Audits, Billing & Compliance Updates for Provider-Based Clinics & Physician Supervision Criteria

Event Information
Product Format
Prerecorded Event
180 Minutes
Product Description

Join us for this on demand webinar series “Provider-Based Clinics & Meeting the Physician Supervision Challenge” on Wednesday - 7th Aug, 2013. You will get to understand the economic advantages of provider-based clinics and the special requirements and compliance concerns associated with provider-based status. Also, understand the steps you need to create and/or convert to a provider-based clinic and how you can maintain the CMS 855 forms as well as be vigilant about the coding and billing issues for provider-based clinics. You will also get valuable insights on the specific requirements for physician supervision and understand what the Medicare program really demands -  is this solely a Medicare issue, what additional changes to anticipate in the future, the compliance implications, and will this ever become a RAC issue.

Key Highlights of the webinar :-

  • Provider-Based Rule (PBR) & the economic advantage of provider-based clinics.
  • How to establish provider-based clinics & Uncover the ambiguities in the provider-based rule (PBR).
  • Can mid-level practitioners satisfy the supervisory requirements?
  • Discover when CMS is interested in making a determination that an operation is provider-based.
  • Underline how physician supervision fits into the provider-based issues.
  • CMS-855 enrollment forms related to provider-based clinics.
  • Highlight what special coding and billing requirements are required for provider-based clinics.
  • How to set up a fee schedule for both the facility and professional components.
  • Delineate the various requirements under the Provider-Based Rule (42 CFR §413.65) relating to physician supervision requirements.
  • Discover the basic operational processes for provider-based clinics and hospital provider-based clinical activities.
  • Understand differing requirements for in-hospital, on-campus and off-campus clinics and hospital operations.
  • Appreciate both the overt and the subtle changes being made by CMS relative to supervisory requirements for hospital-based operations.
  • Learn how the supervision guidance is morphing over time.
  • Go in-depth with the concept of ‘incident-to’ for both physicians and hospitals.
  • Decipher the difference between ‘clarifying’ guidance and ‘changed’ guidance.
  • Discuss possible RAC audit issues for retroactive application.
  • Work through several case studies.


  • Review of the Provider-Based Rule (PBR)
    • Development of the PBR
    • 42 CFR §413.65
    • Review of Definitions
    • Rules and Regulations
    • Recognition by Non-Medicare Third-Party Payers
  • Economic Advantages of Provider-Based Status
    • Clinics
    • Clinical Services
    • Costs for Provider-Based Status
    • Recognizing Provider-Based Clinical Services
  • Compliance Issues & Special Areas of Concern for Provider-Based Clinics
    • Medical Records Integration
    • Off-Campus vs. On-Campus
    • Physicians and Practitioners
    • EMTALA Compliance
    • Fire Safety Concerns
    • Hospital Conditions of Participation
    • Human Resource Issues
  • Physician Supervision Requirements
    • CMS 855 Forms
    • 855-A
    • 855-B
    • 855-I
    • 855-R
  • Coding and Billing
    • Technical Component E/M Coding
    • Surgical Services Coding
    • Medical Services Coding
    • Setting Up The Chargemaster
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About Our Speaker

Duane Abbey Hospital Coding & Compliance Expert

 Duane C. Abbey, Ph.D. is a management consultant and president of Abbey & Abbey, Consultants, Inc., which specializes in healthcare consulting and related areas. Duane earned his graduate degrees at the University of Notre Dame and Iowa State University and has more than 20 years of experience as a consultant. He performs various types of financial analysis involving business structuring, organizational development, enrolment and other financially related concerns of organizations....   More Info
More Events By The Speaker

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