According to CMS regulations, provider-based entities must meet specific criteria for both on-site and off-site departments. In conjunction with the provider-based rules, health care entities need to be cognizant of their own state’s licensure and certification rules. Some states require licensure of each off-site location that wishes to be affiliated with a main provider, while others don’t require any kind of licensure.
You must meet the provider-based rules to bill as provider-based, which means being proactive in meeting the relevant criteria and having information available for CMS review. You can also submit an attestation to CMS to obtain approval that your organization meets provider-based criteria to protect your organization from retroactive review of your provider-based status. We can help you:
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