparities, cost-effective care, financial challenges, importance of Medicaid funding, and remaining challenges. The document uses charts and figures to illustrate trends and comparisons between health center patient populations and national averages.
Delivering Care Under the MACRA Final Rule: Implementation Considerations and...Epstein Becker Green
Presented November 18, 2016, by Mark Lutes, Robert F. Atlas, and Lesley R. Yeung of Epstein Becker Green and EBG Advisors.
http://www.ebglaw.com
http://www.ebgadvisors.com
Chronic Care Management: 6 Tips for Documentation SuccessManny Oliverez
Take advantage of the Chronic Care Reimbursement opportunity with these tips!
Healthcare providers can be reimbursed for the hours that they spend on the phone, filling prescriptions, and completing paperwork. Medicare now offers reimbursement for doctors who are assisting patients with chronic medical conditions.
The key to reimbursement from Medicare is all in the required documentation for Chronic Care Management (CCM). Here are some tips for documenting for CCM.
Visit Our Website: http://www.CaptureBilling.com/
Chronic Care Management Coding Guidelines Effective January 1, 2017Manny Oliverez
The Centers for Medicare and Medicaid Services (CMS) recently released new billing requirements for chronic care management services. CMS initiated these latest billing changes in order to improve payment accuracy for CCM services as well as reduce the administrative burden for providers.
Visit Our Website: http://www.CaptureBilling.com/
Wisconsin/Nicaragua Health Projects PartnershipPSOW
This document provides an overview of Partners of the Americas and the Wisconsin/Nicaragua partnership. It discusses how Partners originated from Eisenhower and Kennedy's initiatives to strengthen ties between the US and Latin America. Wisconsin and Nicaragua were paired due to common agricultural economies and geography. The Wisconsin/Nicaragua partnership focuses on community development projects in areas like agriculture, women's programs, health, youth, and humanitarian assistance. A major initiative involves shipping fire trucks and ambulances from Wisconsin to Nicaragua to assist local fire departments. The partnership aims to enhance quality of life through people-to-people exchange programs promoting cultural understanding and sustainable development.
This document outlines the culture and strategic plan for Austin-Travis County EMS. It discusses their mission to provide reliable and effective emergency medical services that exceed expectations. The strategic plan focuses on four pillars - People, Service, Quality, and Finance. Under each pillar are strategic objectives like attracting and retaining quality employees, delivering high quality patient care, promoting a culture of safety and innovation, and ensuring good financial stewardship. The document emphasizes the importance of leadership and leading with love and respect to inspire employees and achieve exceptional results.
Navigating the Post-Health Care Reform LandscapePSOW
The document discusses several changes occurring in the post-Affordable Care Act healthcare landscape. It describes the rise of Accountable Care Organizations which integrate hospitals and physicians to coordinate patient care. It also notes the trend of hospitals acquiring physician practices, making hospitals the dominant player. Health systems are merging into larger organizations and acquiring ancillary services like rehabilitation facilities. The document outlines the establishment of health insurance exchanges and details the availability of premium subsidies and cost-sharing reductions for lower-income individuals. It provides data on enrollment in exchanges and Medicaid expansion.
The document summarizes a presentation on fraud and abuse compliance in healthcare. It discusses the legal framework around laws like the Anti-Kickback Statute and False Claims Act. It outlines recent government enforcement actions and cases involving ambulance companies allegedly engaging in fraudulent billing practices like upcoding transports. It recommends strategies for healthcare providers to develop strong compliance programs to avoid violations like internal auditing, training, and disciplinary guidelines.
PSOW 2016 - HIPAA Compliance for EMS CommunityPSOW
The document discusses changes to HIPAA regulations and compliance requirements for emergency medical services organizations. Key points include:
- Major changes from HIPAA/HITECH include an expanded definition of business associates, new requirements for business associate agreements and breach notification, and increased civil penalties.
- Non-compliance can result in significant fines from audits by the Office for Civil Rights. Fines have been issued in the millions for violations like unencrypted devices being stolen.
- Third party assistance can help EMS organizations establish HIPAA compliance programs and avoid "willful neglect" violations that carry mandatory minimum fines. Regular risk analysis and security practices are important to maintain compliance.
This document discusses the importance of compliance programs for ambulance services. It outlines key federal agencies and regulations related to compliance, including CMS, OIG, ACA, FCA and AKS. The OIG requires ambulance services to implement a seven-element compliance program. Non-compliance can result in fines and penalties. The document urges services to conduct internal audits, ensure documentation like PCRs support medical necessity and billing, and check that billing companies follow proper coding methods. Maintaining a strong compliance program is necessary to avoid issues with regulators and ensure ambulance services are paid appropriately.
The Future of OB Hospitalist Programs: The Unexpected DeliverablesEmCare
You might expect that with an OB hospitalist onsite 24/7, hospitals are better equipped to manage obstetric and gynecologic care and emergencies, providing the ultimate in patient safety while reducing liability and risk. That’s true. But there are unexpected benefits as well.
