Compliance Officers' Forum

  • 1.  hospital based clinic

    Posted 04-01-2025 12:35:00 PM

    Consider the following scenario/arrangement:

    A hospital-based clinic leases a group of physicians from a medical practice to staff its clinic.  The hospital provides everything typically included in the Practice Expense RVU – space, clinical and administrative staff, medical and office equipment, etc.  It has been proposed that the physician group bill the "global service"  under POS 11, Physician Office, and remit part of its collections back to the hospital instead of typical leasing agreements for space, staff, etc.  It has been opined that this remit may satisfy the PE portion.  Have any of you heard of this or have experience with this?  



    ------------------------------
    Angie Taake
    Compliance Educator
    Washington University in St. Louis School of Medicine
    ------------------------------


  • 2.  RE: hospital based clinic

    Posted 04-22-2025 12:46:00 PM

    Angie:  Happy to chat more.  In some hospital -based locations, we bill commercial payors differently than we do government payors.  For government payors, we continue to bill the facility fee and POS 19/22 for services.  However, for commercial, we may bill only on the 1500 with POS 11 and then the physician practice (which is also partially owned by our healthcare system) pays on a quarterly basis for the overhead services to the hospital based on a predetermined formula.  



    ------------------------------
    Lisa Martin
    Chief Compliance Officer
    Indiana University Health
    ------------------------------



  • 3.  RE: hospital based clinic

    Posted 04-23-2025 01:19:00 PM

    Should you and @Lisa Martin chat, would I be able to join you?I am really struggling with this and would appreciate the conversation. 



    ------------------------------
    Patricia Cooper
    Chief Compliance Officer
    Stony Brook Medicine
    ------------------------------



  • 4.  RE: hospital based clinic

    Posted 04-23-2025 01:27:00 PM

    Of course.  I am happy to help with this discussion.  I have several experts on the team who can share our experience and try to help with your needs.



    ------------------------------
    Melanie Roberts
    Chief Compliance and Ethics Officer
    Parkland Health & Hospital System
    ------------------------------



  • 5.  RE: hospital based clinic

    Posted 04-23-2025 03:50:00 PM

    The scenario described doesn't sound like it would remain a provider-based (hospital) clinic (SOS 19/22) but would just be a physician office (SOS 11). If the hospital wants the site to remain a hospital-based clinic on the Medicare cost report, then at least for Medicare / Medicaid it would need to be a different arrangement.  In my past life, did a lot of work with independent physicians so I'd be happy to discuss some of the models that I've seen.



    ------------------------------
    Christine Bachrach
    Chief Compliance Officer
    University of Iowa Hospitals and Clinics
    ------------------------------