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 JCAHO 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 $30,000 per physician. Each facility needs to do an analysis to identify their impact. Independent Healthcare Consultants can assist with this review.

Areas we can help you 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 form 855s
• 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 Part A (Facility) and Part B (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 faculties of all sizes from 1 physician to integrated delivery systems with 180 physicians. In addition, we have helped convert clinics with as many as 12 clinic locations.

See a typical provider-based implementation process (Hot button to “Typical Provider-Based Implementation” page)

Fee Structure

Provider-based impact analysis and implementation assistances can very based on size, complexity and amount of assistance needed. Please call or email us for a Provider-Based Analysis or Provider-based implementation assistance.

                 Independent  Healthcare  Consultants  LLP

PO  Box 7417

Bismarck, ND  58507-7417

Phone & Fax: (701) 223-8473