23 Miss. Code. R. 202-2.12 - Hospital-Based Physician Clinics
A. The Division of
Medicaid defines a provider-based entity as a hospital-based physician clinic
that meets the Centers for Medicare and Medicaid Services (CMS) requirements to
be considered provider-based.
B. A
hospital cannot bill a hospital clinic evaluation and management code for
hospital-based physician clinic services unless the hospital meets all of the
following:
1. Is a teaching hospital within
the state of Mississippi,
2. Has a
medical resident-to-bed ratio of 0.25 or greater as derived from a calculation
from the hospital provider's cost report, Worksheet E, Part A, Line 19,
3. Is located:
a) On the campus of the main provider's
hospital facility, or
b) Within
thirty-five (35) miles of the physician clinic if the physician clinic is
located off campus.`
4.
Meets the hospital-based determination as outlined in
42
C.F.R. §
413.65(b), and
5. Meets and follows all Division
of Medicaid rules and State and Federal regulations.
Notes
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