Overview
What special coding and billing requirements are required for provider-based clinics? What are the requirements under the provider-based rule (PBR)? What do hospitals have to do to establish provider-based clinics? To answer these questions and more please come join us in this upcoming 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
- Appreciate special requirements for provider-based clinics
- Appreciate special compliance concerns associated with provider-based status
- Understand the steps needed to create and/or convert to a provider-based clinic
- Discuss coding and billing issues for provider-based clinics
- Delineate how the chargemaster should be established to support coding and billing for both technical and professional components
- Discuss operation issues such as setting fees, patient relations and medical staff organizational structuring
- Work through several case studies involving the establishment of the provider-based clinics
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
- Rules and Regulations
- Recognition by Non-Medicare Third-Party Payers
- 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
- Special Areas of Concern
- Medical Records Integration
- Off-Campus vs. On-Campus
- Physicians and Practitioners
- EMTALA Compliance
- Fire Safety Concerns
- Hospital Conditions of Participation
- Human Resource Issues
- Physician Supervision Requirements
- Coding and Billing
- Technical Component E/M Coding
- Surgical Services Coding
- Medical Services Coding
- Setting Up The Chargemaster
- Establishing Charge Structures
- Use of Modifiers
- Special Types of Provider-Based Clinics
- Wound Care Clinics
- Specialty Clinics
- Pain Management Clinics
- Medication Management Clinics
- Sources for Further Information
Target Audience
Chargemaster personnel, compliance personnel, claims transaction 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
About the Speaker
Dr. Duane Abbey is a management consultant and president of Abbey & Abbey Consultants, based in Ames, Iowa. For over twenty years Abbey & Abbey, Consultants, Inc. has provided superior healthcare consulting services to hospitals, hospital systems, physicians, medical clinics and integrated delivery systems.
Abbey & Abbey, Consultants, Inc. specializes in healthcare consulting primarily in the areas of:
- Payment systems - reimbursement consulting
- Delivery systems - organization of healthcare delivery
- Compliance - developing compliance programs - emphasis in the coding, billing and reimbursement areas
In addition to his consulting, Dr. Abbey has been an invited presenter for hospital associations, medical societies, and other groups. He has also published both articles and books on health care topics. Dr. Abbey earned his graduate degrees from the University of Notre Dame and Iowa State University.
Continuing Education Credits
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.
