Maintaining a positive demeanor is also highly beneficial. Hill often begins communication on behalf of her clients by expressing their enthusiasm for the opportunity, even if the contract has issues to fix. This allows her to maintain her client’s leverage for the deal. Leverage is not about being top of the class or having multiple board certifications; it is about possessing skills the other party desires. This could include being excellent with patients, being efficient with electronic medical records, having a niche specialty or speaking a language that caters to a specific patient demographic. Weaving these attributes into the negotiation conversation demonstrates how the physician can bring value and money to the organization. Only after establishing optimism and showcasing leverage should the contract negotiations begin.
Ultimately, even with proper time given and one’s homework completed, a deal may still not work out. Feeling trapped or desperate can be sensed by the other party and undermine a physician’s negotiating position. If a deal exhibits red flags, a client senses something is wrong, and if reasonable requests are dismissed, it is often best to decline. Walking away prevents involvement in potentially fraudulent or exploitative situations, saving significant legal and financial distress later.
EXTREME CAUTION AGREEMENTS
Certain types of agreements are hotbeds for trouble. Medical directorship agreements can appear legitimate but hide fraudulent intent. Physicians must perform legitimate work for the compensation received, such as rounding, keeping logs or writing protocols, rather than simply lending their name for a check. Similarly, supervisory agreements for nurse practitioners or other midlevel roles require physicians to understand their state’s rules regarding prescriptive authority, meeting requirements and supervision limits.
Unwritten agreements or those with strings attached are highly problematic. If a vendor offers free services or equipment in exchange for encouraging patient referrals or if a physician accepts federal plans such as Medicare, Medicaid, or TRICARE, they are subject to both the Anti-Kickback Statute and the Stark Law. The Stark Law prohibits referrals to entities where the physician has an ownership interest or financial relationship, whereas the Anti-Kickback Statute deals with receiving remuneration for referrals. Medical spas are another area of concern, as they often seek supervising physicians but can push boundaries regarding the practice of medicine without a license or improper supervision. “Salesmen do not come into your office looking like criminals with trench coats. They’re not hiding out in alleys. They’re coming in the front door with brochures,” Hill warned.
PROPER DOCUMENTATION
Charts are not merely narratives but must satisfy auditors and support billing. Physicians should avoid cutting and pasting in chart notes, as this can lead to errors that compromise the physician’s integrity, making all information suspect. Follow-ups are often the cause of legal issues. Sending traditional letters to patients, even in the digital age, ensures they understand their results and the importance of returning for appointments.
Informed consent is a process, not just a document. Physicians should engage in direct conversations with patients about the risks of procedures, tailoring the discussion to the top three potential complications rather than listing every remote possibility. “It’s important to have those conversations so patients aren’t surprised, because if there is solid informed consent and something does go wrong, patients are understanding of that,” Hill said. For off-label procedures, it is vital to document why traditional standards of care are insufficient or unsuitable for the patient.
Billing and coding errors can lead to financial losses and legal trouble. Physicians cannot outsource their billing and forget about it; they must understand the basics to effectively oversee and audit their billing companies. There have been instances of billing companies providing improper advice or missing deadlines, often with limited liability provisions in their contracts. “Audits are your best friend.If you hire an auditor to come into your practice and audit your charts, then they give you a report and they say, ‘You know what? You’ve been missing start and stop times, for example. Those should have been documented in the record.’ Then you fix the problem, and you don’t do it going forward,” Hill said. Audits help prevent small issues from escalating into problems costing half a million dollars. Knowledge in all these situations is power, and leveraging legal expertise can be a strategic asset.
Check out the full video and materials of this session.
