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Overview: This webinar provides an overview of the MACRA legislation and developing regulations and guidelines. We'll help you understand how medical practices will be paid in the future for services to Medicare patients. You'll be asked to choose between two paths. If you choose to participate with other providers in an Advanced Payment Model, the larger organization will be paid for services provided and determine how to share those payments as well as any cost savings among the participants. If you choose the Merit-Based Incentive Payment System (MIPS), your payment rate will vary based on how you perform on a variety of Medicare Quality Programs - PQRS, VBM, Meaningful Use and a 4th new component focused on Quality Improvement. You'll want to know as much as possible about the pros and cons of each option and how to make the right choice for your practice. Why should you Attend: Under the MACRA legislation, your providers will need to choose between participating in an Advanced Payment Model (APM) or participating in the new Merit-Based Incentive Payment System. Making the wrong choice can result in significant reductions in your future Medicare payments. You'll want to understand the options and have a plan in place by January 1, 2017 - that's only 6 months away. Areas Covered in the Session: Learn the requirements of the new MACRA legislation and how it will impact your Medicare payments in 2019 and beyond Find out what you need to be doing now to ensure you don't lose Medicare revenue in future years Understand the options - APM vs MIPS - and how your Medicare payments can increase or decrease under each model Identify what aspects of the new payment methodology are written into the legislation, what has been released through proposed regulations and when final rules are expected. Who Will Benefit: Practice Administrators, CEOs, COOs Physicians and all providers who bill to Medicare Quality Officers Nurse leaders Finance Directors Speaker Pro

The Physician Payment Sunshine Act: The Physician Payment Sunshine Act, also called Physician Payments Act, is a piece of legislation passed by the American Congress in 2010. It came to be enacted along with the Affordable Care Act, or Obamacare. The purpose of this legislation is to ensure transparency in the financial relationships that exist between the pharmaceutical industry, teaching hospitals, and physicians. What the Sunshine Act requires is this: Manufacturers of drugs and medical devices, and organizations that purchase in groups (Group Purchasing Organizations or PGO's) have to report payments or their equivalent that they make to physicians and teaching hospitals. Items that are considered equivalent to money payments, transfers of which have to be reported are clearly mentioned. These include the following: Meals Honoraria or grants Gifts Entertainment Speaking fees Writing services, such as research papers or manuscripts Travel reimbursements Purchase of items such as teaching materials and journals, which are paid either directly to physicians or teaching hospitals, supplied either directly or through a third party Funding for research Another core reporting requirement: Another requirement of the Sunshine Act is that when manufacturers of drugs and medical devices and group purchasing organizations have physicians who have a stake in some or another form in their organizations; this has to be reported to the Centers for Medicare and Medicaid Services (CMS). These reporting requirements apply to all kinds of physicians, who are either specialists or are general practitioners. However, the following are excluded from reporting by the Sunshine Act: Nurses Support and office staff Residents Medical students Physicians assistance Advance practice nurses Physicians need not report: The Sunshine Act requires information about these payments and transfers to be made by the paying medical device and drug companies, and not by physicians.

Overview: This webinar is designed for medical practice leaders to gain a working knowledge of the Value-Based Modifier program and how your cost and quality metrics will be used to determine your Medicare payments in future years. Why should you Attend: Your future Medicare payments are at risk. 2018 payment rates may be cut up to 6% if you fail to report quality measures to CMS for the 2016 calendar year. Your practice can also see cuts of 1-4% if you are an outlier on costs or quality. On the other hand, practices that show they are significantly better than average on costs and/or quality can receive an increase over the standard Medicare payment rates. You'll want to understand how this program works, what the potential impact for your practice is, and what steps you need to take now to ensure success in 2018. Areas Covered in the Session: What types of medical practices are impacted by the VBM program and how much is at risk for practices of different sizes. What cost and quality metrics are used and how are they combined to yield your practice's future payments What are the timelines for submitting data and reviewing your status What actions you can take now to ensure the highest possible Medicare payments in future years Who Will Benefit: Practice Administrators Physicians, Podiatrists, Physician Assistants, Nurse Practitioners, CRNAs Quality Officers Nurse leaders Finance Directors Speaker Profile Jeanne J. Chamberlin Jeanne Chamberlin is currently a Practice Management Consultant with MSOC Health. During her 30 years in the healthcare industry, Jeanne has worked in independent medical practices, health systems, state government, and software development. She holds a Masters Degree in Public Policy from Duke University and is a fellow in the American College of Medical Practice Executives. She has been a leader in both state and local MGMA chapters. As practice administrator of a 10-physician multi-specialty practice, Jeanne first began

