PYA hosted a complimentary one-hour webinar aimed at helping independent medical group owners, partners and practice executives, law firms, and financial advisors by offering strategies for physician practice survival. Practices are exploring every avenue to remain solvent while health systems express concerns about the survival of the independent groups in their communities.
PYA Principals Lori Foley and Jeff Bushong, along with Consultant Katie Ray, discussed:
Cash flow support, including the CARES Act Paycheck Protection Program and Medicare Advance Payments.
Staffing considerations, including the Families First Coronavirus Response Act (FFCRA), pay reductions, and furloughs.
Operations during crisis management, including topline revenue preservation and expense reductions.
The webinar took place Monday April 6, 2020, at 11:00 am EDT.
2020 Emergency Relief For Employers Called “Paycheck Protection Plan” Created...CMP
On March 27, 2020, President Trump signed Coronavirus Aid, Relief, and Economic Security Act (CARES Act), aimed at providing financial relief for American businesses in response to the economic fallout from the fast-developing coronavirus (COVID-19) pandemic.
CARES ACT - Economic Relief to Families and BusinessesRajesh Damarapati
CARES ACT is aimed at providing relief for individuals and businesses that have been negatively impacted by the coronavirus outbreak. While that is great news, in and of itself, presentation covers some of the key provisions included in the bill and what that may mean for you
CARES ACT - Economic Relief to Families and BusinessesRajesh Damarapati
CARES ACT is aimed at providing relief for individuals and businesses that have been negatively impacted by the coronavirus outbreak. While that is great news, in and of itself, presentation covers some of the key provisions included in the bill and what that may mean for you
2020 Emergency Relief For Employers Called “Paycheck Protection Plan” Created...CMP
On March 27, 2020, President Trump signed Coronavirus Aid, Relief, and Economic Security Act (CARES Act), aimed at providing financial relief for American businesses in response to the economic fallout from the fast-developing coronavirus (COVID-19) pandemic.
CARES ACT - Economic Relief to Families and BusinessesRajesh Damarapati
CARES ACT is aimed at providing relief for individuals and businesses that have been negatively impacted by the coronavirus outbreak. While that is great news, in and of itself, presentation covers some of the key provisions included in the bill and what that may mean for you
CARES ACT - Economic Relief to Families and BusinessesRajesh Damarapati
CARES ACT is aimed at providing relief for individuals and businesses that have been negatively impacted by the coronavirus outbreak. While that is great news, in and of itself, presentation covers some of the key provisions included in the bill and what that may mean for you
Debt Relief For Small Businesses- Requirements for Your Loan Application – CO...Sylvie Luanghy
Since most banks are not yet ready to start accepting loan applications for the SBA Paycheck Protection Program, I decided to do some research on the program and put a quick PowerPoint overview for those who still lack information on the program eligibility requirements.
CARES Act Update - What you Need to Know Heading into 2021Citrin Cooperman
During this webinar we focused on the interplay between the different CARES Act provisions, in particular PPP loans, Provider Relief Funds, and Medicare Advanced Payments, and how they may impact 2020 year-end planning and 2021 forecasting.
January 2021 Tax Tips Newsletter
Harman CPA PDF Of Jan 2021 Newsletter Content
JANUARY 2021 NEWSLETTER CONTENT WHICH
APPEARED ON OUR WEBSITE
John Harman, CPA PLLC
1402 S. Custer Rd, S-102
McKinney, TX 75070
info@mckinneytax.com
Phone: (469) 742-0283
https://www.mckinneytax.com/
YouTube videos here: https://www.youtube.com/user/mckinneytax
John Harman, CPA PLLC, January 2021 Tax Tips Newsletter, mckinneytax, JANUARY 2021 NEWSLETTER
Payroll Webinar: A to Z of Garnishments Part 1Ascentis
In this three part series on the proper handling and processing of garnishments we will discussed the rules, regulations and requirements as they apply to withholding and paying child support, tax levies, creditor garnishments and others.
In Part 1 we focus on Child Support. Payroll departments must know both the federal laws and the state laws and must determine which one applies to the child support withholding order. In addition to these laws and regulations, the federal rules now require that a standard Income Withholding Order (IWO) be used for all child support withholding garnishments. This webinar will review this form and its requirements. And although the IWO can include all the information necessary to comply with the order, employers must familiarize themselves with both federal and state regulations to avoid penalties and liabilities. Withholding monies for child support is not the only requirement that applies to providing for a child, medical support orders are required to be process by payroll as well. And these orders have their own rules and regulations on both the federal and state level.
This presentation provides an overview of the road map needed to avoid the land mines and traps related to Medicaid. Proper planning is needed to preserve a legacy, cover final expenses and still be eligible for all available Medicaid benefits.
Covid19 guidance for multiemployer plans and labor unions webinarWithum
COVID-19 Guidance: Multiemployer Plans and Labor Unions
In this webinar we talk about how COVID-19 is impacting Multiemployer Plans and Labor Unions, including relief programs and FAQs
How to Avoid a Head-on Collision with The Cadillac TaxBill Conlan
The Webinar addressed what state and local governments need to know about how other provisions of reform that take effect beginning in 2010 will complicate the challenge of meeting the thresholds – and that the time to begin planning for the Cadillac tax is now.
The presenters provided details on the Cadillac tax and factors that complicate compliance with premium thresholds such as the removal of traditional coverage limits, the increase in the dependent eligibility age, additional fees, mental health parity and the estimated 16 million more Americans who will receive Medicaid.
Coronavirus emergency loans via cares act -small business guide & che...Mark Weber
Banks are still waiting for guidance from the regulatory agencies as to how these loans are to be administered and which banks will be able to provide the loan. It may take up to two weeks before they can begin accepting applications. The recommendation is to make contact with your banking relationships ASAP since there will be a lot of asks coming in short order. You should tell the bank that you plan to apply and ask for updates as they learn more.
US Chamber Small Business ELA Loan GuidePaula Carr
The Coronavirus Aid, Relief, and Economic Security (CARES) Act allocated $350 billion to help small businesses keep workers employed amid the pandemic and economic downturn. Known as the Paycheck Protection Program,
the initiative provides 100% federally guaranteed loans to small businesses who maintain their payroll during
this emergency.
The Medicare S-10 and Uncompensated Care AuditsPYA, P.C.
Jonathan Skaggs, PYA Senior Manager, along with attorney Chris Kenny, a partner with King & Spalding, offered an in-depth look at the CMS 2552-10 Medicare cost report worksheet S-10.
Webinar: So You Have a PPP Loan. Now What?PYA, P.C.
The CARES Act provides relief to small businesses through Paycheck Protection Program (PPP) loans, but receiving the loan is only the first part of the equation. PYA discussed what businesses need to know and do next.
Failure to fully understand the requirements for PPP loan forgiveness could cost employers money, at a time when every penny counts. Employers need to stay up-to-date on recent activities regarding the PPP loan forgiveness application, necessary documentation, and other best practices to ensure they are well-prepared for the next steps under the PPP.
As part of PYA’s ongoing commitment to sharing helpful guidance, Tax Principals Debbie Ernsberger and Mark Brumbelow outlined PPP loan forgiveness requirements and answered questions during a one-hour webinar on Wednesday, June 3, 2020.
Based on Treasury Guidance as of 4/6/2020, Donaldson Legal Counseling PLLC presents Q & A of the Paycheck Protection Program from the CARES Act
https://attorneylawny.com/paycheck-protection-program/
Debt Relief For Small Businesses- Requirements for Your Loan Application – CO...Sylvie Luanghy
Since most banks are not yet ready to start accepting loan applications for the SBA Paycheck Protection Program, I decided to do some research on the program and put a quick PowerPoint overview for those who still lack information on the program eligibility requirements.
