On August 1, 2024, the Centers for Medicare & Medicaid Services (CMS) issued the 2025 Medicare Hospital Inpatient Prospective Payment System (IPPS) final rule. PYA’s Martie Ross, Kathy Reep, and Carine Leslie hosted a discussion of the final rule’s key provisions: Rate increases and wage index changes Mandatory Transforming Episode Accountability Model (TEAM) New quality measure reporting requirements Updates to the Promoting Interoperability program Payments for establishing and maintaining access to essential medicines Resources for treating patients with inadequate housing Overview of the inpatient psychiatric facility (IPF), inpatient rehab facility (IRF), and skilled nursing facility (SNF) prospective payment systems for FY 2025 The webinar was presented on September 4, 2024. This webinar was part of PYA’s twice-monthly Healthcare Regulatory Roundup, a popular series during which PYA experts provide practical insights on the latest industry regulatory developments. If you would like assistance with preparing for TEAM or with reimbursement, regulatory impacts, or any matter involving compliance, valuation, or strategy and transactions, our executives would be happy to assist.
In 2024, PYA has sought to understand the toughest, timeliest, and trickiest topics in fair market value (FMV) and physician compensation in our Timely, Tough, or Tricky (TTT) webinar series. We started with a survey of more than 100 physician compensation experts and other healthcare professionals and have continued to collect questions during the 2024 TTT season with the goal of tackling those questions each month. In the spirit of the Olympics, PYA Principals Lyle Oelrich and Angie Caldwell addressed your timeliest, toughest, or trickiest issues during the webinar, “Going for Gold in Physician Compensation Planning,” on August 27, 2024. Webinar attendees gained knowledge through these discussion topics: What lessons can be learned from recent governmental complaints involving physician compensation to help with your planning efforts? What are some tips and best practices to remember when planning and designing physician compensation?
Many providers have significantly improved their revenue by participating in value-based contracts. Most providers, however, remain reluctant to enter into such arrangements because they do not believe they are prepared to manage downside risk. Presented on August 22, 2024. During this webinar, we examined many aspects of value-based care and how it impacts your revenue. PYA Principals Jane Jerzak and Martie Ross addressed the following key learning objectives: Explain the mechanics of various value-based payment models Discuss the status of the transition from fee-for-service to value-based payments Make the case for providers to move forward with a value-based contracting strategy Discuss critical first steps in pursuing such a strategy
PYA executives Sarah Bowman, Katie Croswell, Lori Foley, and Martie Ross will wrap up the four-part series, focusing on the following topics: Quality Payment Program (MIPS) Medicare Shared Savings Program SDOH-related services Clinical Laboratory Fee Schedule payment reductions Presented August 21, 2024. On July 17, PYA presented the first part of its webinar series on the proposed Medicare payment rules for 2025. In parts 2, 3, and 4 of the series, on July 31, August 14, and August 21, we will address the 2025 Medicare Physician Fee Schedule (MPFS) proposed rule, taking a deep dive into the rule’s most impactful provisions.
On July 17, PYA presented the first part of its webinar series on the proposed Medicare payment rules for 2025. In parts 2, 3, and 4 of the series, on July 31, August 14, and August 21, we will address the 2025 Medicare Physician Fee Schedule (MPFS) proposed rule, taking a deep dive into the rule’s most impactful provisions. 2025 Proposed Rules Part 3 – MPFS Presented August 14, 2024. PYA executives Kimberly Campbell, Katie Croswell, Carine Leslie, Brian Raabe, and Valerie Rock covered these proposals: Global surgery payment accuracy Evaluation & management services (including HCPCS G2211) New reimbursement for preventive services Digital therapeutics for behavioral health Supervision of outpatient therapy services Opioid treatment programs Skin substitutes The popular twice-monthly PYA Healthcare Regulatory Roundup provides practical insights on the latest industry regulatory developments. If you would like assistance with legislative or regulatory impacts or any matter involving compliance, valuation, or strategy and transactions, one of our executives would be happy to assist.
