Provider-Based Clinics: Ensuring Compliance

Recorded Webinar | Duane C. Abbey | From: Dec 04, 2017 - To: Dec 31, 2017

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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