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Provider-Based Entities: A Guide to Regulatory and Billing Compliance, Second Edition

Product Code: GPBCB2

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Available May 2017

Provider-Based Entities: A Guide to Regulatory and Billing Compliance, Second Edition

Gina M. Reese, RN, JD, CPHRM

Provider-Based Entities: A Guide to Regulatory and Billing Compliance, Second Edition, is a comprehensive guide to provider-based departments, including qualifying under CMS, unique billing and coding rules, and the business decisions behind owning or acquiring a provider-based clinic. It explains the effect an entity’s location and services have on its ability to operate and attest as provider-based and covers threshold requirements for this unique provider type, as well as more stringent requirements for off-campus clinics and departments.

This book breaks down complex Medicare coverage requirements and provides insight about recent coding and billing changes, including the introduction and use of modifiers -PO and -PN, new place of service codes, billing for excepted and nonexcepted off-campus clinics and departments, and determining excepted and nonexcepted status. It also offers practical advice for helping patients understand the relationship between hospitals and provider-based entities and how this may affect treatment and services.


Table of Contents:

Chapter 1: Billing for Provider-Based Entities: The Big Picture 

Chapter 2: Departments and Entities Not Subject to Provider-Based Requirements

Chapter 3: How to Qualify as a Provider-Based Department

Chapter 4: Provider-Based Determinations and Penalties for Failure to Meet Provider-Based Requirements 

Chapter 5: Medicare Coverage of Outpatient Hospital Services Furnished in Provider-Based Departments

Chapter 6: Billing and Reimbursement for Services Furnished in Provider-Based Departments

Chapter 7: Auditing for Compliance and Common Pitfalls

 

About the Author:

Gina M. Reese, RN, JD, CPHRM, is an expert in Medicare rules and regulations and is an adjunct instructor for HCPro’s Medicare Boot Camp—Hospital Version. She spent a number of years in private law practice representing hospitals and other healthcare clients, in addition to serving as in-house legal counsel, prior to beginning her current legal/consulting practice.