Question

Give answer of the following question

1) What is a physician group practice and why do physicians join group practices rather than having their own private practice?

2) Should physicians have equal participation in the practice if it is to be successful in the long term and why?

3) Who is responsible for the billing and claims for the physician within the group practice?

4) What are some of the documentation guidelines that are required in group practices?

5) How is a physician within a group practice get paid?

6) Can group practices be centered on a specialized discipline (example: a practice that focuses on cardiology) or do these group practices have to be a mix of all disciplines?

7) The concept of Group Physician Practices started in the 1930. Why?

8) How much does the economic market affect the physicians to join group practices?

9) Is it legal for a physician to drop their private practice and join a group physicians practice?

10) Can a group physician practice refuse to take Medicaid or Medicare patients?

Answer 1

Ans) 1) The Stark law defines a group practice as "two or more physicians legally organized as a partnership, professional corporation, foundation, not-for-profit-corporation, faculty practice plan, or similar association." The regulations clarify that a group practice must be a single legal entity.

- The reasons physicians for leaving private practice:

• The overhead and cost of maintaining a medical practice was too high

• A desire to focus on the practice of medicine and patient care, rather than administrative hassles.

• Reimbursement cuts

Because of the larger number of physicians and increased size of the patient base, group practices are usually better able to accept and manage financial risk than solo practices.

2) Physicians should have equity participation in a practice, if it is to be successful in the long term.

- A strong strategic orientation is essential to help a practice plan for the future and partner with key players in its market.

- Above all, physicians must have a strong commitment to the patient, the community, and high-quality, cost-effective care.

3) Physician billing, also known as professional billing is the billing of claims for work that was performed by a physician or other healthcare professionals, including inpatient and outpatient services. Most all of these claims are billed electronically as the 837-P form. The paper equivalent of this form is CMS-1500.

4) Useful Guidelines for Documentation in group practice:
- Stay Up-to-Date: No matter how knowledgeable you are, everyone can use a refresher even in their expert fields.
- Leverage Strong Tools: Microsoft Word documents in a Windows folder don't count.
- Don't Get Caught Up on Templates.
- Include Visuals.
- Set a Time for Writing.
- Have a Purpose.
- Keep It Simple.