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Compliance Update
OIG's new safe harbors, civil monetary penalty exceptions set to take effect Print E-mail
Written by Vitale Health Law   
Monday, 26 December 2016 00:00

On January 6, new safe harbors to the federal anti-kickback statute and amendments to the civil monetary penalty rules will take effect. The expansion of existing safe harbors, along with the addition of new ones, were issued by the Department of Health and Human Services Office of the Inspector General on Dec. 7, and are expected to impact providers, drug manufacturers and pharmacies. You can read them here.


The changes add new safe harbors designed to protect certain payment practices and business arrangements from sanctions under the anti-kickback statute. That statute makes it a crime to knowingly and willfully offer, pay, solicit or receive remuneration to induce or reward business reimbursable under federal healthcare programs. Safe harbors, which are updated periodically, are designed to protect certain business arrangements from prosecution if specific elements of the safe harbor are satisfied.

OIG noted that because of the broad reach of the statute, concern was expressed that some "relatively innocuous commercial arrangements" were covered by the statute and therefore, potentially subject to criminal prosecution.

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CMS Final Rule Overhauls Long-Term Care Facility Regulations Print E-mail
Written by FHI's Week in Review   
Monday, 19 December 2016 00:00

In a December 16, 2016 MWE post by Monica Wallace, Joel C. Rush, Patrick Callaghan and Chelsea M. Rutherford:

The Centers for Medicare & Medicaid Services issued its long-awaited Final Rule on long-term care facility reform...<This CMS final rule> represents the first comprehensive change to long-term care conditions of participation since 1991. The policies in the Final Rule are designed to reduce unnecessary hospital readmissions and infections, improve quality of care and strengthen safety measures for residents and include elimination of pre-dispute arbitration agreements.

Read more in the current issue of Week in Review>> http://conta.cc/2gU6mgF
 
OIG's Far-reaching 2017 Work Plan Designed to Root Out Fraud and Abuse Print E-mail
Written by Vitale Health Law   
Monday, 21 November 2016 00:00

The U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) recently released its work plan for 2017 and its target list is ambitious.

Each year, the agency releases a plan that summarizes new and existing reviews and areas where it will focus its attention for the coming year. It also shows the areas where work has been completed, revised or removed.

Here are some highlights...


Last Updated on Tuesday, 22 November 2016 18:42
 
8 Ways to Get MACRA-Ready Print E-mail
Written by Dr. Seth Flam, CEO & President, HealthFusion, Inc.   
Friday, 28 October 2016 00:00

MACRA begins in 2017 but the time to get ready for the new payment models is now.

The MIPS/MACRA reporting period begins on January 1, 2017. Preparing your practice for changes in reimbursement policies under MACRA is of utmost importance. You’ll have to assess the ways in which you may need to change your practice’s workflow in order to coincide with these transformations. Don’t procrastinate; act quickly to shift focus to the new healthcare structure. Here are some starting points:

Don’t throw Meaningful Use and PQRS out the window. In January 2016, more than 200,000 eligible professionals saw a decrease in Medicare payments because they failed to meet 2014 MU standards. However, now is not the time to breathe a sigh of relief; the components of these programs aren’t going away with the implementation of MACRA. To help you succeed, review your quality measures and identify high-performing areas – MACRA will use certain aspects of the PQRS and VBPM programs.

Take advantage of the resources that your medical societies and EHR vendor provides you. Learn the basics and make sure you and the rest of your staff are educated about the new regulation, and how to improve the care you provide and demonstrate your value to payers. Make sure your vendor provides intuitive strategies to ensure actionable data collection and submission.

Know the timeline and when to prepare and implement the required changes. Keep abreast of CMS news so that you can stay updated on the latest news on MACRA developments and resources.

Outline your strategy well in advance and brainstorm with your staff. Review quality measure benchmarks and understand what is required for above-average performance, and implement practice strategies and workflows to meet quality and cost measures. The reporting period for Clinical Practice Improvement Activities is 90 days, so think through which time period in 2017 would work best for your practice’s selected CPIAs.

Review your CMS Quality Resource and Use Report (QRUR) for 2014 and the first half of 2015 to help you assess how you are currently being rated on cost and quality. You can find more information on accessing your QRUR here. Identify opportunities to improve the quality and cost of the care you provide and internal workflow changes that can be made to support care delivery plans. Think about who your potential partners may be; other specialists to whom you refer patients, in efforts to advance a coordinated care plan.

Make sure your EHR provides you with flexible tools to understand your quality metrics. You should be able to get data easily from your software and your dashboard should be customizable, granular, scalable and transparent.

Invest in a “MACRA-ready” EHR. Speak with your vendor or a potential vendor about how their software will be able to support your success through the transition to the new payment model. Does your vendor offer a patient portal? Does it enable secure messaging or appointment reminders? Is it certified EHR technology? Will your vendor offer you a MACRA-specific dashboard so that you will be aware, at all times, of how you’re performing in each performance category?

Remember that MACRA is a competition. There will be winners and losers – and your software will play an important role in your success. On which side of the bell curve will you be in 2017?

Last Updated on Saturday, 29 October 2016 07:58
 
The CMS MACRA/MIPS Timeline Print E-mail
Written by HealthFusion   
Thursday, 06 October 2016 00:00

As we covered in our blog post, The Sun Sets on SGR and Rises on MACRA, Department of Health and Human Services Secretary, Sylvia Burwell had issued a long term timeline for two reform goals to deliver the new Quality Payment Program system. According to Burwell, 50 percent of Medicare payments are to be tied to participation in an Alternative Payment Model (APM) by the end of 2018.

As for the majority of physicians, who will need to transition much more slowly from fee-for-service to the Quality Payment model, Burwell presented a goal of 85 percent of FFS payments to be tied to quality and value by the end of 2016 and 90 percent by 2018. This goal is to be attained by way of the Merit-based Incentive Payment System (MIPS), which will begin its reporting period on January 1, 2017. Here is a timeline for MIPS and how it will affect you in the near future.

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