CARES Act Update - What you Need to Know Heading into 2021Citrin Cooperman
During this webinar we focused on the interplay between the different CARES Act provisions, in particular PPP loans, Provider Relief Funds, and Medicare Advanced Payments, and how they may impact 2020 year-end planning and 2021 forecasting.
January 2021 Tax Tips Newsletter
Harman CPA PDF Of Jan 2021 Newsletter Content
JANUARY 2021 NEWSLETTER CONTENT WHICH
APPEARED ON OUR WEBSITE
John Harman, CPA PLLC
1402 S. Custer Rd, S-102
McKinney, TX 75070
info@mckinneytax.com
Phone: (469) 742-0283
https://www.mckinneytax.com/
YouTube videos here: https://www.youtube.com/user/mckinneytax
John Harman, CPA PLLC, January 2021 Tax Tips Newsletter, mckinneytax, JANUARY 2021 NEWSLETTER
Payroll Webinar: A to Z of Garnishments Part 1Ascentis
In this three part series on the proper handling and processing of garnishments we will discussed the rules, regulations and requirements as they apply to withholding and paying child support, tax levies, creditor garnishments and others.
In Part 1 we focus on Child Support. Payroll departments must know both the federal laws and the state laws and must determine which one applies to the child support withholding order. In addition to these laws and regulations, the federal rules now require that a standard Income Withholding Order (IWO) be used for all child support withholding garnishments. This webinar will review this form and its requirements. And although the IWO can include all the information necessary to comply with the order, employers must familiarize themselves with both federal and state regulations to avoid penalties and liabilities. Withholding monies for child support is not the only requirement that applies to providing for a child, medical support orders are required to be process by payroll as well. And these orders have their own rules and regulations on both the federal and state level.
This presentation provides an overview of the road map needed to avoid the land mines and traps related to Medicaid. Proper planning is needed to preserve a legacy, cover final expenses and still be eligible for all available Medicaid benefits.
Covid19 guidance for multiemployer plans and labor unions webinarWithum
COVID-19 Guidance: Multiemployer Plans and Labor Unions
In this webinar we talk about how COVID-19 is impacting Multiemployer Plans and Labor Unions, including relief programs and FAQs
How to Avoid a Head-on Collision with The Cadillac TaxBill Conlan
The Webinar addressed what state and local governments need to know about how other provisions of reform that take effect beginning in 2010 will complicate the challenge of meeting the thresholds – and that the time to begin planning for the Cadillac tax is now.
The presenters provided details on the Cadillac tax and factors that complicate compliance with premium thresholds such as the removal of traditional coverage limits, the increase in the dependent eligibility age, additional fees, mental health parity and the estimated 16 million more Americans who will receive Medicaid.
Coronavirus emergency loans via cares act -small business guide & che...Mark Weber
Banks are still waiting for guidance from the regulatory agencies as to how these loans are to be administered and which banks will be able to provide the loan. It may take up to two weeks before they can begin accepting applications. The recommendation is to make contact with your banking relationships ASAP since there will be a lot of asks coming in short order. You should tell the bank that you plan to apply and ask for updates as they learn more.
US Chamber Small Business ELA Loan GuidePaula Carr
The Coronavirus Aid, Relief, and Economic Security (CARES) Act allocated $350 billion to help small businesses keep workers employed amid the pandemic and economic downturn. Known as the Paycheck Protection Program,
the initiative provides 100% federally guaranteed loans to small businesses who maintain their payroll during
this emergency.
The Medicare S-10 and Uncompensated Care AuditsPYA, P.C.
Jonathan Skaggs, PYA Senior Manager, along with attorney Chris Kenny, a partner with King & Spalding, offered an in-depth look at the CMS 2552-10 Medicare cost report worksheet S-10.
Webinar: So You Have a PPP Loan. Now What?PYA, P.C.
The CARES Act provides relief to small businesses through Paycheck Protection Program (PPP) loans, but receiving the loan is only the first part of the equation. PYA discussed what businesses need to know and do next.
Failure to fully understand the requirements for PPP loan forgiveness could cost employers money, at a time when every penny counts. Employers need to stay up-to-date on recent activities regarding the PPP loan forgiveness application, necessary documentation, and other best practices to ensure they are well-prepared for the next steps under the PPP.
As part of PYA’s ongoing commitment to sharing helpful guidance, Tax Principals Debbie Ernsberger and Mark Brumbelow outlined PPP loan forgiveness requirements and answered questions during a one-hour webinar on Wednesday, June 3, 2020.
Based on Treasury Guidance as of 4/6/2020, Donaldson Legal Counseling PLLC presents Q & A of the Paycheck Protection Program from the CARES Act
https://attorneylawny.com/paycheck-protection-program/
Small business owners guide to the cares actVijar Kohli
The programs and initiatives in the Coronavirus Aid, Relief, and Economic Security (CARES) Act that was just passed by Congress are intended to assist business owners with whatever needs they have right now. When implemented, there will
be many new resources available for small businesses, as well as certain nonprofits and other employers. This guide provides information about the major programs and initiatives that will soon be available from the Small Business Administration (SBA) to address these needs, as well as some additional tax
provisions that are outside the scope of SBA.
What the CARES Act Means for Independent Workers and Small BusinessesMBO Partners
What does the CARES Act mean for independent workers and small businesses? MBO Partners explains the nuances of this important act for COVID-19 relief.
PPP Loan Forgiveness and Tax Considerations For the Construction IndustryWithum
Withum’s Construction Services Team is partnered up with New Jersey Subcontractors Association and New Jersey Land Improvement Contractors of America to host a forum regarding Paycheck Protection Program (PPP) Loan Forgiveness and Tax Considerations for the Construction Industry.
How Your Company is Affected by the CARES Act and Related LegislationRoger Royse
"Idea to IPO" Webinar description:
The U.S. government is providing relief and stimulating the economy through the $2 TRILLION CARES Act of 2020 and other measures to help corporations, small businesses, and people laid off due to the COVID-19 crisis.
The speaker will discuss:
1) What is the CARES Act of 2020?
2) What does the CARES Act of 2020 hope to achieve?
3) Will there be follow up programs to come?
4) How can entrepreneurs and small businesses benefit from the CARES ACT of 2020?
5) How does one go about applying for grants and loans administered under the CARES ACT of 2020?
6) What are the new rules relating to sick leave and paid leave?
7) What COVID-19 related tax incentives are available to companies?
and more!
Leveraging Federal Financial Assistance Programs During COVID-19Kareo
Bill Finerfrock, HBMA Director of Government Affairs, will break down the CARES Act and its associated programs to provide you with key takeaways to help ease financial burdens and maintain current staff levels.
In this webinar, Bill will discuss:
-New Paycheck Protection Program
-Other SBA (Small Business Association) programs
-Medicare Advanced Payment Options
-Provider Lost Revenue Program
Coronavirus Financial Assistance ProgramsMark Gottlieb
[Attorneys of All Disciplines] Under The Caption - "Must Be Shared" - Download our PowerPoint Presentation discussing the various Coronavirus Financial Assistance Programs. Many of you are also eligible. Call us if you need further assistance.
[퐀퐭퐭퐨퐫퐧퐞퐲퐬 퐨퐟 퐀퐥퐥 퐃퐢퐬퐜퐢퐩퐥퐢퐧퐞퐬] 퐔퐧퐝퐞퐫 퐓퐡퐞 퐂퐚퐩퐭퐢퐨퐧 - "퐌퐮퐬퐭 퐁퐞 퐒퐡퐚퐫퐞퐝"- Download our PowerPoint Presentation discussing the various Coronavirus Financial Assistance Programs. Many of you are eligible. Call us if you need further assistance.
