With the increasing number of healing facilities and centers comes the all important provider-based clinics of different types. However, the provider-based regulation still has lots of uncertainties and issues that are difficult to comprehend. It is true that hospitals and clinics benefit greatly from provider-based clinics but there is a need for total adherence to the rules and regulations that govern the practice. Recent modifications in the supervisory prerequisites for provider-based operations has caused lots of misunderstanding and compliance challenges. To add on to the situation, there new charging prerequisites for off-campus provider-based facilities that have come into effect.
Objectives of the session:
- To discuss and explore the Provider-Based Rule (PBR).
- To understand the conditions that must be met before hospitals can be treated as provider-based.
- To understand charging and review changes for provider-based operations.
- To keep the basic physician supervisory regulation changes up to date.
- To go through the documentation prerequisites with respect to doctor supervision requirement for PBR.
- To discuss the different aspects in which the PBR applies.
- To analyze and discuss the verification of provider-based care for assurance processes.
- to explore the Bipartisan Budget Act of 2015 that covers provider-based clinical care
- to discuss different financial benefits in relation with compliance prerequisites.
- different conditions for PBR payment
Agenda of the session:
1.Study the Provider-Based Rule (PBR)
- Advancement of the PBR
- 42 CFR §413.65
- Assessment of Definitions
- Standards and Regulations
- Acknowledgment by Non-Medicare Third-Party Payers
2.Economic benefits of Provider-Based Status
- Clinical Services
- Price of Provider-Based Status
- Owned, Operated and Fully Integrated
- Geographic Proximity
- Signage and Recognition
- Clinical Integration
- EMTALA Interface
- Notice of Two Copayments
- Part Billing
1. Utilization of PO Modifier
2. Utilization of appropriate Place of Service
4.Doctor Supervisory Requirements
- Current Modifications and Clarifications
- Conceivable Recovery Audit Contractor (RAC) Problems
5.Compliance and Responsibilities Under PBR
- Satisfy All PBR Criteria
- Report Requirements
- Verification versus Determination Process
- In The Hospital
8.Information Gathering and Evaluation
- Survey of Provider-Based Operations
- Appraisal of Requirements and Prohibitions
10.Current Legislative Initiatives
- Section 603 BiBA 2015
- 21st Century Cures Act Section 16001
- Holding-Out to the Public
- Administrative Contracts
- Under Arrangements
- Conditions for Payment
- Prerequisites for Participation
- Other Third-Party Payer Relations
- Coding and Billing for Provider-Based Clinics
13.Case Studies – Provider-Based Clinics
Who should attend?
- Hospital, clinic and provider-based personnel
- Compliance personnel
- Coding staff
- Billing staff
- Physicians and nurses