INSIGHTS FOR HEALTH CARE 

SEPTEMBER 17, 2015  
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Health Care News Network (HCNN), is published on an as-needed basis to keep you informed of current news impacting health care organizations.
 

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Your Clinics Could Be Costing You Medicare Reimbursement

By: Eddie Phibbs 
 
With increasing pressure to provide a stronger bottom line, you may be overlooking a potential area of Medicare reimbursement for your facility. By making your clinics provider-based you may substantially increase your hospital's Medicare reimbursement payments.
 
As a provider-based clinic and treated as a department of the hospital, you would bill both physician fee (technical component) and facility fee (provider component). As such, overall payments to the facility typically increase. There are numerous regulatory requirements that would need to be met in order to be classified as a provider-based clinic, but the potential positive reimbursement impact would likely outweigh the cost of meeting those requirements. You would also need to consider physicians' buy-in, and how it would be perceived by your patients, as they would receive two bills rather than one.
 
Many hospitals that still treat their clinics as free-standing clinics (independent of the hospital) may not have assessed this opportunity. We encourage you to consider reviewing your clinics annually. If you decide to transition your clinics to provider-based status, you can protect your rights (payments received) by submitting the optional Medicare Provider Based Attestation form, which can be found here.
 
While you may decide that transitioning your clinic or clinics to provider-based status is not the best course of action for your facility, it is still critical to review your options in this environment of shrinking Medicare payments. You may also discover there are other clinic classification options available to you, such as Rural Health Clinic (RHC) or Federal Qualified Health Center (FQHC) that you may want to consider.

For more information, please contact Eddie Phibbs your Eide Bailly representative. We'd be happy to assist you.

  Eddie Phibbs  
Eddie Phibbs
Director, Reimbursement

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