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Chapter 440: UMC Medical Services

440.040 University Physicians Medical Practice Plan

Amended February 27, 1976 & Bd. Min. 12-14-79 & 3-17-87.

  1. Definitions
    1. University Physician Medical Practice Plan -- These rules and regulations shall be known and referred to as the "University Physicians Medical Practice Plan."
    2. Plan -- The word "Plan" as used in these regulations shall be construed to mean the Plan herein created for the rendering of professional services to patients, consultation or any other services related to their professional skills rendered to others than the University by members of the Faculty of the School of Medicine of the University of Missouri-Columbia, providing for the use of any fees or compensation received for such services and providing for additional compensation for those Faculty members who become participants in the Plan.
    3. Plan Income -- The words "Plan Income" shall be construed to mean all income received by the University by assignment which are derived from direct patient care activities inside and outside the Health Sciences Center within the State of Missouri.
    4. Health Sciences Center -- The words "Health Sciences Center" as used herein shall refer to the University Hospital and Clinics and the School of Medicine, University of Missouri-Columbia.
    5. Participant -- The word "Participant" as used in these regulations shall be construed to mean any member of the Faculty of the School of Medicine who is a member of the Plan.
    6. Department -- The words "Department" or "Departments" shall refer to those departments of the School of Medicine for whom departmental accounts have been recommended by the University Physicians Management Committee and approved by the Dean and in which one or more Faculty members shall have qualified as participants in the Plan.
    7. Departmental Account -- The words "Departmental Account" or "Departmental Accounts" shall refer to those departmental accountability records maintained in the University Physicians Administration Office in support of the percentage portion of the Plan income credited to the department as determined by the Plan.
    8. UNIVERSITY PHYSICIANS -- The words "University Physicians" shall mean the operating name of the University Physicians Medical Practice Plan.
    9. Section/Division -- The words "Section/Division" or "Sections/Divisions" shall refer to those sections/divisions of departments of the School of Medicine which have a separate account as provided in Section 440.040 G.3.
    10. Section/Division Chief -- The words "Section/Division Chief" shall refer to the head of a section/division within a department qualified under the Plan.
    11. Section/Division Account -- The words "Section/Division Account" or "Section/Division Accounts" shall refer to those sectional accountability records maintained in the University Physicians Administration Office in support of the portion of the Plan income credited to the section as determined by the Plan.
    12. Dean -- The word "dean" shall refer to the Dean of the School of Medicine, University of Missouri-Columbia.
    13. Chancellor -- The word "Chancellor" shall refer to the Chancellor of the University of Missouri-Columbia.
    14. President -- The word "President" shall refer to the President of the University of Missouri.
    15. Chief of Staff -- The words "Chief of Staff" shall refer to the Chief of Staff, University Hospital and Clinics, University of Missouri-Columbia.
    16. School of Medicine -- The words "School of Medicine" shall refer to the School of Medicine, University of Missouri-Columbia.
    17. University -- The word "University" shall refer to The Curators of the University of Missouri.
    18. Hospital -- The word "Hospital" shall refer to the University Hospital and Clinics at the University of Missouri-Columbia.
    19. Department Chairman -- The words "Department Chairman" or "Department Chairmen" shall refer to the head of a department in which one or more Faculty members shall have qualified as participants in the Plan.
    20. Executive Director of the University Hospital -- The words "Executive Director of the University Hospital" shall refer to the Executive Director of the University Hospital and Clinics University of Missouri-Columbia.
    21. University Physicians Management Committee -- The words "University Physicians Management Committee" shall refer to the committee established by the Plan. As an exception to the general regulation providing for the appointment of University committees, there is hereby created a committee to be known as the University Physicians Management Committee.
    22. Executive Director of University Physicians -- The words "Executive Director of University Physicians" shall refer to the Executive Director of University Physicians.
    23. Base Salary Contract -- The words "Base Salary Contract" shall refer to the regular employment contract approved by the University of Missouri.
    24. Participant Body -- The words "Participant Body" shall refer to the total collective participants in the Plan.
    25. Deduction Rate -- The words "Deduction Rate" or "Deduction Rates" shall refer to the percentage(s) accounted and budgeted annually for the costs of operation of the Plan.
    26. Group -- The word "Group" shall refer to participants within a department and/or section/division who pool their Plan income.
    27. Gender -- Where the masculine pronoun is used it shall be interpreted as feminine where applicable.
  2. Purposes of the Plan -- Faculty members of the School of Medicine of the University of Missouri-Columbia may be engaged in one or more of the following employment duties: teaching, research and patient care. Patient care is an integral part of the educational mission of the school for it provides to the instructor and the medical student the clinical experience essential to medical education. In the course of rendering patient care services, faculty members may generate income described in this Plan as plan income.
        This plan has been created to provide a means for establishing salary compensation for employment services rendered by plan participants to their employer, the University of Missouri an educational organization. All payments to plan participants made pursuant to the provisions of this plan are salary payments by the employer to the participants as employees and subject to the rules and regulations of the University of Missouri governing the approval and payment of salaries. All plan income referred to in Section 440.040 D. shall be irrevocably assigned to the employer by the plan participants as agents (employees) of the employer; no plan participant shall have any right, title or interest in any such plan income; and the employer shall have the unrestricted right to such income and complete control over its disposition. Provisions in this plan for accounting for plan income and expenses and for recommendations from plan participants are not intended to and shall not be construed to confer on plan participants any right, title or interest in plan income, any right control the disposition of plan income and expenses, or any right to determine salaries. In addition, the plan is created to implement the following purposes:
    1. To provide a system by which the faculty is enabled to achieve fulfillment of their commitment to high quality patient care.
    2. To recognize that high quality patient care is related to faculty participation in teaching and research and also that high quality clinical teaching is dependent upon the faculty being engaged in active medical practice, thereby assuring an adequate supply of clinical material for educational purposes.
    3. To establish incentive mechanisms for faculty compensation which enhance the attainment of the Health Sciences Center goals of patient care, teaching and research.
    4. To assure a University Physicians Medical Practice Plan which will be competitive with income plans of other academic medical centers in the United States.
    5. To assist with the retention of qualified faculty by contributing to their total compensation.
    6. To establish and maintain a set of policies for the management of professional income which is sufficiently flexible to respond to the needs of all participating individuals, sections and departmental differences.
    7. To provide a mechanism to support programs that benefit the School of Medicine.
    8. To establish a methodology of professional income generation, distribution and utilization.
  3. Participants -- All Faculty of the School of Medicine who are members of the University Hospital Medical Staff who as part of their faculty responsibilities generate income from professional activities for patient care related services which is assigned to the University pursuant to the Plan shall be participants in the Plan.
    1. For each participant, a written Agreement shall be executed annually and filed in the Business Office of University Physicians. Each Agreement shall contain a statement that the participant will abide by all provisions of the Plan.
  4. Plan Income -- Within the framework of the Plan, Plan income shall be derived from the following sources:
    1. All professional fee for service income derived from patient car shall be Plan income.
    2. All other income derived from direct patient care related services shall be Plan income. As unique instances of patient care occur the University Physicians Management Committee will recommend whether income derived from these instances constitute Plan income.
    3. Income of participants not related to patient care shall not be Plan income.
  5. Distribution of Plan Income
    1. Costs of Operations -- The costs of operations of the Plan will be funded by applying an approved deduction rate (percent) to Plan Income. The costs of operation of the Plan may include expenditures for the following items an d activities:
       
