Provider-Based Clinics: Everything You Wanted to Know

Event Information
Product Format
Prerecorded Event
Conference Date
Thu, Mar 08, 2012
90 Minutes
Product Description

Let us understand the economic advantages of provider-based clinics, and how they are different from freestanding.


Join compliance guru, Duane Abbey as he explains:

  • Provider-Based Rule (PBR).
  • The differences between Freestanding and Provider-based clinics.
  • The Economic Advantages of provider-based clinics.
  • Appreciation of Special Compliance Concerns associated with provider-based status.
  • How to organize provider-based clinics relative to freestanding clinics.
  • Coding and billing issues for provider-based clinics.
  • How the Chargemaster should be established to support coding and billing for both technical and professional components.
  • Operation Issues such as setting fees, patient relations and medical staff organizational structuring
  • The 3-day payment window relative to provider-based clinics.
  • Several case studies involving the establishment of the Chargemaster.


I.    Review of the Provider-Based Rule (PBR)
      a.    Development of the PBR
      b.    42 CFR §413.65
      c.    Review of Definitions
      d.    Rules and Regulations
      e.    Recognition by Non-Medicare Third-Party Payers
II.    Economic Advantages of Provider-Based Status
     a.    Clinics
     b.    Clinical Services
     c.    Costs for Provider-Based Status
     d.    Recognizing Provider-Based Clinical Services
III.    Coding and Billing
     a.    Technical Component E/M Coding
     b.    Surgical Services Coding
     c.    Medical Services Coding
IV.    Establishing the Chargemaster
    a.    Technical Component – UB-04
    b.    Professional Component - 1500
    c.    Setting Fee Schedules
    d.    E/M Levels
    e.    Coding and Modifiers
V.    Special Concerns
    a.    Maintaining Patient Relations
    b.    Medical Staff Organization
    c.    Meeting Other Provider-Based Rule Requirements
    d.    3-Day Payment Window Interface for DRGs
VI.    Special Types of Provider-Based Clinics
    a.    Wound Care Clinics
    b.    Specialty Clinics
    c.    Pain Management Clinics
    d.    Medication Management Clinics


The Virginia Mason case relative to setting charges for provider-based clinics will be addressed.

 Who should attend? Chargemaster personnel, compliance personnel, claims transaction personnel, coding personnel, and all personnel involved with provider-based clinics and/or clinical operations including nursing staff and interested physicians.


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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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