We encourage every dentist to follow state mandates, review and adhere to the ADA and CDC guidelines and to use their best judgment to serve and protect their patients and teams at this time.
“CARES Act Provider Relief Fund: Opportunities, Compliance, and Reporting”PYA, P.C.
PYA Principal Martie Ross spoke at the virtual North Carolina Healthcare Association Critical Access Hospital Statewide Meeting. The two-day event, “Quality Focus is a Finance Focus,” provided critical access hospital leaders with the opportunity to network and review data-informed strategies as well as updates to the Medicare Flexibility Program Project. It also provided guidance on federal compliance and tracking of Provider Relief Funds.
In “CARES Act Provider Relief Fund: Opportunities, Compliance, and Reporting,” Martie gave an overview of the history of distribution of those funds as well as regulations and guidelines including:
Statutory Language
Reporting Requirements
Use of Funds Calculation
Expenses
Risk Management
Martie presented Thursday, March 4, 2021.
If you would like guidance related to Provider Relief Fund regulations, or for assistance with any matter related to strategy and integration, compliance, or valuation, contact one of our PYA executives at (800) 270-9629.
PYA Presented on 2021 E/M Changes and a CARES Act Update During GHA Complianc...PYA, P.C.
The Georgia Hospital Association (GHA) Compliance Officers Roundtable, an active GHA group that meets quarterly and includes educational sessions featuring government representatives, industry experts, and other thought leaders speaking about compliance-related issues, conducted their latest meeting virtually. PYA Principals Lori Foley, Tynan Kugler, and Valerie Rock were among the presenters at this quarter’s event. In their session, they:
Described key elements associated with 2021 E/M changes, and strategies for preparation and implementation.
Explained the impact of 2021 E/M changes on physician compensation and contracting, including potential mitigation approaches.
Presented key components of Stark Law and Anti-Kickback Statute final rules.
Provided an update on the CARES Act.
The Compliance Certification Board offered CEUs for this event, which took place on Friday, December 4, 2020.
Webinar: “Trick or Treat? October 22nd Revisions to Provider Relief Fund Repo...PYA, P.C.
On October 22nd, the Department of Health and Human Services released revised Provider Relief Fund (PRF) reporting requirements. Under HHS’ September 19 directive, “lost revenue” was defined narrowly as a negative change in year-over-year patient care operating net income. Now, HHS will permit providers to use PRF funds to cover the difference between their 2019 and 2020 actual patient care revenue with some adjustments for COVID-related expenses. The October 22nd notice is available here.
PYA Principals Martie Ross and Michael Ramey hosted a complimentary 30-minute webinar, “Trick or Treat? October 22nd Revisions to Provider Relief Fund Reporting Requirements” on Thursday, October 29th.
“Regulatory Compliance Enforcement Update: Getting Results from the Guidance” PYA, P.C.
PYA Principal and Chief Compliance Officer Shannon Sumner and Consulting Senior Manager Susan Thomas presented “Regulatory Compliance Enforcement Update: Getting Results from the Guidance” at the virtual 2020 Montana Healthcare Conference. They reviewed the sources of regulatory enforcement and investigation information—guidelines, statutory updates, best practices, settlements, case studies, etc.—available to healthcare organizations. They will also discuss how to interpret and implement the guidance in order to strengthen the compliance function and protect the organization. The presentation covered:
Compliance regulatory requirements for healthcare organizations.
Guidance available for consideration in organizational compliance programs.
Internal and external reporting to ensure regulatory requirements are met.
Best practices for implementation of guidance.
Case studies for illustration of guidance implementation.
“Federal Legislative and Regulatory Update,” Webinar at DFWHCPYA, P.C.
The Dallas Fort Worth Hospital Council (DFWHC) and PYA co-hosted an exclusive complimentary webinar, “Federal Legislative and Regulatory Update,” on Wednesday, September 23.
DFWHC President/CEO Stephen Love hosted a discussion with PYA Senior Manager Kathy Reep about concerns that have dropped from the radar during the last four months of COVID-19, addressing issues for which hospitals must prepare in approaching 2021. This session focused on these key areas:
Appropriate use criteria
Transparency
Site neutral payments
The future of the Medicare Trust Fund
The federal budget
Key provisions of the final rule for the inpatient prospective payment system for FY2021 and the proposed outpatient rule for CY2021
On-Demand Webinar: Compliance With New Provider Relief Funds Reporting Requir...PYA, P.C.
On September 19, the Department of Health and Human Services (HHS) published its Post-Payment Notice of Reporting Requirements. The Notice details the reporting requirements for all Provider Relief Fund (PRF) recipients that have received $10,000 or more in aggregate payments.
Under the PRF Terms and Conditions, a recipient may use the funds only for healthcare-related expenses and lost revenue attributable to coronavirus. The Notice provides the clearest direction to date regarding permissible uses of PRF funds.
PYA offered a 45-minute complimentary webinar that explained the new reporting requirements and delved into permissible uses. While many questions remain, we provided practical advice on the next steps in the reporting process.
The webinar took place Monday, October 5 at 11 a.m. EDT.
Webinar: “While You Were Sleeping…Proposed Rule Positioned to Significantly I...PYA, P.C.
You likely know from the headlines that the 2021 Medicare Physician Fee Schedule (MPFS) Proposed Rule slashes payments for surgical specialists. But the impact of the Proposed Rule is far broader, reflecting a fundamental realignment driven by the transition to value-based payments. In our webinar, “While You Were Sleeping…Proposed Rule Positioned to Significantly Impact Physician Compensation,” PYA experts addressed these proposals, helping you understand and prepare for the changes ahead.
Following this presentation, attendees were able to:
Understand how a handful of wRVU changes would alter Medicare reimbursement for nearly all physicians.
Appreciate the operational impact of these changes.
Recognize the challenges to existing physician compensation models.
Identify strategies and tactics to prepare for and manage these impacts.
Presenters include PYA Principals Angie Caldwell, Martie Ross, and Valerie Rock. The webinar took place Thursday, September 10 and was hosted in conjunction with the Florida Hospital Association.
If you have additional questions about the MPFS Proposed Rule and its impact on physician compensation or need assistance with any matter involving physician compensation, valuation, strategy and integration, or compliance, contact a PYA executive below at (800) 270-9629.
Webinar: “Cybersecurity During COVID-19: A Look Behind the ScenesPYA, P.C.
Cybersecurity breaches have been in the news almost daily for some time now. COVID-19 has amplified the problem, as “bad actors” seize upon the opportunity to take advantage of hospitals at their most vulnerable time. Given this climate and an aging HIPAA rule, it is difficult to anticipate and prepare for the future.
PYA Principal Barry Mathis presented “Cybersecurity During COVID-19: A Look Behind the Scenes,” on Wednesday, August 12, 2020. This one-hour, complimentary webinar was hosted by PYA in conjunction with the Montana Hospital Association as Part 2 of the Frontier States Town Hall Meeting.
Barry covered information related to HIPAA, cybersecurity, and a special behind-the-scenes view into the tradecraft of bad actors. This unique presentation included:
Recent enforcement trends by the Office for Civil Rights.
The current environment for ransomware.
An opportunity to watch as Barry logs onto the Dark Web and shows you first-hand how bad actors operate.
Ideas for managing cybersecurity threats.
