Provider-Based Clinics: Ensuring Compliance

Event Information
Product Format
Prerecorded Event
60 Minutes
Product Description

Demystify the provider-based rule (PBR) with these tips.

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.  

In this workshop, you’ll examine the overall purpose and function of the provider-based rule as well as critical information concerning physician supervisory changes. Additionally, you’ll tack the overall compliance issues surrounding provider-based status in the context of conducting an audit.

This session will help you:

  • Go in-depth the Provider-Based Rule (PBR).
  • Highlight the criteria that clinics must achieve to be recognized as provider-based.
  • Update the critical physician supervisory rule changes.
  • Follow the documentation requirements relative to physician supervision requirements.
  • Appreciate the different areas in which the PBR applies.
  • Figure out why the attestation and request for determination processes are so important.
  • Determine the need for updating and the documentation of organizational structuring relative to the PBR.
  • Review the process for assessing current and/or potential provider-based situations.
  • Take advantage of economic benefits versus the compliance requirements.
  • Understand the relationship of PBR relative to the Conditions for Payment, Conditions of Participation and gaining billing privileges.
  • Work through several case studies.

Teleconference 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
  • 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
  • Physician Supervisory Requirements
    • Recent Changes and Clarifications
    • In-Hospital
    • On-Campus
    • Off-Campus
    • Possible Recovery Audit Contractor (RAC) Issues
  • Compliance and Obligations Under PBR
    • Meeting All PBR Criteria
    • Reporting Requirements
    • Attestation versus Determination Process
  • Provider-Based Audits
    • Process
    • Data Gathering and Assessment
    • Action Steps
  • Related Issues
    • Conditions for Payment
    • Conditions of Participation
    • Other Third-Party Payer Relations
    • Coding and Billing for Provider-Based Clinics
  • Case Studies – Provider-Based Clinics

Prerequisites for Participating:  General knowledge of hospitals and various clinic and/or clinical operations.

Who should attend? All personnel involved with provider-based clinic and/or clinical operations, compliance personnel, coding and billing personnel, nursing staff and interested physicians are encouraged to attend.

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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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