What special coding and billing requirements are required for provider-based clinics? What are the requirements under the provider-based rule (PBR)? What do hospitals have to do to establish provider-based clinics? To answer these questions and more please come join us in this upcoming Webinar.
Review the Provider-Based Rule (PBR)
Understand the differences between freestanding and provider-based clinics
Understand the economic advantages of provider-based clinics
Appreciate special requirements for provider-based clinics
Appreciate special compliance concerns associated with provider-based status
Understand the steps needed to create and/or convert to a provider-based clinic
Discuss coding and billing issues for provider-based clinics
Delineate how the chargemaster should be established to support coding and billing for both technical and professional components
Discuss operation issues such as setting fees, patient relations and medical staff organizational structuring
Work through several case studies involving the establishment of the provider-based clinics
The following are a few of the topics to be discussed
Review of the Provider-Based Rule (PBR)
Development of the PBR
42 CFR Â§413.65
Review of Definitions
Rules and Regulations
Recognition by Non-Medicare Third-Party Payers
Economic Advantages of Provider-Based Status
Costs for Provider-Based Status
Recognizing Provider-Based Clinical Services
Establishing Provider-Based Clinics
Meeting the PBR Requirements
Special Areas of Concern
Medical Records Integration
Off-Campus vs. On-Campus
Physicians and Practitioners
Fire Safety Concerns
Hospital Conditions of Participation
Human Resource Issues
Physician Supervision Requirements
Coding and Billing
Technical Component E/M Coding
Surgical Services Coding
Medical Services Coding
Setting Up The Chargemaster
Establishing Charge Structures
Use of Modifiers
Special Types of Provider-Based Clinics
Wound Care Clinics
Pain Management Clinics
Medication Management Clinics
Sources for Further Information
Chargemaster personnel, compliance personnel, claims transaction personnel, financial analysts, operating officers, clinic administrators and managers, and all personnel involved with provider-based clinics and/or clinical operations including nursing staff and interested physicians/practitioners.
Review the Provider-Based Rule and Make Smarter Choices for Your Hospital and Clinic
Understanding the Provider-Based Rule (PBR) can be a tall order, especially as changes in the physician supervision and reimbursement rules add confusion. Not only do hospitals’ provider-based operations face unique billing and operations issues, but PBR ambiguities—from multiple PBR-status criteria to joint-use/time-share spaces to signage requirements—make compliance a real challenge. Learn to weigh the economic benefits and compliance concerns of provider-based operations—and make smarter choices for your hospital and clinic.
Join expert speaker Duane C. Abbey, Ph.D, as he explains the key differences between freestanding and provider-based clinics, and the economic advantages of the latter. He will teach you to set fees for your clinic, conduct patient relations, and effectively organize your medical staff. Abbey will walk you through all the complex PBR compliance details, including how to: apply the physician supervision requirements for outpatient services , abide by reporting requirements, use CMS-855 enrollment forms, qualify clinics that are outside the 35-mile default limit, and audit your clinic operations.
The 2017 Outpatient Prospective Payment System (OPPS) rule changed how non-exempted off-campus provider-based departments will be paid. And both Section 603 of the 2015 Bipartisan Budget Act (BiBA) and Section 16001 of the 21st Century Cures Act have significantly affected the establishment and payment systems of provider-based clinics. Be sure your clinic is up-to-date and being paid appropriately!
After attending this informative session, you will be well equipped to implement all PBR-specific billing and coding requirements—and be audit-ready at all times. By the end of this information-packed session, you will have the tools you need to understand how federal legislation and billing requirements converge to impact how your clinic will be paid.
This program will teach you how to:
In this session you will be able to:
Who Should Attend
All persons involved with provider-based clinics will benefit from this session, including:
The chargemaster is both a direct and indirect target of compliance and thus various types of audits. Hospitals should periodically take the time to examine their chargemasters from a compliance perspective. This means examining and review various CDM policies and procedures (P&Ps) which must dovetail to coding P&Ps as well as billing P&Ps. Issues such as transparent pricing, proper use of revenue codes, cost report interface, coding interface, billing interface, supply categorization, etc. must all be considered. A systematic process for auditing the chargemaster relative to this host of compliance issues is discussed.
Who Will Benefit:
Chargemaster Personnel, Coding Personnel, Billing and Claims Transaction Personnel, Chargemaster Coordinators, Cost Report Preparers, Compliance Officers and Compliance Personnel, Auditing Personnel, Revenue Cycle Personnel, Clinical Service Providers, Financial Analysts, Compliance Personnel, Physicians and Other Interested Personnel
Preventing unnecessary readmissions is essential. Hospitals that have a higher rate of readmission now receive less money from CMS. This is why there is increased surveillance activity in the area of discharge planning.
