Provider-Based Clinics - Physician Supervisory Changes and What to Expect in the Future

DURHAM, N.C. - May 19, 2016 - PRLog -- The hospital-based clinics began to grow back in the 90s, when hospitals understood that if clinic services were provided as if the clinic were a part of the hospital, then two different claim forms could be filed-the professional component and outpatient component (for the hospital).This significantly increased the revenue for the clinic activities.

Congress has started to determine the hike in physician practice acquisition by hospitals. This action was done through Section 603, of the Bipartisan Budget Act of 2015. There has been an increase in establishment of all types of provider based clinics by hospitals, both off-campus and on-campus. The provider-based rule (PBR) is complicated and have definite ambiguities. However, the hospitals can reap the benefits of rise in their revenues due to provider-based clinics, being compliant with its regulations and rules is a challenge in itself.

In order to qualify a clinic as provider-based there are a number of criteria that must be met. Plus, the physician supervision requirements have undergone major changes. The OIG and MedPAC have weighed in on the existence of payment differentials for provider-based clinics. The OIG has suggested that the payment differential based on different sites be eliminated entirely, which means that any service that can be provided in either of these settings would be eligible for exactly the same amount of reimbursement. Whereas MedPAC has recommended that payment for E/M services are the same for both settings. Irrespective of the difference between the two settings, the economic advantage for the provider-based clinics has stayed in place.

However, CMS's may be in the process of changing this stance, as in 2015 CMS started data gathering for provider-based clinics. The hospitals should anticipate the possibility of change in coming years, as CMS will be assessing the data from provider-based clinics. The Congress has acted to delimit the increase in physician practice acquisition by hospitals. This action was through the Bipartisan Budget Act of 2015, Section 603. Hospitals have been increasingly establishing provider-based clinics of all types, both on-campus and off-campus.

Join this session by expert speaker Duane C. Abbey, PhD, who will address the overall purpose and function of the provider-based rule. Duane will also give crucial information concerning the physician and supervisory changes and will discuss and analyze the future of provider-based clinics. The possibility of equalization of payments between provider-based and freestanding operations will also be discussed in this session.

For more information visit: http://www.audioeducator.com/hospitals-and-health-systems/provider-based-clinics-05-24-2016.html

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