WEBINAR: Provider-Based Rule-- Update for 2019
Course Curriculum
Hospitals are ever increasingly establishing provider-based clinics of all types. While hospitals can enjoy increased revenue from provider-based clinics, compliance with all the rules and regulations is challenging. The provider-based rule (PBR) is complex and there are definite ambiguities. Recent changes in the supervisory requirements for provider-based operations have created confusion and new compliance challenges. Additionally, with Section 603 of the Bipartisan Budget Act of 2015, there is movement to change the rules and regulations relative to reimbursement for provider-based clinics.
The overall purpose and function of the provider-based rule will be addressed in this workshop, as well as critical information concerning physician supervisory changes and a discussion of the future of provider-based clinics. Particular attention will be given 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. Update information from the CY2018 and CY2019 OPPS and MPFS update Federal Registers will also be discussed.
Learning Objectives
At the completion of this program, the participants will be able to:
1. Identify the criteria that must be achieved for clinics to be recognized as provider-based.
2. Discuss the current status of changes in payment to off-campus provider-based clinics as provided through Section 603 of the BBA 2015.
3. Give examples of changes made by the 21st Century Cures Act.
4. Describe critical physician supervisory rule changes.
5. Discuss the attestation and request for determination processes.
6. Analyze the relationship of PBR relative to the conditions for payment, conditions of participation and gaining billing privileges.
7. Discuss the regulatory pressures for reducing reimbursement for provider-based clinics.
Target Audience
This session is recommended for all personnel involved with provider-based clinic and/or clinical operations, compliance personnel, and coding and billing personnel. Nursing staff and interested physicians are also encouraged to attend.
Faculty
Dr. Duane Abbey is a management consultant and president of Abbey & Abbey Consultants. For over 20 years, Duane has provided health care consulting services to hospitals, physicians, and medical clinics. The focus of his consulting has been in the areas of compliance, payment and delivery systems. In addition to his consulting, Duane is an invited presenter for hospital associations, medical societies and other groups. He has also published articles and books on health care topics. The speaker has no real or perceived conflicts of interest that relate to this presentation.