Have you heard that providers can form a private membership association, (or a private healthcare association or an association membership)? The concept goes by many names, but the basic premise is the same: By forming a private association and only conducting business with members of that association, providers are no longer subject to governing bodies or licensing boards. Private membership association advocates claim that this protection is afforded by the United States Constitution, but at least one private membership association discovered that they were still subject to governance. Read more here.
The Right Coverage
If your practice incorporates treatments, services or product that are not common in traditional practices, don’t assume that a traditional medical malpractice policy will provide all of the coverage your practice needs. Remember: Traditional malpractice policies are written for traditional practices. Integrative, holistic and functional medicine providers need to take extra steps when securing medical malpractice to make sure that their policy covers what they do. Read more here.
What is the focus of your practice? Developing a practice focus that is consistent with marketing and services helps to shape and meet patient expectations. Practice focus is generally a blend of Wellness, Disease, Symptom and Treatment. Understanding your specific practice is important to promote your practice and connect with potential patients. Considering practice focus is also important to understanding expansion opportunities. Read more here.
Nosing-in on a Policy
Most providers are familiar with the dreaded “tail policy” which is a policy purchased for prior acts not covered by a policy going forward. A tail policy is required when a provider ends a claims-made policy and starts a new policy with a current effective date. The tail policy provides coverage for the acts prior to the new policy’s effective date. Another strategy that may be possible is to “nose-in” to a the new policy, which means that the new policy becomes retroactive–its effective date reflects the period of the prior acts–so that the provider doesn’t have to buy a tail. Nosing-in isn’t always an option, but it can be an effective way to maintain coverage and save money when it is an option. Read more here (Question #4).
Does your agreement indemnify the supplement company?
Integrative, holistic and functional medicine providers often use supplements as part of their patient treatment plans. Providers who retail supplements often are required to sign an agreement with each supplement company. Several years ago, one of the most popular supplement manufacturers inserted an indemnification clause into their provider agreement. The company maintained that the indemnification clause was fair, but the clause could force providers to pay out of pocket to defend the supplement company in litigation. Read more here.
One of the major impacts of the COVID pandemic has been the widening acceptance of telemedicine paid on par with in-person visits. Now, as the COVID-19 public health emergency is expected to end, providers may wonder what which changes will be made permanent–and what the future of telemedicine will look like. First, providers should know that a 151-day transition period will proceed any changes for Medicare. Second, providers should recognize that even if telemedicine gains greater acceptance among insurance carriers, reimbursement rates may still make it problematic. Read more here.
Contracts can be a single page or Biblical in size. The can be simple or very complicated, but there are some points to remember about every contract. First, who are the parties involved? Are you contracting with a person, a company or a combination of both, (including people and companies)? Second, what are the obligations of the contract? What is “owed” to you–and what do you “owe” the party? Finally, what constitutes breach, or the failure to perform the contract, by all of the parties? These three factors–parties, obligations and breach–are a good starting point to understanding any contract. Read more here.
Have you heard that you can opt out of Medicare at one while location, while still participating with Medicare at a second location? Or that you can opt out under one tax ID but still participate under a different tax ID? Or that you can participate with Medicare as an employee at your job while charging cash in your start-up practice? You may have also heard other ways providers can play Medicare Hokey-Pokey, (“You put first job in, you take your next job out…”), but in most cases, a provider enrolls with Medicare under the NPI and either is participating or opts out. Read more here.