Bona Fide Physician Contracting & Payment: Meeting the Stark Exception and Ensuring Compliance

Event Information
Product Format
Prerecorded Event
Marcie Swenson, RN, JD, LLM, CHC
60 minutes
Product Description

Developing a Physician Payment Monitoring Program to Avoid STARK Violations

Many healthcare professionals involved in physician contracting get caught up in the contracting process itself and forget that successfully carrying out the terms of the contract is, and will likely always be, the most important aspect of staying compliant with the Stark Law. Executing a bona fide physician contract does not guarantee protection from a Stark violation. However, developing and implementing a comprehensive physician payment monitoring program will likely provide the fail safe program you have always wanted and help your organization be successful in avoiding any payment made outside the terms of the contract.

Having a solid physician contracting process does not always prevent Stark violations. In this session, expert speaker Marcie R. Swenson, RN, JD, LLM, CHC, will discuss why a physician payment monitoring program is the only way to guarantee that payments are being made strictly according to contract terms, and how it helps in avoiding Stark violations. Marcie will also elaborate on a dynamic step-by-step approach that must be completed each time a payment is requested for a physician, physician group, or entity providing physician services.

Session Highlights:

  • Why complying with Stark requires a payment monitoring process.
  • How to develop a comprehensive physician payment monitoring process for both clinical services payments and administrative services payments.
  • Why it is important to conduct the payment monitoring process before a payment is made.
  • Key contract information and terms that should be tracked and referenced before each payment is made.
  • Strategic questions that should be asked, answered, and recorded as part of a comprehensive physician payment program.
  • How to escalate and who should be assigned to resolve a payment issue once one is discovered.
  • A step-by-step outline of how to develop a physician payment monitoring program.
  • List of contract terms that should be tracked and referenced.
  • List of questions that should be asked about each payment, to ensure full compliance with that individual payment—this can be modified and used in your own payment monitoring tracking software or spreadsheets.

Session Agenda:

  • The Stark Laws – Overview
  • Requirements for Common Exceptions
  • AKS Definition
  • Stark Laws vs. AKS
  • Recent Stark Settlements and Developments
  • Senate Finance and Stark Reform
  • What Does Physician Payment Monitoring Look Like?
  • Tracking Components  & Contract Terms
  • Question Specific to Administrative Services
  • Justification of Need Analysis
  • Objective Determination of Hours
  • Qualification of Physicians

Who should attend

Compliance Officer, Compliance Attorney, Chief Financial Officer, Finance Director, Physician Contracting Director, or Operations Officer that works for an organization that contracts with, and makes payments to, physicians, physician groups, or health systems that contract for physician services.

Ask a question at the Q&A session following the live event and get advice unique to your situation, directly from our expert speaker.

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About Our Speaker

Marcie Swenson

Marcie has been involved in healthcare in various job roles including clinical nursing, hospital administration, and regulatory compliance. Marcie currently works for Intermountain Healthcare, a health system with 22 hospitals, 180 physician clinics, and health plans. Marcie graduated with a Juris Doctorate from Brigham Young University and a Masters of Law in Healthcare from Loyola University Chicago. Marcie often presents compliance & healthcare law topics; she co-authored the...   More Info
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