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Provider-Based Status, Under Arrangements, Enrollment and Related Medicare Requirements Catherine T. Dunlap and Thomas E. Dow dell 1 I. WHAT IS PROVIDER-BASED STATUS AND WHEN DO REQUIREMENTS APPLY?

How to fill out provider-based status under arrangements

How to fill out provider-based status under arrangements:

1. Begin by gathering all necessary documentation, such as the provider's legal name, tax identification number, and address.
2. Identify the type of provider-based arrangement being implemented, whether it is a hospital outpatient department (HOPD) or a satellite facility.
3. Determine if the arrangement meets the conditions set forth by the Centers for Medicare and Medicaid Services (CMS). This includes factors such as the level of supervision provided by the main provider, the location of the arrangement, and the extent of integration between the main provider and the arrangement.
4. Complete any required forms or applications, such as the CMS Form 855-A, which is used for initial enrollment or change of ownership for Medicare providers.
5. Submit the completed forms to the appropriate CMS regional office for review and approval. Be sure to include any supporting documentation or additional information that may be required.
6. Maintain ongoing compliance with CMS regulations and guidelines, including regularly reviewing and updating any changes in ownership, location, or services provided.

Who needs provider-based status under arrangements:

1. Hospitals or healthcare facilities that have satellite locations or outpatient departments may need to establish provider-based status under arrangements.
2. Organizations that wish to receive reimbursement from Medicare for services provided at these satellite locations or outpatient departments must meet certain criteria to qualify for provider-based status.
3. Provider-based status under arrangements can provide financial and operational advantages to hospitals, allowing them to bill Medicare at higher rates and receive reimbursement for certain facility-based services. Therefore, organizations seeking these benefits would need to pursue provider-based status.

For pdfFiller’s FAQs

What is provider-based status under arrangements?

Provider-based status under arrangements refers to a determination made by the Centers for Medicare and Medicaid Services (CMS) that a healthcare provider meets certain criteria for billing under the provider-based rule.

Who is required to file provider-based status under arrangements?

Healthcare providers who meet the criteria set by CMS for provider-based status under arrangements are required to file.

How to fill out provider-based status under arrangements?

To fill out provider-based status under arrangements, healthcare providers need to gather the necessary documentation and information specified by CMS, accurately complete the required forms, and submit them to the appropriate CMS office.

What is the purpose of provider-based status under arrangements?

The purpose of provider-based status under arrangements is to ensure that Medicare and Medicaid payments are made appropriately and to allow eligible healthcare providers to qualify for reimbursement under the provider-based rule.

What information must be reported on provider-based status under arrangements?

The specific information that must be reported on provider-based status under arrangements can vary, but generally includes details about the healthcare provider's ownership, financial, and operational relationships and how they meet the criteria for provider-based status.

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