On Friday, August 21, 2020, a webinar co-hosted by PYA prepared hospitals for a new rule taking effect on January 1, 2021, to address price transparency in healthcare. The Centers for Medicare & Medicaid Services published a rule in November 2019 requiring hospitals to establish, update, and make public a list of their standard charges for items and services they provide. In addition to the current requirement to post standard charges on their websites, the Final Rule requires hospitals to publish online, in a machine-readable format, their payer-specific negotiated rates for 300 “shoppable” services and their standard charges for all items and services provided, defined as the gross charge, payer-specific negotiated charges, discounted cash price, and the de-identified minimum and maximum charges.
As we approach January 2021, it is vital that hospitals understand the requirements of the pricing transparency rule and options for compliance. It is unlikely that this rule will “go away”–court decisions are always subject to appeal, and there is even concern that Congress is considering action that would transform these requirements from regulation to legislation.
During the complimentary webinar, PYA Senior Manager Kathy Reep discussed hospital requirements related to pricing transparency, and Chris Kenny, Partner in the Washington, D.C., office of King & Spalding, addressed concerns related to compliance and the legal challenges associated with the final transparency rule.
This webinar was presented in conjunction with:
Dallas-Fort Worth Hospital Council
Florida Hospital Association
Georgia Hospital Association
Kansas Hospital Association
Louisiana Hospital Association
Montana Hospital Association
Not a surprise to most — healthcare is making headlines on an international level. Though not front and center, still of importance to the hospital community are issues working their way through government agencies and the legislature.
As one of the keynote speakers of this year’s virtual Florida Institute of CPAs Health Care Industry Conference, PYA Senior Manager Kathy Reep presented a “Federal Legislative and Regulatory Update.” She covered a number of current issues affecting healthcare providers, including:
Price transparency.
Congressional action on surprise billing.
The Administration’s budget for 2021.
Medicare proposed rules related to hospital inpatient payments and post-acute care for FY2021.
The virtual event took place June 23-24, 2020.
Webinar: Post-Pandemic Provider Realignment — Navigating An Uncertain MarketPYA, P.C.
The COVID-19 pandemic will materially affect U.S. provider industry structure, as financial weaknesses are exposed, risk tolerances are tested, and uncertainties persist. As a result, provider mergers-and-acquisitions (M&A) activities across industry sectors will likely spike in the short- to medium-term future. Providers of all types need to be aware of, and prepared for, the changes they will face.
In this 45-minute joint webinar, PYA Principal Brian Fuller and Juniper Advisory Managing Director Jordan Shields provided a real-time assessment of the COVID-19 pandemic, as well as shared predictions for what the extending crisis means in coming years for M&A activity in the provider space.
The webinar took place Thursday, August 6, 2020, at 11 a.m. EDT.
Since March, PYA experts have closely tracked and carefully evaluated the pandemic’s impact on employed physician compensation. During this complimentary one-hour webinar, PYA Principals Angie Caldwell and Martie Ross highlighted five immediate considerations for hospitals and health systems to manage the storm. They also explored five longer-term considerations impacting future planning.
This webinar took place Friday, July 24, 2020, at 11 a.m. EDT, and was held in conjunction with:
Dallas-Fort Worth Hospital Council
Florida Hospital Association
Kansas Hospital Association
Montana Hospital Association
The COVID-19 pandemic has exposed organizational and industry weaknesses. To build a more resilient delivery system, leaders now must engage their governing boards in re-calibrating strategic plans, re-evaluating investments, and re-imagining hospitals’ and health systems’ roles in their communities.
In this 45-minute webinar, PYA Principals Martie Ross and Brian Fuller provided a framework for these critical discussions including root-cause analysis, market assessment, new realities, guiding principles, and strategic and operational priorities.
This webinar originally took place on Wednesday, June 24, 2020.
Webinar: Free Money with Strings Attached – Cares Act Considerations for Fron...PYA, P.C.
PYA, in conjunction with the Montana Hospital Association, recently co-hosted a Frontier States Town Hall Meeting webinar, “Free Money With Strings Attached: CARES Act Considerations for Frontier States’ Healthcare Provider Organizations.” Principals Lori Foley, Martie Ross, and David McMillan introduced the CARES Act Provider Relief Fund including distribution formulas, the attestation process, the verification and application process, and ongoing recordkeeping requirement. They also answered attendees’ numerous questions regarding these matters.
Webinar: “Got a Payroll? Don’t Leave Money on the Table”PYA, P.C.
Under the CARES Act, every employer with a payroll has an opportunity to retain cash–whether they have a PPP loan or not. What employers need to know right now.
The Coronavirus Aid, Relief, and Economic Security Act (CARES Act) along with the Payroll Protection Program (PPP) offer all business owners relief, but the details can be confusing or overlooked.
Perhaps you don’t fully understand how the deferral of the employer’s share of Social Security taxes works. Maybe you wonder if the deferral even applies to you—good news, it does if you have a payroll!
Failure to fully understand your options could cost you money, at a time when “cash is king.”
As part of PYA’s ongoing commitment to sharing helpful guidance, Tax Principals Debbie Ernsberger and Mark Brumbelow outlined issues and opportunities within the CARES Act, and answered questions during a one-hour webinar that originally aired on Wednesday, May 20, 2020.
Webinar: “Making It Work—Physician Compensation During the COVID-19 Pandemic”PYA, P.C.
What to do with your physician compensation plan in the face of the COVID-19 pandemic? It’s a question that leaves administrators searching for answers.
PYA Principal Angie Caldwell and Senior Manager Katie Culver introduced several key considerations for provider compensation during and after the COVID-19 pandemic. In PYA’s complimentary webinar, they:
Summarized the current environment impacting physician compensation associated with the pandemic.
Provided an overview of the Stark Blanket Waivers and opportunities created for physician compensation.
Described restoration and recovery strategies for physician resources.
PYA hosted this one-hour webinar Tuesday, April 28, 2020, at 11 a.m. EDT in conjunction with the Florida Hospital Association.
Webinar: “Provider Relief Fund Payments – What We Know, What We Don’t Know, W...PYA, P.C.
The federal government is now making CARES Act Relief Fund payments to Medicare providers. These payments are not loans—they do not have to be repaid or forgiven. However, this money comes with strings attached.
During PYA’s 30-minute webinar, Provider Relief Fund Payments—What We Know, What We Don’t Know, What To Do Now, PYA Principals Martie Ross and Lori Foley discussed:
The source of the funds.
The required attestation process.
Compliance, tax, and audit concerns.
The webinar took place Friday April 17, 2020.
Webinar: “Hospitals, Capital, and Cashflow Under COVID-19”PYA, P.C.
Hospitals and providers need to think creatively, strategically, and long-term about capital and cashflow under the pressures of the COVID-19 pandemic. A one-hour webinar hosted by PYA discussed the current state of capital markets for non-profit healthcare systems, and considerations for capital management, including the role of real estate assets.
PYA Principal Michael Ramey joined Realty Trust Group Senior Vice-President Michael Honeycutt and Ponder & Company Managing Director Jeffrey B. Sahrbeck to present “Hospitals, Capital, and Cashflow, Under COVID-19” In this webinar, they covered:
Hospital industry capital market updates and trends, including how the capital markets are responding to the crisis.
Access to capital under recent regulations.
Cash preservation techniques for hospitals considering real estate operations and assets.
The webinar took place Thursday, April 9, 2020, at 11 a.m. EDT.
PYA Webinar: “Additional Expansion of Medicare Telehealth Coverage During COV...PYA, P.C.
Late on March 30, CMS released an interim rule which, among other things, significantly expands Medicare telehealth coverage, even beyond the initial Section 1135 waivers. PYA’s complimentary one-hour webinar explained these changes and how they make telehealth an even more attractive option in response to the COVID-19 pandemic.
PYA Principals Martie Ross and Valerie Rock addressed the latest developments, including:
New reimbursement for telephone-only services.