Wayne L. Farley, Jr., D.O., FACOG, presents “The Future of OB Hospitalist Programs: The Unexpected Deliverables.” This webinar was September 21, 2016, hosted by Becker’s Hospital Review.
This episode continues our COVID-19 COVID-19 Insights Webinar discussing CMS changes, available grants and loans, existing opportunities in telehealth, and more state openings for elective surgeries.
An increasing number of states are expanding managed care. This webinar provides a straightforward overview and history of the Medicaid Managed Care program and how it applies to physicians, practices, and patients.
National health service corp presentation to mo rhit may 27 2010learfield
The document summarizes the National Health Service Corps (NHSC), which provides clinicians to work in underserved areas. The NHSC offers scholarship and loan repayment programs to recruit primary care providers to work in Health Professional Shortage Areas (HPSAs). Sites must be located in and provide services to HPSAs to be eligible. The document outlines NHSC programs and funding provided by the American Recovery and Reinvestment Act to recruit additional clinicians and expand access to care.
Providing and Billing Medicare for Transitional and Chronic Care ManagementPYA, P.C.
PYA Principal Martie Ross co-presented “Providing and Billing Medicare for Transitional and Chronic Care Management,” along with Robert Jarrin, Government Affairs Director of Qualcomm Life at the AHLA 2015 Institute on Medicare and Medicaid Payment Issues program. Together they:
Briefly summarized research regarding advantages of care management services.
Explained the history of Medicare policy regarding care management services.
Provided detailed explanation of billing rules for transitional care management and level of reimbursement.
Provided detailed explanation of billing rules for chronic care management and level of reimbursement.
Highlighted unique arrangements for providing centralized care management services.
NYSHIP provides affordable and comprehensive health insurance to over 1.2 million public employees in New York State through two plan options - Empire Plan and Excelsior Plan. It offers low and stable premium increases, negotiated rates with healthcare partners, and a large pool of enrollees. Administration is simple for participating agencies through the Department of Civil Service Employee Benefits Division. NYSHIP delivers periodic reports and support to help agencies manage benefits. The plans provide in-network and out-of-network coverage nationwide with few out-of-pocket costs for preventive services and specific medical care.
1) The Office of Health Information Technology (OHIT) promotes adoption of health IT in safety net providers like community health centers and aims to improve quality of care, reduce costs, and prevent a digital divide.
2) OHIT provides various funding opportunities and technical assistance to support health centers' planning, implementation, and use of electronic health records and other health IT.
3) OHIT collaborates with other agencies and organizations to advance use of health IT and address related policy issues.
Direct Primary Care (DPC) is an alternative payment model that involves a monthly retainer paid by an individual, employer, or health plan directly to a physician for primary care and prevention services, replacing traditional fee-for-service billing. DPC practices have been established in 46 states and have shown better outcomes, patient satisfaction, and savings of approximately 20% for employers, exchanges, and Medicaid. Legislation has been passed in 13 states defining DPC as a medical service outside insurance regulation. Additional legislation has been proposed or passed in several other states and at the federal level to further support DPC.
Accounting Update Overview with a Healthcare SlantPYA, P.C.
PYA Principal and Director of Audit Services Doug Arnold presented during East Tennessee State University’s 38th Annual Accounting, Auditing, and Tax Updating CPE conference. His presentation covered many recent Accounting Standards Updates, but leaned toward their applications in healthcare.
Fair Market Value: What Rural Providers Need to Know PYA, P.C.
PYA Principal Tynan Olechny and Senior Manager Annapoorani Bhat provided important information for rural providers related to fair market value and commercial reasonableness considerations during a National Rural Health Association webinar, “Valuations: What Rural Providers Need to Know."
Improve Employee Health & Control Healthcare Costs with Direct Primary CareMegan Zimmerman
Direct Primary Care is providing employers of all sizes substantial cost savings while improving health outcomes. Learn how telemedicine, occupational health, wholesale medications, direct labs and imagining are working in tandem to create a cost effective and proactive healthcare model for employers.
CVS Caremark partnered with several organizations to raise awareness of colon cancer through a statewide and nationwide campaign in March 2012. The campaign included in-store radio, signs, and receipts to reach 800,000 monthly store customers. A website banner and emails targeted the 9.3 million monthly CVS.com visitors. The campaign aimed to educate the public on colon cancer and the importance of screenings through CVS's extensive consumer touchpoints.
This document provides an overview of community health centers in the United States. It contains sections on who health centers serve (largely low-income, minority, uninsured or publicly insured populations), their growth over time, the access to care they provide, preventive services offered, efforts to reduce health disparities, cost-effective care, financial challenges, importance of Medicaid funding, and remaining challenges. The document uses charts and figures to illustrate trends and comparisons between health center patient populations and national averages.
Delivering Care Under the MACRA Final Rule: Implementation Considerations and...Epstein Becker Green
Presented November 18, 2016, by Mark Lutes, Robert F. Atlas, and Lesley R. Yeung of Epstein Becker Green and EBG Advisors.
http://www.ebglaw.com
http://www.ebgadvisors.com
Chronic Care Management: 6 Tips for Documentation SuccessManny Oliverez
Take advantage of the Chronic Care Reimbursement opportunity with these tips!
