Our firm is located in Jacksonville, Florida and we work with many medical practices to help them with their accounting, valuations and forensic accounting needs. We serve physicians all over Florida and throughout the United States. Keeping up with accurate accounting records for your business is important not just for tax purposes. Understanding your finances is important management tool for your daily decision making and planning. Not understanding and or not keeping up with your financial data will lead your business to significant loss of income, employee theft, missing deadlines for important agreements and penalties due to late document filings with the State and Federal Government.

One of our biggest strengths is our knowledge of the industry and also keeping close relationship with you so we can assist you with many day to day activities such as:

• Preparation of accurate monthly financial statements to make sure you know profitability margins of your business each month.
• Financial Analysis including costing, month to month and year to year comparisons, review of your financial performance against budget and if available industry benchmark.
• Identifying suspicious activity in spending and reporting on misuse of financial and capital assets by your employees or partners.
• Identifying and confirming that your business is in compliance with applicable accounting and regulatory standards.
• We offer review of your vital agreements such as partnership, rental, purchasing from major suppliers, buy-out proposals and agreements with Medical Associations and / or Hospitals.
• Tax planning and forecasting become critical this year. New 2018 Tax Cuts & Jobs Act (TCJA) might have a significant effect on your business and personal taxes this year.
• Business valuations and forensic accounting

There are many changes happening in medical field. We are always learning new laws and regulations as they became available in the order to help our clients to stay one step ahead and allow you to plan for those changes.

MARCA

Annual fee schedule update for the next 3 years will not change. Adjustment will still be +.5% for the years 2019, 2020 and 2021

MIPS Maximum Positive Payment Adjustment

2019- 4%

2020- 5%

2021- 7%

Maximum Negative Payment Adjustment

2019- (4%)

2020- (5%)

2021- (7%)

MIPS Performance Category Weights

Quality

2019- 60%

2020- 50%

2021- 30%

Cost

2019- 0%

2020- 10%

2021- 30%

Improvement Activities

2019- 15%

2020- 15%

2021- 15%

Improving Interoperability

2019- 25%

2020- 25%

2021- 25%

Bonus Quality Payments

2019- 5%

2020- 5%

2021- 5%

Shared Savings Arrangements

Shared savings arrangements incentivizes providers to reduce healthcare spending for defined patient population by offering a percentage of net savings realized as a result of their efforts

Episodic Payments are single payments for all the services needed by a patient for the entire episode of care (example heart attack). Episodic payment system reduces incentive to overuse unnecessary services within a single episode and gives providers the flexibility to decide what medical care is necessary rather than being constrained by fee codes. Not every type of condition can be or should be treated on episode bases.

Because of the advancement of value based reimbursements (VBR), most recently through MACRA where reimbursement models rely on incentives to providers to achieve better outcomes at lower costs, hospitals are trying to seek closer relationship with Physicians. This trend has been going on for several years as hospitals been acquiring practices, directly employing physicians and creating joint ventures with physician groups.

Because of this integration there has been increased federal and state regulations and more vigorous oversight regarding the legal permissibility of the arrangements. More intense regulatory scrutiny has been given under AKS, Stark Law and False Claims Act. Any safe harbors in Stark law and AKS require that any consideration paid to physicians not exceed the range of FMV and be deemed commercially reasonable.

Government regulators like OIG, and the DOJ have challenged vertical integration transactions under various federal and state fraud and abuse laws. They base their argument on concept of Practice Loss Postulate that the acquisition of physician practice which then operates at a book financial loss is dispositive evidence of the hospitals payment of consideration based on the volume and/or value of referrals. Under PLP a “book financial loss” on a physician practice borne by a vertically integrated health system, when viewed as stand-alone economic enterprise is shown as legally impermissible referrals under the Stark Law. This regulatory conjecture hinders the ability of a vertically integrated health system to withstand fraud and abuse scrutiny, and erects a barrier to satisfying the threshold of commercial reasonableness.

We understand the changes are difficult to navigate and new regulations and reimbursement arrangements make it difficult to focus on the care of the patient. Our firm can help you stay on top of the new laws as well as financial implications of the regulations. Act now to make sure your business receives all support necessary for profitability and growth.