Independent Physician Agreement
THIS INDEPENDENT PHYSICIAN AGREEMENT (this “Agreement”) is made effective on the _____________ by and between Medical Office Force, LLC, with address at 2005 Prince Avenue Athens, Ga. 30606 (hereinafter the “Group”) and _______________with address at ________________(hereinafter the “Physician”).
WHEREAS, Medical Office Force, LLC is a group Provider;
WHEREAS, the Group desires to contract with the Physician in the practice of medicine;
WHEREAS, the Physician will act as a medical practitioner for the Group in the aforesaid capacity;
WHEREAS, the Group and the Physician agree to enter into the Agreement setting forth in writing the terms and conditions herein.
NOW, THEREFORE, FOR and in consideration of the foregoing premises, there Parties is hereby agreed as follows:
REPRESENTATIONS
Physician represents that he/she is a duly licensed medical practitioner in good standing where he/she shall be required to perform his/her duties pursuant to this Agreement.
TERM OF AGREEMENT
This Agreement shall take effect, and the Group shall contract with the Physician on the date of effectivity of this Agreement. The group shall contract with the Physician and further agree that such employment shall continue until either party terminates the Agreement expressly made in writing.
RESPONSIBILITIES OF GROUP
A. The group will sign a BAA to protect the patient’s health information (PHI) shared by the Physicians.
B. The group will analyze the patient data and help to identify high risk patients, and who will qualify for CCM and RPM per Medicare guidelines.
C. The group will help Physicians to register patients in CCM and RPM services, as well as educate the patient about the services and use of devices for monitoring patient data.
D. The group will provide the cellular device to the patient and educate, monitor the patient data, and create a monthly report.
E. The group will respond to out-of-range data using electronic messaging to the patient and Physicians and will occasionally call the patient and or Physicians (non-emergent service) if the data is significantly out of range.
F. The group will create a comprehensive care plan as well as monitor patients using monthly calls as per Medicare guidelines.
G. The group will help the Physicians to reassign Medicare benefits for CCM and RPM.
H. The group will help Physicians to credential with commercial insurance through CAQH.
I. The group will develop a monthly report to justify RPM and CCM services and bill to payers and collect reimbursement.
J. The group will provide Physician monthly reimbursement based on collections and fixed rate per Medicare guidelines.
RESPONSILITIES OF PHYSICIAN
A. Physicians will provide patient medical information electronically or access to the patient chart.
B. Physicians will identify high risk patients where the CCM and RPM is medically necessary and order the service.
C. Physicians shall obtain face-to-face consent to provide medically necessary CCM and RPM.
D. Physicians or staff will forward the information as well as support and resolution of escalations developed during digital monitoring of the Physician’s patient.
PATIENT RECORDS AND NON-DISCLOSURE
The group will sign a Business Associate Agreement with the Physicians, to protect all patient information (PHI).
COMPENSATION
The Physician shall receive as compensation in the amount(s) of $20.00 per month per patient for each completed reimbursed CCM, and $30.00 per patient per month for each completed reimbursed RPM. Physicians shall submit a monthly invoice to the Group on or before the 5th of the month.
The Group will provide the number of medical services provided through CCM and RPM digital services and the Physicians will invoice the group based on the report provided.
The Physician is eligible for a quarterly bonus if all metrics are met.
a. Timely response to escalations.
b. Continue to discuss services during office visits.
c. Timely completion of signature on required documents.
The Group shall have the sole discretion to determine whether to award Physician a bonus and the amount of any bonus to be awarded. Physicians acknowledge that any bonus awarded under this Section is not earned until paid.
TERMINATION AND SUSPENSION
The parties agree that any Party may cause the termination of this Agreement by serving a resignation/termination with sixty (60) days’ notice;
ASSIGNMENT
No part of this Agreement shall inure the benefit of the Physician’s assigns, beneficiaries, heirs, or legal representatives without the Group’s prior written consent, except as to designation by Physician a beneficiary to receive any benefit payable hereunder upon the death of the latter, or for the assigns, executors, administrators, or any other legal representative to represent Physician or Physician’s Estate.
AMENDMENT
No amendment or modifications to this Agreement shall be made effective and enforceable unless or until such is made in writing and signed by the parties hereto.
CONFIDENTIALITY
For the purpose of this Agreement, confidential Information shall mean any information of the Group, owned by them or acquired through the service activity provided by the latter, including business methods, fees, trade secrets, patient records, medical abstracts, and other management methods which are not publicly known. The Physician shall not disclose any information to be deemed confidential without the Group’s express written consent. The foregoing notwithstanding, in the event that the Physician is legally compelled or required by any competent authority to disclose and such confidential information, it shall promptly notify the other party so that the latter may be able to seek protection order or avail itself of other appropriate remedies and/or waive compliance with provisions hereof. The provisions of this section shall survive the termination of this Agreement for whatever reason.
WAIVER
The failure of any party to demand their right to exercise compliance in this Agreement shall not constitute a waiver by said party. Any waiver by and party to any breach constituted by the other must be made in writing and signed by the party waiving such right.
ARBITRATION
The parties hereby agree to submit all disputes and controversies arising from this Agreement by arbitration. The arbitrator shall be selected by both Parties and the arbitration shall be conducted pursuant to the National Health Lawyers Association Alternate Dispute Resolution Service Rules of Procedure for Arbitration and pursuant of the rules and auspices of the American Arbitration Association; The arbitrator’s authority shall be limited to the strict interpretation of its terms of this Agreement. Any resolution by the arbitrator may be reviewed by the court of competent jurisdiction.
GOVERNING LAW
The construction and interpretation of this Agreement shall always and in all respects be governed by the laws of the State of Georgia.
SEVERALBILITY
Should any of the provisions of the Agreement be determined to be invalid, illegal or unenforceable in whole or in part, such invalidity, unenforceability, or illegality shall only affect the said provision, and the remaining provisions hereto shall remain valid, legal, and enforceable.
COUNTERPARTS
This Agreement may be executed in two or more counterparts, each of which shall be deemed an original, but all of which together shall constitute one and the same instrument.
NO EMPLOYER-EMPLOYEE RELATIONSHIP
The Physician is not an employee and shall at all times remain responsible for payment of all taxes due to her/him as a professional with taxing authorities.
IN WITNESS WHEREOF, the Parties hereto have duly executed this Agreement under seal as of the day and year first above written.