WEBINAR: Provider-Based Clinics 2018 Update

In this webinar the overall purpose and function of the provider-based rule is addressed as well as critical information concerning physician supervisory changes along with a discussion of the future of provider-based clinics.

Particular attention is made to rule changes as implemented by CMS relative to Section 603 of BBA 2015 and further changes made by Section 16001 of the 21st Century Cures Act.

Webinar Objectives: 

review the Provider-Based Rule (PBR)
review the criteria that must be achieved for clinics to be recognized as provider-based
discuss the current status of changes in payment to off-campus provider-based clinics as provided through Section 603 of the BBA 2015
review the further changes made by the 21st Century Cures Act
discuss critical physician supervisory rule changes
discuss documentation requirements relative to physician supervision requirements
recognize the increase in reimbursement for provider-based clinics
define the attestation and request for determination processes
review the need for updating and the documentation of organizational structuring relative to the PBR
discuss the review/audit process for assessing current and/or potential provider-based situations
review the economic benefits versus the compliance requirements
recognize the relationship of PBR relative to the Conditions for Payment, Conditions of Participation and gaining billing privileges
review the regulatory pressures for reducing reimbursement for provider-based clinics
identify the evolving guidance that is being provided by CMS and/or the Regional Offices
examine several case studies

Webinar Topics:
Review of the Provider-Based Rule (PBR)
o Development of the PBR
o 42 CFR §413.65
o Review of Definitions
o Rules and Regulations
o Recognition by Non-Medicare Third-Party Payers
o Very Brief History of Provider-Based Clinics
Economic Advantages of Provider-Based Status
o Clinics
o Clinical Services
o Costs for Provider-Based Status
Current Activity Surrounding Medicare Payment for Provider-Based Clinics
o OIG Recommendations
o MedPAC Recommendations
o CMS Data Gathering of Cost for Off-Campus Provider-Based Clinics/Operations
? PO Modifier – UB-04
? POS 19/22 Indicators - 1500
o Section 603, BBA 2015 Changes Starting January 1, 2017
? Final Rules for 2017
? Payment Process or Non-Excepted Clinics
? Special Issues
o Section 16001, 21st Century Cures Act
? Definition of ‘New’ Relative to BBA 2015
? Mid-Build Exception for Grandfathering
Provider-Based Requirements – Special Issues
o Signage and Recognition
o EMTALA Interface
o Notice of Two Copayments
o Split-Billing
o Shared Space Concerns
o Co-Location Issues
o Under Arrangements
o Other Regional Office Issues
Physician Supervisory Requirements
o Recent Changes and Clarifications
o Relationship to Physician Incident-To Billing
Provider-Based Audits
o Process
o Data Gathering and Assessment
o Attestations and Requests for Determination
o Action Steps
Provider-Based Clinics – The Future
Case Studies – Provider-Based Clinics

Target Audience:
All personnel involved with provider-based clinic and/or clinical operations, compliance personnel, coding and billing personnel, nursing staff and interested physicians are encouraged to attend.

Faculty: Duane C. Abbey

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.

Contact Hours: 
Nursing participants: This webinar is approved for 1.8 contact hours by the Iowa Board of Nursing Approved Provider Number 339.

All other participants: Must attend the entire Webinar and complete a Webinar critique to receive a 1.5 Hour Attendance Certificate.
8/9/2017 10:00 AM - 8/9/2017 11:30 AM
United States


Wednesday, 09 August 2017

8/9/2017 10:00 AM
10:00 AM - 11:30 AM
8/9/2017 10:00 AM
10:00 AM - 11:30 AM
8/9/2017 10:00 AM
10:00 AM - 11:30 AM
8/9/2017 10:00 AM

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