Learn How to Correctly Implement All Your PBR-specific Coding and Billing Requirements

Understanding Provider-Based Rules (PBRs) can be tough, and changes in physician supervision and reimbursement rules add to the complexity. Provider-based operations face unique coding and billing challenges – such as how to establish the Emergency Department (ED) portion of the chargemaster to capture all charges, how to line items in the chargemaster for non-emergency care in the ED, and whether ED and clinic modifiers should be in the chargemaster. And if you’re not sure where to begin, you’re not alone.

Attend this audio conference by industry veteran Duane C. Abbey, and get clear about all these issues – and also learn how to correctly implement all your PBR-specific coding and billing requirements. Abbey will review the Provider-Based Rules, help you understand the key differences between freestanding and provider-based clinics, and explain the economic advantages of provider-based clinics. He will walk you through the compliance issues associated with provider-based status, and also explain the benefits of provider-based clinical services within the hospital.

You will understand ED services and their impact on the chargemaster, learn how the chargemaster should be established to support coding and billing for technical and professional components in ED and provider-based clinics. Abbey will also teach you how to: set fees, conduct patient relations, organize your medical staff effectively, and organize multiple provider-based clinics. He will walk you through Section 603 of the 2015 Bipartisan Budget Act (BiBA) and the 21st Century Cures Act – both of which significantly affect provider-based clinics – and will work through several case studies involving the establishment of the chargemaster for both ED and provider-based clinics.

After attending this audio conference, you will be able to implement all PBR-specific coding and billing requirements, and have the tools and the knowledge to ensure that your clinic is paid appropriately.

Session Objectives

You will learn the following:

• Difference between provider-based clinics and the special provider-based clinic, the ED
• How to establish the clinic and ED portion of the chargemaster to capture all charges?
• Do you need to have line items in the chargemaster for non-emergency care in the ED?
• Does your fast-track need special attention in the chargemaster?
• Why the ED are charges so high and how does it affect provider-based clinics?
• Should the ED and clinic modifiers be in the chargemaster?
• What is this provider-based clinic split fee schedule?
• How can you establish your chargemaster to accommodate provider-based clinic activities and freestanding clinics at the same time?
• Do you need to put the non-physician practitioner fees in the chargemaster? Are there any revenue code challenges?

Session Highlights

Abbey will:

• Review the Provider-Based Rule (PBR)
• Discuss the differences between freestanding and provider-based clinics
• Help you understand the economic advantages of provider-based clinics
• Discuss special compliance concerns associated with provider-based status
• Explain provider-based clinical services within the hospital
• Explore ED services and the impact on the chargemaster
• Describe how the chargemaster should be established to support coding and billing for both technical and professional components in the ED and provider-based clinics
• Discuss operational issues such as setting fees, patient relations and medical staff organizational structuring
• Delineate the various types of clinics and operations that can be provider-based
• Teach you how to organize multiple provider-based clinics
• Review Section 603 of BiBA 2015 and the 21st Century Cures Act
• Work through several case studies involving the establishment of the chargemaster for the ED and provider-based clinics

Session 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
  • Current Legislative Activity
• Economic advantages of provider-based status
  • Clinics
  • Clinical Services
  • Costs for Provider-Based Status
  • Recognizing Provider-Based Clinical Services
• Review of the ED As provider-based
  • Types and Levels of Services
  • Professional vs. Facility Coding and Billing
  • Establishing Fee Structures
  • Non-Emergent Care in the ED
• Establishing the chargemaster
  • Technical Component – UB-04
  • Professional Component - 1500
  • Setting Fee Schedules
  • E/M Levels
  • Coding and Modifiers
• Special concerns
  • Maintaining Patient Relations
  • Medical Staff Organization
  • Meeting Other Provider-Based Rule Requirements
• Special types of provider-based clinics
  • Wound Care Clinics
  • Specialty Clinics
  • Pain Management Clinics
  • Medication Management Clinics
• Recent developments
  • CMS Data Gathering
  • BiBA 2015 Payment for Off-Campus Clinics
  • 21st Century Act and Impact on Provider-Based Clinics

Who Should Attend

• Chargemaster personnel
• Compliance personnel
• Claims transaction personnel
• Coding personnel
• ED management staff
• Provider-based clinic management staff
• All personnel involved with provider-based clinics and/or clinical operations including nursing staff and interested physicians