The Future of Provider-Based Clinics

Event Information
Product Format
Prerecorded Event
90 minutes
Product Description

Provider-Based Clinics: Physician Supervisory Changes and What to Expect in the Future

Congress has acted to delimit the increase in physician practice acquisition by hospitals. This action was through the Bipartisan Budget Act of 2015, Section 603. Hospitals have been increasingly establishing provider-based clinics of all types, both on-campus and off-campus. The provider-based rule (PBR) is complex and there are definite ambiguities. Although hospitals can enjoy the benefits of increase in their revenues due to provider-based clinics, being compliant with its rules and regulations is a challenge in itself. There are many confusions regarding the latest changes in the supervisory requirements for provider-based operations, it has brought about fresh compliance challenges.

In this session, expert speaker Duane C. Abbey, Ph.D., will address the overall function and purpose of the provider-based rule. He will also be providing important information regarding physician supervisory changes along with a discussion of the future of provider-based clinics. The possibility of equalization of payments between freestanding and provider-based operations will also be explored in this session.

Session Highlights:

  • Briefly review the PBR
  • Review the criteria that must be achieved for clinics to be recognized as provider-based
  • Understand the current status of changes in payment to off-campus provider-based clinics as provided through Section 603 of the BBA 2015
  • Get insights on critical supervisory rule changes
  • Documentation requirements relative to supervision requirements
  • Identify the increase in reimbursement for provider-based clinics
  • Understand the role of 340(B) drug pricing relative to provider-based status
  • Get insights on the attestation and request for determination processes
  • Understand and comprehend the need for updating and the documentation of organizational structuring relative to the PBR
  • Understand the review process for assessing current and/or potential provider-based situations
  • Learn about the economic benefits versus the compliance requirements
  • Appreciate the relationship of PBR relative to the Conditions for Payment, Conditions of Participation and gaining billing privileges
  • Understand the regulatory pressures for reducing reimbursement for provider-based clinics
  • Work through several case studies for a deeper understanding

Session Agenda:

  • 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
    • Brief History of Provider-Based Clinics
  • Economic Advantages of Provider-Based Status
    • Clinics
    • Clinical Services
    • Costs for Provider-Based Status
  • Provider-Based Requirements
    • Owned, Operated and Fully Integrated
    • Geographic Proximity
    • Signage and Recognition
    • Clinical Integration
    • EMTALA Interface
    • Notice of Two Copayments
    • Split-Billing
    • Shared Space Concerns
  • Movement to Reduce Provider-Based Clinic Reimbursement
    • BBA 2015, Section 603
      • Off-Campus Provider-Based Operations
      • January 1, 2017 Implementation Date
      • Grandfathering of Current Off-Campus Provider-Based Clinics
    • OIG Recommendations
    • MedPAC Recommendations
    • CMS Data Gathering Efforts
      • Special Modifier for Hospitals
      • New POS Codes for Physicians
  • Physician Supervisory Requirements
    • Recent Changes and Clarifications
    • In-Hospital
    • On-Campus
    • Off-Campus
    • Possible Recovery Audit Contractor (RAC) Issues
  • Provider-Based Audits
    • Process
    • Data Gathering and Assessment
    • Attestations and Requests for Determination
    • Action Steps
  • Case Studies – Provider-Based Clinics

Who should attend?

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

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About Our Speaker

Duane Abbey Hospital Coding & Compliance Expert

 Duane C. Abbey, Ph.D. is a management consultant and president of Abbey & Abbey, Consultants, Inc., which specializes in healthcare consulting and related areas. Duane earned his graduate degrees at the University of Notre Dame and Iowa State University and has more than 20 years of experience as a consultant. He performs various types of financial analysis involving business structuring, organizational development, enrolment and other financially related concerns of organizations....   More Info
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