Overview: This webinar is designed for medical practice leaders to gain a working knowledge of the Value-Based Modifier program and how your cost and quality metrics will be used to determine your Medicare payments in future years. Why should you Attend: Your future Medicare payments are at risk. 2018 payment rates may be cut up to 6% if you fail to report quality measures to CMS for the 2016 calendar year. Your practice can also see cuts of 1-4% if you are an outlier on costs or quality. On the other hand, practices that show they are significantly better than average on costs and/or quality can receive an increase over the standard Medicare payment rates. You'll want to understand how this program works, what the potential impact for your practice is, and what steps you need to take now to ensure success in 2018. Areas Covered in the Session: What types of medical practices are impacted by the VBM program and how much is at risk for practices of different sizes. What cost and quality metrics are used and how are they combined to yield your practice's future payments What are the timelines for submitting data and reviewing your status What actions you can take now to ensure the highest possible Medicare payments in future years Who Will Benefit: Practice Administrators Physicians, Podiatrists, Physician Assistants, Nurse Practitioners, CRNAs Quality Officers Nurse leaders Finance Directors Speaker Profile Jeanne J. Chamberlin Jeanne Chamberlin is currently a Practice Management Consultant with MSOC Health. During her 30 years in the healthcare industry, Jeanne has worked in independent medical practices, health systems, state government, and software development. She holds a Masters Degree in Public Policy from Duke University and is a fellow in the American College of Medical Practice Executives. She has been a leader in both state and local MGMA chapters. As practice administrator of a 10-physician multi-specialty practice, Jeanne first began working wi

Overview: This webinar will cover the changes to the PQRS program in 2016 and will provide tips and strategies to help you select the best measures and reporting approach for your practice. Why should you Attend: Your future Medicare payments are at risk. Failing to report quality measures to CMS for Calendar Year 2016 will result in a reduction of up to 6% in your 2018 Medicare payments. The PQRS program carries a potential 2% penalty for each provider who does not report quality measures to CMS - physicians, mid-level providers, therapists, psychologists, social workers, even dieticians. In addition, if your practice has physicians and mid-levels, at least half the physicians must meet the PQRS requirements or the group will face an additional 2-4% penalty from the Value Based Modifier program. Areas Covered in the Session: Understand the difference between a reporting rate and a performance rate? Get access to useful tools to help you identify measures applicable to your specialty. Learn how to choose among the various reporting approaches - what are the pros and cons of each. Understand how CMS will evaluate your submission if you report less than 9 measures. Who Will Benefit: Practice Administrators All providers who bill to Medicare including Physicians (All specialties), Podiatrists, Physician Assistants, Nurse Practitioners, Psychologists, LCSW, Physical and Occupational Therapists, Speech/Language Pathologists, etc. Quality Officers Nurse leaders Finance Directors Speaker Profile Jeanne J. Chamberlin Jeanne Chamberlin is currently a Practice Management Consultant with MSOC Health. During her 30 years in the healthcare industry, Jeanne has worked in independent medical practices, health systems, state government, and software development. She holds a Masters Degree in Public Policy from Duke University and is a fellow in the American College of Medical Practice Executives. She has been a leader in both state and local MGMA chapters. As practice ad

