Catalog Number : cga1905
Title : Auditing Provider-Based Status
Speaker : Duane Abbey

Webplay Recording Date : 5-6-2014
Webplay Price : $ 125 for two weeks viewing

Webinar Purpose:

Hospitals are constantly increasing the number of provider-based clinics of all types. The provider-based rule (PBR) is complex and there are definite ambiguities. While hospitals can enjoy increased revenues from provider-based clinics, compliance with all the rules and regulations is challenging. Recent changes in the supervisory requirements for provider-based operations have created confusion and new compliance challenges. In this webinar the overall purpose and function of the provider-based rule is addressed as well as critical information concerning physician supervisory changes. Additionally, the overall compliance issues surrounding provider-based status will also be discussed in the context of conducting an audit.

Webinar Objectives:

• Review the Provider-Based Rule (PBR)
• Review the criteria that must be achieved for clinics to be recognized as provider-based
• Update critical physician supervisory rule changes
• Discuss documentation requirements relative to physician supervision requirements
• Appreciate the different areas in which the PBR applies
• Understand the attestation and request for determination processes
• Understand the need for updating and the documentation of organizational structuring relative to the PBR
• Understand the review process for assessing current and/or potential provider-based situations
• Understand the economic benefits versus the compliance requirements
• Appreciate the relationship of PBR relative to the Conditions for Payment, Conditions of Participation and gaining billing privileges
• Work through several case studies

Target Audience: 

All personnel involved with provider-based clinic and/or clinical operations, compliance personnel, coding and billing personnel, nursing staff and interested physicians are encouraged to attend.

A Few of the Topics that will be covered:

• 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
• Economic Advantages of Provider-Based Status
  • Clinics
  • Clinical Services
  • Costs for Provider-Based Status
• Provider-Based Requirements
  • Owned, Operated and Fully Integrated
  • Geographic Proximity
  • Signage and Recognition
  • Clinical Integration o EMTALA Interface
  • Notice of Two Copayments
  • Split-Billing
  • Shared Space Concerns
• Physician Supervisory Requirements
  • Recent Changes and Clarifications
  • In-Hospital
  • On-Campus
  • Off-Campus
  • Possible Recovery Audit Contractor (RAC) Issues
• Compliance and Obligations Under PBR
  • Meeting All PBR Criteria
  • Reporting Requirements
  • Attestation versus Determination Process
• Provider-Based Audits
  • Process
  • Data Gathering and Assessment
  • Action Steps
• Advanced Issues
  • Shared-Space
  • Holding-Out to the Public
  • Management Contracts
  • Under Arrangements
• Related Issues
  • Conditions for Payment
  • Conditions of Participation
  • Other Third-Party Payer Relations
  • Coding and Billing for Provider-Based Clinics
• Case Studies – Provider-Based Clinics

Attendance Certificates:

All participants: Must attend the entire Webinar and complete a Webinar critique to receive a 1.5 Hour Attendance Certificate for each program.

Full tuition is refunded immediately on request if the participant has not been sent the program materials and instructions. Once the instructions (including access codes) have been sent, a full refund will be issued only after the program runs and it is verified that the participant did not access the program.