Description

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:-

• 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.
• To discuss different conditions for PBR payment.

Agenda:-

• 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
• Economic benefits of Provider-Based Status
  • Facilities
  • Clinical Services
  • Price of Provider-Based Status
• Provider-Based conditions
  • Owned, Operated and Fully Integrated
  • Geographic Proximity
  • Signage and Recognition
  • Clinical Integration
  • EMTALA Interface
  • Notice of Two Copayments
  • Part Billing
  • • Utilization of PO Modifier
    • Utilization of appropriate Place of Service
  • Shared Space Distress
• Doctor Supervisory Requirements
  • Current Modifications and Clarifications
  • In-Hospital
  • On-Campus
  • Off-Campus
  • Conceivable Recovery Audit Contractor (RAC) Problems
• Compliance and Responsibilities Under PBR
  • Satisfy All PBR Criteria
  • Report Requirements
  • Verification versus Determination Process
• Provider-Based Audits
• Procedure
  • In The Hospital
  • On-Campus
  • Off-Campus
• Information Gathering and Evaluation
  • Survey of Provider-Based Operations
  • Appraisal of Requirements and Prohibitions
• Active Steps
• Current Legislative Initiatives
  • Section 603 BiBA 2015
  • 21st Century Cures Act Section 16001
• Advanced Problems
  • Shared-Space
  • Holding-Out to the Public
  • Administrative Contracts
  • Under Arrangements
• Related Issues
  • Conditions for Payment
  • Prerequisites for Participation
  • Other Third-Party Payer Relations
  • Coding and Billing for Provider-Based Clinics
• Case Studies – Provider-Based Clinics

Who should attend?

• Hospital, clinic and provider-based personnel
• Compliance personnel
• Coding staff
• Billing staff
• Physicians and nurses