Broader coverage for remote patient monitoring.
New payments for rural health clinics and federally qualified health centers.
Use of telehealth to meet supervision requirements.
New rules regarding coding and billing as well as the changed payment rates for telehealth services.
The webinar took place Friday April 3, 2020, at 11 a.m. EDT.
Webinar: “Getting Online with Telehealth: Practical Guidance for Physician Pr...PYA, P.C.
Medicare’s decision to reimburse for telehealth services, concerns for patient and staff safety, and the loss of revenue from canceled elective procedures are leading many physician practices to consider providing or expanding telehealth services.
During this webinar, PYA’s panel of heavy-hitting experts provided guidance physician practices can use to rollout, or further tap into, the telehealth opportunity. The presenters discussed:
Technology options and speed-to-implementation.
Solutions to internal process challenges.
Patient engagement in telehealth.
PYA hosted this one-hour webinar Thursday, March 26, 2020, at 4 p.m. EDT.
The dimensions of healthcare quality refer to various attributes or aspects that define the standard of healthcare services. These dimensions are used to evaluate, measure, and improve the quality of care provided to patients. A comprehensive understanding of these dimensions ensures that healthcare systems can address various aspects of patient care effectively and holistically. Dimensions of Healthcare Quality and Performance of care include the following; Appropriateness, Availability, Competence, Continuity, Effectiveness, Efficiency, Efficacy, Prevention, Respect and Care, Safety as well as Timeliness.
Medical Technology Tackles New Health Care Demand - Research Report - March 2...pchutichetpong
M Capital Group (“MCG”) predicts that with, against, despite, and even without the global pandemic, the medical technology (MedTech) industry shows signs of continuous healthy growth, driven by smaller, faster, and cheaper devices, growing demand for home-based applications, technological innovation, strategic acquisitions, investments, and SPAC listings. MCG predicts that this should reflects itself in annual growth of over 6%, well beyond 2028.
According to Chris Mouchabhani, Managing Partner at M Capital Group, “Despite all economic scenarios that one may consider, beyond overall economic shocks, medical technology should remain one of the most promising and robust sectors over the short to medium term and well beyond 2028.”
There is a movement towards home-based care for the elderly, next generation scanning and MRI devices, wearable technology, artificial intelligence incorporation, and online connectivity. Experts also see a focus on predictive, preventive, personalized, participatory, and precision medicine, with rising levels of integration of home care and technological innovation.
The average cost of treatment has been rising across the board, creating additional financial burdens to governments, healthcare providers and insurance companies. According to MCG, cost-per-inpatient-stay in the United States alone rose on average annually by over 13% between 2014 to 2021, leading MedTech to focus research efforts on optimized medical equipment at lower price points, whilst emphasizing portability and ease of use. Namely, 46% of the 1,008 medical technology companies in the 2021 MedTech Innovator (“MTI”) database are focusing on prevention, wellness, detection, or diagnosis, signaling a clear push for preventive care to also tackle costs.
In addition, there has also been a lasting impact on consumer and medical demand for home care, supported by the pandemic. Lockdowns, closure of care facilities, and healthcare systems subjected to capacity pressure, accelerated demand away from traditional inpatient care. Now, outpatient care solutions are driving industry production, with nearly 70% of recent diagnostics start-up companies producing products in areas such as ambulatory clinics, at-home care, and self-administered diagnostics.
Struggling with intense fears that disrupt your life? At Renew Life Hypnosis, we offer specialized hypnosis to overcome fear. Phobias are exaggerated fears, often stemming from past traumas or learned behaviors. Hypnotherapy addresses these deep-seated fears by accessing the subconscious mind, helping you change your reactions to phobic triggers. Our expert therapists guide you into a state of deep relaxation, allowing you to transform your responses and reduce anxiety. Experience increased confidence and freedom from phobias with our personalized approach. Ready to live a fear-free life? Visit us at Renew Life Hypnosis..
Global launch of the Healthy Ageing and Prevention Index 2nd wave – alongside...ILC- UK
The Healthy Ageing and Prevention Index is an online tool created by ILC that ranks countries on six metrics including, life span, health span, work span, income, environmental performance, and happiness. The Index helps us understand how well countries have adapted to longevity and inform decision makers on what must be done to maximise the economic benefits that comes with living well for longer.
Alongside the 77th World Health Assembly in Geneva on 28 May 2024, we launched the second version of our Index, allowing us to track progress and give new insights into what needs to be done to keep populations healthier for longer.
The speakers included:
Professor Orazio Schillaci, Minister of Health, Italy
Dr Hans Groth, Chairman of the Board, World Demographic & Ageing Forum
Professor Ilona Kickbusch, Founder and Chair, Global Health Centre, Geneva Graduate Institute and co-chair, World Health Summit Council
Dr Natasha Azzopardi Muscat, Director, Country Health Policies and Systems Division, World Health Organisation EURO
Dr Marta Lomazzi, Executive Manager, World Federation of Public Health Associations
Dr Shyam Bishen, Head, Centre for Health and Healthcare and Member of the Executive Committee, World Economic Forum
Dr Karin Tegmark Wisell, Director General, Public Health Agency of Sweden
India Clinical Trials Market: Industry Size and Growth Trends [2030] Analyzed...Kumar Satyam
According to TechSci Research report, "India Clinical Trials Market- By Region, Competition, Forecast & Opportunities, 2030F," the India Clinical Trials Market was valued at USD 2.05 billion in 2024 and is projected to grow at a compound annual growth rate (CAGR) of 8.64% through 2030. The market is driven by a variety of factors, making India an attractive destination for pharmaceutical companies and researchers. India's vast and diverse patient population, cost-effective operational environment, and a large pool of skilled medical professionals contribute significantly to the market's growth. Additionally, increasing government support in streamlining regulations and the growing prevalence of lifestyle diseases further propel the clinical trials market.
Growing Prevalence of Lifestyle Diseases
The rising incidence of lifestyle diseases such as diabetes, cardiovascular diseases, and cancer is a major trend driving the clinical trials market in India. These conditions necessitate the development and testing of new treatment methods, creating a robust demand for clinical trials. The increasing burden of these diseases highlights the need for innovative therapies and underscores the importance of India as a key player in global clinical research.
Navigating Challenges: Mental Health, Legislation, and the Prison System in B...Guillermo Rivera
This conference will delve into the intricate intersections between mental health, legal frameworks, and the prison system in Bolivia. It aims to provide a comprehensive overview of the current challenges faced by mental health professionals working within the legislative and correctional landscapes. Topics of discussion will include the prevalence and impact of mental health issues among the incarcerated population, the effectiveness of existing mental health policies and legislation, and potential reforms to enhance the mental health support system within prisons.