            • Billing and Collections Costs
            • Professional Liability Insurance
            • Support personnel, services and facilities
            • Administrative costs
            • Retirement
            • Other items that are deemed necessary in the operation of the Plan
       
          Annually and as requested by the University Physicians Management Committee, the Executive Director of the University Physicians will report to the University Physicians Management Committee the expenditures to date for the costs of operation of the Plan. A final accounting report will be issued after the close of the accounting period.
         An annual budget will be submitted for the costs of operation of the Plan. Based on the budget that is submitted the University Physicians Committee shall recommend a deduction rate to be proposed for the period covered by the budget. The proposed deduction rate and budget for the next fiscal year must be approved by the Dean.
         Further, for certain types of Plan income, such as contract income and certain other types of "lump sum" income, requiring a minimum of administrative and business office expense, it may be appropriate to establish a special deduction rate(s) to cover operating costs.
         In exceptional circumstances, it may be necessary to alter the deduction rate during the fiscal year. Such an alteration will be recommended by the University Physicians Management Committee and approved by the Dean.
         Separate accounts will be established for each category of expenditures authorized in this Section 440.040 E.1. Expenditures from these accounts will be in accordance with standard University standards.
         From time to time good accounting practice and effective fiscal management may well indicate a need to revise, expand, contract or otherwise modify the accounting system relative to the Plan. Nothing in this Plan shall be interpreted as preventing such accounting revision, expansion, modification or contraction so long as they adhere to generally accepted accounting principles and University policy.
    2. Dean's Office Account -- A Dean's office account shall be maintained. The account shall be credited with 6 percent of the Plan income. Any expenditures or transfers from this account must conform to standard University budgeting policy.
          The Dean's Office account is established to support research and development costs, capital improvements, new members of the faculty, renovation, the Health Sciences Library and for such other purposes that are of general benefit to the School of Medicine.
    3. Departmental Accounts -- A departmental and or Sectional/Divisional account shall be maintained for each department and/or section/division. The departmental accounts shall be credited with 10 percent of the departmental Plan income.
          Annually on the date established by the Dean, the department is to submit a comprehensive budget to include the distribution of the department's share of Plan income. This annual budget must be approved by the Chairman of the Department and the Dean.
         Expenditure from these accounts shall be in accordance with standard University policy.
         Voluntary contributions to the Dean's Office account may be made annually from each departmental and/or sectional/divisional account. The University Physicians Administration Office shall supply the Dean and the University Physicians Management Committee with a periodic statement of account for each departmental and/or sectional/divisional account. A periodic statement of account shall be furnished to each Department Chairman or Section/Division Head for his own departmental or sectional/divisional account.
  6. Distribution of Net Plan Income
    1. For purpose of this section, the following definition applies: The words "Net Plan Income" shall be construed to be plan income (Section 440.040 A.3) less the distribution of plan income as outlined in Section 440.040 E. Net Plan Income will be those funds available to meet base salary contract commitments as outlined in Section 440.040 F.2, and incentive income as outlined in Section 440.040 G.
    2. Salary Contract -- Base Salary -- A participant's base salary may be budgeted from plan income and/or from funds derived outside the Plan Recommendation of the individual faculty member's base salary contract from all sources including Plan income shall be made by the appropriate Departmental Chairman and approved by the Dean to the appointing authority with this determination becoming a part of the recommended School of Medicine budget. That portion of the faculty member's base salary which is budgeted from Plan income shall preferably reflect the extent of his efforts in patient care. The salary contract will be negotiated in the same manner as other School of Medicine faculty contracts.
          The portion of base salary budgeted from plan income is payable only to the extent of departmental net plan income. If Departmental net plan income is not sufficient to meet budgeted base salary, then the individual Department Trust funds or the School of Medicine funds will meet the remainder of the obligation.
         Under normal circumstances the portion of the individual's base salary budgeted from Plan income will be derived through only one Section/Division or Department. Under the special circumstances of interdisciplinary programs individuals with joint appointments may derive salary measured by Plan income from more than one Section/Division or Department with the approval of the participant, the Section/Division Chief or Chiefs, the Department Chairmen, University Physicians Management Committee and the Dean.
