Physician Practice Services Frequently Asked Questions
What should be evaluated when establishing or affiliating a medical practice?
Before moving forward, the parties should define the purpose of the arrangement, proposed ownership and operating structure, provider requirements, governance responsibilities, and necessary policies and procedures. The evaluation may also include whether a management services organization or another alignment model is appropriate, along with the practice’s financial position, business valuation, and due diligence findings.
What issues can an operational assessment identify in a physician practice?
An operational assessment can identify staffing and workflow gaps, weaknesses in practice management processes, documentation and coding concerns, and breakdowns in revenue cycle performance. The findings can help leadership determine where changes may support more consistent operations and financial performance.
What should be included in a physician compensation plan review?
A compensation plan review should examine how compensation is calculated and distributed, how productivity and performance measures are applied, and whether written plan terms reflect the intended methodology. It should also consider the financial effects of wRVU and reimbursement changes and, depending on the arrangement, whether appropriate provider compensation valuation and planning analysis is needed.
What should a medical practice compliance program address?
A medical practice compliance program should address coding, clinical documentation, medical necessity, identified compliance risks, and the policies and processes used to manage those risks. It should also include ongoing regulatory education and appropriate monitoring of information that may require review or follow-up. PYA’s healthcare compliance services address these and other compliance program needs.
How can a medical practice tell whether a financial problem is operational or reimbursement-related?
Practice leaders can review staffing, workflow, documentation, coding, and revenue cycle performance alongside payer contracts, rates, and reimbursement. Looking at these areas together can help distinguish internal operating issues from managed care or reimbursement problems and identify where further analysis or corrective action may be needed.
