Making the Decision to Designate Your Physician Clinics as Provider-Based
Tuesday, March 20, 2012 | 10:00 am - 11:30 am PT
The choice of freestanding or provider-based designation typically has significant financial and operational implications. The Balanced Budget Act of 1997 (BBA) and subsequent clarifying updates have established specific guidelines on the definition of provider-based clinics and fundamentally altered the Medicare reimbursement methodology for services provided in this setting. Other government payors (e.g., Medicaid) may also recognize a site-of-service differential for provider-based clinics. The advantage of these differences in reimbursement may be significant. However, converting to provider-based status often requires facility upgrades and changes to clinic personnel policy in order to meet regulatory requirements and may result in increased operating costs. Therefore, weighing these costs against the potential reimbursement advantage is critical for an informed decision-making process.
During this Webinar, the second in a five part series, we provide an overview of the financial considerations for evaluating the transition to provider-based status.
Specific learning objectives:
- The steps involved with calculating the reimbursement opportunity available under provider-based status.
- How to approach quantifying the associated costs related to the organizational change and additional resources required to meet Medicare regulatory requirements.
- Combining the reimbursement findings with the expense analysis to prepare financial projections and develop a final provider-based income statement.
Featured presenters for this session:
Jim Donohue, Senior Manager, ECG
Jim is a Senior Manager in ECG’s Contracting and Reimbursement practice in our Boston office. He has conducted dozens of consulting engagements with major medical centers, with a focus on business operations and strategic planning, reimbursement strategies, and contracting. Prior to rejoining ECG, Jim founded an independent consulting company, Boston HealthCare Advisors, working with clients that included Partners HealthCare System, Massachusetts General Physicians Organization, Brigham and Women’s Hospital, UMass Memorial Medical Group, and others. Jim also served as Director of Professional Services for MedAptus, Inc., and during a prior tenure with ECG, held the position of Manager. Jim holds a master of business administration degree, concentrating in healthcare management, from Boston University Graduate School of Management. He completed his bachelor of arts degree at Boston University.
Matt Nolan, Manager, ECG
Matt is a member of ECG’s General Healthcare - Midwest practice and has worked on projects related to strategic planning, financial analysis, compensation plan design, and provider-based implementation. He has particular expertise with cardiology service line strategic planning, hospital/physician alignment, and provider-based assessments. Over the past 3 years Matt has been involved in several of ECG’s provider-based projects.
Moderator for this session:
Earl Brigham, Principal, ECG
These sessions are complimentary to our clients, industry colleagues, and other interested parties. ECG reserves the right to deny access to those individuals who may pose a conflict of interest to ECG.
Back to ECG Webinars Events
SUBSCRIBE