Description

• For coding and billing, what is different about the ED and provider-based clinics?
• How can we establish the ED portion of the chargemaster to capture all charges?
• Do we need to have line items in the chargemaster for non-emergency care in the ED?
• Does our fast-track need special attention in the chargemaster?
• Why are our ED charges so high?
• Should the ED modifiers be in the chargemaster?
• What is this provider-based clinic split fee schedule?
• How can we establish our chargemaster to accommodate provider-based clinic activities and freestanding clinics at the same time?
• Do we need to put the non-physician practitioner fees in the chargemaster?

Teleconference/Webinar Objectives:- 

• To review the Provider-Based Rule (PBR).
• To understand the differences between freestanding and provider-based clinics.
• To understand the economic advantages of provider-based clinics.
• To appreciate special compliance concerns associated with provider-based status.
• To appreciate provider-based clinical services within the hospital.
• To understand ED services and the impact on the chargemaster.
• To delineate how the chargemaster should be established to support coding and billing for both technical and professional components in the ED and provider-based clinics.
• To discuss operation issues such as setting fees, patient relations and medical staff organizational structuring.
• To delineate the various types of clinics and operations that can be provider-based.
• To appreciate organizing multiple provider-based clinics.
• To review Section 603 of BiBA 2015 and the 21st Century Cures Act.
• To work through several case studies involving the establishment of the chargemaster for the ED and provider-based clinics.

Teleconference/Webinar Outline/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
  • Current Legislative Activity
• Economic Advantages of Provider-Based Status
  • Clinics
  • Clinical Services
  • Costs for Provider-Based Status
  • Recognizing Provider-Based Clinical Services
• Review of the ED As Provider-Based
  • Types and Levels of Services
  • Professional vs. Facility Coding and Billing
  • Establishing Fee Structures
  • Non-Emergent Care in the ED
• Establishing the Chargemaster
  • Technical Component – UB-04
  • Professional Component - 1500
  • Setting Fee Schedules
  • E/M Levels
  • Coding and Modifiers
• Special Concerns
  • Maintaining Patient Relations
  • Medical Staff Organization
  • Meeting Other Provider-Based Rule Requirements
• Special Types of Provider-Based Clinics
  • Wound Care Clinics
  • Specialty Clinics
  • Pain Management Clinics
  • Medication Management Clinics
• Recent Developments
  • CMS Data Gathering
  • BiBA 2015 Payment for Off-Campus Clinics
  • 21st Century Act and Impact on Provider-Based Clinics

Prerequisites for Participating:- 

General knowledge of hospitals and various clinic and/or clinical operations.

Suggested Attendees:- 

Chargemaster personnel, compliance personnel, claims transaction personnel, coding personnel, ED management staff, provider-based clinic management staff, and all personnel involved with provider-based clinics and/or clinical operations including nursing staff and interested physicians.