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Dealing with Medicare and Medicaid Overpayments : Medicare and Medicaid overpayments are pretty common. If they are not dealt with properly, they invite penalties. Medicare and Medicaid Overpayments happen when a person, provider or supplier receives a payment that is in excess of the amount due to him or her under Medicare statutes and regulations. This overpayment becomes a federal debt that is owed by the individual to the State. So, Centers for Medicare and Medicaid Services (CMS) is required by federal law to recover this amount. Overpayments routinely occur in Medicare and Medicaid. Many a time, these are unintended and are usually a result of oversight, but could also happen due to intent. Some of the most common reasons for which Medicare and Medicaid overpayments occur can be when: Duplicate submissions of the same service or claim are made Excessive or non-covered services are billed or furnished for billing Services that are not necessary medically or are excluded are paid for The wrong payee gets paid. How are Medicare and Medicaid overpayments processed? Obamacare has amended the federal False Claims Act (FCA), which is part of the Fraud Enforcement Recovery Act of 2009 (FERA), to add provisions relating to recovery of Medicare and Medicaid overpayments. This is how the process of Medicare and Medicaid overpayments works: Whenever Medicare comes to know that any overpayment of $10 (raised to $25 from July 2014) or more is made, it directs the Medicare Administrative Contractor (MAC) to initiate the process of recovery of this overpayment. The MAC starts the process by initially mailing a demand letter in which repayment is requested If no action is taken, a second and third demand letters are mailed in a month following the first one. Contents of a demand mail from Medicare/Medicaid: The demand letter sent by the MAC will explain the details of the Medicare and/or overpayment. When repayment is not made in full within 30 days, interest starts get

Healthcare fraud and abuse: Healthcare fraud and abuse are different but related kinds of malpractice. They affect everyone concerned: the patient, the healthcare unit, the healthcare sector, and eventually, the economy. Healthcare fraud and abuse are serious malpractices that can have very grave consequences for the patient, the hospital and the healthcare sector. They can also cost taxpayers heavy amounts of money. Healthcare fraud: There is some distinction between healthcare fraud and healthcare abuse. Healthcare fraud is said to happen, according to medicare.gov, when Medicare gets billed for a service or supply the end user never gets. These fraudulent claims result in loss of billions of dollars of revenue to Medicare each year. Healthcare fraud could be said to happen when: False statements are submitted knowingly or facts are misrepresented with the purpose of obtaining a federal health care payment for claims for which the person is not entitled A person knowingly solicits, pays, or/and accepts a payment with the intention of inducing or rewarding referrals for services or items that any of the federal healthcare programs reimburse Eligibility is falsified Prohibited referrals are made for select, designated health services Healthcare abuse: Although related, healthcare fraud and abuse are not totally similar to each other in spirit. A healthcare abuse can be when physicians do not comply with or bypass established good medical practices or administer treatments that are not necessary. This is less serious than fraud in terms of intent, but carries the same consequences: loss of billions of dollars to the exchequer and potential damage the patient's health and the physician's and/or healthcare provider's reputation. Some examples of healthcare abuse These are some of the examples of healthcare abuse: When services that are not medically warranted are performed and charged for When services and/or supplies are charged in excess of their actual value