         The faculty contract year for the purposes of the Plan will be the faculty contract year of the University of Missouri-columbia. Faculty members who commence employment subsequent to the beginning of the faculty contract year may be a participant for the remainder of the year.
    3. Payment of Base Salary -- A departmental or divisional/sectional base salary pool shall be established for each department or division/section in which net plan income will be pooled and from which base salaries as outlined above (Section 440.040 F.2) will be paid.
  7. Distribution of Incentive Income
    1. For purposes of this section, the following definition applies: The words "Incentive Income" will refer to net plan income less the costs of base salary contract commitments as outlined in Section 440.040 F.
    2. Individual Participant
      1. In addition to base salary (440.040 F. above) a participant may receive available incentive income as incentive salary. A participant can receive incentive salary only if the participant generated net revenue sufficient to meet his portion of base salary as described in Section 440.040 F.2. Individual participants may allows reductions of incentive salary for support of his Department or Section/Division. This amount will be determined by negotiations between the individual and his Department Chairman with approval of the Dean. Such arrangements and the allocation of such incentive salary shall be determined prior to the commencement of the salary contract year and agreed to in writing by the participant and approved by the Chief of the Section/Division, the Department Chairman and the Dean.
    3. Group Participants
      1. In some circumstances it may be appropriate for participants within a department and/or section/division to practice as a group and pool their incentive income. Such arrangements and the allocation of such incentive salary among the participants in the department or section/division shall be determined prior to the commencement of the salary contract year and agreed to in writing by each participant and approved by the chief of the section/division, the Department Chairman and the Dean.
      2. Annually on the date established by the Dean the appropriate Departments will submit proposals to practice as departmental or sectional/divisional groups to pool their Plan income under Section 440.040 G.3.a.
    4. Participant's Account -- An account shall be established for each Participant which shall be credited with the participant's portion of the Plan income as determined by the University Physicians Medical Practice Plan base salary contract and the incentive income distribution schedule. All expenditures or transfers from this account will conform with the participant's plan contract provisions relating to the participant's share of any incentive income.
  8. Administration of the Plan
    1. University Physicians Management Committee -- The membership of the University Physicians Management Committee will include all Department Chairmen or approved alternates, six members from the participants at large or their elected alternate. The Dean of the School of Medicine, the Executive Director of University Physicians, the Chief of Staff of University Hospital and Clinics and the Executive Director of University Hospital and Clinics shall be ex-officio members without vote. The Department Chairmen will appoint the individuals to serve as their alternate. The members at large and their alternates will be elected by the participant body for three year terms but may not serve for more than two consecutive terms. In the first year of the Plan, the six members at large and their alternates will be elected for staggered terms; two members and two alternates for three years, two members and two alternates for two years, and two members and two alternates for one year. Thereafter an annual election will be held for the purpose of electing two members at large and their alternates to serve three year terms.
          The Committee shall organize by electing from the membership of the Plan a Chairman and a Secretary. The term of office for the Chairman and the Secretary will be two years. The Secretary shall function as the Vice Chairman. In the first year of the Plan the Chairman will be elected for a two year term and the Secretary for a one year term. Thereafter, annually the Committee will elect either a Chairman or the Secretary to serve a two year term.
         In the event the Chairman or Secretary is unable to complete the term of office and more than six months of the term remains, a special election will be held to elect a replacement to complete the term of office.
         The Committee shall meet at least quarterly. Additional Committee meetings may be called by the Chairman of the Committee or at the request of a majority of the members of the Committee.
    2. Functions of the University Physicians Management Committee
      1. To establish an Executive Committee consisting of the Chairman of the Plan and seven members of the University Physicians Management Committee. The seven members of the Committee shall be selected in the following manner. Four members shall first be elected by the University Physicians Management Committee from its voting membership. These members shall be elected to a two year term of office and may not serve more than two consecutive terms. In the first year of the Plan the four members will be elected for staggered terms; two members for one year and two members for two years. Thereafter an annual election will be held for the purpose of electing two members for the Committee. After the election of these members the Chairman of the Plan shall appoint an additional three members from the voting membership of the University Physicians Management Committee to the Executive Committee. The Chairman shall appoint three members annually at the date of the election of the other Committee members. There shall be no restrictions on the number of terms an appointee of the Chairman may serve.
