Catalog Number : cra1879
Title : Provider-Based Clinics: Advanced
Speaker : Duane Abbey

Webplay Recording Date : 8-9-2017
Webplay Price : $ 150 for two weeks viewing

Webinar Overview:

How do we go about auditing our provider-based operations? What special coding and billing requirements are required for provider-based clinics? What are the advantages to physicians for being in a provider-based clinic? To answer these questions and more come join us for this Webinar.

Webinar Objectives:

• Review the Provider-Based Rule (PBR)
• Understand the differences between freestanding and provider-based clinics
• Understand the economic advantages of provider-based clinics
• Review and appreciate special requirements for provider-based clinics
• Appreciate special compliance concerns associated with provider-based status
• Discuss coding and billing issues for provider-based clinics
• Understand how to qualify clinics that are outside the 35-mile default limit
• Discuss signage and proper identification for provider-based operations
• Discuss complicated issues such as joint use of space and time-share space utilization
• Understand provider-based reporting requirements and the CMS-855 forms
• Explore the application of the physician supervision requirement for outpatient services
• Discuss operation issues such as setting fees, patient relations and medical staff organizational structuring
• Review on-going ambiguities in the Provider-Based Rule affecting provider-based operations
• Work through several case studies involving special issues in the establishment of the provider-based clinics

Target Audience:

• Chargemaster personnel, compliance personnel, claims transaction personnel, coding personnel, financial analysts, operating officers, clinic administrators and managers, and all personnel involved with provider-based clinics and/or clinical operations including nursing staff and interested physicians/practitioners

The following are a few of the topics to be discussed:

• Review of the Provider-Based Rule (PBR)
  • Development of the PBR
  • 42 CFR §413.65
  • Review of Definitions
• Economic Advantages of Provider-Based Status
  • Clinics o Clinical Services
  • Costs for Provider-Based Status
  • Recognizing Provider-Based Clinical Services
• Establishing Provider-Based Clinics
  • Meeting the PBR Requirements
  • Coding and Billing for Provider-Based Clinics
  • Physician Supervision Requirements
  • CMS 855 Forms
    • CMS-855-B
    • CMS-855-A
    • CMS-855-I
• Special Issues and Sensitivities
  • Split-Billing
    • 1500 Claim Form Requirements
    • UB-04 Claim Form Requirements
  • "Holding-Out to the Public"- Proper Signage
  • Split-Use Facilities
  • Time-Share Use of Facilities
  • Cost Reporting Issues
  • Qualifying Clinics that Are Outside the 35-Mile Default
  • Requesting Determinations and Filing Attestations
  • 3-Day Payment Window Issues - Freestanding vs. Provider-Based
  • Affiliated Hospitals and Remote Campuses
  • Related Laboratory and Radiology Issues
• Case Studies
• Sources for Further Information

Contact Hours:

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.

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.