Facebook
Twitter
LinkedIn
Forward(Recorded Webinar) We Don’t Want to Pay for That: Recent Strategies Employed by State Medicaid Agencies to Limit FQHC Payments and What to Do About It
This webinar will address developing and concerning trends in FQHC reimbursement and why the foundation of any good payment reform initiative is a properly set PPS rate. Many states have started employing similar strategies to limit FQHC payments via the change in scope of services process, often citing budget shortfalls as the reason why rates cannot increase. Such strategies include rate limits based on such devices as a percentage of average (such at 105% of the average rate across the state), productivity standards (the famous 4200 visits per year even though that number was disavowed by HRSA 30 years ago), and limits on administrative costs.
States have also defined and redefined their rules on what is a qualifying event (usually writing out “duration, intensity and/or amount” of services from the definition of changes in the scope of services and only leaving a new type of service as qualifying) to make any qualifying changes very hard to meet. Other strategies include percentage increase requirements and refusing to include as allowable costs such things as outreach, case management and care coordination. Finally, despite at least one favorable court decision, many states refuse to pay up to the Medicaid rate for full dual eligibles and only pay the Medicare co-pay.
Our speakers, Ted Waters and Kathy Ghiladi, two attorneys with extensive experience in Medicaid payment issues, will discuss why failing to address these issues sets the stage for long-term and devastating shortfalls in revenue, with all the attendant problems that come with underfunding, and what the federal rights of FQHCs are for full and accurate Medicaid payments.
Target Audience
- Heath Center C-suite (CEOs, COOs, CFOs, and Compliance Officers)
- Health Center finance personnel
- Primary care association personnel
- Billing personnel
- Revenue cycle personnel
Learning Objectives
After this webinar, you will be able to:
- Understand the Federal law requirements and the policy behind them
- Understand the rationale for why budget limitations are not lawful
- Develop strategies to move towards a compliance system in your state
- Develop strategies to put your center(s) in the best position to prevail in an administrative hearing or in federal court
Kathy Ghiladi
Kathy Ghiladi is a Partner in the firm's Health Care practice group. Her practice focuses on government-sponsored health care programs such as Medicaid, CHIP, Medicare, and the Affordable Care Act, with an emphasis on payment/reimbursement and compliance related issues. Kathy also represents clients in government investigations and audits, litigation before federal and state courts, as well as in administrative appeals with the U.S. Department of Health and Human Services Departmental Appeals Board (DAB) and Provider Reimbursement Review Board (PRRB). She provides reimbursement counseling (including identification, reporting, and repayment of overpayments) with respect to Medicare, Medicaid, and private third-party payors. [Full Bio]
Ted Waters
Ted Waters is Managing Partner of the firm and a member of the Health Care and Federal Grants practices. Ted is a national authority in the area of federal grants, particularly in the health and community service spheres. He advises clients on all aspects of program requirements, including issues such as cost-based reimbursement, governance, grant administration, cost reporting, and administrative issues and routinely handles challenging issues such as government audits, internal investigations, and litigation. His priority is to help each organization carry out its mission by offering practical, down-to-earth counsel and to ensure that legal challenges do not distract from that focus. [Full Bio]
Certificates of Attendance: We verify attendance upon completion of a webinar (live or recorded version) and will only issue certificates in the name of the account holder enrolled in the course. If you need to document attendance for someone other than the account holder, we provide blank Certificates of Attendance for a supervisor to sign and certify that a different individual viewed the course.
Group Attendance: Due to the online nature of webinars, we cannot verify participation by more than one person. For groups, we provide an attendance record form and blank Certificates of Attendance to record attendance at a group viewing session and document each individual's participation. We recommend that a supervisor or colleague sign the certificate to certify attendance.
Read more about maintaining an attendance record in our FAQs.
Available Credit
- 1.50 Certificate of Attendance
Price
ACCESS PERIOD
Recorded webinars are available for 90 days after the date of purchase or date of the webinar. Once posted to your account, you can view this webinar anytime on-demand during the access period identified in your purchase confirmation. For additional information on viewing and accessing webinars, view our full terms and conditions here.
PAYMENT POLICY
If you pay by credit card or PayPal, you will be able to access the recorded webinar immediately (unless the live webinar has not yet occurred). If you pay by check, we will grant access to the recording when we receive your check. You will receive a confirmation email once access is granted. Feldesman Training Solutions reserves the right to suspend access to the webinar if payment is not received within 30 days. For more information on payments and registration, please visit our FAQ page.
CANCELLATION POLICY
No refunds will be provided for recorded webinars. Feldesman Training Solutions can transfer a registration to someone else within your organization or, provided you have not already viewed the webinar, transfer the registration to another on-demand program. Where the registration fee for the new webinar is higher, you must also pay the difference between the original course and the new course registration fee at the time of transfer. Administrative fees may also apply. If your organization purchased a webinar under the account of a staff member who no longer works for your organization, please contact us. View our full policy on refunds and cancellations here.
Required Hardware/Software
Google Chrome and Mozilla Firefox are the preferred browsers.