A concierge medicine legal issues checklist

A concierge medicine legal issues checklist is handy for physicians contemplating a concierge medicine practice and concerned about legal questions.

Concierge medicine legal checklist

Two doctors came to our law firm asking for legal advice on transitioning to a concierge medical practice.

Before advising them, here are some of the fundamental questions we asked:

  • Are each of you participating, non-par, or opted out of Medicare?
  • What are the names of the private insurance panels for which you are participating, in-network providers? Do you have the participation agreements and other related documents handy?
  • What services would you like to have reviewed (what services would you like to see if you can offer in your concierge practice)?  What is the patient care population?
  • What are your existing practice forms–do you have consents; new patient information form; medication record; and other medical practice forms?
  • What do you currently have by way of HIPAA compliance?

These are good starter questions.

Medicare status is important because creating a concierge medical practice is much easier when a physician is opted out of Medicare.  If the physician is Medicare par or non-par, then Medicare rules must be reviewed for limitations on concierge medical billing (i.e. payments outside the Medicare system), and the services must be cross-checked against what Medicare already covers.

Private insurance contracts need to be reviewed as they can impose limitations on payment and billing arrangements outside the agreements.

Concierge medical services require review to be sure they are not prohibited by Medicare (if applicable), private insurance contracts (if applicable), or some other source of legal authority.

Practice forms also need to be given legal review and harmonized with any concierge medicine agreement.

And finally, HIPAA compliance still matters.

Concierge medicine legal resources

For other legal resources on our blog about concierge medicine, see:

Don’t think about purple elephants.  Contact us to structure your concierge medicine legal practice.

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Michael H Cohen Healthcare & FDA Lawyers

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