Provided by: Jennifer Kirschenbaum, Esq.
September 13, 2018
What are you seeing around town these days?
Happy to share! Some recent observations based on the calls we receive...
OPMC - The Office of Professional Medical Conduct seems to have recovered from a staffing deficit. It was somewhat known for a bit that OPMC had some internal shufflings and departures, and from what we can tell they are back in business; letters going out to providers for even the most de minimus infractions (required by statute). Remember, if you do receive a notice, do NOT go in for an interview, do not respond, do nothing before calling counsel (for most of you, our office). OPMC must be dealt with swiftly, competently and, from you, at arms length. That office has the power to deprive you of your license, and has no restrictions from unlimited fishing expeditions.
Payor Terminations seem to be holding course. A noticeable number of our smaller practice or solo clients are seeing payor terminations - some a sizeable impact to their pay base. The reason - there is a limited pot - and when the bigger players get their demands met for higher reimbursement, the money has to come from somewhere... At the end of the day payor participation is a contractual right - and that contract has a termination provision. To date, a private payor has not been held as required to keep a participant in network. In fact, state and federal programs do not guaranty enrollment, being a credentilaled medicare or medicaid provider is a privilege, not a right. I'm not saying its not worth fighting to stay in - for many you have to fight - its a major impact to your livelihood - have to try... Challenging, however, is most of the time an uphill battle.
Roll up, Roll out - STAT. We are seeing mostly status quo with those scooped up and spit out, or electing out. Status quo being we are seeing a steady stream in (to larger constructs - large groups and hospitals) and we are seeing a steady stream out - individuals being terminated or terminating employment arrangements, or buying themselves out of ownership models to return to private practice. Most of the time these decisions are related to money, and almost all of the time the decision to leave, if it is the provider's decision, is related to autonomy and control. A lesson to be learned from this pattern - if you are planning to roll in, make sure you know how to ROLL OUT.
Of course, all of the above are square in our wheelhouse (in case that is news), and if you want to chat more just to kibits or if you need assistance, email Jennifer (Jennifer@Kirschenbaumesq.com) or call 516 747 6700 x. 302 or schedule with Taryn at TCrimi@kirschenbaumesq.com.
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