Description

• Why do hospitals establish provider-based clinics?
• What are the advantages to physicians for being in a provider-based clinic?
• Why are there ambiguities in the provider-based rule (PBR)?
• Do we have to meet each and every criterion in order to establish provider-based status?
• Which required criteria present special problems?
• When is CMS interested in making a determination that an operation is provider-based?
• What CMS-855 enrollment forms must be completed relative to provider-based clinics?
• How do the physician supervision requirements affect provider-based status?
• What special coding and billing requirements are required for provider-based clinics?
• What if we are outside the 35-mile default limit?
• What if we have a facility in which part is provider-based and part is freestanding?
• What if we have space that is used jointly by both the hospital and other providers?
• What kind of signage is really necessary?
• How do we report changes in provider-based operations?
• Should we routinely ask for determinations from out MAC?
• How do we go about auditing our provider-based operations?
• Are there differences for provider-based operation in the hospital vs. on-campus vs. off-campus?
• How have Section 603 of BiBA 2015, Section 16001 of the 21st Century Cures Act, and BiBA 20918 affected provider-based clinics?

Teleconference/Webinar Objectives:-

• To briefly review the Provider-Based Rule (PBR).
• To understand the differences between freestanding and provider-based clinics.
• To understand the economic advantages of provider-based clinics.
• To review and appreciate special requirements for provider-based clinics.
• To appreciate special compliance concerns associated with provider-based status.
• To discuss coding and billing issues for provider-based clinics.
• To understand how to qualify clinics that are outside the 35-mile default limit.
• To discuss signage and proper identification for provider-based operations.
• To discuss complicated issues such as joint use of space and time-share space utilization.
• To understand provider-based reporting requirements and the CMS-855 forms.
• To explore the application of the physician supervision requirement for outpatient services.
• To discuss operation issues such as setting fees, patient relations and medical staff organizational structuring.
• To review on-going ambiguities in the Provider-Based Rule affecting provider-based operations.
• To review the impact of 603 BiBA 2015, Section 16001 of the 21st Century Cures Act, and BiBA2018 affected establishing provider-based clinics?
• To work through several case studies involving special issues in the establishment of the provider-based clinics.

Teleconference/Webinar Outline/Agenda:-

• Review of the Provider-Based Rule (PBR)
  • Development of the PBR
  • 42 CFR §413.65
  • Review of Definitions
• Economic Advantages of Provider-Based Status
  • Clinics
  • Clinical Services
  • Costs for Provider-Based Status
  • Recognizing Provider-Based Clinical Services
• Establishing Provider-Based Clinics
  • Meeting the PBR Requirements
  • Coding and Billing for Provider-Based Clinics
  • Physician Supervision Requirements
  • CMS 855 Forms
    • CMS-855-B
    • CMS-855-A
    • CMS-855-I
• Recent Legislation
  • Section 603 of BiBA 2015
  • Section 16001 of the 21st Century Cures Act
  • BiBA 2018
• Special Issues and Sensitivities
  • Split-Billing
    • 1500 Claim Form Requirements
    • UB-04 Claim Form Requirements
  • ‘Holding-Out to the Public” – Proper Signage
  • Split-Use Facilities
  • Time-Share Use of Facilities
  • Cost Reporting Issues
  • Qualifying Clinics that Are Outside the 35-Mile Default
  • Requesting Determinations and Filing Attestations
  • 3-Day Payment Window Issues – Freestanding vs. Provider-Based
  • Affiliated Hospitals and Remote Campuses
  • Related Laboratory and Radiology Issues
• Case Studies
• Sources for Further Information

Prerequisites for Participating:- 

General knowledge of hospitals and various clinic and/or clinical operations is required along with an understanding of the Provider-Based Rule.  See the workshop “Establishing Provider-Based Clinics – Basics”.

Suggested Attendees:- 

• Chargemaster Personnel
• Compliance Personnel
• Claims Transaction Personnel
• Coding Personnel
• Financial Analysts
• Operating Officers
• Clinic Administrators and Managers
• All personnel involved with provider-based clinics and/or clinical operations including nursing staff and interested physicians/practitioners.