It is essential for Hospitals to objectively evaluate the relation with their Hospital-based Physician Groups.
- Do all payments reflect Fair Market Value?
- Are all terms reasonable and routinely updated for inflation and current circumstances?
- Do contract terms consider future needs?
- How is Programmatic expansion or contraction handled?
Evaluation of Part A Support:
- Is the Part A payment reasonable?
- Does it include Performance Criteria?
- Do customized Time Studies support the payments? Are they reviewed by Department Managers?
- Is an objective hourly rate applied?
This mechanism allows contributions from the Physicians as well as the Hospital to seed new projects and provide resources that lead to opportunities that enhance the Department.
Technical Cost Recovery (TCR) :
- If physicians buy technical services and bill referred patients globally, is the payment calculated at Fair Market Value (FMV)?
- FMV assures payment for TCR include full direct costs and a reasonable allocation for indirect costs.
- Is the TCR evaluation done each year? Is an easily reproducible methodology used?
It is essential to assure a check and balance between Technical and Professional codes being billed.
Analysis of Charge Master
Determine if the technical fees are reasonable and competitive.