QA Paediatric dentistry department, Hospital Melaka 2020Azreen Aj
QA study - To improve the 6th monthly recall rate post-comprehensive dental treatment under general anaesthesia in paediatric dentistry department, Hospital Melaka
2. Physician Practices Survival Tactics
April 6, 2020
Page 1
Katie Ray, MSHA, CPhT
Senior Consultant
kray@pyapc.com
Jeff Bushong
Principal – Consulting
jbushong@pyapc.com
Introductions
pyapc.com
800.270.9629
Lori Foley, CMA, CDI, PHR, SHRM-CP
Managing Principal – Compliance
lfoley@pyapc.com
3. Physician Practices Survival Tactics
April 6, 2020
Page 2
Congressional Response
$8.3 billion in emergency funding for federal agencies to
respond to COVID-19 pandemic
COVID #1 (March 6) Coronavirus
Preparedness and Response
Supplemental Appropriations Act
Paid sick leave; free coronavirus testing; expanded food
assistance and unemployment benefits; protections for
health care workers
COVID #2 (March 18) Families First
Coronavirus Response Act
• $2 Trillion relief package for state & local governments;
big, medium, & small businesses; healthcare providers;
and individuals
• 20% increase in overall federal spending in FY20
COVID #3 (March 27) CARES Act
(Coronavirus Aid, Relief
and Economic Security Act)
4. Physician Practices Survival Tactics
April 6, 2020
Page 3
Agenda
1. Paycheck Protection Program
2. Medicare Advance Payments
3. FFCRA and Staffing
Considerations
4. Operations and Revenue Cycle
Recommendations
6. Physician Practices Survival Tactics
April 6, 2020
Page 5
$349 Billion in Small Business Loans
▪ SBA Act section 7(a) guaranteed loan program
▪ Loans of up to $10 million
▪ Loans must be received before June 30, 2020
▪ No SBA fees
▪ No collateral or personal guarantees required
▪ No SBA recourse against any individual
shareholder, member, or partner if the
proceeds are used as allowed
7. Physician Practices Survival Tactics
April 6, 2020
Page 6
Who Qualifies?
▪ Business concerns, including:
▪ Business entities
▪ Nonprofit organizations
▪ Sole Proprietorships or other eligible Self-Employed Individuals
▪ Independent Contractors
▪ Veterans organizations and Tribal concerns
▪ Companies defined as small businesses in SBA Act
▪ With 500 or fewer employees
▪ Operating on February 15, 2020 with
▪ Compensated employees (salaries and payroll taxes) and/or
▪ Compensated independent contractors (payments reported on IRS Form 1099-MISC)
8. Physician Practices Survival Tactics
April 6, 2020
Page 7
Who Makes the Loans?
▪ Currently authorized SBA Act Section 7(a) lenders that opt to participate
▪ Reimbursement from SBA for processing based on percentage of loan amounts
▪ Other financial institutions may be qualified
▪ Borrower must make good faith certifications that proceeds will be “used to retain
workers and maintain payroll” or make other allowed payments
9. Physician Practices Survival Tactics
April 6, 2020
Page 8
How Much Can Be Borrowed?
▪ Maximum amount = lesser of:
▪ $10 million; or
▪ 2.5 times the borrower’s average total monthly payments for
payroll costs (most applicants will use payroll costs for CY 2019)
▪ Eligible payroll costs
▪ Salaries, wages, and commissions, “or similar compensation”
▪ Cash tips or equivalent
▪ Payment for vacation, parental, family, medical, or sick leave
▪ Separation payments
▪ Group health care benefits / insurance premiums
▪ Payment of any retirement benefit
▪ Payment of state or local employment compensation taxes
10. Physician Practices Survival Tactics
April 6, 2020
Page 9
Paycheck Protection Program
Note: Eligible payroll costs include: wages, salaries; payments for vacation time, leave, sick;
group health benefits; retirement; state and local unemployment compensation taxes.
Sample practice calculation for
Dr. Feelgood Family Medicine
• 2019 average monthly payroll = $40,000
• $40,000 x 2.5 multplier = $100,000
• Calculated loan eligibility = $100,000
2019 Average Monthly Payroll
Gross Payroll: $38,000
Excess Salaries: ($9,000)
State UI Tax: $ 2,500
Employer Paid
Health Insurance: $ 5,000
Employer 401k
Match: $3,500
Total: $40,000
11. Physician Practices Survival Tactics
April 6, 2020
Page 10
How Much Can Be Borrowed?
▪ Eligible payroll costs (continued)
▪ The sum of payments of any compensation to or income of a sole proprietor or independent
contractor that is a wage, commission, income, net earnings from self-employment, or
similar less than $100,000 in 1 year, as prorated for the covered period
▪ Payroll costs do not include
▪ Compensation of an individual employee in excess of an annual salary of $100,000, as
prorated for the covered period
▪ Taxes imposed or with held under chapters 21, 22, or 24 of the Internal Revenue Code of
1986 during the covered period [21 – Expenses for Household and Dependent Care Services;
22 – Credit for the elderly and permanently and totally disabled; 24- Child Tax Credit]
▪ Any compensation of an employee whose principal place of residence is outside of the
United States
12. Physician Practices Survival Tactics
April 6, 2020
Page 11
How Much Can Be Borrowed?
▪ Payroll costs do not include (continued)
▪ Qualified sick leave wages for which a credit is allowed under section 7001 of the Families First
Coronavirus Response Act (Public Law 116– 127); or
▪ Qualified family leave wages for which a credit is allowed under section 7003 of the Families First
Coronavirus Response Act (Public Law 116– 127)
▪ Note - If applicable, borrowers can elect to add the outstanding principal amount of an EIDL
made between 01/31/20 and 03/27/20 thereby making the EIDL eligible for loan forgiveness
13. Physician Practices Survival Tactics
April 6, 2020
Page 12
How May Loan Proceeds Be Used?
▪ Payroll costs (as specifically defined in the Act)
▪ Costs related to continuation of group health care benefits during periods of paid
sick, medical or family leave, and insurance premiums
▪ Rent (including rent under a lease agreement)
▪ Utility payments (power, water, transportation, telephone, and internet access)
▪ Mortgage interest payments and interest on any other debt obligations incurred
before 02/15/20
▪ Existing SBA Act Section 7(a) loan allowable uses, including working capital
14. Physician Practices Survival Tactics
April 6, 2020
Page 13
What Loan Amount May Be Forgiven?
▪ Specified costs incurred and payments made
during the 8-week period following the loan
origination date (8-week period) for the following
things, as specifically defined in the Act:
▪ Payroll costs
▪ Payments on covered rent obligations
▪ Covered utility payments
▪ Payments of interest on any covered mortgage
obligation
▪ Total forgiveness cannot exceed the loan principal
amount
▪ Debt forgiveness ≠ income for federal income tax
purposes
15. Physician Practices Survival Tactics
April 6, 2020
Page 14
Loan Forgiveness Reductions
▪ For any decrease during the 8-week period of
employee wages in excess of 25% for employees
whose pay rate was less than $100,000 per year
▪ Use of more than 25% of the funds for allowed
non-payroll expenses
▪ For any decrease during the 8-week period in full-
time equivalent employees
▪ Note the definition of FTEs for this purpose differs from
the definition of employees for qualification, as
previously discussed
▪ Loan forgiveness will not be reduced for employees laid
off between February 15, 2020 and April 26, 2020 and
re-hired by June 30, 2020
16. Physician Practices Survival Tactics
April 6, 2020
Page 15
Loan Forgiveness Reductions
Forgiveness Calculation
Amount expended
on Allowable Costs
previously defined
Average Number of FTE’s per Month Employed Over
the 8-Week Period Following Receipt of the Loan
At the election of the Non-Seasonal Borrowers, either:
a) Average Number of FTEs per Month Employed
2/15/19 - 6/30/19; or
b) Average Number of FTEs per Month Employed
1/1/20 – 2/29/20
For Seasonal Employers only – the Average Number of
FTEs per Month Employed 2/15/19 – 6/30/19
17. Physician Practices Survival Tactics
April 6, 2020
Page 16
Sample: Loan Forgiveness Calculation
Feel Better Medical Center
$100,000
(Original loan amount)
3.8 FTEs
(Avg. # FTEs in 8-week period)
4.0 FTEs
(Avg. # FTEs in either 2019 or 2020 periods defined)
EQUALS = $100,000 x (3.8/4.0) = $95,000 of loan forgiveness
18. Physician Practices Survival Tactics
April 6, 2020
Page 17
Repayment of Unforgiven Amounts
Unforgiven portion to be repaid over a maximum 2-year period2
Years
Maximum interest rate = 4%, currently 1%4%
No prepayment penaltyPenalty
Deferral of repayment is available for up to one year with a
minimum deferral of six months
19. Physician Practices Survival Tactics
April 6, 2020
Page 18
Act Now
▪ Contact your bank to see if they are an SBA section 7(a) Lender; be
persistent as they are likely swamped with high volume
▪ Gather all information requested and complete application thoroughly;
work in conjunction with your banker, accountant, etc. to complete and
submit expeditiously
▪ Determine borrower loan eligibility to compare to bank calculations
▪ Submit application as soon as possible
▪ SBA started accepting applications Friday, April 3 for small businesses and sole
proprietors
▪ Application acceptance for independent contractors and self-employed individuals is
slated to begin Friday, April 10
20. Physician Practices Survival Tactics
April 6, 2020
Page 19
Tax Credits for Employee Retention
▪ Employee Retention Credit under CARES Act – can cover 50% of qualified
wages, up to $10K of wages per employee (i.e., to $5,000 per employee)
▪ Available to any trade or business that either suspends operations (fully or partially) due
to governmental limitations placed on commerce, travel, or group meetings, OR
experiences a 50% reduction in revenue when compared to the same quarter of the
prior year.
