Hospital-based medical groups, notably anesthesiology and radiology groups, are increasingly returning to creative means to provide coverage and to improve collections. Both are laudable goals. However, some groups cross the line from collaboration to fraud via pass-through billing. Pass-through billing is the healthcare industry term used to describe billing by one entity for services or…
In healthcare, size used to signal strength. Bigger meant more services, more specialists, more veritas. But what if all that bulk is actually a liability? Hospitals have gorged on acquisitions—buying up physician practices, merging with competitors, and adding layers of complexity. But when you stuff too much into a system, it doesn’t become more resilient—it…
It’s not news to you that there’s a huge shortage of physicians in many medical specialties, such as in anesthesiology and radiology. With the overall aging of the physician population, shortages in other medical specialties, including those that are office-based, will intensify.
Even in the face of the provider shortage, during which you think that you have substantial negotiating leverage, when a significant chunk of your revenue comes from the hospital, you’re no longer just a contractor. You’re an appendage.
There are, depending upon the particular arrangement, potential end runs around contractual pass-through billing prohibitions, but they are highly fact specific and technical.
It you haven’t yet read it, see my December 16, 2024, post, Now’s The Time to Overturn the No Surprises Act, for part 1 of this thread.
When that post was published on LinkedIn, my friend James Prudden commented, asking me how patients would be protected if the No Surprises Act were repealed. Here’s my response to James.
Re-frame the issue for what it really is: Surprise physician services stealing. Now’s the time for the No Surprises Act, and each state counterpart, to go.
Although no one is going to do time as a result of thinking that wet sidewalks cause rain, in the case of the federal Anti-Kickback Statute, confusion over correlation can put you in jail.
After having represented medical groups with a particular emphasis on hospital-based groups for 30 years, it has become strikingly clear that what distinguishes the most successful groups, from the great majority of the mediocre.
There are stupid questions. And there are certainly stupid statements. But even so, they often present a kernel of wisdom for your taking.