ENTtoday
  • Home
  • COVID-19
  • Practice Focus
    • Allergy
    • Facial Plastic/Reconstructive
    • Head and Neck
    • Laryngology
    • Otology/Neurotology
    • Pediatric
    • Rhinology
    • Sleep Medicine
  • Departments
    • Issue Archive
    • TRIO Best Practices
      • Allergy
      • Facial Plastic/Reconstructive
      • Head and Neck
      • Laryngology
      • Otology/Neurotology
      • Pediatric
      • Rhinology
      • Sleep Medicine
    • Career Development
    • Case of the Month
    • Everyday Ethics
    • Health Policy
    • Legal Matters
    • Letter From the Editor
    • Medical Education
    • Online Exclusives
    • Practice Management
    • Resident Focus
    • Rx: Wellness
    • Special Reports
    • Tech Talk
    • Viewpoint
    • What’s Your O.R. Playlist?
  • Literature Reviews
    • Allergy
    • Facial Plastic/Reconstructive
    • Head and Neck
    • Laryngology
    • Otology/Neurotology
    • Pediatric
    • Rhinology
    • Sleep Medicine
  • Events
    • Featured Events
    • TRIO Meetings
  • Contact Us
    • About Us
    • Editorial Board
    • Triological Society
    • Advertising Staff
    • Subscribe
  • Advertise
    • Place an Ad
    • Classifieds
    • Rate Card
  • Search

Internal Due Diligence Review Critical for Physician Practices

by Steven M. Harris, Esq. • July 9, 2015

  • Tweet
  • Email
Print-Friendly Version
Internal Due Diligence Review Critical for Physician Practices

Image Credit: Stuart Jenner/shutterstock.com

Whether you’re considering selling your practice, growing your practice, or maintaining the status quo, it’s important to periodically do a checkup on your internal operations and compliance with the law. It’s always preferable to discover problems within your practice and correct them (if possible) before those issues are discovered by third parties, such as the government or a potential buyer.

You Might Also Like

No related posts.

Explore This Issue
July 2015

A failure to review your internal operations prior to selling your practice could limit the interest of potential buyers, delay the closing of a sale, and reduce the economic benefit to you. Increased attention from recovery audit contractors (RACs) and other government agencies that are tasked with finding instances of Medicare and other government expenditure overpayments may also ensue.

This article describes some key areas to address when conducting a checkup of your practice.

Relationships with Referral Sources

Your relationships with referral sources can be a source of potential risk and should be high on your list in an internal review. This may include meeting and interviewing employees in various roles within your organization to best capture an understanding of these relationships.

Consider using the following questions in your review checklist:

  • Do you have any business relationships with referral sources or recipients of your referral?
  • Do you have any “discount” or other benefits that are provided to referral sources? If yes, these should be vetted by legal counsel to ensure that such arrangements are permissible under fraud and abuse laws.
  • Do you have written internal policies and procedures that ensure compliance with all regulatory requirements associated with your referral relationships?
  • Marketing and Sales Activities

Review all of your marketing and sales materials to determine if there are any circumstances in which your marketing activities may involve potential fraud and abuse law violations (e.g., referrals from physicians with a financial interest in the practice). Do you have written policies and procedures that address appropriate and inappropriate marketing and sales activities? If not, implementing written policies and procedures and conducting training for all personnel that may be involved in such activities should be a priority.

If your employment agreement includes a restrictive covenant, such as a noncompetition clause, it’s possible that state law may have changed regarding the enforceability of such a provision since the contract was signed.

Financial Documentation Review

Do you regularly review the coding and charge information for your office visits and procedures? This information can change often, and there should be mechanisms in place to capture those changes. Also, do your medical records document the medical necessity of the procedures performed? This could prove important in government audits and post-payment reviews. Accurate financial reporting is important, and your accounting practice should be consistent. Accounting reports must be prepared in accordance with recognized accounting standards.

