Rule 23-202-2.12 - Hospital-Based Physician ClinicsA. 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.23 Miss. Code. R. 202-2.12
42 C.F.R. § 413.65; Miss. Code Ann. §§ 43-13-117, 43-13-121.