“Provider-based status” indicating
the relationship between a main health care provider, usually a hospital
or critical access hospital, and the facilities and organizations that
it owns that are located outside of the main hospital (either on-campus
or off), is of crucial importance to modern hospital systems. The ability
to treat a facility or organization as provider-based directly impacts
the hospital’s ability to take advantage of economies of scale,
to spread its capital costs over its full facility base, and its level
of federal program reimbursement.
Treating (billing) a facility or organization as provider-based used to
be largely a matter of saying so. The hospital would include the facility
or organization in its Medicare cost report and bill for its services
as if it were part of the hospital, with little, if any, oversight from
CMS. However, since the establishment of the Outpatient Prospective Payment
System (OPPS) in April 2000, CMS has imposed strict requirements on facilities
and organizations claiming provider-based status. These requirements apply
to every aspect of the facility or organization claimed as provider-based:
financial, administrative, and clinical. Failure to comply with any of
the established criteria can expose the hospital to liability for overpayments
for all cost reporting periods that CMS regards as having been improperly
billed. The purpose of this book is to provide you with an easy-to-follow
means of assuring that your facility or organization has met all of CMS’
stated criteria so that its continuing ability to claim provider-based
status is not jeopardized.
Published by CCH, Inc., 2003
Healthcare Records Management
Cherilyn G. Murer, J.D., C.R.A.
Michael A. Murer, J.D.
Lyndean Lenhoff Brick, J.D.
Co-published with the Healthcare Financial Management Association
796 pages ISBN: 007-134964-2 $95.95
Order On-Line using Amazon.com
The Complete Legal Guide to Healthcare Management
gives healthcare professionals an "all-in-one" resource to effectively
manage their record-keeping systems. The authors of this comprehensive
manual have compiled each individual state's law and policies covering
the various aspects of medical records. Also there are full details on
laws regarding records disclosure for cases involving communicable disease
and substance abuse, as well as laws pertaining to advancing electronic
technology.
Cherilyn G. Murer, J.D., C.R.A.
Lyndean Lenhoff Brick, J.D.
Co-published with the Healthcare Financial Management Association
280 pages
ISBN: 0-7863-1221-1 $60.00
Order On-Line using Amazon.com
The Case Management Sourcebook: A Guide to Designing
and Implementing a Centralized Case Management System will provide answers
as to how to establish, develop, and maintain a successful case management
system that will produce high quality that is modestly priced.
Published By McGraw Hill and Co-published with the
Healthcare Financial Management Association, 1997.
