the changing face of healthcare compliance: managing the new ppaca rules and cms guidelines...
Post on 15-Jan-2016
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TRANSCRIPT
The Changing Face of Healthcare Compliance:
Managing the New PPACA Rules and CMS Guidelines
Presented By:Chris Redhage – Co-founderJennifer Ives – Business Development
Agenda
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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!”
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How often are you currently monitoring your provider’s license status for potential sanctions?
1. Upon hire 2. Monthly3. Bi-annually4. Annually
Question 1
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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.
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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
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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