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

Gina M. Reese, Esq., RN

Provider-Based Entities: A Guide to Regulatory and Billing Compliance is a comprehensive guide to compliance with qualifications, operations, and requirements of provider-based clinics and departments. 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, CMS’ applicable Conditions of Participation, and provides insight about recent coding and billing changes, including the use of modifier -PO. It also offers practical advice for helping patients understand the relationship between hospitals and provider-based clinics and departments and how this may affect treatment and services.

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