This program will cover the CMS (Center for Medicare and Medicaid Services) hospital Conditions of Participation regulations for Utilization Review. Every hospital that accepts Medicare and Medicaid reimbursement must be compliance with these standards. Compliance with the UR standards is more important to avoid penalties from the Recovery Audit Contractors (RACs) and other organizations such as the OIG.
After this webinar participants will be able to:
|- Utilization Review under Tag 652||- UR plan requirements|
|- Activities performed in UR plan||- Functions of a UR committee|
|- Agreement with QIO||- MOON Forms for outpatient observation patients|
|- Observation verses inpatient admission||- Admissions or continued stay|
|- Medical necessity determination||And that's just the beginning!|
Anyone involved with or interested in utilization review, including but not limited to: Utilization Review Committee, Transitional Nurses, UR Nurses, CEOs, CFOs, COOs, CMOs, CNOs, CE Directors, Department Directors, Quality Improvement Staff, Physicians, Nurses (all levels), Compliance Officers, CMS Liaisons, TJC Liaisons, Safety Officers and Staff, Ethics Committee Members, Consumer Advocates, Risk Managers, Social Workers, Discharge Planners, Case Managers, Hospice Staff and Regulatory Affairs Staff.
The QAPI (Quality Assessment and Performance Improvement) worksheet is designed to help surveyors assess compliance with the hospital CoPs for QAPI. The worksheet is used by State and Federal surveyors on all survey activity in hospitals when assessing compliance with the QAPI standards including validation and certification surveys. CMS may also just show up at your door to assess the three worksheets.
This program is a must attend for any hospital. This is because it is one of only three sections with a CMS worksheet. It will also discuss the CMS hospital QAPI standards. There is high number of deficiencies and these will be discussed. There are over 1,700 deficiencies and many of these relate to patient safety. This program will also cover some proposed changes to QAPI. CMS is going to implement similar QAPI standards for critical access hospitals in the proposed Hospital Improvement Rule.
After this webinar participants will be able to:
|- Scope of data collection||- Collection methodology|
|- RCA and causal analysis tracers||- PI requirements and leadership|
|- Number of deficiencies in the QAPI standards||- Hospital wide QAPI program|
|- Analyze and tracking of performance indicators||- Identifying opportunities for improvement|
|- Documentation requirements||And that's just the beginning!|
It should be mandatory for the performance improvement director and staff to attend. Others include the risk management, quality staff, compliance officer, chief nursing officer, chief medical officer, patient safety officer, nurse educator, staff nurses, nurse managers, leadership staff, board members, accreditation staff, department directors, infection preventionist and anyone else who is responsible to ensure the CMS CoPs related to performance improvement are met which includes requirements on risk management and patient safety.
In this session Mr. Wolfe will provide a straight-forward, practical explanation of developing concepts, including the quality and value metrics into new federal health care programs and commercial payment systems.
New delivery models, what providers can be doing to develop a value-based strategy, and the application of the Stark Law and other fraud and abuse laws to new models aimed at population health, quality of care and cost control.
Mastering these concepts will be a must for health care executives looking to position their organizations for success in this new value-based world.
Why should you Attend:
Going forward, health care leaders should be developing a value-based strategy so they can position their organizations for financial success in the new value-based world.
A refined and comprehensive value-based strategy can advance several important goals for a health care organization, among them:
(1) enhancement of quality of care and improvement of patient outcomes.
(2) promotion of safe medical practices.
(3) sharing of best clinical practices.
(4) increased efficiencies in care delivery.
(5) facilitation of appropriate utilization of services; and
(6) alignment of financial incentives.
Attendees should register for this webinar to get a better understanding of the legal issues surrounding paying for quality and value so they can refine their current strategy and can identify new delivery models and potential opportunities.
Areas Covered in the Session:
Who Will Benefit:
HIPAA enforcement activity is well established now, with new attention to reported violations of HIPAA. It is easy to become the target of a compliance investigation, and essential to be prepared in advance.
HIPAA Compliance requires that you be prepared to handle Protected Health Information properly and follow the requirements in the HIPAA Privacy, Security, and Breach Notification Rules. If there is a problem that comes to the surface, an enforcement action can result, including financial settlements that can reach into the millions of dollars, and Corrective Action Plans that can take years to complete and can cost many times the expense of the monetary settlements.