Healthcare providers can be reimbursed for the hours that they spend on the phone, filling prescriptions, and completing paperwork. Medicare now offers reimbursement for doctors who are assisting patients with chronic medical conditions.
The key to reimbursement from Medicare is all in the required documentation for Chronic Care Management (CCM). Here are some tips for documenting for CCM.
Visit Our Website: http://www.CaptureBilling.com/
Chronic Care Management Coding Guidelines Effective January 1, 2017Manny Oliverez
The Centers for Medicare and Medicaid Services (CMS) recently released new billing requirements for chronic care management services. CMS initiated these latest billing changes in order to improve payment accuracy for CCM services as well as reduce the administrative burden for providers.
Visit Our Website: http://www.CaptureBilling.com/
Wisconsin/Nicaragua Health Projects PartnershipPSOW
This document provides an overview of Partners of the Americas and the Wisconsin/Nicaragua partnership. It discusses how Partners originated from Eisenhower and Kennedy's initiatives to strengthen ties between the US and Latin America. Wisconsin and Nicaragua were paired due to common agricultural economies and geography. The Wisconsin/Nicaragua partnership focuses on community development projects in areas like agriculture, women's programs, health, youth, and humanitarian assistance. A major initiative involves shipping fire trucks and ambulances from Wisconsin to Nicaragua to assist local fire departments. The partnership aims to enhance quality of life through people-to-people exchange programs promoting cultural understanding and sustainable development.
This document outlines the culture and strategic plan for Austin-Travis County EMS. It discusses their mission to provide reliable and effective emergency medical services that exceed expectations. The strategic plan focuses on four pillars - People, Service, Quality, and Finance. Under each pillar are strategic objectives like attracting and retaining quality employees, delivering high quality patient care, promoting a culture of safety and innovation, and ensuring good financial stewardship. The document emphasizes the importance of leadership and leading with love and respect to inspire employees and achieve exceptional results.
The document discusses the benefits of exercise for mental health. Regular physical activity can help reduce anxiety and depression and improve mood and cognitive functioning. Exercise causes chemical changes in the brain that may help protect against mental illness and improve symptoms.
This document describes the use of ketamine to sedate combative patients exhibiting excited delirium syndrome in Wisconsin. It outlines that ketamine is ideal for this purpose as it works rapidly with a single dose, has minimal adverse effects, and supports heart and breathing function. The document then summarizes Wisconsin's experience using ketamine for over 30 patients, finding it effectively controlled agitation in most cases within 5 minutes with few complications. It discusses dosing, demographic trends, and questions around intubation of some patients.
This document summarizes the components of an EMS quality management program, including quality assurance, continuous quality improvement, after action reviews, and confidentiality policies. It discusses retrospective case reviews, statistical analysis of performance indicators, and multi-agency reviews of major incidents to improve protocols, education, and standardization.
The document provides an overview of recent and upcoming changes to Wisconsin's EMS system. It discusses new licensing rules, educational standards, exam changes, and strategic initiatives around quality reporting and emergency driving. The organizational structure of the EMS Section is also outlined.
Capnography, or the measurement of exhaled carbon dioxide, provides important information about a patient's ventilation and perfusion status. It is more sensitive than pulse oximetry and can detect problems earlier. Capnography should be used for all intubated patients, severely injured patients, cardiac arrest patients, dyspneic patients, and patients who have received sedation. The waveform and trends in end-tidal carbon dioxide levels over time help assess a patient's condition and response to treatment.
This document outlines best practices for pre-hospital and emergency room care of acute stroke patients presented by Dot Bluma and Cathy Etter. It discusses the importance of partnership between EMS and hospitals, describes challenges and strategies for meeting pre-hospital stroke care guidelines, and reviews recommendations from the American Stroke Association and Coverdell program. Statistics on stroke incidence and costs are also presented.
This document provides an overview of managing controlled substances in EMS. It discusses diversion control and why record keeping is necessary to prevent theft and protect public health. Key points include:
- Controlled substances must be securely stored and strict records kept of ordering, inventory, administration and disposal.
- Schedule II drugs like fentanyl require DEA Form 222 to order and have separate record keeping from other schedules.
- Inventories must be taken at least annually and any shortages or evidence of tampering reported immediately.
- Proper training, policies, separation of duties and periodic audits can help ensure compliance and prevent diversion within EMS agencies.
This document discusses the principles of a "just culture" approach in emergency medical services (EMS). A just culture aims to have zero tolerance for reckless behavior while also not blaming individuals for honest mistakes. It references several resources on implementing just culture principles through internal investigations, accountability, leadership, due process, and strategies to create a culture of safety in EMS organizations.
Ketamine for Pre-Hospital Sedation in Excited DeliriumPSOW
This document discusses a study on the use of ketamine for prehospital sedation of patients experiencing excited delirium. The study aims to determine if ketamine is an effective and safe treatment option that allows emergency responders to control agitated patients and transport them for further care. The document outlines the goals, inclusion/exclusion criteria, procedures, and contact information for the Wisconsin ketamine study being conducted by Drs. Curtis and Cady.
