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

Format:

Book

Author/Creator:

Reese, Gina M., author.

Language:

English

Subjects (All):

Provider-sponsored organizations (Medical care).

Hospital care.

Physical Description:

1 online resource (168 p.)

Other Title:

Provider-Based Entities

Place of Publication:

HCPro, a division of BLR

Summary:

Provider-Based Entities: A Guide to Regulatory and Billing ComplianceGina M. Reese, Esq., RNThis is a comprehensive guide to compliance with qualifications, operations, and requirements of provider-based clinics and departments. 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.Provider-Based Entities: A Guide to Regulatory and Billing Compliance breaks down complex Medicare coverage requirements, CMS' applicable Conditions of Participation, and provides insight about recent coding and billing changes, including the use of modifier -PO. This book also offers practical advice for helping patients understand the relationship between hospitals and provider-based clinics and departments and how this may affect treatment and services.Table of ContentsChapter 1: Billing for Provider-Based Entities: The Big PictureChapter 2: Departments and Entities Not Subject to Provider-Based RequirementsChapter 3: How to Qualify as a Provider-Based DepartmentChapter 4: Provider-Based Determinations and Penalties For Failure to Meet Provider-Based RequirementsChapter 5: Medicare Coverage of Outpatient Hospital Services Furnished in Provider-Based DepartmentsChapter 6: Billing and Reimbursement For Services Furnished in Provider-Based DepartmentsChapter 7: Auditing for Compliance and Common PitfallsWho should read this book?HIM directors/managersRevenue cycle managers/directorsCompliance officersAmbulatory documentation managers/directorsOutpatient coders and billersPhysician practice managersChargemaster coordinatorsAuditorsRevenue integrity managers/directorsFinance directors/managersBusiness development, risk managers

Notes:

Part of the metadata in this record was created by AI.

ISBN:

1-55645-716-2