The Changing Face
of Healthcare
Compliance:
Managing the New
PPACA Rules and
CMS Guidelines
Presented By:
Chris Redhage – Co-founder
Jennifer Ives – Business
Development
Agenda
1.
2.
3.
4.
5.
A story – setting the stage
Overview of the law
Understanding your risk
Short product demo
Q and A
ProviderTrust, LLC ©2010
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 2011
1. Section 6501 – If provider is excluded in 1 state, they
are now excluded in all states.
CMS Final Rules and Guidelines - Effective March 25th 2011
1. 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
Example of Contractor Agreement
ProviderTrust, LLC ©2010 - 2011
“How can I manage verifying
every license in every state every
month??”
“We manage this
at the unit
level…”
“We verify and
monitor our state.
That’s always
been enough
before!”
“I’ve been
managing this
process with our
HRIS, recruiters and
employment
coordinators…”
ProviderTrust, LLC ©2010 -2011
“We check the
OIG list. Isn’t
that enough?”
Question 1
How often are you currently
monitoring your provider’s license
status for potential sanctions?
1.
2.
3.
4.
Upon hire
Monthly
Bi-annually
Annually
ProviderTrust, LLC ©2010 -2011
DID YOU KNOW:
•61% of all State reported actions never 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 = $300,000
3 x $12,000
= $36,000
$336,000
ProviderTrust, LLC ©2010 - 2011
$350 Million is devoted to enforcement efforts
$110 Million will be spent in 2011-2012 alone
Catholic Health Care West, $243,819.28
Adventist Health System, $68,831.82
East Boston Neighborhood Health Center, $200,962
Providence Health System, $105,219.49
New York Downtown Hospital, $220,000
AdCare Hospital of Worcester, $254,820
University of Arkansas , $201,689.98
South Pasadena Hospital, $142,731.56
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 list
3. All 50 State boards, Federal and All State
exclusion lists
ProviderTrust, LLC ©2010 -2011
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 YOU
For 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