 Illinois Healthcare Law Attorney, Diane M. Frantell is typically too busy successfully representing physicians against the carriers to publish frequently. Ms. Frantell is a valued member of the Academy's Advisory Board and, in our opinion, one of the best healthcare attorneys in the United States.
The Academy sincerely thanks her for presenting this matter to our Illinois members and friends. |
By: Diane M. Frantell, Esq.
Changes to the Fee Splitting Prohibitions of the Illinois Medical Practice Act of 1987
On August 24, 2009, Governor Pat Quinn signed into law, changes to the Illinois Medical Practice Act, which will affect some members.
Specifically, the fee splitting prohibition has been altered to allow certain percentage payments made in the business of medical practices. Members should be aware that there is still a prohibition against dividing, sharing or splitting a professional service fee with anyone in exchange for a referral. Fee Splitting is still not generally allowed, however, there are new fee percentage arrangement exceptions:
Fee Percentage Arrangement Exception-Medical Billing Companies. Percentage fees paid for billing, administrative preparation and collection of fees are now allowed. A physician would not be subject to discipline for paying a percentage fee to a medical billing company as long as certain limitations are followed. The first is that the compensation to the billing company must be consistent with fair market value. Members should make sure that they have some sort of written evidence of what the market allows for the medical billing service and should keep that file. The second exception is that the physician must determine the fees to be charged and what is actually collected. The physician should set his/her own fee schedule and authorize all collection activity as respects each patient. The third exception is that all of the fees charged must be paid directly to the physician by being deposited directly into an account in the name of the physician or an account that is under his/her sole control. Funds may also be deposited into a Trust Account owned by a licensed collection agency in accordance with the requirements of the Illinois Collection Agency Act.
Fee Percentage Arrangement Exception-Concurrently Rendering Service. This exception allows health care workers who provide concurrent care to receive adequate compensation for their services.
Fee Percentage Arrangement Exception-Pooling, Sharing, Dividing or Apportioning Professional Fees and Other Revenues. This exception allows health care workers who are in recognized physician practice entities to split fees based upon a percentage. Recognized physician practice entities are legally operating medical corporations, professional corporations, professional associations, limited liability companies, hospitals or physician-owned ambulatory surgery centers.
Fee Percentage Arrangement Exception-Bona Fide Advances. This arrangement allows a nonphysician to take a security interest in physician accounts receivable, but only, if the physician retains full responsibility and control of the collection activities.
It should be noted that the new statute also specifically prohibits paying a percentage fee: for marketing or management of a physician practice; for a physician to participate in a healthcare provider network; for someone to negotiate fees, charges, terms of service or payment on behalf of a physician practice; or for the inclusion of a physician in a program providing an incentive for beneficiaries or patients to use his/her service.
September 11, 2009
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