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Comparison of Provider-Based and Freestanding Clinics

Provider-based facilities often receive higher payments for some services than freestanding clinics. The requirements that a facility must meet to be treated as provider-based are at 42 CFR §413.65(d). We will review and compare Medicare payments for physician office visits in provider-based clinics and freestanding clinics to determine the difference in payments made to the clinics for similar procedures. We will also assess the potential impact on Medicare and beneficiaries of hospitals' claiming provider-based status for such facilities.

Announced or Revised Agency Title Component Report Number(s) Expected Issue Date (FY)
June 2019 Centers for Medicare & Medicaid Services Comparison of Provider-Based and Freestanding Clinics Office of Audit Services W-00-18-30026 2019