The document summarizes a CPR challenge between the cities of Wausau and Stevens Point in Wisconsin. It describes how the challenge was organized by Sherrie Galle-Teske to train people in hands-only CPR and deploy more AEDs. Over two months in 2016, the challenge resulted in 3,559 people trained in CPR and 3 new AEDs placed. Wausau trained 2,225 people while Stevens Point trained 1,334. The foundations raised $4,500 total to support new AEDs. The challenge was a success in building community relationships and awareness around CPR training.
PSOW 2016 - WI EMS/Trauma Medical Director ReportPSOW
Suzanne Martens provides a medical director report on EMS/Trauma activities in Wisconsin. She discusses revisiting the concept of a just culture that balances accountability with good intent. As medical director, her activities include advising various EMS councils and committees, reviewing protocols, and investigating a dozen cases. Her latest project is developing additional training for EMRs to administer IM epinephrine for anaphylaxis. Future projects include further protocol edits, defining new EMS roles, and improving data collection and resources.
This document discusses establishing a culture of safety in emergency medical services. It notes that most medical errors are due to systemic issues, not individual mistakes. A "just culture" is proposed that is not focused on blame but rather shared accountability. Under a just culture, the organization is responsible for safe systems and processes, while employees are responsible for safe behaviors. Errors are categorized as human errors from flawed systems, at-risk behaviors where risks were unrecognized, or reckless behaviors with conscious disregard for risk. Different approaches are recommended for managing each type of issue, focused on system improvements, coaching, or discipline depending on the situation. An overall goal is to establish trust so that employees feel safe providing feedback to further improve safety.
This document describes an EMS physician program called MD-1 that provides enhanced medical capabilities and physician oversight to prehospital emergency response. MD-1 is equipped with advanced life support equipment and deploys a Chevrolet Tahoe for responses. The program has integrated into the local EMS system through approvals and training. MD-1 physicians respond to requests from incident commanders and provide assistance to crews on medical calls, mass casualty incidents, and difficult extrications. Initial responses have included managing difficult airways, treating cardiac events, and providing support during blizzard conditions. Feedback from EMS crews has been positive about the additional medical resources and oversight provided by the MD-1 physicians.
This document provides Medicare payment data and summaries for ambulance services for fiscal year 2013. Key points include:
- Total Medicare payments for ambulance services in 2013 were $4.9 billion, a slight 0.2% decrease from 2012.
- Ground mileage and BLS non-emergency transports saw small increases in payments and volume from 2012 to 2013.
- Dialysis-related transports increased 6.15% in volume and 3.44% in payments from 2012 to 2013.
- Data is provided on national, state (Wisconsin), and dialysis transport levels. Recent Medicare rule changes and reports addressing ambulance utilization and payments are also summarized.
This document discusses cardiac arrest survival rates and efforts to improve outcomes. It notes that approximately 360,000 out-of-hospital cardiac arrests occur annually in the US, with a 90.5% mortality rate. The author then outlines changes made by the Wausau Fire Department between 2010-2014 to protocols, equipment, and tracking of cardiac arrest data that corresponded to improved survival rates, from 12-18% to 23.6% overall. Maintaining a statewide cardiac arrest data bank that collects standardized information from all services could further increase survival rates by allowing analysis of best practices.
The document discusses the Commission on Accreditation of Ambulance Services (CAAS), which accredits EMS providers. It outlines CAAS's mission and history, the accreditation process and standards, and the value of CAAS accreditation. Accreditation demonstrates a commitment to quality and can result in increased productivity, safety, accountability and clinical performance while decreasing risk, liability and insurance costs. CAAS accreditation is also recognized by some states and is becoming a preferred or required qualification for municipal contracts and hospital agreements.
1) The document discusses the convergence of quality management and compliance in healthcare organizations. Reimbursement is increasingly tied to quality measures, requiring quality and compliance teams to collaborate.
2) Key risks to address include false claims liability, unnecessarily procedures, and poor quality care. Organizations must improve quality oversight, engage leadership, provide education, and ensure accountability.
3) Achieving high quality and compliance requires embedding these priorities in the organizational culture so that employees feel empowered to report issues and pursue excellence.
The document discusses strategies for home health agencies to prepare for Recovery Audit Contractor (RAC) audits. It outlines the history of the RAC program, the audit process, potential targets like coding issues, and the 5-level appeals process. Agencies are advised to evaluate quarterly coding audits, ensure coding specificity, and prepare documentation in case of an audit or appeal. The appeals process involves redetermination, reconsideration, administrative law judge hearing, appeals council review, and potential judicial review, with various deadlines and requirements at each stage.
The document discusses strategies for home health agencies to prepare for Recovery Audit Contractor (RAC) audits, including identifying high risk areas like therapy thresholds, reviewing documentation practices, and establishing an internal RAC response team to handle medical record requests and appeals. It also outlines the RAC review and appeal processes and provides tips for submitting supporting information to improve the chances of a favorable decision.
