How to Leverage Your Billing & Collection Company for Optimal Success in Your Medical Practice

Running a successful medical practice requires more than just offering top-notch patient care. Effective management of billing and collections is crucial for maintaining financial health. Many practices partner with specialized billing and collection companies to handle these tasks, but fail to recognize that the relationship requires active management to truly unlock its full potential. In this post, we’ll explore how to effectively work with your billing and collection company, the importance of quarterly check in meetings, and how your healthcare legal team can be deployed where needed to ensure maximum revenue for your practice.

Understanding the Role of Billing & Collection Companies

Billing and collection companies specialize in handling the financial transactions of your practice. They manage claims processing, patient billing, and collections, ensuring that your practice gets paid for the services rendered. However, they aren’t always forthcoming about their own limitations. This makes it essential for you, as a practice owner, to take an active role in managing this relationship.

The Importance of Taking the Lead

One common challenge practices face is not knowing what they don’t know. Billing companies may not highlight their own shortcomings, so it’s up to you to lead the relationship to success by asking strategic questions that reveal opportunities for improvement. Here are key areas to focus on:

1. Regular Communication

Establish regular communication channels with your billing company. Schedule quarterly meetings to review performance, address issues, and set goals for the upcoming quarter. These meetings are an excellent opportunity to ask questions and get a clear picture of your financial health.

Questions to Ask During Quarterly Meetings:

  • What are our current collection rates, and how do they compare to industry standards?
  • How do our collection rates in each age bucket compare to the prior quarter?
  • What are the top 3 denial reasons?
  • How many zero pays do we have? 
  • How long is the average time from service rendered to payment received?
  • Are there any emerging trends that we should be aware of, such as changes in insurance policies, coding procedures or regulatory requirements with respect to documentation?
  • Are there any trends that you’ve observed that you think we need to evaluate to ensure compliance? 

2. Performance Metrics

Understand and monitor key performance metrics. Knowing these metrics will help you gauge the effectiveness of your billing company and identify areas for improvement. Important metrics include:

  • Days in Accounts Receivable (AR) – The average number of days it takes to collect payments.
  • Net Collection Rate – The percentage of eligible payments collected.
  • Denial Rate – The percentage of claims denied by payers.

3. Compliance and Legal Considerations

Work closely with your healthcare legal team to ensure compliance with healthcare regulations. Your legal team can help you understand where the billing company’s responsibilities end and where you need to step in. This can prevent potential legal issues and ensure that your practice operates within the bounds of the law.

Questions to Discuss with Your Legal Team: 

  • Are there any compliance issues we need to address?
  • What steps can we take to reduce the risk of audits and penalties?
  • How can we ensure that our patient billing practices are fair and transparent?
  • Do I have any systemic payment issues that my legal team can assist with?

4. Continuous Improvement

Encourage a culture of continuous improvement within your practice and with your billing partner. Regularly review processes and look for ways to enhance efficiency and effectiveness. This can involve updating technology, training staff, or revising workflows.

5. Leveraging Technology

Investing in the right technology can significantly improve your billing and collections process. Many practices are investing in AI tools to assist physicians and staff with progress notes and charting, ensuring that progress notes support the codes being charged in each claim. Ensure that your practice management software integrates seamlessly with the billing company’s systems and that any direct payments made to your office are reported within both systems. This integration can streamline processes, reduce errors, and provide real-time data for better decision-making.

Conclusion

Effective billing and collections are vital for the financial health of your medical practice. By taking an active role in managing your relationship with your billing and collection company, scheduling regular check in meetings, and leveraging the expertise of your healthcare legal team, you can uncover opportunities for success and ensure that your practice thrives.

Ready to take your billing and collections to the next level? Schedule a consultation with our expert team today and discover how we can help you streamline your operations and maximize your revenue.

Credit: Sinead

Peptides Gone Wild:  Why Is This So Hard To Pin Down?

Peptides are short chain amino acids (40 or less amino acids) that are fast becoming one of the underpinnings of the “wellness movement.”  When we’re young and healthy, our bodies make plenty of them.  When we’re older or stressed or sick, the story goes, their production falls off and our physical (and mental quality) of life is undermined.  Because they’re essentially the same chemicals made by our bodies, it makes sense that we ought to be able to augment their decline by injection or ingesting them, right?  Kinda of like bioidentical hormones.  Not so fast Charlie!

