Physicians
Contract Negotiations for employed physicians: What you need to know!
Employed_physicians-Contract_Negotiations-Atty_Mike_Igel.pdf
MICHAEL A. IGEL
Attorney
200 Central Avenue, Suite 1600 St. Petersburg, FL 33701
Phone: 727-896-7171 Fax: 727-820-3982
Direct: 727-820-3963
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FMA’s 2013 legislative agenda and fact sheets are posted on the FMA website. To access the fact sheets, please visit the following: www.fmaonline.org. Once on the home page, at the top of the page, highlight the “Advocacy” Tab and then click on “Legislative Affairs” in the drop-down list. From there, on the right hand side of the new screen, click on “Issue Briefs & Fact Sheets”. Please note that such documents are for members-only and so you will be required to log in to access these documents. If you have any trouble logging in, you can request help on that screen or call the FMA for assistance.
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License Renewal Process
Please click on the link below for information concerning the renewal of your medical license.
http://doh.state.fl.us/mqa/medical/me_ceu.html
For Initial Licensure
All applicants must have completed a minimum of two (2) hours of an approved prevention of medical errors course since June 1, 2002.
For Licensure Renewal
For first renewal, all physicians initially licensed within the biennium are exempt from the continuing medical education (CME) requirements for renewal with the exception of:
Two (2) hour course relating to prevention of medical errors
One (1) hour of HIV/AIDS.
Otherwise, all physicians must complete:
Two (2) hour course relating to prevention of medical errors
Two hours of Domestic Violence as part of every third biennium renewal (or every six years)
38 hours of general CME
Up to 5 credit hours per biennium may be fulfilled by performing pro bono medical services for entities under the Department of Health, Volunteer Health Care provider programs, in an area of critical need and in Community and Migrant Health Care Centers.
Three (3) to six (6) credit hours may be fulfilled by serving as a monitor
Up to 5 credit hours may be fulfilled by any volunteer expert witness who is providing expert witness opinions for cases being reviewed pursuant to Chapter 458 or 468, F.S., in the area of risk management for each case reviewed up to a maximum of 15 hours per biennium
Five (5) credit hours in the subject area of risk management or medical ethics may be obtained by attending one full day or eight (8) hours, whichever is more, of disciplinary hearings at a regular meeting of the Board of Medicine in compliance with the following:
The licensee must sign in with the Executive Director of the Board before the meeting day begins.
The licensee must remain in continuous attendance.
The licensee must sign out with the Executive Director of the Board at the end of the meeting day or at such other earlier time as affirmatively authorized by the Board. A licensee may receive CME credit in risk management or medical ethics for attending the disciplinary portion of a Board meeting only if he or she is attending on that date solely for that purpose; he or she may not receive such credit if appearing at the Board meeting for another purpose
See Rule 64B8-13.005, F.A.C. for more information about continuing education requirements.
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Dear Physicians:
Have you ever thought about a great way to give back to your local community through education? How about being a preceptor for eager and talented clinical students from a local Physician Assistant Program?
Barry University Physician Assistant Program at St. Petersburg College is currently accepting applications for physicians to become preceptors for the Physician Assistant students during their clinical year.
Preceptors are needed in the core rotations: Internal Medicine, OB/GYN, Pediatrics, Emergency Medicine, Family Medicine, Surgery, and Psychiatry.
7 Reasons why you should become a Barry University Preceptor:
1. Share your knowledge and experience with the next generation of medical professionals.
2. Become a Barry University Adjunct Professor.
3. Distinguish yourself as a role model and teacher.
4. Earn Category II CME for recertification.
5. Gain access to free attendance at the annual Primary Care Recertification Review each December.
6. PA Students are covered under Barry University's Malpractice Insurance Policy with $1,000,000/$3,000,000 limits.
7. Students are a great source of future employees.
For more information, please contact me directly.
Regards,
Gregory L. Burns, MMS, PA-C
Associate Director of Clinical Education/Assistant Professor
Barry University Physician Assistant Program
St. Petersburg College, Health Education Center
7200 66th Street North
Pinellas Park, FL 33781
305-899-4044-office
305-899-4083-fax
gburns@mail.barry.edu
www.barry.edu\pa
Florida Board of Medicine - Mailman System
One of the Board of Medicine's missions is to disseminate appropriate information to consumers and practitioners. In an effort to reach out to more applicants, licensees and the public to provide information, the Board has established a "Mailman" system. Each time the Board of Medicine posts new items in Mailman, subscribers receive an email including that information.
