Establishing Provider-Based Clinics And It's Future

Event Information
Product Format
Prerecorded Event
180 minutes
Product Description

A Comprehensive Review of Provider-Based Clinics and their Future


Hospitals are ever increasingly establishing provider-based clinics of all types. The provider-based rule (PBR) is complex and there are definite ambiguities. While hospitals can enjoy increased revenues from provider-based clinics, compliance with all the rules and regulations is challenging. Recent changes in the supervisory requirements for provider-based operations have created confusion and new compliance challenges. Additionally, there is movement to change the rules and regulations relative to reimbursement for provider-based clinics.

Join compliance expert Duane C. Abbey, Ph.D., in a power packed 2-in-1 on-demand webinar series that delves deeply into the overall function and purpose of the provider-based rule. During this 180 minute session, Duane provides important information regarding physician supervisory changes along with a discussion of the future of provider-based clinics. Get up-to-speed on all the changes in the supervisory requirements for provider-based operations and share specific compliance concerns associated with provider-based status.

Session Highlights:

  • Review on-going ambiguities in the Provider-Based Rule affecting provider-based operations.
  • Learn about the application of the physician supervision requirement for outpatient services.
  • Review of complicated issues such as joint use of space and time-share space utilization.
  • Understand provider-based reporting requirements and the CMS-855 forms.
  • Know how to qualify clinics that are outside the 35-mile default limit.
  • The Provider-Based Rule (PBR)
  • The criteria that must be achieved for clinics to be recognized as provider-based
  • Review the changes made by BBA 2015, Section 603
  • Update on the critical physician supervisory rule changes
  • Documentation requirements relative to physician supervision requirements
  • The increase in reimbursement for provider-based clinics
  • Understanding the attestation and request for determination processes
  • The need for being updated and documenting the organizational structuring concerning the PBR
  • The review process for examining present or/and potential provider-based situations
  • Economic welfare versus the requirements for compliance
  • The association of PBR relative to gaining billing privileges, Conditions of Participation and Conditions for Payment
  • The regulatory pressures for decreasing reimbursement for provider-based clinics
  • Learn through various case studies

 Session Snapshots:

  • 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
  • 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
  • Special Issues and Sensitivities
    • Split-Billing
    • 1500 Claim Form Requirements
    • UB-04 Claim Form Requirements
  • Economic Advantages of Provider-Based Status
    • Clinics
    • Clinical Services
    • Costs for Provider-Based Status
  • Provider-Based Requirements
    • Owned, Operated and Fully Integrated
    • Geographic Proximity
    • Signage and Recognition
    • Clinical Integration
    • EMTALA Interface
    • Notice of Two Copayments
    • Split-Billing
    • Shared Space Concerns
  • Movement to Reduce Provider-Based Clinic Reimbursement
    • BBA 2015, Section 603
      • Off-Campus Provider-Based Operations
      • January 1, 2017 Implementation Date
      • Grandfathering of Current Off-Campus Provider-Based Clinics
    • OIG Recommendations
    • MedPAC Recommendations
    • CMS Data Gathering Efforts
      • Special Modifier for Hospitals
      • New POS Codes for Physicians
  • Physician Supervisory Requirements
    • Recent Changes and Clarifications
    • In-Hospital
    • On-Campus / Off-Campus
    • Possible Recovery Audit Contractor (RAC) Issues
  • Provider-Based Audits
    • Process
    • Data Gathering and Assessment
    • Attestations and Requests for Determination
    • Action Steps
  • Case Studies – Provider-Based Clinics

Who should attend

Chargemaster personnel, compliance personnel, claims transaction personnel, coding personnel, financial analysts, operating officers, clinic administrators and managers, and all personnel involved with provider-based clinics and/or clinical operations, including nursing staff and interested physicians/practitioners.

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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
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