            The Executive Committee is to review and recommend items for the agenda of the University Physicians Management Committee and to review other items as deemed necessary by the Chairman or the University Physicians Management Committee.
      2. To review the functioning of the Plan to assure it is meeting the objective of the Plan.
      3. To annually review the operating costs of the Plan and the appropriateness of individual expenditures. It shall make any appropriate recommendations for changes in the operation of the Plan to the University.
      4. To recommend the hiring and be responsible for the administrative direction of the Executive Director of University Physicians in accordance with University Policy and Personnel guidelines.
      5. To develop and recommend such detailed policies and procedures as necessary to assure the effective implementation and operation of the Plan to the University.
      6. To make recommendations for revision of the Plan to the Participants.
      7. To recommend the budget for the costs of operation of the Plan including the amount of the Deduction Rate or Rates to the University.
      8. To initiate and approve professional fees schedules of the participants with the advice of the Clinical Department Chairmen.
      9. To discharge such other duties necessary to the efficient operation of the Plan and Committee.
    3. Participant Body -- The participant body will consist of all Plan participants, each with one vote, and will meet for the following reasons:
      1. To elect the University Physicians Management Committee members at large and their alternates.
      2. To vote on recommended revisions of the Plan.
      3. For business as called by the Chairman of the Committee.
      4. As petitioned by 20% of the voting body to consider issues and develop recommendations for the Committee.
      5. To consider business referred by 2/3 vote of the Committee.
            The Participant Body shall meet annually, as provided below, and at such other times as appropriate. Written notices giving the date, hour and place of all meetings shall be given to all participants in the Plan by the Committee Chairman at least 15 days prior to the meeting date. The Committee Chairman will presided and in his absence the Vice-Chairman. Fifty percent (50%) of the Plan Participants shall constitute a quorum and a majority vote of those present and voting shall be required to conduct business, except voting to approve recommendations for revisions of the Plan shall follow Section 440.040 I. of the document.
    4. Annual Meeting -- In May of each year, the Chairman of the Committee shall call a meeting of all participants in the Plan for the purpose of electing two committee representatives from the membership at large and conducting other business as appropriate. Nominations shall be made from the floor. Voting for the Committee shall be by secret ballot. No more than two members at large may be from the same Department. In the event a quorum is not present the Chairman shall reschedule the meeting to a definite date and hour, but not more than ten days hence and written notice of such meeting shall be given to all participants in the Plan; or the Chairman may, at his discretion, direct that the election be held by mail ballot, in which event a ballot shall be sent to each participant of the Plan and the participants receiving the highest number of votes cast shall be elected the representative of the Committee.
  9. Revision of the Plan -- The University Physicians Management Committee shall take all recommendations for revision of the Plan to the Plan participants. The Chairman of the Committee shall call a meeting of all participants and the Plan for the purpose of voting on the proposed revisions of the Plan. A two-thirds affirmative vote of a 50% quorum shall be required for revisions to the Plan. Voting for the revisions shall be by secret ballot. In the event a quorum is not present the Chairman shall reschedule the meeting to a definite date and hour, but not more than ten days hence, and written notices of such meeting shall be given to all participants in the Plan; or the Chairman may at his discretion direct that the revision be voted on by mail ballot in which even a ballot shall be sent to each participant in the Plan. If approved the proposed revisions shall be forwarded through the Dean, Chancellor, and President, to the Board of Curators, University of Missouri for their approval.
  10. Appeal Process for the Individual -- Any participant(s) perceiving unfair treatment under the provisions of the Plan may request a hearing before the university Physicians Management Committee. The request must be in writing to the Chairman of the Committee. The Chairman will call a special meeting of the Committee in not less than ten days nor more than thirty days following receipt of the request. The participant(s) and the Committee may be represented by legal counsel at the hearing. A report of the hearing along with recommendations for action will be prepared by the University Physicians Management Committee for the Chancellor. Copies of the report and recommendation will be provided the participant, his Department Chairman, and the Dean, all of whom will offer their comments directly to the Chancellor who shall make the final decision.