The biggest stumbling block re peptides is this:  the Food and Drug Administration (FDA) regulates them as drugs.  More specifically, the FDA has been clear that they can be compounded at compound pharmacies but not made by pharmaceutical companies, because they aren’t “approved” by the FDA.  Moreover, since they are essentially what’s found in nature, they are not subject to the usual intellectual property (IP) protections that allows a company that creates them to “own” them and monetize them in the same way that pharmaceutical companies can.  And unless and until Pharma changes the molecular structure of a peptide, no IP can be obtained and it cannot be FDA approved.

All that said, the FDA is clearly concerned about the growth of peptide use.  Which explains why in February, 2024 (updated in May), the FDA expanded the 503A Category 2 list (bulk drugs items raising “significant safety risks”) to include peptides like BPC-157, Kisspeptin, MOTs-C, ipamorelin, thymosin A and B and many other that were the cornerstone of the peptide wellness movement.  In many instances, the FDA commented about the peptides on the expanded Category 2 list that there was insufficient data to show efficacy or harm, so they’re “suspect.”  Even more “interesting” is the current Category 1 list (“under evaluation) that includes items like aloe vera, CoQ10, curcumin, glutathione, L-Theanine, NAD, pregnenolone, quercetin, resveratrol, tea tree oil and many others that clinicians and patients count on as part of their regular wellness regimen. 

The “why” of all this is confounding to clinicians in the wellness space and the patients who want the right to be proactive about their wellness.  One narrative is how it’s a Big Brother driven issue, that Big Money (i.e., Pharma) is behind it all and just wants to prevent people from driving their wellness regimen and instead turn each of us into drone like consumers of pharmaceutical products that have unwanted side effects.  I don’t know!  But I do know this:  if you don’t know how law is made and if you don’t have a “seat at the table,” your unique point of view will be completely missing from all the laws and regulatory activity downstreamed to us consumers.  Pharma knows the system and has a hand in designing it.  Those businesses understand how policy is created and enforced.  And they pay a ton of money each year to (1) validate their products, and (2) lobby both legislators and regulators to promote their products and invalidate products they didn’t create and which don’t meet the standards (they help design and implement). 

So then…where is all the research on peptides?  Why don’t compound pharmacies or providers that rely on peptides for wellness solutions spend millions of dollars a year on double blind studies to validate peptides?  Maybe…because there is no IP protection for such products.  And if there’s no IP protection, how can any company justify the investment?  They’ll never be repaid.  And if they did make the investment, all their competitors would reap the benefit, since there is no IP protection for wellness solutions found in nature.  Until stakeholders in the wellness industry either (1) invest in changing the regulatory/legislative game and (2) play a very active role in that process, they will just bugle victim and fairness stories.  They’ll sound like a bunch of sore losers.  There is no winning the game without playing it.

So where does that leave peptide providers and consumers right now?  Are they illegal?  Nope.  Can you go to jail if you prescribe or use them?  Nope.  That said, given the fact that the latest FDA directives are aimed at compound pharmacies, the pharmacy space is where we see the most scrambling and confusion.  Because if the FDA takes issue with them, their licensure is on the line.  The net effect for the moment is (i) fear among prescribing professionals and (ii) contraction of peptide availability.  That contraction in the compound pharmacy space has spurred new companies that label peptides “for research use only” or “not for human consumption.”  The trouble is that these new “research companies” are not subject to any quality related regulations.  

Consumers ought to be wary of these new (non pharmacy) companies.  The Alliance for Pharmacy Compounding (APC), for instance, advises that such peptides not be labeled as described above.  They advise that any such substances “must be manufactured by an FDA-registered facility.” For similar reasons, clinicians need to be selective about the companies they’re using to fulfill prescriptions for peptides during this dynamic time. 

All of that said, some peptides, like semaglutide and tirzepatide, are free flowing, which is confusing to consumers and clinicians.  The short reason is there’s an exception for compounding that applies to FDA approved drugs that are “currently in shortage.”                                      

The current state of the law and peptide industry is in flux.  That will mean some providers will contract and others will fill the void created by leaving the market.  It’s a short-lived situation that is expected to develop further during the next year or so.  But if the past is any predictor of the future, the future belongs only to those clinicians and providers (and consumers) that organize and interact with the FDA and legislators to demonstrate both safety and efficacy.    

