How to Craft Provider Contracts That Deal with Board Sanctions and Protect the Practice

Many provider contracts commonly address the handling of board actions regarding the provider’s prior history as well as their ongoing employment or partnership with the practice, said Briskin.

“Physician employment and partnership agreements commonly require the individual physician to state at the beginning of the relationship that the physician is licensed in good standing without restrictions to practice medicine in each state in which the physician is to practice, and provide that the medical group may terminate the physician’s agreement if that ceases at any time to be so,” Briskin added.

A practice may go further and require that the provider disclose any previous disciplinary action taken against them, even if resolved, and may also include discipline taken by medical facilities as well as by state authorities, said Briskin. In addition to providing a fuller picture of the provider’s work habits and history, this requirement ensures that the provider has nothing on their record that might affect their ability to work and bill at the practice, such as a payer exclusion.

It’s not just billing that affects the revenue of the sanctioned provider. Insurers may boost your liability premiums in response to a provider sanction. It pays to anticipate this in the contract.

“Groups are generally free to structure their compensation arrangements with physicians in a manner that can account for costs that are specific to each physician, such as higher insurance premiums,” Briskin concluded. Be sure to review state law first, though, to make sure it allows you to do this.