Guillermo J. Beades, Esq. Frier Levitt, Attorneys at Law

When Spring comes around every year, with it comes a sense of rebirth as we see flowers bloom, trees growing leaves and birds singing. The warmer weather and longer days are much welcomed after a long dark winter.

Many treat Spring as a time to do some cleaning or decluttering around the house. Others tackle projects they said they would get to when they had the time. But few think of Spring as the time to clean up, declutter or tackle overdue projects at work.

Regardless of the size of your practice, there are some housekeeping items that should always be in order. Although this list is not meant to be exhaustive, the following “Spring cleaning” items relate to areas of higher importance:

SELF-AUDITS

If the last year has taught us anything about the world of audits, it is that there is literally nothing that will stop them. Many payors, including the largest payors in the state of New Jersey, have all maintained the frenetic pace of the past few years. Now, we are seeing audits that are requesting records for the past 18 months, which covers arguably the most hectic period of time for medical practices in the last 50 years.

With the shift to telemedicine came shifts in the documentation of services.While certain rules for conducting telemedicine were relaxed, the rules and regulations governing medical coding and billing did not cease to exist.

A practice should hire an outside independent certified professional coder to conduct a self-audit of its most used codes, its most highly reimbursable codes and any new codes being used. This will limit exposure in the future that will hopefully avoid large overpayment demands.

EMPLOYMENT CONTRACTS & EMPLOYEE MANUALS

Many small practices do not have employment contracts and/or employee manuals. Employment contracts protect the practice and the employee.The practice, absent a contract with the employee with restrictive covenants, has very little recourse if a physician leaves, opens a practice across the street and poaches staff and patients.

Similarly, a physician employed by a practice with no contract in place has little recourse if promises made are not kept and has virtually no expectations on what needs to happen to become a partner or qualify for a bonus or raise.

Similarly, employee manuals are needed to set uniform expectations for all staff and physicians at a practice. When staff and physicians do not have uniform rules that they are all required to follow, it sows discontent and can lead to discrimination lawsuits if an employee feels they are being unfairly treated in comparison to others. Employee manuals set expectations for all parties and can be used to diffuse potential lawsuits.

COMPLIANCE & CONTRACTS WITH THIRD PARTIES

Compliance, for years, has been seen as a four-letter word. Compliance, however, can be a profit center for practices when done correctly. Some aspects of compliance are preventative in nature, such as the job of a HIPAA Compliance Officer. But other aspects of compliance, such as internal auditing to ensure compliant billing, can lead to higher profits when practices who “have been doing this for 30 years” discovery they have been undercoding and leaving money on the table.

As part of a Spring-cleaning compliance plan, the practice should also ensure that all its corporate documents are updated and all partnership agreements reviewed and updated as well.

Lastly, with regulations in healthcare constantly changing, and the penalties for violating them draconian, practices should have all contracts reviewed by healthcare attorneys prior to entering into them. If a contract has been entered into between a physician and a third party, but no healthcare attorney reviewed it, please consider retaining counsel to ensure it is compliant. Every type of contract a practice or physician signs has the potential to violate state and/or federal laws and regulations – from leases to teaching positions – if all requirements are not met.

CONCLUSION

Again, although this list is not exhaustive, and it cannot be expected for a practice to tackle every single item on this in a short period of time, ignoring potential problems will only continue to clutter your practice, like many people’s garage after the winter.

Take some time this Spring to look at your practice with fresh eyes and be ready to roll up your sleeves to do some cleaning.