Lowering the overall cost of healthcare is a constant struggle for both providers and consumers. Patients, payers, and providers seek to find the operational inflection point that affords financial success while simultaneously improving quality and value. During this webinar on August 13, 2024, PYA Principal Deuce Lukemeyer led a robust panel discussion with industry leaders sitting in the key seats responsible for optimizing lower cost-of-care environments. Joining Lukemeyer on the panel were these experts: Scott Black, VP and Chief Financial Officer for System Health Solutions, Indiana University Health Dan Handel, MD, Chief Medical Officer, Atrium Health Jim Laughlin, MD, Indiana University Health/Indiana University School of Medicine The panel addressed these learning objectives: Significant trends from the last 25 years The impact of these historical events on today’s ambulatory care models Looking forward, where physicians and providers will find opportunities for ambulatory care improvements Why investments in ambulatory care create opportunities for efficiency in both inpatient and outpatient care settings Discussion of the next webinar episode taking a deeper dive into tactics for optimizing individual ambulatory care settings
On July 17, PYA presented the first part of its webinar series on the proposed Medicare payment rules for 2025. In parts 2, 3, and 4 of the series, on July 31, August 14, and August 21, we will address the 2025 Medicare Physician Fee Schedule (MPFS) proposed rule, taking a deep dive into the rule’s most impactful provisions. PYA executives Miriam Murray, Valerie Rock, and Martie Ross covered the following topics from the proposed rule: 2025 payment rate reduction Deadline for reporting overpayments Advanced primary care management payments Telehealth Rural health clinics and federally qualified health centers The popular twice-monthly PYA Healthcare Regulatory Roundup provides practical insights on the latest industry regulatory developments. If you would like assistance with legislative or regulatory impacts or any matter involving compliance, valuation, or strategy and transactions, one of our executives would be happy to assist.
Throughout 2024, PYA has sought to understand the toughest, timeliest, and trickiest topics in fair market value (FMV) and physician compensation in our Timely, Tough, or Tricky (TTT) webinar series. We started with a survey of more than 100 physician compensation experts and other healthcare professionals and have continued to collect questions during the 2024 TTT season to tackle those questions each month. This webinar took place on July 23, 2024. Webinar attendees gained knowledge through these discussion topics: What are some tips and best practices to help you assess physician compensation risk? What are several common management services agreement structures, and how are these valued? PYA’s Timely, Tough, or Tricky—Physician Compensation and Fair Market Value webinar series is in its third successful season. To learn about all of PYA’s webinars, follow PYA on LinkedIn and bookmark the PYA Webinars page. PYA performs more than 1,200 fair market value opinions and reviews or develops hundreds of physician compensation plans each year. If you would like assistance with physician compensation, fair market value, or any matter involving valuation, compliance, or strategy and integration, our executives would be happy to assist.
Whether you’re looking to activate a clinical trial or you need help streamlining the management of your clinical trials program, PYA’s webinar, “Optimizing Clinical Trial Administration,” can help. Learn about some common challenges to clinical trial administration and ways you can address them in your organization. The webinar took place on July 18, 2024. During this webinar, PYA Principal Deborah Biggs, Director Jennifer Parnell, and Manager Katie Croswell discussed some common clinical trial administration challenges and provided tips for addressing them in your organization. Attendees gained knowledge from these learning objectives: Understanding common clinical trial administration challenges in study startup and management Identifying process improvement opportunities and ways to optimize how trials are managed Learning key best practices for clinical trial administration Learn about the PYA Clinical Research Administration Office. If you would like assistance with activating or managing clinical trials or any matter involving compliance, budgeting, or contracting, one of our executives would be happy to assist.
Part 1: CMS CY 2025 Proposed RulesPresented July 17, 2024 The Centers for Medicare & Medicaid Services (CMS) have released the Calendar Year (CY) 2025 proposed rules. In Part 1 of our two-part series, PYA’s Martie Ross and Kathy Reep covered the following proposed rules: CY25 Hospital Outpatient PPS Policy Changes and Payment Rates and Ambulatory Surgical Center Payment System Policy Changes and Payment Rates CY25 Changes to the End-Stage Renal Disease (ESRD) PPS and Quality Incentive Program CY 2025 Home Health PPS Rate Update and Home Infusion Therapy and Home IVIG Services Payment Update In addition, Martie and Kathy discussed two recently published final rules (the Cures Act Final Rule and the Consumer Financial Protection Bureau Final Rule) and the impact of recently published Supreme Court decisions, including Loper Bright Enterprises (overruling Chevron deference to administrative agencies). The popular twice-monthly PYA Healthcare Regulatory Roundup provides practical insights on the latest industry regulatory developments. If you would like assistance with legislative or regulatory impacts or any matter involving compliance, valuation, or strategy and transactions, one of our executives would be happy to assist.