  11. Professional Charges -- Each participant may review his schedule of fees and recommend any changes to the Section/Division Chief, Departmental Chairman and the Committee. It shall be the responsibility of the Committee to recommend general operating policies under which professional fees will not be billed to the patient or third party.
  12. Billing and Collection of Professional Fees -- All professional charges will be initiated and signed by the provider of the service and submitted to the University Physicians Business Office for processing. Billing for professional charges will be distinct from other services and will indicate the name of a participant or group of participants of the Plan. Fees collected shall be credited to the account of the participant or participants rendering the services for which the fee is collected as otherwise provided for in the Plan.
        When it is clearly the intent of the payor to satisfy a specific portion of the patient's obligation to the Health Sciences Center, the monies received will be deposited in the account or accounts corresponding to the payor intent. In those instances where the intent of the payor is unclear, University Physicians Management Committee procedures for the allocation of monies received to the proper account shall apply.
       In the instance of contractual agreements, special billing arrangements may be accomplished through other mechanisms as provided for in the contractual agreement.
  13. Retirement and Other Staff Benefits -- For the purposes of determining average regular annual salary of a plan participant under the University of Missouri Retirement Disability and Death Benefit Plan and for purposes of determining regular salary of a plan participant for other staff benefits such as life insurance and disability insurance the base salary as provided in 440.040 F. of this plan shall be used and incentive salary under 440.040 G. of this plan shall be excluded.
  14. Special Situations -- All fees for professional services rendered by a plan participant are assigned to The Curators of the University of Missouri, and a plan participant shall at no time have any ownership interest in uncollected fees. For situations described below the disposition of uncollected fees. For situations described below the disposition of uncollected fees and payments to a plan participant shall be made in accordance with this section.
    1. Termination of Employment - Voluntary or Involuntary -- Upon termination of employment a plan participant shall be entitled to receive salary payments in accordance with his current salary contract for services rendered to the time of termination. Incentive salary, if any, will be based upon fees earned and collected at the date of termination. Uncollected fees at the date of termination which are subsequently collected shall be allocated to the departmental base salary pool (Section 440.040 F.3) after deductions for the cost of operation of the plan (Section 440.040 E.1) School of Medicine Account (Section 440.040 E.2), and Departmental Account (Section 440.040 E.3).
    2. Death or Disability of a Plan Participant -- Upon the death or disability of a plan participant there shall be paid to the participant or the participant's estate all salary payments then due in accordance with his current salary contract for services rendered to the date of death or disability. Incentive salary, if any, will be based upon fees earned and collected at the date of death or disability. In addition there shall be paid to the participant or the deceased participant's estate an amount equal to the participant's incentive salary based on uncollected fees at the time of his death or disability, reduced by the amount of such fees that are not in disability. Reasonable efforts shall be taken to collect all such accounts within the six month period. This additional payment shall be made to the participant or the estate of the deceased participant as soon after the end of the six month period as is practicable. Income from any fees uncollected at the end of the six month period which are subsequently collected shall be allocated to the departmental base salary pool (Section 440.040 F.3), School of Medicine Account (Section 440.040 E.2), and Departmental Account (Section 440.040 E.3).
    3. Termination of Plan Participation -- If the plan participant ceases to generate income form professional fees he will no longer be a participant in the plan. The effective day off the termination of his participation shall be recommended by the Department Chairman subject to review by the Committee, and determined by the Dean. On termination of his participation, income from any uncollected fees which are subsequently collected shall be allocated to the departmental base salary pool (Section 440.040 F.3), School of Medicine Account (Section 440.040 E.2), and Departmental Account (Section 440.040 E.3).
  15. Fiscal Year and Transition -- The fiscal year of the Plan shall be the fiscal year of the University of Missouri-Columbia. Unencumbered balances in all accounts shall be carried forward to the succeeding year.
        Upon implementation of this Plan, current departmental and Dean's Office accounts will become part of the new departmental, sectional/divisional, or School of Medicine Dean's Office account as appropriate or as otherwise specified in this Plan.
  16. Assignment of Fees -- Each Participant shall execute the following assignment annually.

