Article | March 22, 2022

Fair Market Value Determinations and Acquisition Challenges for Medical Practices

The Current Environment

Physicians are becoming employees of the Hospital or hospital enterprise. The level of reimbursement challenges and Practice hassles have combined to change the concerns of purchasers from “how much should we pay for the Practice” to “how can we be sure that we are paying appropriately and billing compliantly.” Increased Practices are being purchased, but the private practice approach by the physician may be hard to meld easily with the Hospital environment.

Their concerns are not always the same as the Hospital, yet there needs to be an understanding and agreement of how specific issues should be handled—such as staffing, patient care coverage, documentation, coding and billing.

Specific Issues Being Faced:

  • Fair Market Value of Amount
    • How to base compensation initially and fairly set rates for the future. Understanding and implementing features to measure individual productivity (including bundling of services) and use of non-physician providers in RVU methodologies.
  • Medicaid Requirements Different than Medicare
    • In some states, Medicaid will not pay for a professional fee and the facility fee billed on separate claims—UB and Form 1500. Determine if the billing is provider-based, and what methodology is compliant for each payer.
  • Documentation of Services Provided
    • Moving the physician to needed standards is challenging dependent upon the way the physician has been documenting in private practice.
  • Selection of Codes/Services to Be Billed
    • This is always a key component of any physician compliance plan. We provide an unique approach creating understanding and improvement to address ongoing income considerations of pricing and contract needs to be evaluated.

Approach to Improvements

The philosophical approach to compliance and operations is to evaluate the details while understanding the global problems, and implement understandable guidance and specific tools to allow our providers to succeed.