Provider Based Instructions and Regulations
Regulations in 42 Code of Federal Regulations (CFR) §413.65 describe the criteria and procedures for determining whether a facility or organization is provider-based. The Medicare Hospital Inpatient Prospective Payment System final rule published on August 1, 2002 (67 FR 50078) revised those regulations effective on October 1, 2002 for facilities or organizations that are not grandfathered as provider-based as described below and, in the case of grandfathered facilities, effective for main provider cost reporting periods beginning on or after July 1, 2003. Provider-based regulations for ESRD facilities can be found in 42 CFR §413.174.
What is not considered provider-based
A facility that is not located on the campus of a hospital and is used as a site of physician services of the kind ordinarily furnished in physician offices will be presumed to be a free-standing facility, unless it is determined by CMS to have provider-based status.
CMS will not make determinations of provider-based status for facilities or organizations if by law their status (freestanding or provider-based) would not affect either Medicare payment levels or beneficiary liability. Provider-based determinations will not be made with respect to Ambulatory Surgical Centers (ASCs), Comprehensive Outpatient Rehabilitation Facilities (CORFs), Home Health Agencies (HHAs), Skilled Nursing Facilities (SNFs), hospices, inpatient rehab units, facilities that furnish only clinical diagnostic laboratory tests, or facilities that furnish only physical, occupational, or speech therapy (as long as the $1500 annual cap on coverage remains suspended).
Page Last Updated: Monday, 09-Jun-2008 13:18:41 CDT
