Starting a Private Practice? Get Familiar with Insurance Carriers First

Healthcare providers who start a private practice have the option to apply for in-network status with insurance carriers or remain as an out-of-network provider.

Out-of-Network Coverage

A provider can elect to provide a super bill to their patients, in order for their patients to directly submit a claim to their insurance for out-of-network coverage. The insurance carrier will then cover whatever their out-of-network rate is for the particular service. However, for all out-of-network services, the patient is always responsible for the full amount charged by the provider. It is up to the provider if they will accept, as partial payment the insurance coverage or not.

Dissolving Your Practice: Be Careful, Not Hasty

When dissolving your practice is time-sensitive, and you need to expediently move on, there are some important things to pay attention to in order to ensure it is done correctly.

First and foremost, you can never abandon your patients. There needs to be ample notice of at least 30 days and appropriate referrals for continuity of care.

Second, you will need to examine any contracts that you have in place with landlords, third parties, and employees, to ensure that you are not in breach of any of the terms and to give the appropriate notice of termination.

MSO Partnership for Physicians: Be Careful of the Wording in Your Agreement!

Practitioners often look to establish Management Service Organizations (MSOs) to help run the business end of a medical practice. Some of these services may include the following: handling payments for office space, providing equipment and supplies, or managing the practitioner’s insurance payments. The MSO can be a partnership between a number of physicians or between a physician and a non-physician. It is important to remember that any medical practice, which provides the actual medical services, may only be owned by licensed practitioners in New York.

How does a Management Service Organization get paid?

MSO Partnership for Physicians: Be Careful of the Wording in Your Agreement!

Practitioners often look to establish Management Service Organizations (MSOs) to help run the business end of a medical practice. Some of these services may include the following: handling payments for office space, providing equipment and supplies, or managing the practitioner’s insurance payments. The MSO can be a partnership between a number of physicians or between a physician and a non-physician. It is important to remember that any medical practice, which provides the actual medical services, may only be owned by licensed practitioners in New York.

How does a Management Service Organization get paid?

Blending Professionals: Ensuring the Overall Protection of Practitioners

When a practice is undergoing changes, it is important for practitioners to work jointly with an attorney, financial advisor, and accountant to ensure the overall protection of their practice.

The lawyer concentrates on the legal compliance of the practice; the accountant ensures that monies are treated according to the tax laws; and the financial advisor/investment broker works to ensure that there is a return on investment. It’s important that all professionals understand the concept of a healthcare practitioner’s needs and goals.

Obtaining a New Job: Important Transition Considerations

It is not uncommon for practitioners to change jobs and join a new practice during the course of their career. When first considering a change in employment, it is imperative to immediately review the current employment contract and examine the following clauses:

Practitioners: What You Need to Know About the GDPR

As of May 25, 2018, the GDPR, which stands for the General Data Protection Regulation, was implemented in the European Union (EU). This regulation is much more expansive than our United States HIPAA law, and its coverage area is quite large considering many different countries comprise the EU. The concept of the GDPR is to protect PHI of residents from the EU.

Does the Changing Healthcare Landscape Affect Doctor-Patient Privilege?

In most scenarios, doctor-patient privilege that is protected by HIPAA takes priority—similar to the way attorney-client privilege is treated. However, what was once a certainty is being challenged in the courts, primarily due to the increase of physicians who are employed by hospitals and the resulting overlap in treatment among professionals.

Hospitals have expanded the types of care that are available to patients, who often receive care from multiple physicians in one setting. A study from 2012-2015 documented a 50% increase in the amount of physicians who work in hospital settings.

The Murky Waters of Continuous Treatment Just Got Murkier

The recent case of Lohnas v. Luzi, 2018 N.Y. Slip Op 01114 (February 15, 2018) brings the implications of the continuous treatment doctrine to the forefront.

In this case, a physician performed shoulder surgery on a patient in 1998. The patient had follow-up treatments and then stopped for several months. After this brief hiatus, the patient then returned for follow-up appointments due to continued shoulder pain and ended up having a second surgery and subsequent follow-up treatments.

When a Non-Compete Is Non-Enforceable

In most instances, when a physician is hired at a practice, he or she must agree to a non-compete clause. By agreeing to this clause, the physician will be restricted on where they can continue to practice and render services within a particular geographical zone for a specified period of time after their employment ends.

In the case of Cindy Hoffman, D.O., P.C. v Raftopol, 2018 NY Slip Op 50020, Dr. Hoffman, a dermatologist, brought suit against her former physician’s assistant, Raftopol, for resigning and accepting a job within 15 miles of two of her offices — a violation of the non-compete agreement between the parties.