Establishing Provider-Based Clinics, All That You Want To Know In 2013

Event Information
Product Format
Prerecorded Event
90 Minutes
Product Description

Define the Provider-Based Rule and Conquer These Specific Challenges

Do you fully understand the Provider-Based Rule (PBR)? Go in-depth with the differences between freestanding and provider-based clinics. You need to understand the economic advantages of provider-based clinics; and the special requirements and compliance concerns associated with provider-based status.

Join this 90-minute power-packed audio event, presented by Duane C. Abbey, Ph.D., CFP, and understand the steps you need to create and/or convert to a provider-based clinic. Also, understand how you can maintain the CMS 855 forms as well as be vigilant about the coding and billing issues for provider-based clinics. Duane will delineate how the chargemaster should be established to support coding and billing for both technical and professional components. Plus, you’ll learn to apply the physician supervision requirement for outpatient services.

In this expert audio conference, you’ll discuss operation issues such as setting fees, patient relations and medical staff organizational structuring. Then you’ll work through several case studies involving the establishment of the provider-based clinics.

This session will help you:

  • Determine the advantage of provider-based clinics to hospitals.
  • Find out what do hospitals have to do to establish provider-based clinics.
  • Uncover the ambiguities in the provider-based rule (PBR).
  • Here are the criteria you have to meet to establish a provider-based clinic. 
  • Learn if you have to meet each and every criterion in order to establish provider-based status.
  • 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.
  • Complete these CMS-855 enrollment forms relative to provider-based clinics.
  • Highlight what special coding and billing requirements are required for provider-based clinics.
  • Set up a proper fee schedule for both the facility and professional components.

Webinar Agenda: 

  • 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
  • Establishing Provider-Based Clinics
    • Meeting the PBR Requirements
    • Special Areas of Concern
      • 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

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, enrollment and other financially related concerns of organizations....   More Info
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