CorporateBusiness Services

09/23/2011

Provider-Based: Terms and Definitions

The following are terms and definitions that are used frequently in the context of provider-based issues. (Reference 42 CFR 413.65 (a)(2))

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.

On-Campus

refers to a facility located on the campus of the potential main hospital.

Off-Campus

refers to a facility that is not located on the campus but is within 35 miles of the potential main hospital.

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.

Provider-based status

the relationship between a main provider and a provider-based entity or a department of a provider, remote location of a hospital, or satellite facility, that complies with the provisions of this section.

Remote location of a hospital

a facility or an organization that is either created by, or acquired by, a hospital that is a main provider for the purpose of furnishing inpatient hospital services 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 inpatient hospital services in its own right, and Medicare conditions of participation do not apply to a remote location of a hospital as an independent entity. This does not include a satellite facility.

Satellite facility

a part of a hospital that provides inpatient services in a building also used by another hospital, or in one or more entire buildings located on the same campus as buildings used by another hospital.

   

Two Vantage Way, Nashville, TN 37228 ©2017 CGS Administrators, LLC. All Rights Reserved