Provider-Based Clinics: Ensuring Compliance

Live Audio Conference | Duane C. Abbey | Jun 28, 2017   01 : 00 pm EST | 90 minutes |  4 Days Left


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 

  • Facilities 
  • Clinical Services 
  • Price of Provider-Based Status 

3.Provider-Based conditions

  • 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 

  • Shared Space Distress

4.Doctor Supervisory Requirements 

  • Current Modifications and Clarifications 
  • In-Hospital 
  • On-Campus 
  • Off-Campus 
  • Conceivable Recovery Audit Contractor (RAC) Problems

5.Compliance and Responsibilities Under PBR 

  • Satisfy All PBR Criteria 
  • Report Requirements
  • Verification versus Determination Process 

6.Provider-Based Audits 


  • In The Hospital 
  • On-Campus 
  • Off-Campus 

8.Information Gathering and Evaluation

  • Survey of Provider-Based Operations 
  • Appraisal of Requirements and Prohibitions 

9.Active Steps 

10.Current Legislative Initiatives 

  • Section 603 BiBA 2015 
  • 21st Century Cures Act Section 16001 

11.Advanced Problems

  • Shared-Space 
  • Holding-Out to the Public 
  • Administrative Contracts 
  • Under Arrangements 

12.Related Issues 

  • 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

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Live Session   +   $198
Recorded Session   +   $198
DVD   +   $208
Live & Recorded Session   +   $318
Live Session & DVD   +   $328
Recorded Session & DVD   +   $328
Corporate Live 1-3-Attendees   +   $499
Corporate Live 1-6-Attendees   +   $699

* Or more than 6 attendee call us at 1800-935-3714 or mail us at

* For Check and ACH payment call us at 1800-935-3714 or mail us at