▪ Credit takes the form of reduced remittance of federal employment taxes, including
withheld taxes, that are required to be deposited with the IRS or by requesting an
advance of the credit from the IRS.
21. Physician Practices Survival Tactics
April 6, 2020
Page 20
Economic Injury Disaster Loans (EIDL)
▪ Working capital loans of up to $2 million from SBA
▪ Available to businesses with fewer than 500
employees, sole proprietors, and independent
contractors
▪ Waiver of personal guarantees for loans of
$200,000 or less
▪ Waiver of showing inability to obtain credit
elsewhere
▪ EIDLs may be refinanced as part of a Section 7(a)
loan, but loan proceeds may not be used for same
purposes as the allowed uses of a Section 7(a) loan
22. Physician Practices Survival Tactics
April 6, 2020
Page 21
$10,000 EIDL Advance/Grant
▪ Available through December 31, 2020
▪ Requested as part of EIDL loan request process
▪ Advance must be used for payroll, sick leave,
increased supply costs, rent/mortgage
payments, and certain other items
▪ SBA pays applicant within 3 days of application
▪ Advance does not have to be repaid even if
denied a loan under EIDL; will offset
forgiveness under a Section 7(a) loan
24. Physician Practices Survival Tactics
April 6, 2020
Page 23
Address Providers’ Cash Flow Challenges
Part A providers and Part B
suppliers - up to 100% of
Medicare payments for
3-month period
Image source: Shutterstock
25. Physician Practices Survival Tactics
April 6, 2020
Page 24
Eligibility
1
Billed Medicare
for claims within
last 180 days
2
Not be in
bankruptcy
3
Not be under active
medical review or
program integrity
investigation
4
Not have any
outstanding
delinquent Medicare
overpayments
26. Physician Practices Survival Tactics
April 6, 2020
Page 25
Application Process
1. Use advance payment request form posted on each Medicare Administrative
Contractor’s website
▪ Each MAC maintains COVID-19 Hotline to assist with requests
2. Required information:
▪ Provider/supplier identification information
▪ Amount requested
▪ Reason for request
▪ Check Box 2 and state request is for advance payment due to COVID-19 pandemic
3. Signed by authorized representative
4. Submit by e-mail
28. Physician Practices Survival Tactics
April 6, 2020
Page 27
Approval Process
MAC confirms form
is complete and
requestor meets
eligibility
requirements
MAC notifies
requestor of
approval/denial
via email
MAC issues
payment within
7 calendar days
from request
29. Physician Practices Survival Tactics
April 6, 2020
Page 28
Recoupment and Reconciliation
▪ Recoupment begins 120 days following receipt
▪ MAC withholds payment on all claims up to the amount of the
advance payment
▪ Reconciliation
▪ MAC makes demand for payment of any remaining amount one
year following receipt for hospitals, 210 days for all other providers
▪ Opportunity for extended repayment schedule (with interest)?
▪ Impact of bankruptcy?
X
120
31. Physician Practices Survival Tactics
April 6, 2020
Page 30
Families First Coronavirus Response Act (FFCRA)
▪ Who qualifies?
▪ Businesses with less than 500 people
▪ Employers with less than 50 workers may ask the Secretary of Labor for
an exemption
▪ What are the effective dates?
▪ April 1, 2020 – December 31, 2020
▪ Who can be exempted?
▪ Healthcare providers and emergency responders allowed to be excluded
from the definition of employees who are permitted to take leave
▪ Initially lacked clarity of definition of “healthcare provider”
▪ Clarified in regulations released late last week
32. Physician Practices Survival Tactics
April 6, 2020
Page 31
Definition of health care provider
▪ Definition of a health care provider is anyone employed at
▪ Any doctor’s office
▪ Hospital
▪ Health care center or clinic
▪ Post-secondary educational institution offering health care instruction
▪ Medical school
▪ Local health department or agency
▪ Nursing facility, retirement facility, nursing home, home health care provider
▪ Facility that performs laboratory or medical testing
▪ Pharmacy
▪ Any similar institution, Employer, or entity
33. Physician Practices Survival Tactics
April 6, 2020
Page 32
Definition of health care provider
▪ Definition of a health care provider also includes
▪ any individual employed by an entity that contracts with any of these
institutions described above to provide services or to maintain the
operation of the facility where that individual’s services support the
operation of the facility.
▪ anyone employed by any entity that provides medical services,
produces medical products, or is otherwise involved in the making of
COVID-19 related medical equipment, tests, drugs, vaccines,
diagnostic vehicles, or treatments.
34. Physician Practices Survival Tactics
April 6, 2020
Page 33
FFCRA: Out or In?
▪ Regardless of decision, practices must post required FFCRA poster
▪ https://www.dol.gov/sites/dolgov/files/WHD/posters/FFCRA_Poster_WH1422_Non-Federal.pdf
▪ If opting out, notify employees of opt-out decision
▪ If opting in, practices must follow the guidelines of both the Emergency
Family and Medical Leave Expansion Act (EFMLE) and Emergency Paid
Sick Leave (EPSL)
35. Physician Practices Survival Tactics
April 6, 2020
Page 34
FFCRA
▪ Emergency Paid Sick Leave
▪ Up to 80 hours of paid sick leave benefits if unable to work for six reasons due to COVID-
19; part time employees based on average number of hours worked, on average, over 2-
week period
▪ Any employee having to care for any individual, regardless of length of employment, is
eligible
▪ Leave paid at regular rate of pay for the following up to daily cap of $511:
1. Quarantine or isolation order
2. Advice from health care professional to self-quarantine
3. Experiencing symptoms of COVID-19 and seeking medical dx
▪ Leave paid at 2/3 regular rate for the following up to daily cap of $200:
4. Caring for individual subject to quarantine/isolation order or who has
been advised to self-quarantine by health care professional
5. Caring for own child whose school, place of care is closed, provider of care is unavailable due to COVID-19
6. Experiencing substantially similar condition specified by Secretary of HHS
36. Physician Practices Survival Tactics
April 6, 2020
Page 35
FFCRA
▪ Emergency Family and Medical Leave Expansion Act
▪ 12 weeks of job-protected leave due to a son or daughter’s school or childcare
service being closed due to public health emergency
▪ First 10 days (2 weeks) are unpaid unless employee uses other paid-leave
benefit of employer
▪ For the subsequent 10 weeks, workers must receive two-thirds of their regular
pay, capped at $200/day or $10,000 total
▪ For employees with variable hours, the paid family leave will be based on the
average number of hours worked per day over the previous 6 months
▪ Eligible employees include those that have been on payroll at least 30
calendar days immediately prior to the day leave would begin
37. Physician Practices Survival Tactics
April 6, 2020
Page 36
Funding FFCRA Leave
▪ Eligible employers can fund
▪ Qualified leave wages
▪ Allocable qualified health plan expenses
▪ Eligible Employer’s share of Medicare tax on the qualified leave wages
▪ Via federal employment taxes related to wages paid between April 1 –
December 31, 2020 that would otherwise be required to be deposited with
the IRS.
