In one of his popular books, Better, Dr. Atul Gawande, a surgeon at the Brigham and Women’s Hospital in Boston, Massachusetts, talks about his experiences after completing his residency and being offered employment at a hospital. Point-blank he is asked by the Chairman of the particular department to quote a figure, which starts a train of thought in his mind, and eventually becomes responsible for one of the chapters in his now famous book.
That was approximately a decade or so ago. Perspectives on physician pays have undergone a sea-change since then, although a fixed salary (revised annually of course) is still a much-used mode of compensating physicians. Besides that, nowadays, physician compensations are closely tied to performance, quality of care, and a lot of other factors.
Physicians may be compensated for their labours based on different models. The most popular ones are:
a. Equal Sharing: Here everyone is assumed to contribute equally.b. Productivity Based: The capitalistic model seen in many industries.c. Salary Based: An instance of this was referred to above.
d. Capitation: Here Physicians are rewarded for certain cost-saving behaviours.
e. Fee-for-Service: The all-prevalent model for small independent practices till some time back.
f. Performance Based: Like PQRI (Physician Quality Reporting Initiative).
g. Blended Models(combining some of the above).
Now, whatever the model, certain federal laws overlook the gamut of compensation formulas and ensures that they are fair and do not violate federal statutes. The most famous and important of this is the Stark Law, after Peter Stark, the Democratic Party Congressman. This states that Medicare & Medicaid patients should not be directly or indirectly referred (through family members) by physicians to a facility providing health services in which they or their family members have financial interests.
Now violation of this law results in civil charges and fines besides rejection of claims by Medicare and Medicaid. A recent high-profile violation of this statute is the Tuomey Hospital case of South Carolina.
BillingParadise is here to aid physicians and clinics alike in making sure their physician compensation models do not violate any provisions of any federal statutes. Consequently our medical billing services incorporate ethics derived from the above, and you will find no claims, submitted via BillingParadise, rejected by neither Medicare nor Medicaid citing Stark Law violation.
Call BillingParadise at 1-888-571-9069 to explore the above concept in depth and to avail our dedicated medical billing and medical coding services.
