Attachment A to CHMG Policy – Physician/Clinic Separation from CHMG
Physician Separation Checklist
(use if physician leaving, but clinic is not closing)
Physician Name:
Clinic Name:
Physician’s Separation Date:
Clinic Address:
Physician’s Last Date to See Patients
Clinic Phone Number:
Practice Administrator:
CHMG Operations Director:
Notify the following departments via e-mail of the physician’s separation as soon as basic information and dates
are determined. Please note that some notifications will generate work efforts in the respective departments.
(c)
Department
Accounting
Administration – CEOs
Central Scheduling
Clinic Billing & Coding
Community Health
Compliance
Credentialing
EMR
Finance
Human Resources
IS
(c)
Department
Mail Room
Marketing
Medical Records
Medical Staff
Payor Relations
Pharmacy
Physician Relations
Purchasing
Risk Management
Telecommunications
Detailed Separation Tasks (Some tasks already in department specific checklists)
Task/Issue
Notes/Description
Due
Date
Responsible
Marketing/Communication
Develop talking points Develop talking points addressing separation
reasons in collaboration with physician
separating, CEO, Physician lead,
administrative lead and project manager.
Include key dates....
Marketing
Leadership &
Notification
Communicate separation with leadership,
Board, Physicians, Service Line Director
Physician Lead
Medical Group
Communicate separation with Administrative
staff, Practice Administrators
Admin Lead
Physician Notification Communicate separation of physician with
community providers as needed. This can be
addressed in offline discussions instead of
broad based e-mail communication.
Marketing,
Physician relations
Patient Notification
Marketing, Practice
Administrator.
Communicate separation of physician/clinic to
patients with at least 45 days advance notice.
Communication should also include notice on
how to reschedule appointments and
information on calling about other physicians
who will be able to take over their care.
** COPIC requirement is 30, but 45 is more
proactive. Under no circumstances will
communication be less than 30 days.
1
Status
Attachment A to CHMG Policy – Physician/Clinic Separation from CHMG
Patient Scheduling
Arrange for patients to reschedule
appointments with other physicians. Notify
central scheduling and develop transition plan
for schedules. If no other physician acceptable
or available, advise patient of AMA or Colorado
Medical Society contact.
Practice
Administrator
Return mail
Advise staff of what to do with patient
notifications returned to clinic as undeliverable.
Tracking required.
Practice Admin
Physicians
Malpractice
CMO will review tail with physicians. CMO will
send information to Legal and Credentialing on
reason for termination. Legal will draft letter to
physician. Credentialing will review info from
CMO and route to Risk Management. Risk
Management will notify malpractice and
arrange transition of coverage to physician.
Legal, CMO
Outreach
Arrange for coverage for the physician’s
clinic/outreach areas
Admin Lead
Payor credentialing
Notify all payors of physician separation dateincluding Medicare and Medicaid.
Credentialing
Hospital Credentials
Determine ongoing Medical Staff credentials
and notify Medical staff. Include Physician
Lead in decision.
Admin Lead.
COBRA, Benefits
Review benefits including COBRA with
separating physician.
Human Resources
CLIA
Adjust CLIA License if physician leaving is
listed as lab director on the license.
Lab
Call
Adjust physician on call schedule.
Practice Admin
Tests
Follow-up on tests that were ordered prior to
separation. Make sure all tasks are completed.
Practice Admin
Future Orders/tasks
Run reports of these to allow staff to catch up
and reassign as needed
Practice Admin
Research
If physician was involved in research project,
notify Compliance Research Team and IRB
Practice Admin
Avatar/Press Gany
Provide all Avatar –North or Press Gany –
South information to appropriate manager
Manager for
Avatar/Press Gany
reporting
CME
Reconciliation of CME – that all is submitted,
paid and reconciled to annual limits
Finance
RVU Reconciliation Reconciliation of work RVUs after all
Finance
encounters are entered. Settle up any “bonus”
we may owe a provider.
Human Resources/Staff
Meet with Physician
Go through all separation activities with
physician
HR
Staff Transfers and
Terminations
Collaborate with management to determine
what staff needs to be repositioned at another
Practice Admin.
and HR
2
Attachment A to CHMG Policy – Physician/Clinic Separation from CHMG
clinic or within the system. If staff termination is
required, HR will take the lead on that. **30 day
notification to staff is required if job changes or
is eliminated.
Terminate badge
access
Retrieve badge from physician, and terminate
access with the badge from the system
Practice Admin
and HR
Payroll Notification
Notify accounting of when paycheck stops.
HR
Staff Paperwork
Complete Current Manager Checklist –
Transfer, Change of Status EAF and Computer
Access Request form for any clinic staff that is
transferring to another clinic or department.
Practice
Administrator
Purchasing/Equipment/Facilities/IT
Mobile Devices
All equipment (especially mobile devices)
collected & accounted for
IT
EMR Access
All access terminated to Allscripts (assume
they will still have access to Meditech if they
still have privileges at the hospital?)
IT
Contracts and
Services Notification
Terminate appropriate supplier and service
provider contracts in place specifically for the
separating physician. Notify suppliers and
service providers regarding separation date.
This is in collaboration with the practice
administrator.
Purchasing
Medications &
Supplies
Inventory of supplies & drugs used by the
specific physician who is leaving & return for
credit if possible (or re-deploy to another clinic)
Practice Admin
Medical Records/Billing
Medical Records
Completion
All charts complete--signed, done etc...prior to
separation so they can be properly billed.
Medical Records
Billing
Check that all encounters, tasks and notes are
signed and complete prior to physician
separation. Encounters must be ready for
billing.
OP Billing & Coding
Pharmacy
Medications
If physician leaving the practice is the medical
and Medical Supplies director, contact pharmacy. An inventory of
supplies and drugs must be done and new
Medical Director assigned DEA.
3
Pharmacy