Considering a Hospital/Private Practice Alignment? Do Your Due Diligence
By Sally Eggleston, MBA, RT(T)
The increasing shift specialty physicians are making from private practice to employment by another entity—or in a practice arrangement that is a hybrid—isn’t unusual considering the uncertainty surrounding healthcare payments. We’ve seen this trend in the past, but it’s been prevalent particularly in the last few years. When looking specifically at oncology practices—radiation or medical—hospital administrators may find that specialists who come from private practices may have an approach and expectations that are somewhat different than those of other physicians they employ. Incoming oncologists will most likely be very proactive not only in ensuring that the business setup is rock solid but that billing will be accurate and timely.
At RC Billing, we have experienced a shift from physicians being our clients to hospitals being our clients. We have found that physicians are adamant about asking that their current billing company continue to provide services for their practice. This ensures continuity of the cash stream. While the initial period of an employment agreement may not be solely tied to production, inevitably production is the mainstay of a physician’s paycheck. Consistency is key.
Hospital staff may be intimidated by the coding and billing intricacies of specialty services such as oncology. Or their professional billing services department simply may not have the manpower to process the influx of claims. We typically see the latter case as the more frequent—and again, we find that often physicians meet with no resistance when demanding, as part of their employment agreement, that professional billing be outsourced to a specialty billing company.
With the many CMS incentive and penalty programs such as eRx and PQRS requiring attention to detail for claims-based reporting and timeliness of attestation and/or exemptions filing, it’s imperative that physicians have go-to personnel who understand the specialty, the clinical scenarios and their practice. Hospitals may not have experts readily available to fulfill this much-needed service. Outside billing entities, however, can provide continual education and 24/7 support that hospitals may struggle to accommodate.
Financial reporting and benchmarking are vital to any physician practice. If a physician becomes one of many in a hospital practice arrangement, it can result in a letdown of expectations. Again, outsourcing could be the solution for handling monthly financial calls and referrals tracking, which shift when a physician works within a hospital system.
RC Billing can provide custom solutions to advance the business side of your oncology practice. Whether you are a physician affiliated with a hospital, part of a large practice, or a freestanding facility, we are here to assist you with your billing operations. With a unique combination of medical and radiation oncology clinical experience and practice management, RC Billing can provide need-specific billing services that allow a seamless transition and steady revenue stream. If you would like more information about our services, please email us at firstname.lastname@example.org or call 512.583.2000.Top
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