Assignment

9/1/19_____ through 8/31/19_____

In consideration o f my employment by The Curators of the University of Missouri and the salary payments described in this Plan, I hereby assign to The Curators of the University of Missouri all fees charged by me for professional services, as defined in the University Physicians Medical Practice Plan. This assignment shall be an absolute assignment, subject only to the conditions that the fees charged by me shall not be altered, except as provided in the rules and regulations reestablishing said Plan.

I further agree that all monies received by me for such services shall be promptly turned over to the Business Office of the University Physicians and all checks made payable to me for such fees shall be promptly endorsed and delivered to said Business Office. It is distinctly understood that this assignment applies only to the income specifically identified in the University Physicians Medical Practice Plan.

In consideration of my being permitted to participate in the University Physicians Medical Practice Plan, I agree to fully cooperate therein and comply with all the rules and regulations of the Plan and my Department. I acknowledge receipt and understanding of the attached materials regarding billing and documentation polices relative to rendering professional services.

Participant's signature

Date

Attachments:

  • Introduction
  • Policy Statement
  • Definitions
  • Part B Intermediary Letter 373
  • Part B Intermediary Letter 70-2
  • Medicare/General American Policy on Teaching Physician Documentation
  • Assistants to Surgery in Teaching Hospital Departmental Polices (where applicable)

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