Navigating Increased Scrutiny: What Acupuncturists Need to Know About VA Audit Findings and Legal Risks

By: Sinead Killeen

The regulatory environment for acupuncture providers is becoming increasingly complex as scrutiny and enforcement actions under the False Claims Act intensify. A 2021 audit by the Department of Veterans Affairs (VA) has revealed significant concerns about the handling of payments and authorizations for acupuncture services provided to veterans through non-VA providers. Understanding these findings and their implications is crucial for practitioners to effectively navigate these changes.

Expanding Coverage and Scrutiny

Acupuncture services for veterans have been a part of the VA’s offerings long before traditional Medicare even considered covering these treatments. The Veterans’ Access to Care through Choice, Accountability, and Transparency Act of 2014 (Choice Act) and the VA MISSION Act of 2018 were pivotal in expanding veterans’ access to acupuncture and accelerated referrals to non-VA providers. These acts allowed veterans to access funding to obtain acupuncture treatment from non-VA providers, given that the VA lacked sufficient in-house acupuncturists to meet demand.

During Fiscal Years (FYs) 2018 and 2019, the VA paid approximately $114 million to non-VA community acupuncture providers. However, a December 2021 audit by the VA’s Office of Inspector General (OIG) revealed significant issues with many of these payments. As a result, the number of VA acupuncture audits has increased dramatically. This article will examine the reasons cited for denying acupuncture claims and discuss strategies to reduce audit risks.

Problems Identified in VA Acupuncture Audits

The December 2021 VA OIG audit uncovered several issues with the acupuncture claims that had been paid in 2018 and 2019:

  • Lack of Authorization: Approximately 51,200 claims lacked the necessary pre-authorization from the VHA. The VA’s financial services system automatically paid for all claims within a year of authorization leading to overpayments for unauthorized services; including the number of visits in excess of the authorization, dates of service after the allowable dates on the authorization, etc.
  • Documentation Deficiencies: About 76% of the claims lacked proper documentation. The OIG found that many claims were not supported by medical documentation meeting VHA requirements, including illegible or incomplete records. The VA requires that claims conform to Medicare’s billing requirements.
  • Incorrect Billing for E/M Services: Some Evaluation and Management (E/M) services billed were not fully supported by medical records or illegible, leading to further issues with claims.
  • VHA Staff Failed to Follow Reauthorization Guidelines: The VHA failed to evaluate the efficacy of non-VA care prior to reauthorizing additional acupuncture services, thus improper payments were made with faulty authorization.

Lessons Learned from VA OIG’s Acupuncture Audits

  1. The acupuncturist is responsible for medical necessity and documentation.
  2. You must adhere to authorization limits – make sure that the services provided are administered by the provider listed on the authorization and limit the services to the amount of treatment and within the time period authorized by the VA.
  3. Correct Coding: Follow the AMA CPT Codebook for accurate coding of services.
  4. Maintain Legible Documentation: Ensure all documentation is clear and legible to avoid claim denials based on poor record-keeping.

Current Enforcement Trends

Followingthe VA OIG acupuncture audit report there have been a large number of resulting provider audits and investigations, in an attempt to recoup some of the funds that were paid in 2018 & 2019. The audits are being performed by the VA, third-party administrators and even the U.S. Department of Justice. You may receive a subpoena requesting claims information including progress notes or your entire case file on a group of VA patients as the initial indication of a pending investigation. Following transmission of these documents, you may be informed of several possible results. You may be subject to administrative recoupment which simply requires you to repay improperly paid funds. Common issues include unauthorized services or incomplete/illegible documentation. In more extreme instances the VA or DOJ may pursue you for civil damages pursuant to the False Claims Act. Providers may face significant penalties under the False Claims Act for knowingly submitting false claims. The DOJ often handles these cases, pursuing treble damages and substantial fines. If the investigation finds that your conduct may rise to the level of health care fraud you may be subject to criminal liability.

New Challenges: Veteran Interviews and Documentation Issues

Recent developments indicate that the VA is now interviewing veterans to challenge the validity of acupuncture claims. This new approach includes questioning whether treatments were actually received and undermining the claims made by acupuncturists. Notably, progress notes are increasingly being deemed insufficient evidence of treatment completion, particularly where legibility is an issue.

Recommendation: To counteract these challenges, we are advising acupuncture providers to incorporate an attestation form for patients to sign at each appointment. This attestation should confirm that the treatment was received and can serve as additional documentation to support the claim.