Examples of the types of updates provided by the Mailman system includes changes in the law and board rules, reminders about legal requirements and updates that impact physicians and patients in Florida. Subscriber' email addresses are not publicly displayed and are not posted onto the Board's website or onto public practitioner profiles. You are encouraged to subscribe and instructions for how to sign up are as follows:
Instructions for Joining the Board of Medicine's Mailman System
Step 1: Go to http://www.doh.state.fl.us/mqa/medical/index.html
Step 2: Select Interested Parties (Mailman) from the left side of the screen
Step 3: Enter your email address where indicated
Step 4: Click on Subscribe
You will receive a confirmation of subscription.
When the Board of Medicine posts information, you will receive an email with the posted information.
Managed Care Information
The PCMA’s insurance committee meets regularly to evaluate physicians’ interaction and contracting with third party payers. To serve as a resource to address individual concerns of physician providers and the concerns of the Medical Association as a whole while ensuring fair and ethical payment practices.
Please email Anissa Raiford at araiford@pinellascma.org to submit an issue for the Insurance Committee to review. If you have a complaint or issue with a specific third-party payor, email us with the details and we’ll arrange to have you or the appropriate person in your office join us to resolve the issue when we meet with leaders and representatives of the specific insurance companies.
PCMA Managed Care Survey - The Pinellas County Medical Association (PCMA) is tabulating information about physicians’ relationships with insurance companies. Even if you are not a PCMA member, we value your input. On the following page is a list of several insurance companies doing business in Pinellas County; there is also a space for “other” if you do significant business with a company not listed.
PCMA Prompt Pay Survey - Your PCMA is asking for information from all physicians in the county in an effort to determine which insurance companies have not been following Florida law regarding prompt pay and other issues relating to reimbursement for your professional services.
Medicare/Medicaid
Maintaining Medicare Medical Records
Medicare Publication 100-16, Chapter 11 of the Internet Only Manual (IOM) provides information regarding records retention. Section 100.4 states, "Contracts must contain accountability provisions specifying that first tier and downstream entities must comply with Medicare laws, regulations, and CMS instructions, and agree to audits and inspection by CMS and/or its designees and to cooperate, assist, and provide information as requested, and maintain records a minimum of 10 years."
National Practitioner Identifier (NPI)
If you are a billing provider, your NPI will be your billing number for life. Your NPI does not belong to your employer or to any health plan, even if your employer or a health plan obtained it for you by bulk enumeration. It is the one number that identifies you as a health care provider in standard transactions with other health care providers, health plans, and health care clearinghouses.
Avoid Delays in the Processing of Your Medicare Provider Enrollment Applications
First Coast Service Options (FCSO) Provider Enrollment has compiled a list of common reasons for additional information (development reasons) from providers/suppliers regarding their submitted CMS-855 applications, and/or the CMS 588 application. Neglecting to provide the required information to complete your application will create delays to the provider/supplier. The list will help to ensure your application is complete and accurate. If development is requested by FCSO, providers and suppliers will need to review the development letter they received, and make the required corrections to their application in order to continue with the enrollment process. This information should be submitted to FCSO as soon as possible to expedite processing the application(s). FCSO asks that you not contact the customer service department, as they will have the identical information that is listed on the development letter. Click here for the list of common reasons.
"Doughnut Hole" In Medicare Drug Coverage Approaching For Some
With millions of seniors expected to reach a gap in their Medicare Part D prescription coverage before the end of the year, physicians should be prepared for questions from patients looking to avoid or delay any break in benefits -sometimes called the "doughnut hole." Seniors could face difficult choices about coverage if they are forced to pay out of pocket for prescriptions previously covered by Medicare Part D, and some could even decide to go without their prescriptions until their coverage begins again Jan. 1. Physicians can direct Medicare beneficiaries to
www.medicare.gov/bridging-the-gap.asp or tell them to call 800.633.4227 for information on pharmaceutical assistance plans and other ways of getting through the coverage gap period.
Regulatory Issues
Licensure
Licensure renewal notices have been mailed to the one half of Florida MDs whose licenses expire January 2007. If you have not received your licensure renewal information and are unsure if it is your year to renew, go to www.flhealthsource.com to view your profile, which has your license expiration date at the top. Renewals can be done via the Internet; this is recommended as you automatically receive proof of renewal when completed online. Waiting for written proof can take several weeks. Whether you renew via the Internet or by paper, please take the time to fill out the Physician Workforce Survey. This is a joint project between the FMA, the Department of Health and Florida medical schools. Information from the surveys will provide necessary data regarding the status of Florida's physician workforce that currently is unavailable.
Please note: If you are among the MDs whose license expires, remember that all CMEs must be completed by midnight of January 31. CME Web sites will be very busy as the deadline approaches, so you are encouraged to review your hours and take any necessary courses now.