What is HIPAA ? Compliance with the Health Insurance Portability and Accountability Act (HIPAA) is a core requirement of the stakeholders involved in health information. HIPAA has prescribed standards with which to protect critical data relating to patients. Electronic Health Records (EHRs) are important documents that contain sensitive patient data, and are thus considered Protected Health Information (PHI). Since this data is accessible to a number of players involved in the field of healthcare; it extremely important to set regulatory guidelines aimed at ensuring that patient information remains protected. HIPAA compliance is essentially about staying in compliance with these guidelines. Measures needed to show compliance with HIPAA HIPAA requires a healthcare organization dealing with PHI to implement all of the following measures and comply with them: Physical measures Network measures, and Process security measures The role of HIPAA Privacy Rule and HIPAA Security Rule HIPAA has set out two important rules that pertain to compliance. These are the HIPAA Privacy Rule and the HIPAA Security Rule. While the Privacy Rule relates to how the medical information of a patient is saved, accessed and shared; the Security Rule is about how to implement national security safeguards for protecting electronic PHI, or ePHI. Who all need to be HIPAA compliant? Since the aim of HIPAA compliance is to ensure complete safety of patient data, it has requirements for every stakeholder in the EHR process. These stakeholders comprise: Covered Entities (CE): Anyone involved in the treatment, payment and operations in healthcare Business Associates (BA): Any person who has access to patient information and is involved in supporting treatment, payment or operations. These include third-party administrators and private sector vendors Those with whom BA's work, or those that are called subcontractors Hosting providers. These typically include healthcare software pro

Overview: The Sunshine Act, or Open Payments Program, requires manufacturers of drugs, medical devices, and biologics that participate in U.S. federal health care programs to report certain payments and items of value given to physicians and teaching hospitals. This Act was part of a healthcare reform bill adopted in March 2010. It came about due to requests for increased transparency about the financial relationships between physicians and industry. The Centers for Medicare and Medicaid (CMS) issued the final rules in 2013 which implemented the Sunshine Act. Why should you Attend: Anyone required to adhere to the Sunshine Act standards or anyone interested in knowing what must be reported and made public. Areas Covered in the Session: Purpose of the Sunshine Act Who is required to report under the Sunshine Act? What is reported? Exclusions Tracking Penalties Useful links Who Will Benefit: This webinar will provide valuable assistance to all personnel in: Human Subjects Research Healthcare interested in exploring the field of Clinical Research Clinical Research Coordinators Principal Investigators/Physicians Administration in charge of Clinical Research Regulatory Compliance Speaker Profile Sarah Fowler-Dixon is Education Specialist and instructor with Washington University School of Medicine. She has developed a comprehensive education program for human subject research which has served as a model for other institutions. She crafted budgets, policies, procedures, reporting, and training for the new program. She has initiated the planning, development, authorship and implementation of many human subjects research policies, practices, guidelines, submission and reviewer forms often working with state and federal authorities. She has provided consultation regarding ethical, federal, state, and institutional requirements for faculty and staff both in the design and execution of their projects and teaches research ethics and regulatory affairs and the fu

The Center for Medicare and Medicaid Services (CMS) proposed a new rule that will update the payment policies and rates. The update will specifically cater to Hospital Outpatient and Ambulatory Surgical Centers (ASC). The rules will set forth a motion to promote efficient service and promote higher quality service for all the Medicare beneficiaries.

CMS released the proposed Outpatient Prospective Payment System - OPPS rule for 2018- which includes a major proposed cut for separately payable drugs purchased under the 340B program.

Before we go into the details, the Merit-based Incentive Payment System (MIPS) comes under the direct obligation of the Medicare Access and CHIP Reauthorization Act (MACRA), the law that regulates the incentive program across the US.

CMS increased the Medicare payment rate of Hospices, Skilled nursing facilities, and Inpatient psychiatric facilities by certain percentages.

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Since the healthcare industry has taken serious measures to revamp healthcare services, the emphasis on incentive payment programs has increased. MIPS and MACRA, and more offer facilities to physicians that regular payment method can never provide

Studies show that physicians have to pay approximately $1 million to deal with the post-payment integrity audits. It is concerning, especially, when we are trying to minimize healthcare expenses.

CMS announces a decline of $15 billion in Medicare Fee-For-Service improper payments. The money that is going to come into the system is going to aid programs like MIPS 2020 and APMs and value-based care in general.

CMS released a report about 2020 payment adjustments for participants in MIPS 2018, which reflect a high number of successful clinicians because of the lower performance threshold.