Provider-Based Definitions

Home MAC Provider Medicare Areas Audit & Reimbursement

Campus - the physical area immediately adjacent to the provider's main buildings, other areas and structures that are not strictly contiguous to the main buildings but are located within 250 yards of the main buildings, and any other areas determined on an individual case basis, by the CMS Regional Office, to be part of the provider's campus.

Department of a provider - a facility or organization or a physician office that is either created by, or acquired by, a main provider for the purpose of furnishing health care services of the same type as those furnished by the main provider under the name, ownership, and financial and administrative control of the main provider, in accordance with the provisions of this section. This may not be licensed to provide health care services in its own right and may not by itself be qualified to participate in Medicare as a provider. Medicare conditions of participation do not apply to a department as an independent entity. This does not include an RHC or, except as specified in these regulations, an FQHC.

Free-standing facility - an entity that furnishes health care services to Medicare beneficiaries and is not integrated with any other entity as a main provider, a department of a provider, remote location of a hospital, satellite facility, or provider-based entity.

Main provider - a provider that either creates, or acquires ownership of another entity to deliver additional health care services under its name, ownership, and financial and administrative control.

Provider-based entity - a provider of health care services or an RHC or FQHC, as specified, that is either created by, or acquired by, a main provider for the purpose of furnishing health care services of a different type from those of the main provider under the name, ownership, and administrative and financial control of the main provider, in accordance with the provisions of this section.

Page Last Updated: Monday, 09-Jun-2008 13:18:41 CDT