Practicing Medicine in Multiple States: Inherent Medical Billing Challenges

Contrary to single-location practices that were the norms during olden days, the recent trend has been the exploring of practice opportunities in multiple locations. It is not strange for a medical practice/clinic/hospital to expand its operations beyond the original location once it has built up a considerable reputation. Moreover, multiple-location operation has its own advantages: economies of large-scale operations, regional advantages, off-setting adverse practice results in some dormant locations against the profitable locations, and above all nurturing the vision of nation-wide presence.

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While some of these expansions are well-planned, often there have been cases that emerge as reflexive actions to situations or circumstances. And these circumstantial expansions are the ones that will be vulnerable to regional rules and regulations. Although, the U.S. healthcare norms generally tend to be rationalized, yet each of the Federal states does exercise some degree of authority when it comes to governing certain clinical and operational functions. Therefore, it is imperative that physicians/clinics/hospitals on the verge of expansion plans realize, anticipate, and respond positively to the advantages and restrictions in the states in which they embark on clinical practices desire to have a presence.

  • One of the foremost issues associated with multiple-location operations is the registration. Although, your practice, clinic or practice is licensed to be clinical operational entity, yet you still require to be registered in each of the states you intend to expand yours operations to. Failure to comply with this norm will be deemed as violation of the law, and state will have every right to expel your operations from the state/s concerned.
  • Rules regarding fee-splitting, corporate practice of medicine and scope of practice vary from state to state. As these diverse rules directly impact your contracts and compensation methodologies, it is important to be mindful of diverse rules prior to foraying into multiple-location practice.
  • Insurance agreement regarding employees and contractors are governed differently across the states. Therefore, it is necessary to get your agreements tailor-made to the governing rules of the state/s you intend to open your practice.
  • Medicare billing requirements too vary across the states. Therefore, it is crucial to adapt to the requirements of the state with regard to local coverage decisions and other factors. Certain states may audit more than others or have other unfamiliar requirements to which you will need to adapt.
  • Certain states do not encourage professionals with multiple operating licenses. Therefore, it is important verify your physicians’ operating license before taking them on board while expanding your business operations to multiple states or states with such restrictions.
  • Certain states have their own policies when it comes to monitoring marketing communication associated with healthcare. Therefore, it is important you know what is allowed to be communicated and what is not.
  • There are also state-specific laws that govern practices operating over the internet or telecommunication medium. Therefore, it is important that you know and respect the laws that govern dissemination or exchange of healthcare data over this medium.

While these are apparent issues associated with operating in multiple locations, there could be more that are often elusive but pertinent to physicians/hospitals’ clinical and operational excellence. Moreover, negligent attitude to them can adversely impact both clinical and operational efficiency. Physicians, who may not be in a position to track such elusive factors, need necessarily have to solicit expert advice from competent and credible sources. – providing medical billing services across all 50 US states, being the largest consortium of medical billers and coders competent to advice on diverse clinical and operational rules prevalent in diverse states across the U.S – comes across a preferential name in the healthcare services outsourcing industry.