Physician Service Agreement With Hospital

• Category: Contracts - Physicians
• State: Multi-State
• Control #: US-00771BG
• Format: Word; Rich Text

Description Physician Professional Corporation

A corporation may be organized for the business of conducting a profession. These are known as professional corporations. Doctors, attorneys, engineers, and CPAs are the types of professionals who may form a professional corporation. Usually there is a designation P.A. or P.C. after the corporate name in order to show that this is a professional association or professional corporation. Although no definite rule exists for determining whether one is an independent contractor or an employee, certain indicia of the status of an independent contractor are recognized, and the insertion of provisions embodying these indicia in the contract will help to insure that the relationship reflects the intention of the parties. These indicia generally relate to the basic issue of control. The general test of what constitutes an independent contractor relationship involves which party has the right to direct what is to be done, and how and when. Another important test involves the method of payment of the contractor.

An agreement physician contract with an insurance company is an essential arrangement that outlines the terms and conditions for medical service provision between a physician or medical group and an insurance company. This binding contract ensures clarity and establishes a mutual understanding between both parties involved. The agreement physician contract regulates the rates, services, and responsibilities of each party, ensuring a seamless and efficient healthcare system. In such contracts, there are typically several types, each serving a specific purpose. Some common agreement physician contract types include: 1. Fee-for-Service Contract: This type of contract establishes payment rates for each specific service provided by the physician. It delineates the agreed-upon fee for each service delivered, allowing the physician to bill the insurance company accordingly. 2. Capitation Contract: In a capitation contract, the insurance company pays the physician a fixed amount per patient per period (usually monthly or annually). This type of contract provides an incentive for physicians to focus on preventive care and manage the overall health of their patients. 3. Preferred Provider Organization (PPO) Contract: PPO contracts are agreements between the insurance company and a network of healthcare providers, including physicians. These contracts offer discounted rates to patients if they visit network providers. Physicians who sign PPO contracts agree to accept lower reimbursements in exchange for an increased patient base. 4. Exclusive Provider Organization (EPO) Contract: Similar to PPO contracts, EPO contracts also involve a network of physicians and hospitals. However, EPO contracts typically require patients to see only in-network physicians, except in case of emergencies. EPO contracts may provide higher financial incentives to physicians but limit their patient pool. 5. Medicare or Medicaid Contract: These contracts relate specifically to physicians who opt to participate in government-funded healthcare programs such as Medicare (for the elderly) or Medicaid (for low-income individuals). These contracts regulate reimbursement rates and specify the services covered by these programs. 6. Bundled Payment Contract: In bundled payment contracts, the insurance company pays a single fee to cover multiple services or treatments related to a specific condition or procedure. This type of contract encourages physicians to provide cost-effective care and coordinate services across different healthcare providers. 7. Accountable Care Organization (ACO) Contract: ACO contracts involve a coordinated approach to healthcare delivery, where a group of providers, including physicians, work together to provide cost-effective care to a specific patient population. These contracts often include financial incentives based on improved patient outcomes. In summary, an agreement physician contract with an insurance company is a crucial contractual arrangement defining the relationship, payment terms, and services between physicians and insurance companies. Understanding the nuances of these contracts ensures clarity and enables efficient healthcare delivery.