Physician Supervision for Provider-Based Clinics - Basics to Advance

Event Information
Product Format
Prerecorded Event
180 minutes
Product Description

A Comprehensive Review of Hospital-Based Clinics and The Complexities Around Them


Why do hospitals establish provider-based clinics? Do you know what advantages physicians have for being in a provider-based clinic? Why are there ambiguities in the provider-based rule (PBR)?

Physician supervision recently has become a big issue and the CMS has changed the supervision requirements over the last few years. CMS’s physician supervision requirements under the Provider-Based Rule (42 CFR §413.65) continue to be an area of uncertainty and confusion for many Provider-Based Clinics. To make matters worse, the rules differ depending on the type of service (s) provided. Following physician supervision requirements is crucial for compliance and reimbursement. Services not meeting applicable guidelines are considered “not reasonable and necessary,” and are ineligible for Medicare payments.

Join us for this On-Demand Webinar series—“Physician Supervision for Provider-Based Clinics - Basics to Advance” on Tuesday, March 22, 2016, where expert speaker Duane C. Abbey, Ph.D., will review the PBR based rule and CMS’ requirements, brief the economic advantages of provider-based clinics, and explain affirmative steps hospitals must take to ensure compliance.

Also, understand the difference between freestanding and provider-based clinics, documentation you need on file to justify proper physician supervision. Find out what additional changes are anticipated in the near future and its compliance implications, and analyze if physician supervision may become an RAC issue in the future.

Get answers to the most pertinent questions in this combined webinar session:

  • What are the specific requirements for physician supervision?
  • What affirmative steps must hospitals take to ensure compliance?
  • Is this solely a Medìcare issue?
  • Can auditors go back in time to verify proper physician supervision?
  • What advantages physicians have for being in a provider-based clinic?
  • What additional changes are anticipated in the near future?
  • What are the compliance implications?
  • When is CMS interested in making a determination that an operation is provider-based?
  • What is the Medìcare program really demanding?
  • What CMS-855 enrollment forms must be completed relative to provider-based clinics?
  • What if we are outside the 35-mile default limit?
  • Are there differences for provider-based operation in the hospital vs. on-campus vs. off-campus?
  • Will this ever become a RAC issue?
  • 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?

 Session Highlights:

  • Coding and billing issues for provider-based clinics.
  • Application of the physician supervision requirement for outpatient services.
  • On-going ambiguities in the Provider-Based Rule affecting provider-based operations.
  • Insights on the various requirements under the Provider-Based Rule (42 CFR §413.65) relating to physician supervision requirements.
  • Basic operational processes for provider-based clinics and hospital provider-based clinical activities.
  • Supervisory requirements for provider-based services.
  • Changes made by CMS relative to supervisory requirements for hospital-based operations.
  • Identify the need for affirmative documentation to substantiate proper physician supervision.
  • Comprehend the concept of ‘incident-to’ for both physicians and hospitals.
  • Learn the difference between ‘clarifying’ guidance and ‘changed’ guidance.
  • Review the steps that must be taken relative to documentation for meeting the supervisory requirements.
  • Auditing provider-based operations.
  • Discuss operation issues such as setting fees, patient relations and medical staff organizational structuring.
  • Review of the possible RAC audit issues for retroactive application.
  • Case studies involving special issues in the establishment of provider-based clinics.

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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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