Legal Waiver Available
Minimum Wage Poster
Prescription Update
National Practitioner Identifier (NPI)
If you are a billing provider, your NPI will be your billing number for life. Your NPI does not belong to your employer or to any health plan, even if your employer or a health plan obtained it for you by bulk enumeration. It is the one number that identifies you as a health care provider in standard transactions with other health care providers, health plans, and health care clearinghouses.
Rule on Internet Prescribing
The Florida Board of Medicine issued a rule that prohibits the writing of a prescription unless a patient evaluation, including a history and physical examination, has been performed. It was implemented to address the Internet prescribing cases that were coming before the Board, but the rule also covers any other type of telemedicine prescribing, including by phone. To view the rule, click here.
DOH Auditing Profiles
The Florida Department of Health currently is auditing the disciplinary history and medical malpractice claims information self-reported by Medical Doctors in their Practitioner Profiles against the data reported to the National Practitioner Data Bank.
Board of Pharmacy Rule Invalid
An administrative law judge (ALJ) recently issued an order stating that the Board of Pharmacy exceeded its rulemaking authority when it passed a rule allowing pharmacists to substitute another drug for the one prescribed by the physician without the physician’s approval. The ALJ found the rule invalid. For more information about the rule and the FMA challenge, click here.
CMS Regulation on Records Retention
Medicare Publication 100-16, Chapter 11 of the Internet Only Manual (IOM) provides information regarding records retention. Section 100.4 states, "Contracts must contain accountability provisions specifying that first tier and downstream entities must comply with Medicare laws, regulations, and CMS instructions, and agree to audits and inspection by CMS and/or its designees and to cooperate, assist, and provide information as requested, and maintain records a minimum of 10 years."
Physician Profiles
The Florida Department of Health has published its Practitioner's Guide to Completing and Updating the Profile. This guide provides information to practitioners on what data is reported by the practitioner or other sources, what facts are verified by DOH, and whether the information is optional or mandatory. The guide also provides instructions on how to complete and update the practitioner profile. If you have any questions about the guide or updating your profile, contact a Licensure Services Specialist at 850.488.0595, ext. 3 for assistance, Monday-Friday, 8:00 a.m.-5:00 p.m., excluding state holidays.
Practitioner profiles are required for all Medical Doctors (MDs), Osteopathic (DO), Chiropractic and Podiatric Physicians, and Advanced Registered Nurse Practitioners licensed in Florida. The profile contains required and optional information from the practitioner. Optional information may include committees/memberships, professional or community service awards, and publications the practitioner has authored.
Worker's Compensation
Listed below is information needed when treating Florida workers' compensation patients.
Do not hesitate to contact the Agency if you need additional assistance (850) 922-6481. Hours are 8am - 5pm, Monday - Friday.
All health care providers MUST receive authorization from the carrier (WC insurance companies) BEFORE treating the patients.
Certification
According to Florida workers' compensation law, s.440.13 (3)(a), F.S., a health care provider must be certified. You may access a copy of the certification application by following the instructions below or clicking on this link-This will open the certification application that may be printed for completion. Complete the application. Mark number 4 as N/A as this education requirement was rescinded as of October 1, 2001. Mail the signed and accurately completed application to the address noted at the top of the application. Additionally, you will want to review the Health Care Provider Certification Rule, 59A-29, Florida Administrative Code.
When printing this document, identify only pages 298 - 302 or you will print the entire chapter.
Heatlthcare Provider Certification Database
You may verify your certification status. If you have non-physician employees that require certification, you may wish to check the database FIRST to determine if they are already certified.
Treatment and Status Reporting Form
(to be completed by physicians) The DWC-25, required Florida Workers' Compensation Uniform Medical Treatment/Status Reporting Form with instructions. Completion instructions are available by clicking this link. Additional information is available in the DWC-25 Completion Tutorial.
(It might be helpful to print out the tutorial to review, as this is a relatively new form). INSURER
Databases/WCMCA List
View or print a list of the insurers authorized to provide WC coverage in Florida
List of the WC Insurers/Administrators for WC insurers in Florida:
To obtain a list of the Workers' Compensation Managed Care Arrangements, send an email request to Jane Martin.
Reimbersement
The 2005 Florida Workers' Compensation Health Care Provider Fee for Service Reimbursement Manual is effective for dates of service on or after
May 9, 2005. You may download or print a copy of the manual at no charge or you may purchase a copy of either manual for $0.50 per page (there are approximately 360 pages). An order form is available on the Division of Workers' Compensation page, noted above, listed under 'Publications". The new 2005 Florida Workers' Compensation Health Care Provider Reimbursement Manual, 2nd edition, will become effective September 4, 2005 and may be obtained from the Division website: www.fldfs.com/WC.