Healthcare Reform and Physician Compensation— Presentation Examines What’s in...PYA, P.C.
Among the many questions facing physicians in the wake of healthcare reform—how will they get paid? PYA Principal David McMillan recently addressed this question at the PKF Healthcare Fly-In with “Current Reform Initiatives and Their Impact on Physician Compensation.”
ClaimFACTS is a company that aims to streamline the processing of third party medical claims related to motor vehicle accidents (MVAs). It leverages over 20 years of healthcare revenue cycle management experience to identify inefficiencies in how hospitals, medical providers, insurance carriers, and plaintiff attorneys currently handle MVA medical claims. ClaimFACTS develops technology and services to directly connect hospitals, providers, and carriers. This allows medical claims to be submitted electronically to ClaimFACTS, researched, and presented to carriers to determine liability and enable quick payment and resolution. The goal is to reduce administrative costs and outstanding accounts receivable for all parties involved.
This document discusses Symetra Financial and Crowne Group's partnership in providing stop loss insurance solutions. It highlights Symetra's financial strength and experience. Crowne leverages its long relationship with Symetra to obtain competitive pricing and claims terms for clients. The document also outlines Crowne's services, including proposals, reporting, renewals, and claims assistance. Case studies show how Crowne has intervened to reduce clients' claims costs and rates. In the end, the document emphasizes Symetra and Crowne's commitment to partnering with agents and providing extensive service and leverage for favorable stop loss terms.
Tackling The Unique Challenges Of ASC Billing Services.pptxalicecarlos1
Tackling The Unique Challenges Of ASC Billing Services
Learn how ASC billing services can help Ambulatory Surgery Centers optimize revenue, cover operational costs, & provide quality patient care.
Setting Your Business Up for MIPS Success in 2019Kareo
In this webinar, Sr. Training Specialist, Marina Verdara, will provide you with the information and tools you need to ensure that your business avoids receiving penalties related to MACRA.
Marina will:
-Provide an in-depth analysis of MACRA, including APM and MIPS
-Review the four MIPS reporting categories and how your business can meet each of their individual requirements
-Recommend industry best practices so both independent medical practices and billing companies can avoid penalties in 2019
The RAC's are coming: Is your medical practice prepared?sstgelais
Important notice to Medical providers/ Hospitals: starting in 2010, CMS (Medicare) has hired four RAC (Recovery Audit Contractors) to pursue claim billing violations. Their mission is to collect as many $$$ in overpayments as possible nationwide. They\\’re heavily incentivize (17% of what they collect). This presentation provides an overview of the RAC program as well as our baseline audit service to help protect you against the impending RACs
Team Hcrs Presentation Review Draft V2a 08 30 2011GCAPEL
The document summarizes the value proposition and approach of Team HCRS, which is comprised of HCRS Medical Coding, Auditing and Payment Integrity Specialists and TC3. Team HCRS provides medical coding, auditing, and payment integrity services to over 70 clients nationally. They have a multi-layered technology and human-driven approach that achieves high returns on investment through the identification and recovery of improper payments.
2015 athenahealth PayerView Report and ReviveHealth Trust Index WebinarReviveHealth
ReviveHealth and Catalyst Healthcare Research, along with special guest athenahealth, reveal the findings from our 9th Annual ReviveHealth National Payor Survey of health system executives and discuss how those findings compare and contrast with the 10th Annual athenahealth PayerView report.
In this 60-minute webinar, athenahealth Payer Operations Manager Laurie Graham, ReviveHealth CEO Brandon Edwards, and Catalyst Healthcare Research President Dan Prince will address the following essential questions:
How do payors stack up against each other in terms of trust, reliability, honesty, and fairness?
How does a payor’s denial rate and claims speed inform provider trust?
What strategies are providers and health systems implementing for continued success in the changing healthcare environment?
What are the major trends in the healthcare industry?
The document discusses several trends reshaping the US healthcare system, including more consumers cutting cable TV cords or never subscribing, ongoing Medicare payment cuts challenging the traditional hospital business model relying on cross-subsidization, and more providers taking on risk through programs like Accountable Care Organizations (ACOs) or Medicare Advantage as fee-for-service reimbursement declines. It also covers the expansion of insurance through the Affordable Care Act (ACA) and emerging state-level Medicaid reforms. Key issues addressed are the transition away from fee-for-service payment, challenges of the insurance exchange rollout, and how these changes impact providers, payers, and consumers.
A Look Under the Hood: 5 Critical Questions You Should be Asking about ACOsSheri Litchford
The document discusses 5 critical questions about Accountable Care Organizations (ACOs): 1) what an ACO is, 2) whether ACOs are failing, 3) if there is money to be made through ACOs, 4) examples of successful ACOs, and 5) the information technology costs of ACOs. It provides details on these topics, including definitions of ACOs, perspectives on their viability, examples of ACOs that have generated savings, and the types of IT systems needed to support ACO operations and goals such as quality reporting, cost control and care management.