In an era marked by evolving healthcare policies and regulations, the dynamics between payers and hospitals play a crucial role in shaping financial outcomes and patient care quality. Understanding and managing payment disputes is essential for both parties to maintain financial stability while ensuring patient access to quality care remains uncompromised. This webinar delved into the intricate landscape of payment disputes between insurance companies and hospitals. Industry experts explored the underlying causes of disputes and proactive strategies to mitigate financial risk. PYA Principals Jane Jerzak and Jason Hardin addressed the following key learning objectives: Understanding Payment Dispute Dynamics: Gain insights into the common causes and complexities of payment disputes between insurance companies and hospitals. Best Practices for Resolution: Learn strategies for effective negotiation and resolution of payment disputes. Analytical Approaches for Dispute Resolution: Explore analytical methods for analyzing and repricing disputed claims. Long-term Strategy: Develop a long-term strategy for monitoring contract performance, including periodic reviews of contract terms and ongoing reimbursement monitoring using analytics to identify deviations and prepare for disputes. By the end of this webinar, participants gained actionable insights into navigating payment disputes effectively, fostering collaborative relationships between payers and providers, and ensuring sustainable financial health. Watch for more episodes of the Revenue Recharge webinar series. In the series, PYA shares ways health systems and physicians can identify revenue opportunities, leading to a more sustainable and visionary future and better healthcare for patients. By addressing net revenue opportunities in your operational planning, you can support your mission.
In early 2024, PYA surveyed more than 100 physician compensation experts and other healthcare professionals to understand their timeliest, toughest, or trickiest (TTT) topics in fair market value (FMV) and physician compensation. Based on this survey, PYA has covered many of the items so far in our Timely, Tough, or Tricky webinar series 2024 season. PYA Principal Lyle Oelrich and Manager Ericka Dickinson continued the discourse on your most pertinent issues during the webinar, Timely, Tough, or Tricky: “Top-Notch Trends, Executives, and Team-Based Compensation” on June 25, 2024. Webinar attendees gained knowledge through these learning objectives: What trends are emerging in the 2024 physician compensation benchmarking surveys? How can you attract top-notch physician executives while ensuring their compensation is FMV? What are team-based physician compensation models, and when might they be appropriate to help you accomplish your organizational goals? PYA’s Timely, Tough, or Tricky—Physician Compensation and Fair Market Value webinar series is in its third successful season. Check out the TTT webinars so far in 2024 that have covered these topics: Physician recruitment/retention Physician compensation for travel time Private equity physician compensation offers Physician wage inflation Rising physician starting bonuses Evolving physician compensation models Compensating extremely productive/unproductive physicians Top 10 high-demand physician specialties To learn about all of PYA’s webinars, follow PYA on LinkedIn and bookmark the PYA Webinars page. PYA performs more than 1,200 fair market value opinions and reviews or develops hundreds of physician compensation plans each year. If you would like assistance with physician compensation, fair market value, or any matter involving valuation, compliance, or strategy and integration, one of our executives would be happy to assist. Contact them via email or by calling (800) 270-9629.
The recent cyber attack on Change Healthcare was more than a cyber security event. It was a business continuity wake-up call. In today’s digital healthcare world, information systems serve as the backbone of clinical and business operations. As providers increasingly depend on complex information technology (IT) systems, identifying critical pathways and preparing for cyber disasters becomes imperative to ensure resilience and continuity. PYA’s Barry Mathis, former CIO, CTO, and IT auditor, helped the audience focus on the most important lessons from recent cyber events. Hear methods to identify critical pathways in healthcare IT and recognize their significance in clinical and operational settings Understand the common vulnerabilities and threats facing healthcare IT systems Learn strategies to prepare for and respond to cyber disasters effectively, including the development of an incident response plan PYA is pleased to announce its third annual Summer CPE Symposium: “Hot Topics in Healthcare,” June 20-21, a complimentary virtual learning opportunity for healthcare leaders and other professionals. Over two days, PYA thought leaders will present four sessions on trending topics and provide key takeaways and helpful tools for attendees. The 2024 symposium offers two sessions each day for a total of four opportunities to learn from a team of PYA experts on topics related to reimbursement, healthcare compliance, audit and accounting, and cybersecurity.
