First Healthcare Compliance CONNECT- June 2016

®
CONNECT
June 2016
An Exclusive Monthly Publication for Clients
Partner Spotlight:
SPHER, Inc
New
System
Features
Prepare
Your
Staff
Government
Auditors and
Investigators
Don’t Be
Unprepared!

Important Compliance Dates
April
4
2017 Rate announcements for
Medicare Advantage and Part D
April
25
Public comments on MACRA proposal ends
June 27, 2016
May
2
May
4
Increasing Penalties for FCA violations effective
August 1, 2016. Public comments until July 1,
2016
New Fire Safety Requirements for Certain
Healthcare Facilities compliance by July 3, 2016
May
17
EEOC’s final Rule on Employer Wellness Programs
and Title I of ADA compliance begins January 2017
May
23
Providers new to the EHR incentive program will be able
to attest online for any 90 day reporting period for 2016
starting July 5, 2016
In This Issue:
Important Compliance Dates
System Feature Highlights
EEOC Files Landmark Lawsuit for LGBT Employees
Prepare Your Staff to Meet an Auditor or Investigator
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First Healthcare Compliance, LLC © 2016

New System Features
Our goal is to continually improve the First Healthcare Compliance solution,
and we are excited to announce some of the new features that have been
added as part of our most recent update:
Enhanced Features
• Title/position field available in user record
• All webinars assignable as supplemental trainings
• Training status visable from the Employee Zone
• Training log displays due/expiration date
• CME course results included in training log
New Features
• User preferences available for yearly PPD alerts
• Printable certificates available for all trainings
• Manage and track flu vaccination records
• Option to upload and store up to 5 additional training modules, as part of
Training Plus edition.
• Summary reporting for Supervisory Users across their assigned locations
Once Again! CMS is Changing Physician Payments
Partner Spotlight: SPHER
Upcoming Webinar Calendar
First Healthcare Compliance Referral Program
Contact Toll Free: 888-54-FIRST 3

Federal anti-discrimination laws are an
evolving beast and the Equal Employer
Opportunity Commission (EEOC), the agency
charged with enforcing these laws, has made it
a priority in recent years to ensure that the law
evolves to include protections for lesbian, gay,
bisexual, and transgender (LGBT) individuals.
Currently, under the main federal anti-discrimination
law affecting employers with 15 or
more employees, Title VII of the Civil Rights Act,
employees are afforded protections from discrimination
on the basis of race, color, religion,
sex, and national origin (referred to as the protected
classes). Discrimination and harassment
based on any of these protected classes is prohibited
by law. Title VII includes discrimination
based on gender, gender stereotyping, pregnancy,
and sexual harassment as forms of sex
discrimination. But the EEOC takes a broader
view, having concluded that discrimination on
the basis of sexual orientation is another form
of sex discrimination. (For more information
click here.) In addition, many states have followed
suit by defining sexual orientation as a
protected class. But federal Title VII has yet to
explicitly include such protections.
By Sheba Vine, JD, CPCO
On March 1, 2016, in an effort to standardize
the law on this matter, the EEOC filed its first
two sex discrimination lawsuits based on sexual
orientation in federal court according to a
recent press release:
EEOC v. Scott Medical Health Center, P.C.—
The EEOC sued Scott Medical Health Center,
P.C., a provider of pain management and
weight loss services, alleging that it discriminated
against employee David Baxley on the
basis of sex when it subjected him to harassment
because of his sexual orientation and/or
because he did not conform to the employer’s
gender-based stereotypes.
According to the lawsuit, Baxley’s immediate
supervisor knew that Baxley was gay and
frequently assailed him with highly offensive
anti-gay epithets, and other vulgar epithets
based on sex stereotypes. When Baxley complained
about the harassment to the medical
director, the medical director took no corrective
action, resulting in his constructive discharge.
Read more on the blog!
Federal Discrimination and
Harassment Prevention
Training for Employees is now
available in the Training Zone!
The four main federal anti-discrimination
laws are:
• Title VII of the Civil Rights Act
• Age Discrimination in
Employment Act
• Americans with Disabilities Act
• Genetic Information
Nondiscrimination Act
The federal laws prohibit
discrimination, harassment and
retaliation based on an individual’s:
Race/ Color, Religion, Sex/
Gender, National Origin, Disability,
Age, and Genetic Information
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First Healthcare Compliance, LLC © 2016

When a healthcare entity is the
target of a government investigation
or audit, it is the Compliance
Officer who is responsible for leading
the response to, and coordinating and
tracking all steps and details of the
challenging and unnerving process.
In responding appropriately to such
government requests or contacts, it is
important to not only have a prepared
compliance officer, but also prepared
employees— do you have a clear plan
for employees if an auditor arrives at
your office?
The federal and state governments
have made the investigation and prosecution
of healthcare fraud one of their
highest priorities and have proposed
many new initiatives for identifying
By Julie Sheppard, BSN, JD, CHC
fraudulent and abusive practices. A
number of these initiatives include conducting
audits of healthcare providers.
A healthcare entity’s policy should be
to provide reasonable cooperation to
these government authorities while at
the same time protecting the rights
of the entity and all of its employees.
However, many administrators admit
that they are not well prepared for the
first steps if a government enforcement
agency shows up for an official, unannounced
visit. This is because time and
resources are typically spent training
team members to comply with multiple
rules and regulations regarding privacy,
coding, billing, and documentation. But
careful and advance preparation will
make all the difference when faced
with a government inquiry.
Even for a routine audit, your staff
should be prepared to stop, think, and
follow the plan. It is advisable to contact
an attorney licensed in your state
who specializes in the applicable regulatory
issues.
Read more here!
Contact Toll Free: 888-54-FIRST 5

