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 of the session:

• 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.

• different conditions for PBR payment

Agenda of the session:

1.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 

2.Economic benefits of Provider-Based Status 

• Facilities 

• Clinical Services 

• Price of Provider-Based Status 

3.Provider-Based conditions

• Owned, Operated and Fully Integrated 

• Geographic Proximity 

• Signage and Recognition 

• Clinical Integration 

• EMTALA Interface 

• Notice of Two Copayments 

• Part Billing 

1.    Utilization of PO Modifier 
2.    Utilization of appropriate Place of Service 

• Shared Space Distress

4.Doctor Supervisory Requirements 

• Current Modifications and Clarifications 

• In-Hospital 

• On-Campus 

• Off-Campus 

• Conceivable Recovery Audit Contractor (RAC) Problems

5.Compliance and Responsibilities Under PBR 

• Satisfy All PBR Criteria 

• Report Requirements

• Verification versus Determination Process 

6.Provider-Based Audits 

7.Procedure 

• In The Hospital 

• On-Campus 

• Off-Campus 

8.Information Gathering and Evaluation

• Survey of Provider-Based Operations 

• Appraisal of Requirements and Prohibitions 

9.Active Steps 

10.Current Legislative Initiatives 

• Section 603 BiBA 2015 

• 21st Century Cures Act Section 16001 

11.Advanced Problems

• Shared-Space 

• Holding-Out to the Public 

• Administrative Contracts 

• Under Arrangements 

12.Related Issues 

• Conditions for Payment 

• Prerequisites for Participation 

• Other Third-Party Payer Relations 

• Coding and Billing for Provider-Based Clinics 

13.Case Studies – Provider-Based Clinics 

Who should attend?

• Hospital, clinic and provider-based personnel

• Compliance personnel

• Coding staff

• Billing staff

• Physicians and nurses