Stacking – Risks and Prevention

Posted on
November 21, 2017

Stacking has come to greater prominence following an OIG advisory opinion that defines problematic compensation structures.

Submit your email below to receive this post directly in your inbox

Thank you! Your submission has been received!
Oops! Something went wrong while submitting the form.

Stacking is a popular topic in physician contract compliance, and for good reason. While overpayments, such as paying higher than FMV or paying for too many hours in administrative agreements, can be easy to spot sometimes payments that look reasonable in one agreement are not reasonable when looked at in aggregate across all agreements.

Stacking has come to greater prominence following an OIG advisory opinion that defines problematic compensation structures. These stacking structures can easily occur when a physician or group has multiple agreements with a hospital for coverage, administrative, or medical director services. While the agreement may be compliant when considered independently, when taken in total, payment may be greater than 90th percentile or the time commitment, particularly in the context of the physician’s clinical practice, requires more hours per year than full time! Stacking may additionally occur if an emergency department call payment rate is based on opportunity cost of assumed lost private practice income but the physician or group is not actually suffering losses.

Despite the challenges that the risk of stacking can create, an organization can take clear approaches to develop best practices and review procedures to avoid stacking. A first major step should be to develop policies and review procedures, targeted towards physicians who hold more than one position or who perform more than one service. These policies should focus on diligent administrative time tracking, reviewing and monitoring restricted call payments, establishing guidelines and payment caps for physicians being paid for two simultaneous call positions, and staying aware of physicians receiving multiple emergency department call payments.

BACK TO BLOGS