What This Means for Acupuncturists

  1. Increased Scrutiny: Providers with high billing amounts are under heightened scrutiny. The VA’s focus on these cases, combined with DOJ investigations, means that billing discrepancies or errors can lead to severe legal repercussions.
  2. Potential Penalties: The DOJ’s pursuit of treble damages for improper claims under the False Claims Act can lead to substantial financial penalties, significantly exceeding the original claim amounts.
  3. Proactive Measures: To mitigate risks, acupuncture providers should review and strengthen their compliance practices. This includes ensuring all treatments are pre-authorized, maintaining comprehensive and accurate documentation, and using additional patient attestations to confirm treatment receipt.
  4. Seek Professional Advice: Engaging with healthcare compliance specialists or legal advisors is crucial. These professionals can help navigate the complex regulatory landscape and ensure your practice remains compliant.

Conclusion

With the expanding coverage for acupuncture services and the rise in audits by federal, state, and private payors, acupuncturists must be vigilant. Reviewing and updating medical necessity, documentation practices, and billing procedures is crucial. By adhering to regulatory requirements and maintaining thorough records, providers can better manage audit risks and continue to offer valuable care to veterans with confidence.

So, You Want to Open Your Own Veterinary Practice?

As a veterinarian, the dream of owning your own practice often represents the pinnacle of professional achievement. However, venturing into practice ownership is a monumental decision that requires thorough preparation and strategic planning. Here’s a comprehensive guide to help you navigate this exciting journey.

First Things First: New Practice vs. Established Practice

Starting from Scratch – Opening a new veterinary practice means building everything from the ground up. This option provides you with the ultimate level of control over every aspect of your practice, it also involves substantial initial investment and higher risk, as you will need to attract a clientele from scratch and navigate the unpredictable early stages of business growth.

Purchasing an Existing Practice – On the other hand, acquiring an established practice comes with a built-in client base, experienced staff, and an existing revenue stream, which can significantly mitigate initial risks. Many lenders prefer financing acquisitions because they can assess the financial history of the practice to predict future revenue. However, you will inherit the existing business culture and practices, which may require time and effort to align with your vision. Potential downsides include staff turnover and adjustments in business philosophy.

Key Questions to Ask When Purchasing an Existing Practice

Once you decide to take the leap and purchase an existing practice there are a few questions you must ask yourself when evaluating the potential purchase which include:

  • How did the seller arrive at the sale price?
  • What all is included in the sale? 
  • Does the sale include any special conditions?
  • Why is the owner selling, and what are his or her plans following the sale?

Due Diligence: Ensuring a Smooth Transition

Due diligence is a critical phase in acquiring a veterinary practice, requiring meticulous attention to detail and professional expertise.

  • Compliance Documentation: Ensure all regulatory requirements are met. A compliance audit can prevent costly future fines and enhance the practice’s value.
  • Non-Disclosure Agreements:
    Protect sensitive business information with NDAs to prevent information leaks that could harm the practice’s value or operations.
  • Non-Compete Agreements
    Verify that existing veterinarians have non-compete agreements to safeguard against them taking clients if they leave the practice.

Conclusion

Owning a veterinary practice is a significant milestone, representing either the start of an exciting new venture or the culmination of a dedicated career. Whether you choose to build a practice from scratch or acquire an existing one, being well-prepared and informed is key. By asking the right questions, understanding valuation methods, and ensuring thorough due diligence, you can set the foundation for a successful and fulfilling practice ownership journey.

Clients who work with the Florida Healthcare Law Firm are protected by deep healthcare industry experience and fully served by attorneys aligned with their success. The team here doesn’t dabble in healthcare law, we specialize in full spectrum representation of healthcare providers and nearly every type of healthcare business.

MSAs in the IV Hydration Space

The concept of an MSAs (management services agreement) can be confusing for IV hydration business owners.  If you’re curious, you should have these questions:  What is an MSA?  Why do I need one?  What does a “good” one have in it?

An MSA is a contract.  That’s the simple part.  It’s a contract between two entities, a clinical entity (e.g., company, professional corporation, partnership or LLC) and a business entity.  One entity does clinical things (e.g., provides IV hydration services).  The second one does all the business things that any healthcare business needs—reception, accounting, HR, financial management, marketing, sales.

