Article 31 Vs Article 28

It`s even more important to make sure you`re using the right software when billing or coding at an Article 28 medical facility and that you`re getting the most out of your skills. These programs or schools may also provide you with the appropriate Article 28 medical billing software, which is sometimes free for their students. Any provider offering to share the space must be licensed or certified to operate at this location, unless it is a private medical practice. In addition, providers must have the appropriate Memorandum of Understanding (MOU), Health Insurance Portability and Accountability Act (HIPAA), Business Partnership Agreement (BAA), Qualified Service Organization Agreement (QSOA), or similar agreements to share medical records and treatment information necessary for the care and treatment of patients together. Before a medical facility is built, it must pass the right surveys and other regulations to ensure that it meets all requirements. Subsequently, it shall receive a certificate of operation as an establishment in accordance with section 28. In addition, the applicant must submit architectural/engineering drawings as required by their state licensing or certification body. These drawings must comply with the submission requirements and clearly define the space to be occupied and the common areas to be shared (exclusive office space, indoor office space, common room building, clinical and non-clinical spaces, etc.). For the purposes of this document, „shared space” means space occupied by one supplier, part of which is leased to another supplier or otherwise used by another supplier, or space leased or purchased by at least two suppliers. „Shared space” must be distinguished from „co-location”. Shared space can be „temporally different,” meaning that physical space can be shared at different times (i.e., provider uptimes do not overlap) or can be used „simultaneously” (i.e., providers have simultaneous or overlapping uptime). Physical space may include both the clinical room, such as an exam room, and a non.B-clinical room such as a shared waiting room, a shared bathroom outside the waiting room, or a common reception area, to the extent permitted by federal and state regulations. You may be wondering why a medical institution would go through the strictly detailed and complex process of section 28 certification.

Any changes from the approved app as to how the shared space should be used require notification from the licensing agency to the other provider. Nothing in this document relieves suppliers of any responsibility for compliance with any laws or regulations governing the DOH Certificate of Need (CON), Pre-Approval Review (RAP) or OASAS certification requirements or other requirements for filing notices. Applications may be approved subject to additional documentation necessary to satisfy the relevant government agencies, including leases executed, management service agreements, personnel contracts, etc., and any other documents required and acceptable to the Department. You should also use the appropriate type of medical billing software. It must comply with all data protection and other regulations under Article 28 in order to maintain certification. Section 28 certified entities participate in Medicare, Medicaid, and private health insurance plans with a higher reimbursement rate than non-certified entities. Performing Supplier Systems (SPS), as well as their supplier partners pursuing Model 1 or Model 2, may also choose to allow two or more unaffiliated suppliers to work together to meet the integration requirements of the 3.a.i project through a shared space agreement that integrates the expertise of these providers to provide integrated services. Such an operating certificate must be prominently displayed at the location. This higher reimbursement rate is intended to reflect the higher standards of health practice, recognize the difficult certification process, and keep pace with the standards set out in section 28. Any licensed or certified supplier may provide these services as authorized on its operating certificate and must comply with all applicable federal, state, and local laws, regulations, and guidelines. Section 28 is a New York State Public Health Act that recognizes and governs the accreditation of public health facilities.

Although the term „designated by the federal government” is not defined in legislation or regulations, doH, OMH and OASAS use the term for the purposes of this guide to refer to a company that has entered into an agreement with CMS to participate in the Medicare program in order to receive reimbursement for services provided by the institution. Federally designated providers include FQHC, RHC, SCA, hospitals, hospital extension clinics, RHCF and ESRD The applicant must indicate on its application for a licence or certification that it intends to share storage space with another supplier under a written shared space agreement between suppliers. The application must also identify the supplier and the supplier`s operating certificate number, as well as the PFI/Facility ID (if applicable). Because Section 28 is such a strict process, it results in higher reimbursement rates than typical medical billing and coding. The stakes are higher than in a medical facility under section 28. Licensed or certified providers, as described in Section III, who plan to share the space with other licensed or certified providers or private medical practices must obtain a decision signed by the board of directors, partners, officers or members of LLC, or any other governing body of a legal entity: which approves the shared space contract and must document in writing the conditions under which it frees up the storage space. Appendix B contains information that must be included as part of a shared space agreement. The objective of the Shared Space Agreement is to maximize patient safety and program effectiveness, as well as to ensure confidentiality by identifying the roles and responsibilities of each provider, describing the clinical structure, and clarifying commitments. However, an entity shall not transfer responsibility for matters it is otherwise required to provide under applicable laws and regulations.

Each provider must keep a copy of the signed shared space contract and be able to submit this agreement immediately upon request, as required by the state body responsible for licensing/certification or vendor oversight. The DSRIP billing guidelines for suppliers in shared space agreements can be found in Appendix C. Each provider under the shared space contract is responsible for filing claims covering all procedures/services provided on a service date provided by that provider on a service date. A clinical payment is processed separately for each supplier through the APG grouper/price and paid in accordance with APG`s pricing rules (packaging, discount, bundling) as part of the services normally charged under this APG tariff code. To facilitate the exchange of information, providers may also wish to review consent and authorization forms, including a general purpose form that can be used to disclose medical records, an example of which can be found here. You can find accreditation or certification programs that certify your ability to accurately and correctly process and submit claims for medical reimbursement under section 28. Colocation is an allowed option that consists of two or more entities located at the same address, but each with its own physical space. It is permitted, provided the following applies: New York State approved or certified providers and not federally designated may be approved to share resources such as waiting rooms, telephones, and various services.

Strict adherence to accurate records must be carried out, which is the sole responsibility of providers to ensure that all costs are allocated appropriately, that patient privacy is protected, and that patients know who is providing their care at all times. In addition to sharing physical space, shared space agreements may include sharing clinical devices to the extent permitted by applicable federal and state regulations. A provider should also refer to the DoH, OMH, and OASAS Integrated Care Approaches document for additional options for a provider who wants to integrate primary care and behavioral health (mental health and/or substance use disorder). The FAQ covers the following approaches: If an applicant wishes to certify a clinical room in a room that is already occupied by a supplier, the designated space (not the entire room) must comply with the relevant higher physical standards of the plant and the requirements of the program room, including standards for visual and acoustic confidentiality, the State authority responsible for licensing or certifying the supplier, and whether the applicable national conditions for participation, coverage or certification. For the requirements of the Safety of Persons Code, suppliers must meet the higher requirements for the relevant type(s) of fire wall(s). In order to ensure the safety of patients and staff, and depending on the services to be provided, additional changes outside the designated common area may be required to address any impact on the institution or private medical practice that could affect continued compliance with applicable laws and regulations. Any new outpatient clinic location must be able to meet the physical standards of state authorities that authorize or certify providers who share space. .