• Review terms and rates. You should know the cost of your services and consider if the contract will generate non-covered services. Verify contract terms and confirm that your clinic or lab and finance department can meet these terms. Consider fee scheduling, infection control, licensing, quality assurance, site visit, and any other requirements stated in the contract. You may also contact a health care attorney to review the contract before you sign it as well. • Negotiate. After reviewing the contract, you can modify contract terms. Look for paragraphs that restrict your ability to collect reimbursement. Ensure that the third party payer agreement includes a description of covered services as well as a current fee schedule. • Signing the contract. Identify the person in your organization that is authorized to establish contracts and keep them informed throughout your efforts to obtain a contract. • Have contract on file. For periodic renewal and annual updating of fees, you must be able to readily access your contract. CONTINUING MEDICAL EDUCATION (CME) Continuing Medical Education (CME) is a very important part of your life as a physician. It allows you to maintain competence and learn about developing areas of medicine. CME comes in many forms: live events, written publications, online programs, audio, video, or various electronic media. The Louisiana State Board of Medical Examiners (LSBME) administrative rules require every physician seeking the renewal or reinstatement of licensure shall annually evidence and document, upon forms supplied by the board, the successful completion of not less than 20 hours of board-approved CME. An applicant for renewal of licensure who fails to evidence satisfaction of the continuing medical education requirements prescribed by these rules shall be given written notice of such failure by the board.
PREFERRED PHYSICIANS ORGANIZATIONS
A Preferred Physician Organization (PPO) is a managed care organization of medical doctors, hospitals, and other health care providers who have agreed with an insurer or third-party to provide health care at reduced rates to the insurer’s or administrator’s clients.
CONTRACTINGWITH HEALTH PLANS
Physicians must practice caution when entering a contract with health plans. Here are some things to keep in mind:
• Choose which third party payers with whom you are interested in contracting. You can do this by assessing the coverage of your patient population to see which 3rd parties are used most often. Usually, 50 responses or four weeks of data collection, via survey, should give you enough information to make a decision. • Research companies. Reach out to colleagues to see if they have contracts with insurance companies with whom you are interested in establishing contracts. If they do have contracts with any of these companies, request a contact name, phone, or email address. Also, ask them about their personal experience with the company. If none of your colleagues have similar practices, you can also reach out to your Medical Director. Insurance companies also have “provider lines” which you can call for information. Ask them if your practice will be considered a “medical practice” or an “ancillary practice.” They often have different employees handling these types of applications. • Contact insurance company. Try to get the name and number of a contact person and ask them to send you an application. Companies often ask for a letter from your clinic requesting to become a provider. • Get a NPI (National Provider Identifier) for practice and clinicians. A NPI is a 10-digit code identification number given to healthcare providers in the United States by the Centers for Medicare and Medicaid services (CMS). • Credential your clinicians. Register your clinicians with the Council for Affordable Quality Healthcare’s (CAQH) - Universal Provider Datasource (UDP). Keep copies of all clinical licenses, medical degrees, DEA information, overhead insurance coverage, board member’s information, hours of operations, NPIs, Tax ID Number, and SSN of managing officers. You will need these to complete the application. • The application. Keep a copy of your applications and attachments for your records. Follow up regularly with questions such as: • The status of your application. • When the board meets to approve new applications. • How long will it take to receive the fee schedule and contract (once your application is approved). • When you may begin charging the insurance company for their covered patients.
CONTROLLED DANGEROUS SUBSTANCE (CDS) LICENSE RENEWAL CME REQUIREMENT
Pursuant to Act 76 passed by the Louisiana Legislature during the Regular Legislative Session of 2017, all practitioners with a Controlled Dangerous Substance (CDS) license in Louisiana are now required to complete three hours of LSBME-approved continuing medical education (CME) for the 2019 renewal year. An authorized prescriber renewing his/her license for the first time in 2019may be excused fromtheCME requirement upon submission of a certification attesting that he/she has not prescribed, administered, or dispensed any CDS during the entire year covered by the prescribers’ expiring license. The LSBME will verify this through the Louisiana Prescription Monitoring Program. An exempted licensee, who subsequently prescribes, administers, or dispenses a CDS shall satisfy the CME requirement as a condition to license renewal for the year immediately following that in which the CDS was prescribed, administered, or dispensed.
22 La State Med Soc NEW PHYSICIAN’S GUIDE
La State Med Soc NEW PHYSICIAN’S GUIDE 23
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