Team Hcrs Presentation Review Draft V2a 08 30 2011GCAPEL
Team HCRS provides health information management services including medical coding, auditing, and payment integrity. They have over 150 certified medical professionals on staff operating in over 40 states. Their expertise includes payment integrity services for over 70 payers, experience with Medicaid audits in multiple states, and a single entry point model for claims review that achieves 0.5-3% savings. They utilize technology integrated with experienced staff for claims screening, validation, and recovery of overpayments.
Team hcrs presentation review draft v2a 08 30 2011capel13
Medical Coding, Auditing and Payment Integrity Specialists
More than 150 certified medical professionals on staff
Operating at 70 sites in over 40 states
In business since 1998
Williamson Presentation to OKAMA Oct 21-2015 - EMS in OklahomaKelli Bruer
EMS IN OKLAHOMA Today & Tomorrow was a presentation by H. Stephen Williamson, President of the Emergency Medical Services Authority (EMSA), to the Oklahoma Ambulance Association on October 21, 2015. The presentation discussed payment reform in the healthcare environment, quality initiatives for ambulance services, and the shifting priorities of the Department of Health and Human Services toward alternative payment models and value-based purchasing. It also reviewed concepts from the Institute for Healthcare Improvement like the Triple Aim framework and new rules for radical redesign in healthcare.
The Key to Transitioning from Fee-for-Service to Value-Based ReimbursementsHealth Catalyst
The shift from fee-for-service to value-based reimbursements has good and bad consequences for healthcare. While the shift will ultimately help health systems provide higher quality lower cost care, the transition may be financially disastrous for some. In addition, the shifting revenue mix from commercial payers to Medicare and Medicaid is creating its own set of challenges. There are, however, three keys to surviving the transition: 1) Effectively manage shared savings programs to maximize reimbursement. 2) Improve operating costs. 3) Increase patient volumes. With an analytics foundation, health systems will be able to meet and survive today’s healthcare challenges.
Similar to PSOW 2012 - Quality & Reimbursement (20)
Sophisticated Prehospital Stroke Systems of CarePSOW
1. Kerry Ahrens discusses the importance of building a stroke system of care in Wisconsin to improve patient outcomes through faster treatment times.
2. Stroke is a leading cause of disability and costs $34 billion annually in the US. Building regional stroke systems can help optimize patient care through protocols to administer tPA within 30 minutes and transfer patients with large vessel occlusions to interventional centers within 90 minutes.
3. Effective collaboration between EMS, hospitals, and healthcare agencies is essential to establish standardized processes and monitor performance metrics to continually improve the efficiency of stroke care delivery.
The document summarizes a community paramedic pilot program between the South Area Fire District and Wausau Fire Department. The program aimed to reduce preventable hospital readmissions through home visits by paramedics within 48-72 hours of discharge. Initial results found lower than national readmission rates for heart failure, COPD and pneumonia patients, as well as high patient satisfaction ratings. The program demonstrated the potential for community paramedics to improve outcomes and lower healthcare costs through post-discharge support in the home.
This document summarizes Wisconsin's EMS program and provides updates from 2016. It outlines the number and types of EMS services and personnel in the state. It also reviews statewide call volumes from 2013 to 2016. The EMS section is described as having 7 staff members who license approximately 783 services and over 18,000 providers. Information is provided on the EMS website, WARDS data system, funding assistance program, licensing renewals, and E-Licensing. Healthcare coalitions and the EMS board are also summarized.
This document discusses the triggers and symptoms of trauma, stress, and mental health issues among firefighters and EMTs, such as depression, suicidal thoughts, substance abuse, and bullying. It notes that 57 firefighters died by suicide in 2013 and 2014, and a survey found 36% had thoughts of suicide and 6% attempted. It provides recommendations for what to do if someone exhibits signs of suicide risk, such as getting help from medical professionals or a crisis hotline. The document advocates for employee assistance programs, critical incident stress debriefing, and rehabilitation programs to help those struggling with mental health issues stemming from their work in emergency services.
Addiction is a chronic brain disease that involves pathological pursuit of reward and relief through substance use and other behaviors, despite their negative consequences. The brain's reward center is activated by natural rewards like food and sex but becomes dysfunctional in addiction. Genetics and life experiences influence this. For addicts, nothing else stimulates the reward center normally. Continued substance use or behaviors cause biological, psychological, social, and spiritual problems. Prevention focuses on healthy activities with family and friends while treatment requires confronting the issue with care but also firmness when needed.
This document summarizes a case where a paramedic pleaded guilty to tampering with a morphine supply. The paramedic confessed to starting to tamper with drugs in 2014 following a medical procedure. In early 2015, the ambulance company discovered issues with their morphine supply and notified authorities. An investigation revealed the paramedic had given patients water instead of pain medication on multiple occasions. He ultimately pleaded guilty to three counts of tampering with controlled substances. The case highlights the importance of secure drug storage, inventory control, and monitoring personnel for signs of diversion to protect patients and the agency.
This document discusses a study on the use of ketamine for prehospital sedation of patients experiencing excited delirium. The study aims to determine if ketamine is an effective and safe treatment option that allows emergency responders to control agitated patients and transport them for further care. The document outlines the goals, inclusion/exclusion criteria, procedures, and contact information for the Wisconsin ketamine study being conducted by Drs. Curtis and Cady.
