Clearly define nonphysicians' status, role

Often, when physicians begin providing ancillary services, they move into the world of contracting independently with nonphysician staff to help provide those services.

Many of my clients have worked with physician assistants, advanced practice nurses and physical therapists to provide services to patients. When structuring contracts with nonphysicians, it is imperative that you carefully consider all legal, regulatory and financial issues associated with providing ancillary services.

The key issues before signing a professional service contract for ancillary services include liability, scope of practice, supervision, documentation and billing.

The issue to consider first is liability, in the sense of defining the status of all parties in the relationship and professional coverage.

Most contracts with nonphysicians for ancillary services identify the professional as an independent contractor of the practice, if he or she is not an employee.

You should indicate in the contract that this person is neither an employee nor an agent of your practice and that the provision of service does not create a joint venture, partnership or other affiliation.

You also should make sure that any individual providing ancillary services has professional liability insurance and that coverage extends to services provided to your patients. Make sure you receive certificates of insurance before any services are performed within your practice.

If you are contracting with a staffing agency, these steps should be a prerequisite before any nonphysician sets foot in your practice. Also, consider contract language that addresses apportionment of liability and damages indemnification.

Next comes scope of practice. It is crucial you confirm that all nonphysician professionals have appropriate credentials, licensure and insurance coverage to provide services before the contract begins.

Some physicians conduct a background check to ensure professionals are not involved in pending administrative or legal actions, under investigation or sanctioned in a way that would affect their ability to provide contracted services.

In addition to complying with all applicable regulations, including state practice acts that govern specific professions, the contracted nonphysician must understand and abide by your practice's policies and procedures.

You should clearly define expectations and the professional's responsibilities within the contract, so there are no misunderstandings regarding the scope of practice. Make sure the defined responsibilities are consistent with the professional's education, training and expertise.

You should determine if the professional requires continuing education to maintain a license or achieve additional certification and identify who will be responsible for the cost. Also, investigate whether any regulatory issues might preclude this service from being offered by your practice.

Next comes supervision. Most states have regulations governing the amount of supervision nonphysicians must have when providing medical services within physicians' practices. You should consider incorporating the parameters of such regulations within your contract.

If the nonphysician professional provides services to Medicare or Medicaid patients, there likely will be further supervision requirements.

An important question to ask before signing a contract with an ancillary service professional is whether the physician in charge has the ability to supervise the delivery of care.

If you and the nonphysician are providing services in a separately licensed venue, such as an ambulatory surgical center or independent diagnostic testing facility, you should check state and federal laws regarding the provision of services and related supervision requirements.

Another important step is documentation. Concise, complete and timely documentation is critical to the delivery of services to patients and the protection of your practice. In the contract, you should require the ancillary services professional to document treatment provided in compliance with all policies, procedures and state and federal regulations.

You should regularly review medical records to ensure the services provided are being properly documented and that such documentation is not exposing you or your practice to any liability.

Depending on the professional service and site, payment for ancillary services generally is broken down in two components: professional and technical. If you are billing ancillary services "incident to" your services, make sure all codes and claims are properly completed and submitted.