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

Quick Overview

This book breaks down complex Medicare coverage requirements and provides insight about recent coding and billing changes, including the introduction and use of modifiers -PO and -PN, new place of service codes, and more.

Availability: In stock

Pubcode: GPBCB2
Price: $155

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

Gina M. Reese, RN, JD, CPHRM

Provider-Based Entities: A Guide to Regulatory and Billing Compliance, Second Edition, is a comprehensive guide to provider-based departments, including qualifying under CMS, unique billing and coding rules, and the business decisions behind owning or acquiring a provider-based clinic. 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.

This book breaks down complex Medicare coverage requirements and provides insight about recent coding and billing changes, including the introduction and use of modifiers -PO and -PN, new place of service codes, billing for excepted and nonexcepted off-campus clinics and departments, and determining excepted and nonexcepted status. It also offers practical advice for helping patients understand the relationship between hospitals and provider-based entities and how this may affect treatment and services.


Table of Contents:

  • Chapter 1: Billing for Provider-Based Entities: The Big Picture 
  • Chapter 2: Departments and Entities Not Subject to Provider-Based Requirements
  • Chapter 3: How to Qualify as a Provider-Based Department
  • Chapter 4: Provider-Based Determinations and Penalties for Failure to Meet Provider-Based Requirements 
  • Chapter 5: Medicare Coverage of Outpatient Hospital Services Furnished in Provider-Based Departments
  • Chapter 6: Billing and Reimbursement for Services Furnished in Provider-Based Departments
  • Chapter 7: Auditing for Compliance and Common Pitfalls


About the Author:

Gina M. Reese, RN, JD, CPHRM, is an expert in Medicare rules and regulations and is an adjunct instructor for HCPro’s Medicare Boot Camp—Hospital Version. She spent a number of years in private law practice representing hospitals and other healthcare clients, in addition to serving as in-house legal counsel, prior to beginning her current legal/consulting practice. 

Published: May 2017

ISBN: 978-1-68308-190-6
Page Count: 192
Perfect Binding