2. About Your Presenter:
Jerry Miller, NREMT-P
CEO/President – LifeQuest Services
Jerry has been actively involved in the
EMS and fire industry for 33 years.
6. Accreditation
A process whereby a professional
association or non-governmental agency
grants recognition to a school or healthcare
institution for demonstrated ability to meet
pre-determined criteria for established
standards such as accreditation of hospitals
by the Joint Commission on Accreditation of
Healthcare Organizations.
7. Certification
A process in which an individual, an
institution, or an educational program is
evaluated and recognized as meeting certain
pre-determined standards. A Certification is
usually made by a non-governmental
agency.
8. Accreditation
Example:
National Academy of
Ambulance Coders (NAAC)
Certification
9. Accreditation
Example:
National Academy of
Emergency Dispatch (NAED)
Accreditation
10. Accreditation
Example:
Commission on Accreditation
of Ambulance Services (CAAS)
Accreditation
11. Accreditation
Example:
Commission on Accreditation of
Medical Transport Systems (camts)
Accreditation
14. Accreditation
Camts
Primary Focus:
Fixed Wing and Rotary Transportation as
well as Critical Care Ground Transport
15. Accreditation
camts
Will also provide accreditation for
ALS and BLS Ground Transportation
when related to a Critical Care
Transport Service that is accredited.
16. Accreditation
CAAS & camts
Primary Focus:
CAAS: Business processes
camts: Patient care and safety
17. Accreditation
CAAS & camts
Both CAAS and camts
evaluate reimbursement processes
within the organization as part of
accreditation.
18. Accreditation
CAAS & camts
When asked about reimbursement
being tied to accreditation…
19. Accreditation
CAAS
...CAAS does not place a lot
of emphasis on accreditation
being a key part of reimbursement
20. Accreditation
CAAS
...This was confirmed in discussions
with a former CAAS board member
and attorney at law
21. Accreditation
Camts
...camts is currently working
with CMS to explore having
reimbursement tied to accreditation.
22. Accreditation
Camts
In discussions with industry experts:
there seems to be some in-fighting
among air transportation providers at
this time with disagreements about who
should regulate the air ambulance
industry (FAA vs State)
23. Accreditation
camts
Other disagreements include:
Elevated reimbursement for more
sophisticated air transport systems
i.e., better equipment
and enhanced staffing
29. Accreditation
Jerry’s Crystal Ball
The next five years:
not much change for ground
ambulance in relationship to
accreditation and its
impact on reimbursement
32. Accreditation
Jerry’s Crystal Ball
Next five years:
Accreditation could have
impact on reimbursement
33. Accreditation
My Two Cents Worth
Regulate ourselves before we
are regulated by CMS
34. Accreditation
Accredited Center of Excellence
(EMD)
•Dane County Public Safety Communications
Madison WI
•Camts MedLink Air across Wisconsin
•Flight for Life Milwaukee WI
•Mayo Medical Transport Minnesota
•Gold Cross Ambulance Minnesota
35. Accreditation
CAAS
Wisconsin CAAS Accredited Services
•Rib Mountain Fire Department Wausau, WI
•Wisconsin Rapids Fire Department WI Rapids, WI
36. Accreditation
CAMTS Accredited Services
Wisconsin
•MedLink Air – La Crosse, WI
•Flight For Life – Milwaukee, WI
•Mayo Medical Transport – Minnesota
•Gold Cross Ambulance - Minnesota
40. Reimbursement Issues
2013 Medicare Rates
• 2013 Ambulance Inflation Factor
•Calculated by taking CPI-U
minus the MFP = AIF
41. Reimbursement Issues
2013 Medicare Rates
• MFP = multi-factor productivity
index (10 year moving average of
private non-farm businesses)
For 2013, estimated to be 1.1 to
1.2%
42. Reimbursement Issues
2013 Medicare Rates
• 2013 Ambulance Inflation Factor
estimated:
CPI-U at 1.7% minus 1.1% = an
Ambulance Inflation Factor 0.5 to
0.6%
43. Reimbursement Issues
Sequestration
• 2% reduction in Medicare
payments
•(eff: January 1, 2013)
•Result of “Super Committee”
failing to reach an agreement on
spending cuts
44. Reimbursement Issues
Sequestration
•This will likely not be resolved
prior to the elections.
