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Independent Healthcare Consultants, LLP

Provider Based Analysis &  Implementation Assistance

 

The provider-based requirements are confusing at best and implementing provider-based billing is a difficult task. IHC can help you with the financial analysis and converting your clinics or other areas to provider-based status.

As a hospital facility you incur hospital levels of cost in clinic areas (Licensing, State or TJC Surveys, Medical Staff Oversight, Higher Nursing Costs, etc). As such, you may be meeting Medicare’s provider-based criteria. Medicare does recognize these higher costs and pays for them either on an APC or cost based (Critical Access Hospital) based payment.   

 

Financial Impacts
Typical annual financial benefits are $40,000 per physician. Each facility needs to do an analysis to identify their impact. Independent Healthcare Consultants can assist with this review.

Areas we can assist with include:

  • Analysis of the reimbursement impact of moving a free-standing clinic to provider-based
  • Analysis of the ability to obtain and retain provider-based status
  • Submission of the provider-based attestment document with appropriate back-up documentation and CMS 855s forms
  • Assist with the implementation of provider-based billing by providing guidance and support to the leaders of the project
  • Assist with determining the level and structure of the Facility and Professional fees
  • Billing system decision process (Hospital versus Clinic)
  • Process flow redesign for revenue cycle areas
  • Process flow redesign for facility fee charging
  • Design of nursing documentation to support facility fees
  • Facility Fee EM level design

 

Experience with Provider Based Status
IHC has assisted many facilities with converting their clinics to provider-based status. We have assisted facilities of all sizes; from 1 physician to integrated delivery systems with 300+ physicians. Additionally, we have helped convert clinics with as many as 15 clinic locations.

 

Fee Structure
Provider-based impact analysis and implementation assistances can vary based on size, complexity and amount of assistance needed. Please call or email us for a Provider-Based Analysis or Provider-Based Implementation Assistance proposal.

Independent  Healthcare  Consultants  LLP

PO. Box    7417

Bismarck,.ND. 58507-7417

Phone & Fax: (701) 223-8473