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
Price of Provider-Based Status
Owned, Operated and Fully Integrated
Signage and Recognition
Notice of Two Copayments
1. Utilization of PO Modifier
2. Utilization of appropriate Place of Service
Shared Space Distress
4.Doctor Supervisory Requirements
Current Modifications and Clarifications
Conceivable Recovery Audit Contractor (RAC) Problems
5.Compliance and Responsibilities Under PBR
Satisfy All PBR Criteria
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
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
Physicians and nurses