Healthcare businesses need (or want) MSAs for two reasons:  first, because the law of the state where they operate requires only a specific clinician to own a clinical entity.  For instance, the law in a state might say a physician (and no one else) must own any entity that provides medical services.  And it might define even IV hydration services as a medical service.  In that state then, only a physician could own a business that provides IV hydration services.  In that event, non-clinicians (or clinicians without the requisite license) would/could own the business entity (but not the clinical one).  the second reason for using an MSA is because that’s what the entrepreneur thinks a buyer will want.  The entrepreneur will build an MSA based model (called an MSO model) in states that don’t require an MSO model because the entrepreneur believes private equity only wants to buy MSO modeled healthcare businesses.  And (if you haven’t figured it out already) the laws that drive this issue are state laws (not federal ones), which means there are at least 50 different moving pieces.  State laws change regularly (more often than federal ones) so this is something that needs to be checked periodically.

One of the difficult things in an industry where regulations are emerging (e.g., the IV hydration space) is to consider this question:  although the laws in my state don’t require an MSO model, are the legal developments that apply to the IV hydration industry such that we ought to do an MSO model anyway?   This sort of analysis assumes there is change afoot and it may “hit” your state sometime, and it’s best to adapt before the laws in your state are impacted.   This is a complex business decision that requires a thorough discussion with experienced counsel.

What about the MSA itself?  What should be in it?  This depends on state law since states do address the content of such agreements.  New York law, for instance, requires the management fees to be consistent with fair market value.  California law forbids percentage based MSAs (as do other states).  Regardless of the specific state laws applicable, a thoughtful MSA needs to address—

  1. The detailed business-related services the MSO will provide to the clinical entity;
  2. The clinical services that the clinical entity will provide;
  3. A clear commitment on the part of both parties to adherence to state and federal laws;
  4. The fees payable to the MSO;
  5. Financial controls in place, such as a sweep account and lien provisions (to protect the MSA fees payable to the MSO);
  6. The rights of the MSO relative to the clinical entity as it relates to issues like the ability to require a change of clinical owner;
  7. Restrictive covenants like confidentiality, non-solicitations and noncompetes;
  8. Termination provisions, particularly those that are based on threats to the business of either party (e.g., bad actor clauses); and
  9. To the extent possible under state law, the possibility of the MSO sharing liquidity event proceeds if the clinical entity is sold.

Mergers and Acquisitions in the Veterinary Space

The veterinary industry has been experiencing a significant wave of mergers and acquisitions (M&A) in recent years. As corporate entities and private equity firms recognize the potential for growth and profitability in this sector, veterinary practices have become attractive targets for M&A activity. This article explores the trends, benefits, challenges, and overall impact of M&A in the veterinary industry.

Why Veterinary Practices Are Attractive Targets for M&A

1. Growing Demand for Veterinary Services – The escalating demand for pet healthcare services make veterinary practices lucrative investments. Advances in veterinary medicine and a growing emphasis on pet wellness have further fueled this demand.

2. Predictable Revenue Streams –
Veterinary practices often have stable and predictable revenue streams, making them appealing to investors. Regular check-ups, vaccinations, and treatments provide consistent business, reducing financial risks.

3. Fragmented Market –
The veterinary industry is highly fragmented, with many independently owned practices. This fragmentation presents opportunities for consolidation, allowing larger entities to achieve economies of scale and enhanced market presence.

The M&A Process in the Veterinary Industry

1. Identifying Potential Targets –
The first step in the M&A process is identifying veterinary practices that align with the acquirer’s strategic goals. This involves market research, financial analysis, and understanding the practice’s reputation and client base.

2. Valuation –
Valuing a veterinary practice can be complex. Common valuation methods include:

  • Asset-Based Valuation: Adding up the value of all tangible and intangible assets.
  • Income-Based Valuation: Projecting future earnings and discounting them to present value.
  • Market-Based Valuation: Comparing the practice to similar ones that have recently been sold.

3. Due Diligence –
Due diligence is crucial for assessing the practice’s financial standing, compliance with regulations, and any potential liabilities. It involves reviewing financial statements, legal documents, and operational practices.

4. Negotiation and Deal Structuring –
Once due diligence is complete, negotiation begins. This stage involves determining the purchase price, payment terms, and any contingencies. Deal structuring may include upfront payments, earn-outs, or equity swaps.

5. Integration –
Post-acquisition integration involves merging the acquired practice with the acquirer’s operations. This can include aligning business processes, integrating software systems, and managing changes in leadership and staff roles.

Benefits of M&A in the Veterinary Industry

1. Enhanced Resources and Capabilities –
Mergers and acquisitions can provide access to better resources, including advanced technology, specialized equipment, and enhanced training programs for staff.