▪ In anticipation of claiming the credits on the Form 941, Eligible Employers can retain
▪ federal income tax withheld from employees
▪ the employees’ share of Social Security and Medicare taxes
▪ the Eligible Employer’s share of Social Security and Medicare taxes with respect to all
employees
▪ If above is insufficient to cover FFCRA leave costs, can request an advance of the credit
from the IRS by filing Form 7200.
38. Physician Practices Survival Tactics
April 6, 2020
Page 37
Reductions, Layoffs, & Furloughs
▪ Reduced compensation considerations include
▪ Salary/rate freezes
▪ Reconsidered raises
▪ Held or reconsidered bonus payments
▪ Pay cuts – graduated, across the board
▪ CAN reduce salaries unless employees are protected by an employment contract or a
collective bargaining agreement
▪ CANNOT
▪ Reduce hourly rates below minimum wage (non-exempt)
▪ Reduce exempt employee compensation below $455/week FLSA exempt employee threshold
▪ Vary compensation for exempt employees based on the number of hours worked during a work
week
39. Physician Practices Survival Tactics
April 6, 2020
Page 38
Layoffs, Furloughs & Reductions
▪ Layoffs
▪ Separations from employment equivalent to a termination with a potential for rehire
▪ Typically includes termination of benefits
▪ Furloughs
▪ Temporary, mandatory unpaid leave
▪ Often includes continuation of benefits such as health insurance
▪ Challenge: portion of benefits historically paid by employee
▪ If practice adopts FFCRA and subsequently enacts a furlough or layoff, FFCRA
obligations cease from date of such furlough/layoff
40. Physician Practices Survival Tactics
April 6, 2020
Page 39
Unemployment Insurance
▪ CARES Act extended eligibility, added funds to eliminate one week waiting period,
added 13 weeks to each state’s current benefits
▪ Employees cannot receive UI benefits concurrently while receiving sick leave or
expanded family/medical leave
▪ Employees who are furloughed or laid off can apply for unemployment insurance,
regardless of whether Employer seeks CARES Act financing and intends to rehire
▪ Partial unemployment insurance, worksharing and short-time compensation
programs are available in some states for employees who experience reduced
hours/wages
▪ Benefits vary by state but CARES Act funds an additional $600/week/beneficiary
through July 31, 2020
▪ Very fluid as states evaluate their programs and await guidance from Federal
Department of Labor
42. Physician Practices Survival Tactics
April 6, 2020
Page 41
Potential Revenue Sources
▪ Paycheck Protection Program (PPP)
▪ Loans of up to $10 million based on loan calculation as laid out in SBA application
▪ Economic Injury Disaster Loan (EIDL)
▪ Eligible for up to $10,000 in advance
▪ Cannot be used for same purpose as PPP loan funds
▪ Medicare advance payments
▪ Part A providers and Part B suppliers - up to 100% of Medicare payments for 3-
month period
▪ Commercial/Medicare Advantage plans – explore advance based on receipts/VBP
▪ Line of credit access for cash flow
▪ Reach out to lender to inquire about increasing line of credit
▪ Telehealth
43. Physician Practices Survival Tactics
April 6, 2020
Page 42
Practice Revenue Cycle Initiatives
▪ Outsourced billing and/or collections considerations:
▪ Set up daily check-in calls with vendor to
review key metrics and provide feedback
▪ Understand any potential challenges the
third-party may be facing (i.e., staffing
shortages, bandwidth issues, etc.)
▪ Work in tandem with third-party to
monitor denials and identify
opportunities to improve likelihood of
receiving payment
▪ Consider revising small balance write-off
thresholds
44. Physician Practices Survival Tactics
April 6, 2020
Page 43
Practice Revenue Cycle Initiatives
▪ Aged accounts receivable (A/R) analysis
▪ Prioritize A/R and focus efforts on collecting high dollar, aged, and/or self-pay
amounts
▪ Identify routine denial types or payer-specific trends such that follow-up could
be streamlined
▪ Follow-up on patient responsibility balances - co-insurance/deductibles
▪ Consider implementing additional flexibility/options for patient payment
plans to increase incremental cash flow
▪ Potential benefit: increase cash, improve staff efficiency, and reduce A/R in
“high-risk” populations
45. Physician Practices Survival Tactics
April 6, 2020
Page 44
▪ Timely filing and timely appeals review
▪ Create list of each payer’s timely filing and
appeal deadlines
▪ Identify any unbilled accounts nearing timely
filing deadline and prioritize for resolution
▪ Review claims denied for timely filing to
identify accounts that are nearing appeal
deadlines and take the necessary steps
▪ Potential benefit: increase cash, accelerate
submission of unbilled claims, and reduce
timely filing denials and write-offs
Practice Revenue Cycle Initiatives
46. Physician Practices Survival Tactics
April 6, 2020
Page 45
Expense Reductions
▪ Rent
▪ Rent payment = allowable use for PPP loan funds
▪ Mortgage interest payments also allowable use, but no prepayment of interest
allowed
▪ If not seeking PPP loan, may consider:
▪ Reviewing leases and potential amendments for language relating to rent
abatement or force majeure clause;
▪ Negotiating rent reduction or deferment;
▪ Applying security deposit to upcoming rent payment;
▪ Utilizing insurance coverage (some states considering legislation to mandate
insurers pay COVID-19 business interruption claims)
47. Physician Practices Survival Tactics
April 6, 2020
Page 46
Expense Reductions
▪ Malpractice premiums
▪ Not an allowable use of PPP loan funds
▪ May want to seek deferment of these payments
▪ Review state law and/or follow-up with carrier
to evaluate options
▪ Example: Governor Cuomo in New York
allowing consumers and small businesses
experiencing financial hardship due to
COVID-19 to defer paying premiums for
property and casualty insurance, including
medical malpractice.
48. Physician Practices Survival Tactics
April 6, 2020
Page 47
Staffing Model Considerations
▪ Many staffing considerations as mentioned
previously (i.e., layoff, furlough, reduced
hours, position consolidation)
▪ Consider key revenue-generating functions
needed during this time (patient and payer
follow-up, denials management, etc.) and
staffing complement needed to complete
these functions
▪ Identify cross-trained employees who may
be able to complete multiple functions
49. Physician Practices Survival Tactics
April 6, 2020
Page 48
Communication with Staff
▪ Communicate with staff early and often
▪ Utilize daily huddles to discuss updates to
practice protocols regarding policies and
operations
▪ Equip staff with tools to most efficiently
and effectively communicate with patients
regarding COVID-19 changes
▪ Continue to routinely monitor your practice
and assess whether policies and
procedures currently in place are sufficient
or need to be updated
▪ Includes work from home policies especially
related to non-exempt employees and total
hours to be worked
50. Physician Practices Survival Tactics
April 6, 2020
Page 49
PYA Resources
▪ Prior webinar recordings, slides, transcripts, follow-up Q&As
▪ PYA thought leadership
▪ Links to important resources
www.pyapc.com/covid-19-hub/
COVID-19 HUB