HCCA 2015: Physician Relationship Audit Workshop: Addressing Identified Issues

Physician Relationship Audit Workshop
Anna M. Grizzle, Partner, Bass, Berry & Sims PLC
LeToia Crozier, Chief Compliance Officer, Emdeon
April 22, 2015

Once you have analyzed your physician contracts, it is likely that you will find some issues that need to be resolved.

Common issues to find include:

  • Expired agreements
  • Lack of proper approvals
  • No written agreement or other technical deficiency
  • Lack of documentation to support payments or noncompliance with payment terms, rates, or caps.
  • Lack of FMV documentation

MD Ranger has reports which help prganizations quickly determine which contracts may be out of compliance.  Facilities then use MD Ranger's reports to document FMV for each contract in a simple and standardized way.

There are several, less than ideal, but possibly feasible ways to try to produce informal documentation or reduce the trouble cause by these contracts.

  • There is a 6-month holdover provision. While you shouldn't make a habit of allowing contracts to expire, you may be safe under this provision. Work quickly to rectify the expired contract.
  • What constitutes a contract under your state laws? It may be less formal than you think.
  • Do you have an email chain which could show an agreed upon renewal, continued agreement, or change in duties?
  • Are there meeting notes, physician's calendar record, or claims data that could support the arrangement in the absence of proper documentation?
  • Can you implement retroactive opinions or other contemporaneous documentation to support decisions and actions?

Most importantly as soon as you find a problem, rectify it. If you can rectify the problem, you cut off the period where you may be noncompliant and could be held accountable for repayments.

Some potential responses to noncompliance once you have investigated how big the violation is are:

  • Repay claims
  • CMS voluntary self-disclosure protocol
  • OIG self-disclosure
  • US Attorney's office or state Attorney General's office

Finally, once identified issues are resolved, it would probably be a good idea to implement a policy to avoid future issues.

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