3. Expanded Service Offerings –
Acquiring or merging with another practice can allow veterinary practices to expand their range of services, such as specialty care or advanced diagnostics, thereby attracting a wider client base.

4. Improved Client Experience –
Larger, consolidated practices often have the resources to invest in client-centric initiatives such as extended hours, online booking, and enhanced communication, improving overall client satisfaction.

Challenges of M&A in the Veterinary Industry

1. Cultural Integration –
Merging different practice cultures can be challenging. Differences in management styles, staff expectations, and client service philosophies need to be carefully managed to ensure a smooth transition.

2. Staff Retention –
Maintaining staff morale and retaining key employees during and after the transition is critical. Clear communication, proper training, and involvement in the integration process can help mitigate staff turnover.

3. Client Retention –
Clients may be wary of changes resulting from an M&A. Maintaining transparency, continuity of care, and consistent service quality are essential to retaining clients’ trust and loyalty.

4. Regulatory Compliance –
Navigating the regulatory landscape is vital. Ensuring compliance with local, state, and federal regulations, as well as industry standards, requires meticulous attention to detail.

Conclusion

Mergers and acquisitions in the veterinary space present significant opportunities for growth. By understanding the trends, benefits, and challenges of M&A, stakeholders can navigate this dynamic landscape effectively. With strategic planning and careful management, M&A can lead to successful outcomes for veterinary practices, their staff, and their clients.

Please contact us at Florida Healthcare Law Firm to discuss in more detail the growth of your veterinary practice and how your business can benefit from acquiring or merging with another practice.

Business Considerations for Starting a Medical Practice

Medical school equips physicians with the skills to care for patients but often leaves them unprepared for the business side of running a medical practice. Here are some crucial considerations for physicians before opening their own practice.

Business Expectations:  Most professionals (not just doctors) think if they’re amazingly good at what they do, patients will flock to them.  Not true at all, especially in this digital marketing age where our attention is the commodity.  Marketing and sales and administration is at least as important as excellent clinical skills.  If you’re not prepared to build a marketing business that provides medical services, you’re setting yourself up for an expensive lesson in business in the modern era.  

Florida Medical Licensing:

To practice medicine in Florida, you must be licensed by the state (the Board of Medicine). While it may seem straightforward, many doctors inquire about reciprocity, mistakenly believing they don’t need a Florida license if they’re licensed elsewhere. Timing and completeness are key here. Allow more time than you think you’ll need, especially around holidays. If your application is delayed, consult an attorney specializing in Board of Medicine matters to expedite the process. Omitting pertinent information can lead to delays or denials, so seek help from a Florida healthcare lawyer to ensure your application is complete and accurate. Flexibility in your start date can accommodate any unforeseen licensing delays.

Deciding Between Employee and Employer:

Most new physicians lack the experience, interest, or capital to start their own practice immediately. Therefore, many begin as employees in existing medical practices, hospitals, or universities. It’s crucial to get a Florida healthcare lawyer experienced in physician employment contracts rather than relying on lawyers from unrelated fields. Expert advice can save you money and headaches in the long run, especially now given the confusion about noncompetes and such.  Starting an employment relationship with an assumption that the noncompete you signed isn’t enforceable is a disaster.  Don’t use your neighbor or a friend doing you a favor because he’s a (real estate) lawyer.    

The Physician Entrepreneur:

For those with an entrepreneurial spirit, one option is to explore recruitment packages from local hospitals. These packages typically offer income guarantees and various forms of financial support, which are usually forgiven over several years.

Physicians wanting to start their own practice will need to form a legal entity. Common choices in Florida include professional corporations (P.A.s) and LLCs (or PLLCs). A single physician can easily form a legal entity, but multiple physicians will need an operating agreement or shareholders agreement. These documents cover decision-making processes, loan arrangements, overhead allocation, and protocols for events like the death or disability of a physician owner. While forming a corporation can be quick, preparing ownership-related documents can take months, depending on availability.  Even more perplexing is this:  while getting to Medicare is a snap, getting on commercial payer panels is a panicky endeavor.  “What do you mean you’re closed.?”  “Can payers do that?”  Yep, let’s talk!

Additional Considerations:

Contracting with managed care payers and building out office space can also be time-consuming. As a general rule, plan for everything to take twice as long and cost twice as much as initially anticipated.

Opening a medical practice involves significant planning and numerous legal and business considerations. Seeking expert advice early can streamline the process and help ensure long-term success.