During this session, Trevor Brown and Mimi Grachek discussed recently issued or effective authoritative literature along with current accounting and auditing issues impacting organizations today. They explained changes to date made by the Financial Accounting Standards Board, Auditing Standards Board, and Governmental Accounting Standards Board. In particular, Brown and Grachek discussed changes related to supplier finance program obligations, common control arrangements, joint venture formations, crypto assets, risk assessment process, and information technology controls, among many other changes. The PYA thought leaders also provided timelines for effective dates for the updates, discussed immediate and future impacts of the changes, and offered an outlook on upcoming changes. Describe accounting, auditing, and other attest issues important to the industry Share best practices for complying with professional, technical, and regulatory requirements related to common accounting and auditing issues faced by public and industry accountants Apply examples and illustrations to “real-life” circumstances PYA is pleased to announce its third annual Summer CPE Symposium: “Hot Topics in Healthcare,” June 20-21, a complimentary virtual learning opportunity for healthcare leaders and other professionals. Over two days, PYA thought leaders will present four sessions on trending topics and provide key takeaways and helpful tools for attendees. The 2024 symposium offers two sessions each day for a total of four opportunities to learn from a team of PYA experts on topics related to reimbursement, healthcare compliance, audit and accounting, and cybersecurity.
The U.S. Department of Justice (DOJ) released a playbook that its healthcare fraud prosecutors will use to evaluate an entity’s compliance program in February 2017 and revised in June 2020 and again in March 2023. Accordingly, management should be well versed in the factors fraud prosecutors will use to evaluate the effectiveness of an entity’s compliance programs, which, in turn, influence the severity and materiality of any charging decisions. During this session, Karin Anderson and Tynan Kugler provided an overview of these factors including industry best practices management teams can implement to demonstrate an effective compliance program. They incorporated insights obtained while serving as the compliance subject matter expert as part of the compliance monitorship team for the largest DOJ-imposed non-prosecution agreement of a health system in U.S. history. Hear an overview of the “Principles of Federal Prosecution of Business Organizations” in the U.S. Justice Manual Learn from an overview of the U.S. Department of Justice Criminal Division’s “Evaluation of Corporate Compliance Programs” Understand the government’s expectations for demonstrating an effective compliance program Gain best practices for assessing and implementing the key provisions of the DOJ’s guidance. PYA is pleased to announce its third annual Summer CPE Symposium: “Hot Topics in Healthcare,” June 20-21, a complimentary virtual learning opportunity for healthcare leaders and other professionals. Over two days, PYA thought leaders will present four sessions on trending topics and provide key takeaways and helpful tools for attendees. The 2024 symposium offers two sessions each day for a total of four opportunities to learn from a team of PYA experts on topics related to reimbursement, healthcare compliance, audit and accounting, and cybersecurity.
Understanding a hospital’s Medicare reimbursement is becoming more complex each year. A significant aspect of the reimbursement is tied to the annual hospital Medicare cost report. With additional scrutiny of the annual reports by Medicare Administrative Contractors (MACs), hospitals must file accurate reports and supporting documentation for smooth cost report audits. Settlement impacts tied to the annual cost report may have a significant consequence on an organization’s reimbursement. During this session, Emily Wetsel discussed the various reimbursement impacts tied to the annual hospital Medicare cost report and their influence on your organization’s reimbursement. Understand the key prospective payment system hospital settlement impact items Learn key cost-based reimbursement strategies for critical access hospitals for efficient cost reporting Learn provider-based rural health clinic settlement impacts from and strategies for the Medicare cost report Understand the wage index and what it means for your organization’s Medicare reimbursement Gain helpful tips for smooth Medicare cost report reviews or audits PYA is pleased to announce its third annual Summer CPE Symposium: “Hot Topics in Healthcare,” June 20-21, a complimentary virtual learning opportunity for healthcare leaders and other professionals. Over two days, PYA thought leaders will present four sessions on trending topics and provide key takeaways and helpful tools for attendees. The 2024 symposium offers two sessions each day for a total of four opportunities to learn from a team of PYA experts on topics related to reimbursement, healthcare compliance, audit and accounting, and cybersecurity. Continuing professional education (CPE) credits are available, and attendees can register for as many sessions as they’d like.
