Evolving Reimbursement in On- and Off-Campus Provider-Based Departments -
A sub-regulatory clarification has been released since the recording of this webinar. The January 2017 update to the outpatient prospective payment system clarified that facilities should not use modifier -PO when using modifier -PN. Additionally, the definition of the -PO modifier has been changed effective January 1, 2017, to read: “Excepted services provided at an off-campus, outpatient, provider-based department of a hospital.” Keeping up with CMS regulation can be challenging for hospital and clinic staff. For more information on the latest provider-based regulations, register for the Medicare Boot Camp—Provider-Based Departments Version.
Tuesday, November 22, 2016
Kimberly Anderwood Hoy Baker, JD, CPC
Level of Program:
Reimbursement for off-campus provider-based departments is not as straightforward as it used to be. The 2017 outpatient prospective payment system (OPPS) final rule and Section 603 of the Bipartisan Budget Act of 2015 call for an alternate payment methodology for off-campus provider-based departments. Under the new law, CMS adopted the Medicare Physician Fee Schedule (MPFS) and a new modifier (-PN) for “non-excepted” services, but the basis of payment and claims edits will still be the OPPS. The new payment methodology is a severe reduction for these services. Hospitals face revenue and compliance problems if they do not properly identify provider-based departments and services. But identifying these services is challenging because there are multiple definitions of and complex guidance for off-campus departments and services that are nevertheless exempt from the law.
Join expert speaker Kimberly Anderwood Hoy Baker, JD, CPC, for this 90-minute program as she discusses the changing landscape of provider-based department reimbursement, including increased packaging of services and the alternate payment system under the MPFS that CMS plans to implement for certain off-campus departments in 2017 under Section 603.
The program will review the different definitions of “off-campus department” under provider-based regulations, the use of modifiers -PN and -PO, and the implications of changing definitions and guidance. Case studies comparing payment for provider-based and freestanding departments, along with the implications of the 2017 OPPS final rule and Section 603, will also be reviewed.
At the completion of this program, participants will be able to:
- Describe two departments considered off-campus under provider-based department regulations (42 CFR 413.65) but not under the instructions for modifier -PO
- Name three types of off-campus departments under Section 413.65 that are proposed to be “excepted” from the definition of off-campus under Section 603
- Describe the impact of increased packaging on the payment for provider-based departments paid under the OPPS
- Identify the proposed payment system for “non-excepted” services at off-campus departments beginning in 2017
Who Should Listen:
- HIM directors/managers
- Revenue cycle managers/directors
- RAC coordinators
- Compliance officers
- HIM staff members
- Billing/reimbursement staff members
- Outpatient coders and billers
- Chargemaster coordinators
- Practice managers
- Defining on- and off-campus
- Provider-based regulations
- Appropriate use of modifier -PO
- Off-campus payment limitations associated with Section 603 of the Bipartisan Budget Act of 2015 and the 2017 OPPS final rule
- Payment for provider-based departments
- Increased packaging in all provider-based departments
- Proposed change to payment for off-campus provider-based departments under Section 603 of the Bipartisan Budget Act of 2015
(Live + On Demand) - This program has been approved for 1 continuing education unit for use in fulfilling the continuing education requirements of the American Health Information Management Association (AHIMA). Granting prior approval from AHIMA does not constitute endorsement of the program content or its program sponsor. (Ability to claim CEU’s for this webcast expire on: 11/21/2017)
Meet the Speaker
Kimberly Anderwood Hoy Baker, JD, CPC, is the director of Medicare and compliance for HCPro. She is a lead regulatory specialist and lead instructor for HCPro's Medicare Boot Camp®—Hospital Version and Medicare Boot Camp®—Utilization Review Version. She is also an instructor for HCPro’s Medicare Boot Camp®—Critical Access Hospital Version. She is a former hospital compliance officer and in-house legal counsel, and has 10 years of experience teaching, speaking, and writing about Medicare coverage, payment, and coding regulations and requirements.
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