Starting a medical practice requires meticulous planning and adherence to healthcare regulations. By addressing these business considerations and by creating a team, that can bring all the solutions to the table (not just legal stuff), healthcare providers can establish a successful and compliant practice that meets the needs of their patients while achieving financial stability.  It’s easy to get in business.  It’s not easy to stay in business.  And a lot of that depends on what you know and do up front!

Physicians & Nurses in for a Long Ride on the Health Train

Nearly half of US states have expanded the scope of nursing practice, with several more evaluating the appropriateness of such measures. The debate between physicians and nurses regarding nursing autonomy remains a contentious issue that is likely to resurface in legislative discussions. In the meantime, the Board of Medicine and the Board of Nursing will continue to enforce existing requirements quietly. Under current Florida laws, advanced registered nurse practitioners (ARNPs) are authorized to perform medical diagnoses, treatments, and prescriptions, but these acts generally require the supervision of a physician. This supervisory relationship must be detailed in a protocol that specifies the medical acts to be performed and the conditions for their performance.

Contents of an ARNP Protocol:

With few exceptions, every ARNP must file an original protocol with the Florida Board of Nursing within 30 days of:

  1. Entering into a supervisory relationship with a physician,
  2. Renewing a State of Florida medical license, or
  3. Any changes to the information contained in an existing protocol

The protocol should include:

  • The date of the protocol or amendment,
  • The nature of the ARNP’s practice and duties,
  • The location of the ARNP’s practice,
  • The names, signatures, license numbers, and DEA numbers of the supervising physician(s),
  • The duties of each supervising physician, and
  • All medications that each supervising physician has agreed the ARNP may prescribe.

If multiple physicians supervise the ARNP, only one protocol needs to be filed, but it must include signatures, license numbers, and DEA numbers of all supervisors. A sample ARNP protocol is available on the Board of Nursing’s website at floridasnursing.gov/forms/arnp-protocol-sample.pdf.

Physician Obligations:

Every physician supervising an ARNP must file a notice of supervision with the Board of Medicine within 30 days of entering or terminating the relationship. If the physician supervises an ARNP in an office different from their primary practice location, they must post:

  1. The times when the physician is physically present in each office, and
  2. Office hours when the physician is not present.

Primary care physicians may not supervise more than four primary care offices other than their primary location, while specialists are limited to two additional offices. Additional regulations apply if the ARNP provides dermatologic or skin care services.

Evolution:

Florida law has greatly expanded the scope of APRN services to include those which don’t require physician supervision.  That expansion is expected to continue and is something to watch virtually every legislative session.

By: Jeff Cohen

Founder, Florida Healthcare Law Firm

¿Qué es un MedSpa y qué se necesita para iniciar uno?

Elaborado por: Carlos Arce, Esq.

Bufete de abogados de atención médica de Florida

Un MedSpa es una práctica médica que ofrece servicios de atención médica que normalmente no son médicamente necesarios. Son servicios que normalmente no son reembolsados por el seguro y normalmente los paga directamente el paciente que los recibe. Pueden incluir servicios de atención médica como Botox, hidratación intravenosa, procedimientos faciales, terapia hormonal, pérdida de peso y terapia de rejuvenecimiento. Todos estos servicios de atención médica tienen una cosa en común: requieren que un proveedor de atención médica preste estos servicios, de acuerdo con el ámbito de práctica del proveedor.

Según la ley de Florida, cada proveedor de atención médica se clasifica dentro de un determinado tipo de proveedor según sus requisitos de educación, capacitación y licencia. Los servicios de atención médica ofrecidos por un MedSpa requieren que un proveedor de atención médica autorizado diagnostique al paciente antes de recibir los servicios. Es en este paso que muchos propietarios de MedSpa no cumplen con las normas o terminan causando daño al público en general. El propietario de un MedSpa no necesita ser proveedor de atención médica ni requiere una licencia para operar el negocio (es posible que se requiera alguna licencia de la ciudad y el condado para operar el negocio). La razón clave por la que el estado de Florida permite esto es porque este tipo de negocios no reembolsan las reclamaciones del seguro. Por lo tanto, no exigen una licencia de la Agencia para la Administración de Atención Médica (AHCA).

