Evolving Reimbursement in On- and Off-Campus Provider-Based Departments

Learn the alternate payment methodology for off-campus provider-based departments

Presented on:
Tuesday, November 22, 2016
1:00-2:30 p.m. Eastern

Presented by:
Kimberly Anderwood Hoy Baker, JD, CPC

Level of Program:
Intermediate

Reimbursement for off-campus provider-based departments is not as straightforward as it used to be. Section 603 of the Bipartisan Budget Act of 2015 calls for an alternate payment methodology for off-campus provider-based departments, and defining these departments can be a challenge—individuals’ perceptions of what counts as “off-campus” may not match recent CMS regulations.

Join expert speaker Kimberly Anderwood Hoy Baker, JD, CPC, for this 90-minute program as she discusses the changing landscape of provider-based department reimbursement, including increased packaging of services and proposed changes for off-campus departments in 2017 under Section 603.

The program will review the different definitions of “off-campus department” under provider-based regulations, the use of modifier -PO, and the implications of changing definitions and guidance. Case studies comparing payment for provider-based and freestanding departments, along with the implications of Section 603, will also be reviewed.

At the conclusion of this program, participants will be able to:

Describe two departments considered off-campus under provider-based department regulations (42 CFR 413.65) but not under the instructions for modifier -PO
Name three types of off-campus departments under Section 413.65 that are proposed to be “excepted” from the definition of off-campus under Section 603
Describe the impact of increased packaging on the payment for provider-based departments paid under the OPPS
Identify the proposed payment system for “non-excepted” services at off-campus departments beginning in 2017

Agenda

Defining on- and off-campus
- Provider-based regulations
- Appropriate use of modifier -PO
- Off-campus payment limitations associated with Section 603 of the Bipartisan Budget Act of 2015 and the 2017 OPPS final rule
Payment for provider-based departments
- Increased packaging in all provider-based departments
- Proposed change to payment for off-campus provider-based departments under Section 603 of the Bipartisan Budget Act of 2015
Live Q&A

Meet the Speaker

Kimberly Anderwood Hoy Baker, JD, CPC, is the director of Medicare and compliance for HCPro. She is a lead regulatory specialist and lead instructor for HCPro's Medicare Boot Camp®—Hospital Version and Medicare Boot Camp®—Utilization Review Version. She is also an instructor for HCPro’s Medicare Boot Camp®—Critical Access Hospital Version. She is a former hospital compliance officer and in-house legal counsel, and has 10 years of experience teaching, speaking, and writing about Medicare coverage, payment, and coding regulations and requirements.

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