We will review the contents of the updated 2018 HIPAA Audit Protocol to show what documentation needs to be on hand should your organization be selected for a compliance review. We will present methods for using the contents of the HIPAA Audit Protocol to build your own compliance plan by relating your compliance activities directly to the questions that might be asked.
In this session we will discuss the HIPAA enforcement regulations and processes, how they apply to HIPAA covered entities and business associates, and how state Attorneys General can use the provisions enacted in the HITECH Act to file suit under Federal law. We will explain the enforcement regulations and the increased fines and new penalty levels, including penalties for willful neglect of compliance that begin at $10,000 and reach into the millions of dollars.
Areas Covered in the Session:-
Learn about how the HIPAA enforcement rules work, and how HIPAA investigations can take place.
Why Should You Attend:-
In this session we will discuss HIPAA enforcement activities and how they work, including how state Attorneys General can play a role in enforcement, and discuss the areas that caused the most issues in prior audits and enforcement actions. We will explore what kind of issues and what kind of entities had the most problems, and show where entities need to improve their compliance the most. We will also explore the typical risk issues that lead to breaches of health information and see how those issues may lead to significant penalties for non-compliance.
We will discuss what information and documentation must be prepared in advance so that you can be ready for an audit or enforcement review at any time, including sample information request forms and questions asked in prior audits and reviews. The session will also cover how to know if you may become the subject of an audit or enforcement action, and what you can do to help limit your exposure. We will discuss how most enforcement actions come about and what can be done to prevent incidents that lead to enforcement activity.
The results of prior HIPAA audits and enforcement actions (and their penalties) will be discussed, including recent actions involving multi-million-dollar fines and settlements, as well as penalties levied as a result of state lawsuits. A plan for attaining compliance will be presented. The steps to follow to prepare for and respond to a compliance review or audit request will be outlined.
Enforcement of the HIPAA Privacy and Security Rules has become a significant reality, and now not only is the US Department of Health and Human Services Office for Civil Rights involved, with penalties in the millions of dollars, but also individual state Attorneys General are also picking up the enforcement ball and running with it, leading to several recent penalties in the hundreds of thousands of dollars. Even if there is a slowdown in enforcement at the Federal level, enforcement activities continue where the state AGs see their states’ residents’ rights to the privacy and security of their health information threatened. Now, more than ever, it is essential to have your HIPAA compliance in order so you can avoid the significant penalties for non-compliance.
Who Will Benefit:-
Attendees should include Compliance Officers, Privacy and Security Officers, and leadership and staff in health information management, information security, and patient relations, as well as staff in patient intake and front-line patient relations and any others that are involved in, interested in, or responsible for, patient communications, information management, and privacy and security of Protected Health Information under HIPAA, including:
When new drugs or devices are tested in humans, the data generated by, and related to, these trials are known as clinical data. This data represents a huge investment by the biopharmaceutical or device company and is one of its greatest assets. It is this data that will eventually make a new product both useful as a treatment or therapy and marketable.
The management of clinical data, from its collection during a trial to its extraction for analysis, has become a critical element in the steps to prepare a regulatory submission and to obtain approval to market a treatment. As its importance has grown, clinical data management (CDM) has changed from an essentially clerical task in the late 1970s and early 1980s to the highly computerized specialty it is today.
This seminar is based on the current state of regulations and will cover the essential parts of the data management plan, study start up, study conduct, study closeout and study monitoring.
A data management plan or DMP is a formal document that outlines how data are to be handled both during a research project, and after the project is completed. The goal of a data management plan is to consider the many aspects of data management, metadata generation, data preservation, and analysis before the project begins; this ensures that data are well-managed in the present, and prepared for preservation in the future.
Study start up activities include designing case report forms (CRFs), paper or computer; specifying cleaning rules (edit checks); building and testing the database; and releasing the study database to collect data.
Study conduct activities include collecting the data on CRFs and via electronic files, cleaning that data, managing adverse event and serious adverse event collection, and producing reports.
Study closeout focuses on ensuring the data is complete and of a quality to support final analysis.
Study monitoring is an in-person evaluation carried out by sponsor personnel or representatives at the sites at which the clinical investigation is being conducted. On-site monitoring can identify data entry errors (e.g., discrepancies between source records and case report forms (CRFs)) and missing data in source records or CRFs; and assess compliance with the protocol and investigational product.
Lecture 2 :-
Study Conduct (cont'd)
Lecture 3 :-
Lecture 4 :-
Why you should attend:-
At the end of this class (Part I & Part II) attendees will be able to:
Who Will Benefit:-