Understanding the Latest Coding, Billing and Strategic Considerations for Off-Campus Provider-Based Departments

Event Information
Product Format
Prerecorded Event
90 minutes
Product Description

Impact of CMS’s 2017 CY HOPPS Rule Changes and Cures Act on Coding, Billing & Reimbursement of Off-Campus Provider-Based Departments

CMS’s contract year 2017 Hospital Outpatient Prospective Payment System (HOPPS) Rule contained a number of changes from the proposed rule with respect to Section 603 of the Balanced Budget Act that impacts the coding, billing and reimbursement for off-campus provider-based departments. Additionally, the 2016 Cures Act contains additional exceptions and guidance that is important for providers to understand, as this will impact future reimbursement as well as strategic decisionmaking.

Join expert speakers Jugna Shah, MPH and Valerie Rinkle, MPA in this webinar to review the latest conditions in coding and billing for off-campus provider-based departments. Get a review of the provider-based rules that impact both on- and off-campus departments of a provider. Also, gain an understanding of the coding and billing requirements for modifiers –PO and –PN that are required to be reported by all off-campus provider-based departments.

You’ll learn about the impact of the recent changes on reimbursement that affect certain off-campus provider-based departments. In this session, Jugna and Valerie will shed light on key strategic and operational issues through the use of case studies and examples.

Session Highlights

  • Requirements for provider-based departments
  • Definitions of excepted and non-excepted locations
  • Provisions of the Cures Act
  • Ruling about service expansion
  • Requirements related to relocation
  • Billing requirements and the payment mechanism
  • Modífier -PN vs. –PO reporting requirements
  • Review of case scenarios
  • Evaluating financial impact
  • Assessing strategic options
  • Review Medicare’s final rules for off-campus provider-based departments affected by Section 603
  • Assess the operational and financial impact of CMS policies on your hospital
  • Determine what you need to do now in CY 2017 and beyond

Session Agenda

  • Review of CMS's General Requirements for Hospital Provider-Based Departments
    • The Basics
    • General Information about PBDs
    • General Information about Reimbursement for PBDs
    • A Review of the Requirements for Both On- & Off-Campus PBDs
    • Additional 42 CFR 413.65 Requirements for Off-Campus PBDs
    • Additional Considerations, Voluntary Attestations and Enrollment
  • Section 603, CMS’ Implementing Regulations, and the Cures Act
    • Reminders About Section 603 from the Balanced Budget Act of 2015
    • The CY 2017 OPPS Proposed Rule and Fínal Rule
    • 21st Century Cures Act and The Latest on Section 603
    • Change in Ownership and Relocation
    • Off-Campus PBDs in “Mid-Build” Situations
    • “PN” Modífier Requirements for Non-Excepted PBDs
    • “PO” Modífier Requirements
    • Summary of “Interim Fínal” Payment System
  • Case Scenarios and Some Frequently Asked Questions
  • Protecting PBD Status, Financial Impact
    • Coding & Billing of Provider-Based Services to Commercial Payers
    • Patient Notifications
    • Types of Outpatient Hospital Services and Payment
    • Estimating PBD Reimbursement
    • Provider Implications and Future Considerations

Who should attend

This program is designed to help hospital coding & billing staff, charge description master (CDM) managers, auditors, department managers/supervisors, hospital administrators, finance directors, compliance officers, and others; as well as healthcare consultants understand the operational and financial implications for off-campus provider-based departments, including the coding and billing requirements as well as the reimbursement impact.

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About Our Speaker

Jugna Shah and Valerie A. Rinkle

Jugna Shah, MPH, is the president and founder of Nimitt Consulting Inc. and specializes in working with hospitals, health systems, advocacy organizations, and international governments on regulatory and health care financing issues. In the U.S., Ms. Shah works with hospitals to manage the clinical and financial operations related to OPPS/APCs. She also raises important payment system issues to Medicare and the APC Advisory Panel to improve...   More Info
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