Sin embargo, el hecho de que el estado no requiera una licencia especial no exime a un MedSpa de la necesidad de gobernarse a sí mismo como una práctica médica regulada por el estado. Por el contrario, un MedSpa es una práctica médica y debe cumplir con las leyes de privacidad, los procedimientos de mantenimiento de registros de pacientes y la documentación a través de registros médicos, la licencia mantenida de cada proveedor de atención médica que opera en el MedSpa y el cumplimiento de las leyes específicas de fraude y abuso de Florida. . En Florida, es ilegal pagarle a alguien por la derivación de un paciente que busca o recibe y paga por servicios médicos. Los servicios de efectivo están incluidos en esta ley. También es ilegal que un proveedor médico divida los honorarios con otro proveedor médico si no se presenta la documentación adecuada de conformidad con los puertos seguros apropiados.

Iniciar MedSpa es una función legal fácil, la mayor parte de la formación es similar a la de cualquier negocio. Sin embargo, los requisitos de licencia local que pueden ser necesarios dependerán de los tipos de servicios prestados por los proveedores que ejercen en MedSpa. Antes de que pueda comenzar el viaje para iniciar un MedSpa, primero debe determinar qué planea ofrecer en la práctica, cómo piensa cobrar, cuál es el grupo de edad de los pacientes a los que se dirige, si su proveedor de salud acepta Medicare ( ¿Están participando total o parcialmente), tiene las pólizas de seguro adecuadas, etc.?

No dejes tu MedSpa al azar, llámame y te guiaré.

El abogado Carlos H. Arce trabaja con Florida Healthcare Law Firm en Delray Beach, FL. Tiene una amplia experiencia en derecho de la salud, derecho comercial y fusiones y adquisiciones. Carlos ha manejado transacciones de atención médica multimillonarias y se ha desempeñado como asesor externo de varias entidades de atención médica, pequeñas y grandes. Puede comunicarse con él por correo electrónico a [email protected] o llamando al 561-455-7700.

Hoja de ruta de la “Licencia de clínica de atención médica” de AHCA

Si busca recibir un reembolso por parte de los pagadores de seguros en Florida, ya sea a través de programas federales (Medicare, Medicaid y Tricare) o seguros comerciales (incluida la protección contra lesiones personales y lesiones corporales), necesitará una licencia de clínica de atención médica o calificar como exento bajo una de las exenciones. El proceso de obtención de una Licencia de Clínica de Atención Médica es tedioso y requiere una atención detallada a las consideraciones y requisitos.

Aplicación inicial

La etapa de solicitud inicial requiere que la persona o entidad que intenta solicitar la licencia complete varios formularios. También debe completar un formulario de prueba de capacidad financiera para operar que debe ser completado por un contador público certificado con licencia. Además, usted y cualquier otra persona que planee compartir la propiedad de la entidad que busca la licencia deben poder pasar una verificación de antecedentes de nivel 2. Cada solicitud requiere la presentación de una tarifa de $2,000 para obtener la licencia. La etapa inicial es donde ocurren muchos bloqueos y retrasos. Trabajar con profesionales que presentaron esta solicitud a la Agencia para la Administración de Atención Médica (AHCA) y la aprobaron será de gran ayuda.

Carta de omisión

Cada solicitud enviada a la AHCA recibe una carta de omisión como respuesta a la solicitud. Esta es la forma en que AHCA le avisa que han revisado su solicitud y le señalarán los problemas que vean en su solicitud. Si no completa ni responde a esta carta de omisión dentro de los 21 días, perderá su solicitud y perderá su tarifa de licencia inicial de $2,000.

Encuesta

La Licencia de Clínica de Atención Médica se basa en la ubicación donde planea operar la clínica de atención médica. Por lo tanto, cada lugar donde se prestarán los servicios debe ser inspeccionado por el equipo de auditoría de la AHCA. La encuesta requiere que tenga toda la publicación requerida en la clínica, así como la documentación que el estado requiere que usted tenga en sus archivos en relación con su licencia y los requisitos de inspección de su director médico. Si pasa la inspección, se le avisará verbalmente y deberá recibir la licencia entre 2 y 4 semanas después de la inspección.

Pasos adicionales

Si planea facturar beneficios de protección contra lesiones personales, necesitará una acreditación de una de las cuatro agencias acreditadoras de Florida. Esto le permitirá facturar los beneficios de protección contra lesiones personales de inmediato. La ley de Florida establece que debe esperar 3 años antes de facturar los beneficios de protección contra lesiones personales a una aseguradora, a menos que cumpla con el requisito de la agencia acreditadora o una de las otras excepciones según la ley de Florida.