Provider-Based Rule [PBR]

Hospitals are making efforts to establish provider-based clinics of all types. The provider-based rule (PBR) is quite complex and confusing; and there are definite ambiguities that make it challenging. HPP Management Group can assist you with the information you need , on explaining different aspects of CMS, and why is it interested in making a determination that an operation is provider based. HPP will also touch upon the importance of CMS-855 enrollment forms and completion to provider-based clinics.

 Understand the advantages of provider-based clinics to hospitals, the role of the hospitals to establish provider-based clinics, various ambiguities in the provider-based rule (PBR), the art of selecting criteria and meeting the demand to establish a provider-based clinic; and to brace up for the upcoming challenges..

Important questions:

• What is the advantage of provider-based clinics to hospitals?
• What do hospitals have to do to establish provider-based clinics?
• Why are there ambiguities in the provider-based rule (PBR)?
• What are the criteria that we must meet to establish a provider-based clinic?
• Do we have to meet each and every criterion in order to establish provider-based status?
• When is CMS interested in making a determination that an operation is provider-based?
• What CMS-855 enrollment forms must be completed relative to provider-based clinics?
• What specìal codìng and billing requirements are required for provider-based clinics?
• How do we set up a proper fee schedule for both the facility and professional components?
• What if we are outside the 35-mile default limit?
• What if we have a facility in which part is provider-based and part is freestanding?
• What if we have space that is used jointly by both the hospital and other providers?
• What kind of signage is really necessary?
• How do we report changes in provider-based operations?
• Should we routinely ask for determinations from out MAC?

For more details , please call 786-231-7585.