Licensure and Human Resources

Ensure that both the practice and each professional (e.g., physician, nurse, nurse practitioner) have maintained all required licenses, accreditations, certifications, and other requirements. Review your employee handbook and current employment and independent contractor agreements to ensure they are up to date and that there have not been any changes in law that would affect the validity of any contract provision. For example, if your employment agreement includes a restrictive covenant, such as a noncompetition clause, it’s possible that state law may have changed regarding the enforceability of such a provision since the contract was signed.

Data Privacy and Security

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) and its implementing regulations are intended to protect the privacy and security of patients’ protected health information. Ensure your practice has implemented (and enforces) internal policies and procedures to comply with the HIPAA Privacy, Security and Breach Notification Rules. The HIPAA Privacy Rule provides limitations and conditions on the use and disclosure of patients’ protected health information. The HIPAA Security Rule requires implementation of administrative, physical, and technical safeguards and certain other organizational requirements to protect the confidentiality and security of electronic protected health information. The HIPAA Breach Notification Rule outlines the requirements pertaining to responding to breaches of patient protected health information.

Pages: 1 2 | Single Page

Filed Under: Departments, Legal Matters Tagged With: compliance, due diligence, legalIssue: July 2015

You Might Also Like:

The Triological SocietyENTtoday is a publication of The Triological Society.

The Laryngoscope
Ensure you have all the latest research at your fingertips; Subscribe to The Laryngoscope today!

Laryngoscope Investigative Otolaryngology
Open access journal in otolaryngology – head and neck surgery is currently accepting submissions.

Classifieds

View the classified ads »

TRIO Best Practices

View the TRIO Best Practices »

Top Articles for Residents

  • Do Training Programs Give Otolaryngology Residents the Necessary Tools to Do Productive Research?
  • Why More MDs, Medical Residents Are Choosing to Pursue Additional Academic Degrees
  • What Physicians Need to Know about Investing Before Hiring a Financial Advisor
  • Tips to Help You Regain Your Sense of Self
  • Should USMLE Step 1 Change from Numeric Score to Pass/Fail?
  • Popular this Week
  • Most Popular
  • Most Recent
    • The Dramatic Rise in Tongue Tie and Lip Tie Treatment
    • Vertigo in the Elderly: What Does It Mean?
    • Complications for When Physicians Change a Maiden Name
    • Rating Laryngopharyngeal Reflux Severity: How Do Two Common Instruments Compare?
    • Is Middle Ear Pressure Affected by Continuous Positive Airway Pressure Use?
    • The Dramatic Rise in Tongue Tie and Lip Tie Treatment
    • What Happens to Medical Students Who Don’t Match?
    • Rating Laryngopharyngeal Reflux Severity: How Do Two Common Instruments Compare?
    • Vertigo in the Elderly: What Does It Mean?
    • Neurogenic Cough Is Often a Diagnosis of Exclusion
    • Novel Bioabsorbable Plate Associated with Lower Leak Risk in Patients Receiving Endoscopic Skull Base Repair
    • New Findings Support Use of Cemiplimab as Neoadjuvant Therapy in Patients with Resectable Cutaneous Squamous Cell Carcinoma
    • Kinetic Oscillation Stimulation an Effective, Lasting Second-Line Treatment for Patients with Nonallergic Rhinitis
    • Otolaryngologists Vary Significantly in Choice of Injectable Materials for Vocal Fold Injection Augmentation
    • COVID-19 Infection May Be Associated with Unique Manifestation of Facial Nerve Paralysis/Palsy

Polls

Do you believe that having more otolaryngologists appear on mainstream media outlets is a good thing for the field?

View Results

Loading ... Loading ...
  • Polls Archive
  • Home
  • Contact Us
  • Advertise
  • Privacy Policy
  • Terms of Use
  • Cookie Preferences

Visit: The Triological Society • The Laryngoscope • Laryngoscope Investigative Otolaryngology

Wiley
© 2023 The Triological Society. All Rights Reserved.
ISSN 1559-4939