General Category > General Questions
Anit-Kickback and Stark Law Question
medauthor:
Isn't it funny how it's OK for us billing companies to charge a %, but considered dangerous for the doctors to enter into such an agreement with us......
For NY state
Is it a problem for a physician to employ a billing company or a collection agency?
That depends on the type of the agreement between the physician and the billing company. By default, many billing businesses prefer a contingency-based model where they charge the doctor a percentage of the doctor's income. While permissible for the billing companies, such practice is a sure way to professional discipline for the physician. The right way would be to arrange for a fixed rate representing fair market value of the services. However, this is different with the collections agencies. Paying collections agencies on a contingency basis depending on the amount recovered is not illegal fee-splitting.
medauthor:
California prohibits fee-splitting, however see below:
(b) The payment or receipt of consideration for services other than the referral of patients which is based on a percentage of gross revenue or similar type of contractual arrangement shall not be unlawful if the consideration is commensurate with the value of the services furnished or with the fair rental value of any premises or equipment leased or provided by the recipient to the payer.
So to me, it seems it is LEGAL to charge a % based on the services of 'billing'.
PMRNC:
(b) The payment or receipt of consideration for services other than the referral of patients which is based on a percentage of gross revenue or similar type of contractual arrangement shall not be unlawful if the consideration is commensurate with the value of the services furnished or with the fair rental value of any premises or equipment leased or provided by the recipient to the payer.
Depends on how you interpret this which is what makes THIS one very grey .. how do you show your % commensurates with the value of services? Since most charge a % of full revenue..to which revenue is brought in by patient's.. So when that's the case.. I like to go with the most safest solution... If in question.. better safe than sorry!
Michele:
"So...the holidays are coming up and we would really like to so something for our wonderful providers--and still stay legal.
What do you all do for your clients around the Christmas/Channukah/Winter Solstice/New Years season?"
For our local providers we usually do up a tray for the office, cheese, crackers, candy, fruit, cookies. A variety of 'goodies'. For our out of area providers usually a box of chocolates, or something else. We also rate the office by size. Our smaller offices, with less staff, get a smaller tray or smaller box of chocolates. We have one Jewish provider and we send her a gift (mail order - cuz she's out of the area) at Channukah.
PMRNC:
I try to do something different each year. I might bring in lunch before the holiday's along with goodies for the staff as well as the provider. I give gift certificates to restaurants such as Red Lobster, Olive Garden, etc. Only thing I don't do is Fruit Cake. LOL eww
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