The winds of healthcare privacy continue to shift, most recently with the release of a new rule supporting reproductive healthcare privacy under HIPAA, the Federal Trade Commission’s (FTC) new rule on breach notification for healthcare applications, and the Centers for Medicare & Medicaid Services’ (CMS) revisions and clarifications regarding informed consent. Webinar attendees learned about these new rules and received insights into what’s on the horizon during PYA’s webinar, “The Healthcare Privacy Forecast: Navigating the Regulatory Climate,” on June 19, 2024. PYA’s Karin Anderson and Erin Walker discussed key provisions of the following final rules impacting healthcare providers: HIPAA Privacy Rule to Support Reproductive Healthcare Privacy FTC Health Breach Notification Final Rule CMS revisions and clarifications to Hospital Interpretive Guidelines for Informed Consent This webinar was part of PYA’s twice-monthly Healthcare Regulatory Roundup, a popular series during which PYA experts provide practical insights on the latest industry regulatory developments. If you would like assistance with legislative or regulatory impacts or any matter involving compliance, valuation, or strategy and transactions, one of our executives would be happy to assist. You may email them or call (800) 270-9629.
Twice each year, PYA’s Center for Rural Health Advancement presents a deep dive into the most challenging regulatory and reimbursement issues facing rural health providers and the communities they serve. Attendees learned more about the unique issues facing rural health providers during PYA’s webinar, “Let’s Get Rural: Managing Regulatory and Reimbursement Challenges,” presented on June 13, 2024. During this webinar, PYA’s Martie Ross and Kathy Reep provided practical insights and advice for rural health leaders. They hosted a lively discussion of more than a dozen hot topics in rural health: Surviving Medicare Advantage Tips for Negotiating Commercial Contracts Ways to Stem Patient Outmigration Update on the Rural Emergency Hospital Program Status of Rural IPPS Hospital Medicare Add-On Payments Current Status and Future of Telehealth Reimbursement Compliance with Price Transparency Requirements Regulatory Requirements on the Horizon Rural Health Clinic Opportunities CAH Cost Report Considerations Defending Swing Bed Reimbursement Changes to Conditions of Participation What’s Happening in D.C. Attendees of the live webinar were eligible for 1.5 CPE* credits in Specialized Knowledge. This webinar was part of PYA’s Let’s Get Rural series, which reflects PYA’s commitment to helping rural health providers preserve access to high-quality services for their communities. Watch for another Let’s Get Rural webinar soon, and learn more about PYA’s Center for Rural Health Advancement. If you would like assistance with the unique needs of rural healthcare, including regulatory impacts, reimbursement opportunities, or any matter involving compliance, valuation, or strategy and transactions, our executives would be happy to assist. Contact them via email or by calling (800) 270-9629
During Episode 4 of PYA’s Revenue Recharge series, Principal Bob Paskowski and Senior Manager Kathy Reep discussed many aspects of Medicare Advantage. Specifically, they covered the following key points: Monitoring MA contract yields Knowing your MA payer policies that may impact reimbursement Seeking value-based arrangements as a supplemental revenue so The webinar took place on June 13, 2024. Watch for more episodes of the Revenue Recharge webinar series. In the series, PYA shares ways health systems and physicians can identify revenue opportunities, leading to a more sustainable and visionary future and better healthcare for patients. By addressing net revenue opportunities in your operational planning, you can support your mission. If you would like assistance with revenue management and strategies or any other area related to healthcare operations, strategy and transactions, or valuation, one of our executives would be happy to assist. You may contact them via email or by calling (800) 270-9629.
Medicare now reimburses providers for services addressing patients’ social determinants of health (SDOH), such as housing instability, transportation challenges, and food insecurity. PYA’s Martie Ross, Miriam Murray, and Katie Croswell addressed technical and practical issues relating to payment for SDOH risk assessments, community health integration (CHI), and principal illness navigation (PIN). The PYA team provided key insights regarding these topics: Workflow for SDOH risk assessments Initiating visits for CHI and PIN Billing practitioner responsibilities and staff qualifications Scope of services and documentation Reimbursement rates Business plan for SDOH services This webinar took place on June 5, 2024. Attendees of the live webinar were eligible for 1 CPE* credit in Specialized Knowledge. This webinar is part of PYA’s twice-monthly Healthcare Regulatory Roundup, a popular series during which PYA experts provide practical insights on the latest industry regulatory developments. If you would like assistance with legislative or regulatory impacts or any matter involving compliance, valuation, or strategy and transactions, one of our executives would be happy to assist. You may email them or call (800) 270-9629.