Billing
Another important document is the Florida Workers' Compensation Billing, Filing and Reporting Rule, effective July 4, 2004, which instructs health care providers how to bill for services and which billing forms to use. You may print this copy (print all pages). Obtain specific instructions for completion of the DWC-9 (HCFA 1500) medical services billing form. FLORIDA LAW
In order to access a copy of the Florida Statutes (FS): Access the Division of WC web site: locate the list on the left side of the screen; scroll down to "Ch.440, FL Statute". This enables you to view or print a copy of Chapter 440, which contains the statutes relating to
Florida Workers' Compensation. Subsection, 440.13 F.S., is the section specific to medical services. Other subsections of the statues important to physicians treating patients covered under the Florida workers' compensation system are subsections 440.09(1), 440.13(16)(a)and 440.15(3)(a) 1-4, F.S. These sections address "major contributing cause", "objective relevant medical findings" and the physician's responsibility regarding Permanent Impairment. The Florida Impairment Rating Guide may be obtained from the Florida Workers' Compensation Institute (FWCI) at (850) 425-8156.
Immediate reference to the 1996 Florida Impairment Rating Guide. The Agency for Health Care is not the publisher of this site and does not acknowledge that the entire impairment rating guide is identical to the printed copy available from FWCI.
Retiring/Closing/Relocating a Practice
Section 456.057, Florida Statutes, sets forth the requirements that must be followed when a physician retires, closes his office or relocates his practice. The statute adopts the concept of a “records owner.” A “records owner” may or may not be a physician. A “records owner” means any health care practitioner who generates a medical record after making a physical or mental examination of, or administering treatment or dispensing legend drugs to, any person; any health care practitioner to whom records are transferred by a previous records owner; or any health care practitioner's employer, including, but not limited to, group practices and staff‑model health maintenance organizations, provided the employment contract or agreement between the employer and the health care practitioner designates the employer as the records owner. Section 456.057(2), Florida Statutes. The statute now requires the “records owner” to notify patients of the retirement, closing or relocation of a physician. When the records owner retires, terminates a practice, or is no longer available to patients, Section 456.057(13), Florida Statutes, requires the records owner to notify the patients of the termination, relocation or unavailability in the following manner:
1. Publish in a local newspaper a notice containing the date of termination or relocation and include an address where the records may be obtained from the physician terminating practice or another licensed physician. This is now required by law (Florida Administrative Code 64B8-10.002(4).) A copy of this notice must also be submitted to the Florida Board of Medicine.
2. Physicians may also, but are not required to, notify patients in writing of the date of termination or relocation and include an address where the records may be obtained from the physician terminating practice or another licensed physician) or place a sign in a conspicuous location on the façade of the physician’s office.
3. Both notices must advise patients of their opportunity to obtain a copy of their records.
In addition, Section 456.057(14), Florida Statutes, requires that the records owner notify the Florida Board of Medicine and advise the Board who the new record owner is, and where the physician’s medical records can be found. The records owner should also review all managed care contracts to determine if any notification provisions must be complied with.
This change will primarily affect employed physicians whose employment agreement designates the employer as the records owner. It will have little effect on other physicians, especially those physicians in independent practice. In that case, the physician who generated the record after treating the patient will be considered to be the “records owner,” and, therefore, the requirements discussed above will fall upon the physician. In the case of an employed physician (whose employment agreement designates the employer as the records owner), this responsibility is placed upon the employer.
It is important to note that the Board of Medicine has adopted a rule that imposes certain requirements on physicians who relocate or terminate their practices and are no longer available to patients. Rule 64B8-10.002(4), Florida Administrative Code, requires physicians to publish a notice once a week for four consecutive weeks in a local newspaper of greatest circulation. The notice must contain the date of termination or relocation and include an address where the records may be obtained from the physician terminating practice or another licensed physician. A copy of the notice must be submitted to the Board within one month from the termination or relocation. The rule also gives physicians the option of either placing a sign in a conspicuous location in or on the façade of the physician’s office or notifying patients by letter of the termination, sale or relocation of the practice (this is NOT required, however), in addition to publishing the notice in the local newspaper. The sign or letter must notify patients of their opportunity to transfer or receive their records. The requirements set forth in the Board’s rule are separate and apart from the requirements set forth in Section 456.057, Florida Statutes, and must be followed by all licensed physicians.
Concomitantly, a physician is responsible for ensuring that these records will be available to his former patients for a period of five (5) years from their last visit. A physician thus must make arrangements to either have another physician become the new records owner, have a medical records service store copies of the medical records and provide copies upon request to former patients, or himself be available to provide copies.
