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CMS to launch new MIPS Participation Framework in 2021 Performance Period

CMS is implementing a new participation framework for the Merit-based Incentive Payment System (MIPS), called the MIPS Value Pathways (MVPs), starting with the 2021 performance period. The goal of this new framework is to move away from siloed performance category measures and activities, and move toward an aligned set of measures and activities that are more meaningful to clinicians and patient care. With the MVPs framework, CMS is aiming to connect measures and activities across the Quality, Cost, Promoting Interoperability, and Improvement Activities performance categories of MIPS for different specialties and conditions. The new framework is designed to: Simplify MIPS and reduce clinician burden; Improve value and create a more cohesive and meaningful participation experience; and Better align with Alternative Payment Models (APMs) to help ease the transition from MIPS… . . . read more.

Employment Law Update

New overtime rule now in effect

By Mike O’Brien bio Jan. 1, 2020 was the deadline to comply with new FLSA overtime rule. At the end of September the Department of Labor issued its long-awaited final rule updating the salary level test for white-collar overtime exemptions under the Fair Labor Standards Act. Under the new rule, the minimum salary level for exemption is raised from $455 a week to $684 a week, or $35,568 annually. The change marks the first increase in the minimum salary level to take effect in more than 15 years. It is expected to bring overtime eligibility to over a million employees who are ineligible under the current threshold. Although the DOL released a final rule raising the salary level in 2016, the rule was blocked by a federal district court and… . . . read more.

QUALITY PAYMENT PROGRAM

MIPS 2020 payment adjustments in effect based on 2018 performance

In July 2019, each Merit-based Incentive Payment System (MIPS) eligible clinician received a 2018 MIPS Final Score and associated payment adjustment factor(s) as part of their 2018 MIPS performance feedback, available on the Quality Payment Program website. 2020 MIPS payment adjustments, based on each MIPS eligible clinician’s 2018 MIPS final score, will now be applied to payments made for Part B covered professional services payable under the Physician Fee Schedule. Payment adjustments are determined by the final score associated with your Taxpayer Identification Number (TIN)/National Provider Identifier (NPI) combination. MIPS eligible clinicians, identified by TIN/NPI combination for the 2018 performance period, will receive a positive, neutral, or negative MIPS payment adjustment in 2020 if they: Were a clinician type that was included in MIPS; Enrolled in Medicare prior to Jan…. . . . read more.

BILLING & COLLECTIONS

5 ways to break down bureaucracies to get payer contracts

By Steve Selbst bio It is important to remember that payers are large companies, with protocols, policies and business practices. As with any large company, there are bureaucracies, and they are necessary to maintain the order and success of these organizations. Therefore, the first tip is to understand that to get contracted you need to identify the right department and right person to send your request to get contracted. This is usually the payer contracting department and payer contracts’ manager. Generally, you will be sending your requests to the payer contracts’ manager in your state. A common mistake is to—instead—send these requests to provider relations or to another department. This brings us to our second tip. That is, figure out the approach the payer is using to establish its fee… . . . read more.

ENFORCEMENT

Feds Take Down $2.1 Billion Medicare Genetic Test Fraud Scheme

You know that a branch of lab testing has gone from fad to mainstream when it becomes the subject of a major federal enforcement takedown. Accordingly, the newly announced breakup of a $2.1 billion genetic billing fraud scam, one of the largest Medicare frauds ever undertaken, signifies that genetic testing has officially arrived. Operation Double Helix Known as Operation Double Helix, this landmark investigation and prosecution was a joint HHS, DOJ and FBI crackdown carried out in five federal districts against 35 defendants associated with genetic testing labs (CGx) and telemedicine companies, including doctors, CFOs and CEOs that allegedly “capitalized on the fears of elderly Americans to induce them to sign up for unnecessary or non-existent cancer screening tests,” according to one of the U.S. Attorneys involved. Old Wine in… . . . read more.

COMPLIANCE

Hiring and firing risk factor: careless words

Today’s administrators need to be aware of the casual – albeit well meant – words that are bringing on claims of discrimination. Legal risks of both hiring and firing include careless words, says employment law attorney Donald W. Benson, a partner with Hall Booth Smith in Atlanta. The friendly hiring remark The dangers start with the interview, where a wrong comment can generate a claim no employer ever expects, says Benson. Everybody knows not to ask the obvious questions of “are you married?” or “do you have children?” or “are you planning to have a family in the future?” Yet many an interviewer brings up a discriminatory topic obliquely and unwittingly in an effort to build rapport with a candidate, never thinking about the danger. Remarks such as “we have a… . . . read more.

ERGONOMICS

Better productivity and a happier staff happen as ergonomics steps in

Ergonomics is good economics. When the work areas are in sync with the people spending their days in them, there’s no time lost to sick days and no money lost to low productivity, says Hayley Kaye, a certified professional ergonomist with HLK Consulting in New York City. Achieving that calls for attention to the desks, the telephones, and the chairs. But it also calls for teaching people how to set them up correctly. It’s of zero value to have thousands of dollars of ergonomically correct furniture that nobody has adjusted. The elbow-wrenching desktop A good place to start is with the hands and elbows. For typing, they need to be level, Kaye says. Yet most desks are too high to the point that anybody shorter than 6’2″ has to sit with… . . . read more.

INFORMATION SECURITY

HIPAA enforcement takes a dramatic new direction

Historically, HIPAA enforcement has focused predominantly on the failure of covered entities to keep protected health information (PHI) private and secure; but now the scope is broadening to encompass keeping PHI too private and too secure. The HHS Office for Civil Rights (OCR), the agency that enforces HIPAA rules, has broken new ground by fining a Florida hospital for failing to provide access to PHI to the individual it relates to. Here’s a look at the case and what it portends about the new direction in HIPAA enforcement. The HIPAA Right of Access When you hear the term “HIPAA Privacy Rule,” the first thing likely to jump into your mind is the obligation to keep PHI secure and refrain from disclosing it to third parties without appropriate authorization. But there’s… . . . read more.

HIPAA compliance with document management

By Andreas Rivera bio Recordkeeping can be one of the most stressful aspects of running a healthcare business since privacy compliance is scrutinized in healthcare more than any other industry. Anyone with experience in the healthcare industry knows that violating HIPAA comes with steep penalties. It’s a constant anxiety to make sure your records are being stored in an appropriate manner, with all the security and privacy requirements being met for each new record added. Even if you’re being diligent with how you file your paperwork, having physical paper exacerbates the possibility of human error occurring. Most of the time, the most common HIPAA violations usually occur without the facility realizing it. Here are a few common HIPAA violations when it comes to electronic data storage. Insufficient or lack of… . . . read more.

Department of Labor enters final stage of update to ‘regular rate’ rule under FLSA

By Mike O’Brien  bio Department of Labor enters final stage of update to ‘regular rate’ rule under FLSA. As we have discussed previously in these updates, the Department of Labor has been working to update the definition of “regular rate” of pay under the Fair Labor Standards Act. The regular rate is used to calculate overtime pay. The rule has not been updated in half a century, and fails to capture the realities of the modern workplace. The DOL recognized this, and has now proposed a final rule to the White House Office of Management and Budget. Although the details are not yet publicly available, prior versions of the rule clarified that forms of compensation like tuition reimbursement, employee discounts, employer-provided gym costs, wellness programs, and certain other benefits are… . . . read more.


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