• Establishing Provider-Based Clinics – Advanced Issues by Duane C. Abbey
  • Duration: 90 Minutes
  • Date: Oct 01, 2019 | , 01 : 00 PM EST |  2 Days Left


  • Why do hospitals establish provider-based clinics?
  • What are the advantages to physicians for being in a provider-based clinic?
  • Why are there ambiguities in the provider-based rule (PBR)?
  • Do we have to meet each and every criterion in order to establish provider-based status?
  • Which required criteria present special problems?
  • When is CMS interested in making a determination that an operation is provider-based?
  • What CMS-855 enrollment forms must be completed relative to provider-based clinics?
  • How do the physician supervision requirements affect provider-based status?
  • What special coding and billing requirements are required for provider-based clinics?
  • What if we are outside the 35-mile default limit?
  • What if we have a facility in which part is provider-based and part is freestanding?
  • What if we have space that is used jointly by both the hospital and other providers?
  • What kind of signage is really necessary?
  • How do we report changes in provider-based operations?
  • Should we routinely ask for determinations from out MAC?
  • How do we go about auditing our provider-based operations?
  • Are there differences for provider-based operation in the hospital vs. on-campus vs. off-campus?
  • How have Section 603 of BiBA 2015, Section 16001 of the 21st Century Cures Act, and BiBA 20918 affected provider-based clinics?

Teleconference/Webinar Objectives:-

  • To briefly review the Provider-Based Rule (PBR).
  • To understand the differences between freestanding and provider-based clinics.
  • To understand the economic advantages of provider-based clinics.
  • To review and appreciate special requirements for provider-based clinics.
  • To appreciate special compliance concerns associated with provider-based status.
  • To discuss coding and billing issues for provider-based clinics.
  • To understand how to qualify clinics that are outside the 35-mile default limit.
  • To discuss signage and proper identification for provider-based operations.
  • To discuss complicated issues such as joint use of space and time-share space utilization.
  • To understand provider-based reporting requirements and the CMS-855 forms.
  • To explore the application of the physician supervision requirement for outpatient services.
  • To discuss operation issues such as setting fees, patient relations and medical staff organizational structuring.
  • To review on-going ambiguities in the Provider-Based Rule affecting provider-based operations.
  • To review the impact of 603 BiBA 2015, Section 16001 of the 21st Century Cures Act, and BiBA2018 affected establishing provider-based clinics?
  • To work through several case studies involving special issues in the establishment of the provider-based clinics.

Teleconference/Webinar Outline/Agenda:-

  • 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
    • 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
  • Recent Legislation
    • Section 603 of BiBA 2015
    • Section 16001 of the 21st Century Cures Act
    • BiBA 2018
  • 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

Prerequisites for Participating:- 

General knowledge of hospitals and various clinic and/or clinical operations is required along with an understanding of the Provider-Based Rule.  See the workshop “Establishing Provider-Based Clinics – Basics”.

Suggested Attendees:- 

  • Chargemaster Personnel
  • Compliance Personnel
  • Claims Transaction Personnel
  • Coding Personnel
  • Financial Analysts
  • Operating Officers
  • Clinic Administrators and Managers
  • All personnel involved with provider-based clinics and/or clinical operations including nursing staff and interested physicians/practitioners.

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Establishing Provider-Based Clinics – Advanced Issues by Duane C. Abbey

  • Brand: Skillacquire
  • Product Code: m202
  • Availability: In Stock
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