keyglobeiollogoPhone (319) 626-2302

Catalog Number : cra1380
Title : Conducting a Provider-Based Audit
Speaker : Duane Abbey

Duration : 90 minutes

Webplay Recording Date : 5-12-2016
Webplay Price : $ 150 for two weeks viewing

Webinar Overview:

Recent changes in the supervisory requirements for provider-based operations have created confusion and new compliance challenges. In this workshop the overall purpose and function of the provider-based rule is addressed as well as critical information concerning physician supervisory changes. CMS has recently made significant changes in the interpretation of physician supervision for on-campus (out of hospital) provider-based operations. While CMS claims these are not changes, but simply clarification, hospitals must take appropriate action to maintain compliance. Additionally, the overall compliance issues surrounding provider-based status will also be discussed in the context of conducting an audit.

Webinar Objectives:

  • To review the Provider-Based Rule (PBR)
  • To update critical physician supervisory rule changes
  • To appreciate the different areas in which the PBR applies
  • To understand the attestation and request for determination processes
  • To understand the need for updating and the documentation of organizational structuring relative to the PBR
  • To understand the review process for assessing current and/or potential provider-based situations
  • To understand the economic benefits versus the compliance requirements
  • To appreciate the relationship of PBR relative to the Conditions for Payment, Conditions of Participation and gaining billing privileges
  • To work through several case studies

Webinar Outline/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
  • Economic Advantages of Provider-Based Status
    • Clinics
    • Clinical Services
    • Costs for Provider-Based Status
  • 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
  • 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

Target Audience:

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

Attendance Certificate:

Upon attending this course you will receive a 1.5 Contact Hour Attendance Certificate. There is usually a reciprocal agreement between state associations to allow these to count for each state. If you have any questions, please ask your state association.

Refund Policy:

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.