the changing face of healthcare compliance: managing the new ppaca rules and cms guidelines...

The Changing Face of Healthcare Compliance:

Managing the New PPACA Rules and CMS Guidelines

Presented By:Chris Redhage – Co-founderJennifer Ives – Business Development

Agenda

ProviderTrust, LLC ©2010

1. A story – setting the stage2. Overview of the law3. Understanding your risk4. Short product demo5. Q and A

ProviderTrust, LLC ©2010 - 2011

How will you “know or should have known?”

ProviderTrust, LLC ©2010 - 2011

ProviderTrust, LLC ©2010 - 2011

Overview of PPACA and CMS Final Rules

PPACA - Effective January 1st 20111. Section 6501 – If provider is excluded in 1 state, they

are now excluded in all states.

CMS Final Rules and Guidelines - Effective March 25th 20111. Required to review monthly State licenses for status

change and/or sanctions for all providers.2. Recommended with guidance monthly monitoring of

exclusions.3. Expanded definition of exclusions to include student

loan default and criminal drug convictions.

ProviderTrust, LLC ©2010 -2011

“How can I manage verifying every license in every state every

month??”

“I’ve been managing this

process with our HRIS, recruiters and

employment coordinators…”

“We manage this at the unit

level…”

“We check the OIG list. Isn’t

that enough?”

“We verify and monitor our state.

That’s always been enough

before!”

ProviderTrust, LLC ©2010 -2011

How often are you currently monitoring your provider’s license status for potential sanctions?

1. Upon hire 2. Monthly3. Bi-annually4. Annually

Question 1

ProviderTrust, LLC ©2010 - 2011

DID YOU KNOW:

•Only 61% of all State reported actions make it to Federal OIG exclusion lists

•Exclusions now include: failure to pay student loans and controlled substance convictions

• Civil fines can be up to $10,000 per incident, plus 3 times what you bill.

ProviderTrust, LLC ©2010 - 2011

IN THE NEWS…

ProviderTrust, LLC ©2010 - 2011

WHAT’S AT RISK:$10,000 fine for each item, plus up to three times the amount billed

Fines and Penalties

10 x 3 x $10,000 = $300,0003 x $12,000 = $36,000

$336,000

ProviderTrust, LLC ©2010 - 2011

Catholic Health Care West, $243,819.28Adventist Health System, $68,831.82East Boston Neighborhood Health Center, $200,962Providence Health System, $105,219.49New York Downtown Hospital, $220,000AdCare Hospital of Worcester, $254,820University of Arkansas , $201,689.98South Pasadena Hospital, $142,731.56

$350 Million is devoted to enforcement efforts$110 Million will be spent in 2011-2012 alone

ProviderTrust, LLC ©2010 -2011

Question 2

What sources are you currently searching to verify licenses and search for sanctions and exclusions?

1. State of boards 2. State boards and Federal OIG exclusion list3. All 50 State boards, Federal and All State

exclusion lists

There IS Good News!

• Fast, simplified, streamlined• Actionable data• Pull from over 1300 primary data sources• Efficiently Manage workforce• Avoid fines• Ensure patient safety and integrity • We Indemnify you

ProviderTrust, LLC ©2010 - 2011

Demo of ProviderTrust

ProviderTrust, LLC ©2010 - 2011

Question and Answer Time

ProviderTrust, LLC ©2010 - 2011

THANK YOUFor more information, a live demo or to download a

whitepaper on the CMS final rules

Please visit or contact us:

www.ProviderTrust.com

615.93TRUST

ProviderTrust, LLC ©2010 - 2011