Healthcare Regulatory Update - 2012

For the twelfth consecutive year, EisnerAmper's Healthcare Services Group is honored to have created and have the opportunity to present its 2012 Healthcare Regulatory Update.  

As healthcare consultants in the northeast market (NY/NJ/PA) with a combined 20 years of experience, EisnerAmper's Healthcare Services Group consistently monitors and educates itself on all regulations and updates from the Centers for Medicare and Medicaid Services (CMS) as well as the latest in healthcare reform from Washington. This preparation allows the group to discuss, educate and provide an audience comprised of healthcare providers, office staff and outside healthcare professionals with the latest information on the issues impacting the healthcare industry.

The 2012 Healthcare Regulatory Update includes the latest information on: Healthcare Reform, including the most recent changes to be implemented as part of the Patient Protection and Affordable Care Act; An Ambulatory Services update that includes physician reimbursement, EHR, Audit Insurance, revalidation, RAC’s;

A Hospital Services update that includes inpatient rates, outpatient rates, ACO’s, merger/acquisitions, new payment models, physician and nurse shortages; A Compliance update that includes HIPAA, Stark, Anti-Kickback statute, RAC’s and ZPICS.


Healthcare Regulatory Update - 2012


Marketplace Challenges
  • Reimbursement
  • Costs
  • Consolidation
  • Overpayment Audits
  • Regulatory Changes


Healthcare Reform
  • HHS Draft Rules on Exchanges Cite State Flexibility but Don't Offer Much Detail
  • Debt Solutions May Impact Way Medicaid Reform Expansion Occurs, Observers Say
  • Reform Law Boosts Incentives, Protections for Whistleblowers
  • Debt Proposal Targets Long-Term Insurance
  • Insurers Seek to Buy Physician Practices To Comply, Cope With Reform Law Provisions
  • States Will Save Billions Because of Reform Law, Urban Institute Finds
  • States May Take Lead on MLR Broker Issue As NAIC, Congress Turn Attention Elsewhere
  • The 4th Circuit Court of Appeals in Richmond, Va., dismissed two challenges to the health reform law
  • Oklahoma and North Carolina have both applied for waivers from the health reform law's minimum medical loss ratios
  • IRS Seeks to Clarify, Solicit Comment on How Firms Gauge Coverage Affordability
  • AHIP Says Providers Aren't Prepared for Accountable Care Arrangements
  • Health Plans Will Participate In Exchanges; HHS Tries To Engage States
  • Insurer Says Plans Are Weighing Options on How to Deal With, Distribute MLR Rebates
  • HHS Awards May Encourage States to Adopt 'Prior Approval'
  • IOM Suggests Basing 'Essential Benefits' On What's Typical in Small-Employer Plans
  • Delays in Issuing Reform-Law Regs Start Worrying Insurers as Much as Regs' Content
  • Presbyterian, Everett Clinic See MA as Their Best Route Into ACOs
  • Survey Finds Reform's Impact on 2011 Premium Increases Is Minimal


Ambulatory Services
  • Hospital practices could lose revenue with proposed 3-day requirement
  • Steps to adopt EHR software
  • Control risk with Audit Insurance
  • New initiative will pay lump sums to hospitals and providers for coordinating care
  • Final e-Rx rule gives you four new exemptions, November deadline
  • Four ways to ensure physician quality ratings don't hurt cash flow
  • CMS clarifications show why Medicaid's bigger EH R bonus check is easier to get
  • Physician Practices could be recruited to partner with hospitals in bundled payments initiative
  • E/M utilization soared and denials fell after consult elimination
  • New primary care program pays extra monthly fee per patient
  • Most CMS providers will have to revalidate by March 2013
  • RAC demand letters to come from MACs
  • Providers must use new Medicare enrollment forms by Nov. 1
  • MGMA supports repeal of the 3 percent withholding tax


Hospital Services
  • Healthcare Costs Rise 5.58 Percent, According to S&P Indices
  • Hospital Executives Open to ACOs
  • Health Insurance Exchanges to Spur Competition Among Insurers
  • Healthcare Mergers, Acquisitions Hit Record Pace
  • FASB Updates Healthcare Accounting Standards CMS Issues Final Rule on Hospital IPPS payments
  • Healthcare IT Spending on the Rise
  • Medicare Drug Plan Leads to Hospital Cost Savings
  • HHS Awards $71.3 Million to Expand Nursing
  • Moody's: Revenue Growth Lowest in Two Decades
  • Appeals Court Strikes Down Reform Law's Insurance Mandate
  • Moody's: Negative Outlook Continues for Healthcare Sector
  • Healthcare Fraud Prosecutions on the Rise
  • Physician Assistant Profession Growing Rapidly, Report
  • Number of Uninsured Nears 50 Million: U.S. Census Findings
  • Hospital CEOs: Reimbursement Cuts and New Payment Models
  • Managed Care in Medicaid Rising Steadily
  • HHS Issues Rule on Medicaid RAC Program
  • Major Health Insurers to Pool Claims Data
  • Hospitals Increasing ICD-10 Preparation Efforts
  • Campaign Begins to Sign Up Americans for Health Insurance
  • Medicare Advantage Enrollment Rising
  • Justice Department Seeks Supreme Court Review of Healthcare Law
  • Companies Expect Healthcare Costs to Rise at Lowest Rate Since 1997
  • MedPAC Votes to Recommend SGR Repeal
  • New Physicians Recruited Heavily
  • Final ACO Rule Eases Requirements for Physicians, Hospitals


Compliance Concerns
  • Hospitals Navigate Fair-Market Value Under Stark as Feds Scrutinize Arrangements - Fair Market Value Algorithm
  • MACs' Policies on Cloning Electronic Medical Records
  • RAC Letters Are Shifted to MACs in Bid to Solve Lateness Problem
  • RAC Medical Necessity Audits Accelerate
  • Health Systems Strive to Identify, Eliminate Compliance Gaps at Joint Ventures
  • CMS Nearly Doubles Investment in RACs
  • OIG Plans a Sweeping Review of Physician- Owned Distributors
  • Irked by Ongoing Noncompliance and Repeat Offenders, Feds Focus on Individuals
  • Provider-Based Status May Be Smart Move As DRG Window Rule Is Applied to Clinics
  • OIG Work Plan for 2012 Opens the Door to More Sweeping Reviews of Hospitals
  • Screening Excluded Employees Is Essential, Fines Can Be Painful
  • Feds Focus on Individuals because of consistent noncompliance

Contact Information 

Steven Bisciello, MBA EisnerAmper, LLP Manager, Healthcare Services Group 

EisnerAmper LLP is an independent member firm of PKF International Limited

The material contained in this presentation is for general information and should not be acted upon without prior professional consultation. 

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