In today’s environment surrounded by physician/hospital economic alignment opportunities, hospitals are constantly searching for ways in which to partner with physicians. While some of these opportunities bear more risk than others, most all hospital/physician partnerships include contracts and/or agreements that detail the responsibilities of each party, the fair market value compensation for the provision of services, and the required documentation to be submitted for payment. However, after an agreement is signed, don’t forget to monitor the payments made to and the documentation provided by physicians! Recent PYA contract reviews indicate that complex and complicated contractual language, in addition to time constraints placed on hospital staff, often create opportunities for hospitals to pay physicians without ensuring the terms of a contract are met by both parties.
Through our extensive experience in this area, we would like to share some tips based upon some of the more common issues we have noted when we review physician/hospital contracts on behalf of our clients. These tips include:
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Carefully review the description of each service rendered by a physician and make sure it falls within the terms of a contract. We have found that, on occasion, physicians submit documentation for reimbursement which falls outside the terms of their respective agreement. It may be difficult to discover such entries when they are entered within the documentation that meets the terms of the contract. If these non-contractual services are not discovered, the hospital runs the risk of paying a physician for services not covered under a contract.
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Double check physician time documentation for mathematical errors. More often than you may think, documentation is submitted for reimbursement which contains inadvertent mathematical mistakes. And, some of these mistakes can be substantial. PYA recently discovered one mathematical error which impacted the amount due by approximately $30,000. Careful attention to this simple yet extremely important issue will help ensure only those dollars that are earned are paid to physicians.
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Carefully review the dates in which services were rendered by the physician. Physician time documentation often requires a field for the date of service. When this occurs, ensure the dates fall within the time period of the contract and/or the payment period. If the dates fall outside of the specified time period, the payment could potentially be outside the terms of an agreement and/or pay period.
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Ensure time sheets are legible and include required signatures before submitting payment to the physician. When physicians submit documentation for payment, make sure that the documentation is legible and signed off on by an authorized party. Otherwise, the legitimacy of the service required may be called into question at a later date. Additionally, if the documentation is illegible, ask for clarification, and, if needed, require “typed” versus handwritten physician documentation.
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Ensure contractual services are reimbursed only after the agreement has been signed by all parties. Current Stark regulations require that the compensation for various physician/hospital agreements be written, set in advance and signed by the parties receiving and providing the service(-s). To avoid any potential compliance issues with this language, ensure that both parties sign the contract and physicians are not compensated for any time incurred prior to receipt of all signatures on the agreement.
For additional tips on how to better monitor your physician/hospital contracts, or for more information on this service, please contact the experts listed below at (800) 270-9629.