45. Reimbursement Issues
Next Factor: Expiration of
Temporary Adjustments
Scheduled to expire on December 31, 2012
•2% increase for urban
•3% increase for rural
•22.6% increase for super rural
46. Reimbursement Issues
Let’s Do the Math
2013 Medicare Rates
•0.5 – 0.6% inflation (AFI)
•Minus temporary adjustments
•Minus additional 2%
(sequestration)
•Approximately 3.5% loss in MC rates
based on loss of urban adjustments
47. Reimbursement
Legislative Update
MedPAC
•MedPAC to study ambulance reimbursement
•Study appropriateness of temporary adjustments
•The need to affirm current payment structure
•Including permanent ambulance relief
•Expected to show the same results as the last report
from 2007
2007 GAO Report
•Medicare pays an average of 6% below cost
•17% below cost in super rural areas
48. Reimbursement
Permanent Ambulance Relief
Current Proposed Legislation
Medicare Ambulance Access Preservation Act (MAAPA)
•6% increase for urban and rural transports
•22.6% increase for super rural
•This is for 2012-2016
•Still pending; building support from legislature
49. Reimbursement
Payment Data
Fiscal Year 2010
•Total spent on ambulance transport including air
ambulance:
$4,589,990,960
50. Reimbursement
Payment Data
That was a 1.66% increase from
the year before (2009)
52. Reimbursement
Payment Data
•Houston, TX area – 9 out of 10 patients
transported for dialysis go by ambulance.
•Nationwide the average is 1 in 10
53. Reimbursement
Payment Data
•Puerto Rico recently on a per capita basis were
transporting more patients by ambulance for
dialysis than the entire state of New York
54. Reimbursement
Overpayments
•Sixty day requirement to report and return
overpayments
•Significant false claim act liability
•Overpayments must be returned 60 days after
it’s been identified
•There was some discussion about clarifying
when an overpayment has been “identified”
55. Reimbursement
Overpayments
•AAA is asking that overpayment not be
“identified” until the latter of:
•Exhaustion of appeal rights
•Expiration of time to appeal under the
next level
56. Reimbursement
Revalidation
•CMS is requiring all Medicare providers and
suppliers to “revalidate” their Medicare
enrollment information
•Current target date is March of 2015
•Contractors have been given the discretion I
went to revalidate each provider group
57. Reimbursement
Revalidation
•Every service will require a site inspection
•There is one company in the US providing these
inspections – don’t expect this any time soon
•No advance notice provided
58. Reimbursement
PECOS
Provider Enrollment, Chain &Ownership System
•Medicare’s electronic enrollment database
•CMS wants all providers and suppliers
enrolled in PECOS by the end of the year
•If Medicare sends you a request to
revalidate, you have 60 days
•Failure to respond can result in termination
of your billing privileges with a potential one
year band on “re-enrollment”
59. Reimbursement
ANSI 5010
•Initial implementation date – 1/1/2012
•Enforcement delays through 6/20/2012
60. Reimbursement
Wisconsin Carrier
•WPS
•Appealing CMS decision
•Currently in dispute
•Wisconsin could end up in Region 6 and
potentially be administered by Noridian
61. Reimbursement
Co-Insurance Waivers
•Opinion issued 6/20/2012
•Permitted a non-profit ambulance service to
waive co-payments due from county residents
that had paid an EMS user fee
•Membership/user fee must exceed the amount
being waived
62. Reimbursement
ICD-10 Codes
•Implementation date now pushed to October
1st, 2014
63. Reimbursement
Healthcare Reform
•Court held that individual mandate was a
valid exercise of congress’ power to levy
taxes
•That was a 5 to 4 decision
64. Reimbursement
Affordable Care Act (ACA)
•ACA will require all states to expand their
Medicaid program to include all individuals with
incomes up to 133% of the federal poverty level
•Federal govt will pick up 100% of initial cost
and 90% of the costs in 2020
•Penalty for failing to meet this mandate would
be forfeiture of all Medicaid dollars
65. Reimbursement
Affordable Care Act (ACA)
•By a 5 to 4 margin, the court held that any
constitutional problem could be remedied
by rewriting “the law to allow any state
that opted out of the Medicaid expansion
to keep existing Medicaid funding”
66. Reimbursement
Effects of Court Decision
•ACA implementation will go forward
•States will have the option to:
•Expand their Medicaid programs and accept
federal money to cover cost for these
additional recipients
•Elect not to expand their programs and keep
only the money they currently receive from
the federal government
67. Reimbursement
Healthcare Exchanges
•ACA requires states to establish state exchanges
68. Reimbursement
Exchange Timeline
• 2010 – Passage of ACA
• 2011 – Release of exchanged propose rule
• 2011 – Release of essential healthcare benefit
guidance
• 2012 – Release of final exchange rule
• 2014 – Exchange is implemented
69. Reimbursement
Accountable Care Organizations
(ACO)
•A network of hospitals, physicians that will
share responsibility for providing care to patients
•ACO would be responsible for pre-
hospital, inpatient acute care, and post-acute
care patients
•Goal is to replace insurance company as the
gatekeeper
•Ultimately a capitated payment program
70. Reimbursement
Fraud
Texas Dialysis
•Trailblazer in Texas now requires pre-payment
review after patient’s twelfth transport per year
•90+% denial rate
71. Reimbursement
Fraud
Puerto Rico Dialysis
•2008 Medicare data – estimated that Puerto
Rico has 620,000 Medicare beneficiaries
•They had 407,000 dialysis transports
•Comparatively, CA, FL, and NY combined have
an estimated 11 million Medicare beneficiaries
and 356,000 dialysis transports
•The answer...