Have you had the opportunity to read the recently
released 962-page proposed rule from Center
of Medicare and Medicaid Services (CMS) regarding
changes to physician payments? This lengthy
document echoes the same goal throughout, create
an “innovative, outcome-focused, patient-centered,
resource-effective health system.” For a provider, big
changes are ahead and the time to submit public comments
ends on June 27, 2016.
As part of the Medicare Access and CHIP Reauthorization
Act of 2015 (MACRA), CMS plans to repeal the sustainable
growth rate (SGR) and replace it with the CMS
by Dr. Jill Brooks, MD, CHCO
Quality Payment Program. Just as the name suggests,
payment will no longer be volume based fee-forservice
(FFS); the program will reward the value of
care and the patient outcomes in a patient-centered
healthcare system. In achieving the ultimate goal of
improving overall healthcare, CMS considers patient
and family involvement as the keys to success of this
value-based approach. The Quality Payment System is
based on the Merit-Based Incentive Payment System
(MIPS) and the Advanced Alternative Payment Models
(Advanced APMs).
The Department of Health and Human Services (HHS) has 3 basic strategies for the Quality Payment
Program:
1. Improve clinician payment regarding quality not quantity of services with MIPS which combines the main
parts of Physician Quality Reporting System (PQRS), Value-based Payment Modifier (VM) and Electronic
Health Record Incentive program for four performance based categories:
• Quality
• Resource Use
• Clinical Practice Improvement Activities (CPIAs)
• Advancing Care Information (Meaningful Use of EHR technology)
2. Improve care delivery with care coordination, team-based approaches, improved patient communication
and focus on population health and continuous learning using:
• Clinical practice support
• Data and Feedback Reports on Clinical Quality Measures (CQMs), utilization and cost
3. Use of certified EHR to support care delivery focusing on:
• Tracking patients through the care continuum
• Optimizing EHR Interoperability
Continue reading on the blog
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First Healthcare Compliance, LLC © 2016

Partner Link
An Interview with Raymond Ribble of SPHER Inc.
Q: How does SPHER define compliance?
Compliance is not security. Too often a company is
federally compliant, but they are missing key factors
that lead to a false sense of security.
Q: How does your solution help detect EHR
breaches?
SPHER is a tool that is part of an overall healthcare
security framework that automates the user activity
monitoring process and provides 100% ePHI
coverage.
Q: What is your favorite part about working
with your clients?
My favorite part is the aha! moment when they
realize that a required manual, daunting task can
be completely automated into a value-added solution
that takes no more than 8 minutes a morning.
SPHER Inc. is a leading national healthcare solutions
firm, directly involved in and delivery of
mission critical ePHI security solutions. They bring
14+ years of experience in developing proprietary
technology solutions for healthcare companies in
the US and globally, including delivery of tailored
and progressive solutions to national and regional
healthcare providers.
Healthcare organizations have been directed to
monitor ePHI system audit logs in order to identify
suspicious patterns of usage by staff or worse, an
unauthorized intrusion into the environment. HIPAA
and Meaningful Use requirements are very difficult
to adhere to without a solution like SPHER, the
healthcare market’s leading ePHI Audit Log Review
and incident detection solution. SPHER’s tailored
pattern recognition architecture consistently monitors,
analyzes, and alerts compliance departments
and Privacy Officers of abnormal user activity.
This capability enables a healthcare business to
identify and quickly remediate suspicious incidents
that may be indicative of a breach, across any ePHI
system.
Their mission is to provide security around your
ePHI and transparency into user activity by delivering
a comprehensive set of tools within SPHER to
assist healthcare compliance specialists.
First Healthcare Compliance builds mutually rewarding
partnerships with companies, associations,
societies and organizations also serving those in
healthcare compliance. We are excited to share more
information about those partnerships with our clients
here, and hope that you find these relationships as
helpful as we do!
Contact Toll Free: 888-54-FIRST 7

Join Us for These Upcoming Webinars
and Earn Complimentary CEU Credits!
July 13th @12pm EDT
Updates on 2017 ICD-10 CM
Karna Morrow, CPC, CCSP, RCC, AHIMA
approved ICD 10 Trainer
Coding Strategies
July 19th @12pm EDT
OSHA for Medical and Dental Office
Employees
Kelly Ogle, BSDH, MIOP, CMP, CHOP
Doctor’s Management
August 16th @12pm EDT
Three Recent HIPAA Breaches
Encryption Failed to Prevent
Mary Beth Gettins, Esq
Gettins’ Law
October 11th @12pm EDT
What Healthcare Employers Should
Know About Exclusion Screening
PreCheck
November 15th @12pm EST
Enterprise Risk Management in
Healthcare
Mike Midgley, RN, JD, MPH,
CPHRM, FASHRM
Swiss Re
December 13th @12pm EST
Is a Firewall Enough Security for My
Business?
Albert Whale, CEH, CHS, CISA, CISSP
IT Security, Inc
September 20th @12pm EDT
Dealing with Bullying in the
Workplace
Lauren Russell, Esq
Young Conaway Stargatt & Taylor, LLP
First Healthcare Compliance Referral Program
Don’t forget about the referral program! The tremendous growth realized
during our first few years in business was derived primarily from our
clients’ endorsements and referrals. We are so grateful for this, and for the
opportunity to continue helping your practice achieve its compliance goals.
Give us a call today, or visit the “My Account” section of your compliance
portal to get more information about current rewards. We look forward to
making new connections through your support!
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First Healthcare Compliance, LLC © 2016