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 ProviderTrust, LLC © A story – setting the stage 2.Overview of the law 3.Understanding your risk 4.Short product demo 5.Q and A

ProviderTrust, LLC © How will you “know or should have known?”

ProviderTrust, LLC ©

Overview of PPACA and CMS Final Rules PPACA - Effective January 1 st Section 6501 – If provider is excluded in 1 state, they are now excluded in all states. CMS Final Rules and Guidelines - Effective March 25 th 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 © “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!”

ProviderTrust, LLC © How often are you currently monitoring your provider’s license status for potential sanctions? 1.Upon hire 2.Monthly 3.Bi-annually 4.Annually Question 1

ProviderTrust, LLC © 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.

ProviderTrust, LLC © IN THE NEWS…

ProviderTrust, LLC © 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 © Catholic Health Care West, $243, Adventist Health System, $68, East Boston Neighborhood Health Center, $200,962 Providence Health System, $105, New York Downtown Hospital, $220,000 AdCare Hospital of Worcester, $254,820 University of Arkansas, $201, South Pasadena Hospital, $142, $350 Million is devoted to enforcement efforts $110 Million will be spent in alone

ProviderTrust, LLC © 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

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 ©

Demo of ProviderTrust ProviderTrust, LLC ©

Question and Answer Time ProviderTrust, LLC ©

THANK YOU For more information, a live demo or to download a whitepaper on the CMS final rules Please visit or contact us: TRUST ProviderTrust, LLC ©