is the Educational Program Director and a CERTIFIED FINANCIAL PLANNER

 at MEDIQUS Asset Advisors, Inc. He specializes in wealth management solutions

The end of the year is a good time to check in on your financial plan to see if everything is on track or if some things need adjusting. You will be in a better position for 2022 the sooner these items are addressed and adjusted if they are off-track.

If you utilized your emergency fund at some point this year, it is important to make sure the account is replenished to appropriate levels. The general rule of thumb for appropriate emergency fund amounts is:

6 months if in a single income household.

A 6-month emergency fund is also recommended if one person earns significantly more than the other and their income is relied upon to maintain the family’s standard of living.

The contribution limit for 401(k)s and 403(b)s in 2021 is $19,500. The catchup contribution amount for those over age 50 is an additional $6,500. The deadline for making 401(k) and 403(b) contributions is 12/31/2021. The contribution limit for individual retirement accounts (IRAs) is $6,000 and an additional $1,000 for those over age 50. IRA contributions can be made up to the April 2022 tax filing deadline.

Use Money Saved in Flexible Spending Accounts (FSAs)

Utilizing a healthcare, dependent care, or limited purpose FSA is a great way to pay for certain services on a pre-tax basis. Be aware, most FSAs are use-it-or-lose-it accounts, meaning any money remaining at the end of the year gets forfeited back to the plan, not back to you. Some employers allow a $500 carryover to the following year or a grace period into the spring, but most do not.

The cost of college continues to rise. 529s provide tax-advantaged investment growth to assist with saving for post-high school educational opportunities like university, community college, trade schools, and apprenticeships. Many states offer considerable state income tax deductions for contributing to a 529. To receive a 2021 tax deduction, contributions must be made before 12/31/2021.

You can give up to $15,000 as an individual and $30,000 as a married couple to an unlimited number of people per year without having to pay gift tax. Making gifts can be an effective way of removing assets from an estate to avoid future estate taxes. To count for 2021, gifts must be made before year-end.

If you are hoping to get a tax deduction for donating to charity, those donations must be made by 12/31/2021 to count toward your 2021 taxes. However, to get a tax deduction, you may need to gift a significant amount to get above the standard deduction. Look to see if you have appreciated assets you could donate instead of cash. Donating appreciated assets from your taxable accounts allows you to avoid paying capital gains taxes when the investments are sold. The charity can sell the investments and avoid paying the taxes, and you get to claim a deduction for the full value of the donated investments.

Tax loss harvesting can be an effective tool to reduce taxes. If any investments in your taxable accounts have lost money, those investments can be sold, and the loss captured. This loss can then be used offset gains in other investments or potentially lower your 2021 tax bill. Up to $3,000 ($1,500 if you are married filing separately) of net capital losses can be deducted against ordinary income, self-employment income, and interest income. If you have captured losses above these amounts, the excess can be carried over to future years to offset gains or deduct against income. Tax loss harvesting must occur before 12/31/2021 to count towards 2021.

Major life events can result in a need to update your beneficiaries. If you got married, divorced, had a birth or death in the family, you may need to update the beneficiaries on your retirement accounts and life insurance policies. These events may also necessitate updating your Will and Power of Attorney documents. There is no deadline for these changes, but the sooner the better.

This list should give you a nice head start, but there are likely to be other items to check up on. Speak with your financial advisor and/or accountant to see if they recommend any additional strategies for the year. Doing so should put you on strong financial footing heading into 2022.

Jeff Witz, CFP® welcomes readers’ questions. He can be reached at 800-883-8555 or at 

200 North LaSalle Street - Suite 2300 - Chicago, Illinois 60601

312-419-3733 - Toll Free 800-883-8555 - Fax 312-332-4908 - www.mediqus.com

Investment advisory services offered through MEDIQUS Asset Advisors, Inc. Securities offered through Ausdal Financial Partners, Inc. Member FINRA/SIPC ∙ 5187 Utica Ridge Rd ∙ Davenport, IA 52807 ∙ 563-326-2064 ∙ MEDIQUS Asset Advisors and Ausdal Financial Partners, Inc. are independently owned and operated.

Effective June 21, 2005, newly issued Internal Revenue Service regulations require that certain types of written advice include a disclaimer. To the extent the preceding message contains written advice relating to a Federal tax issue, the written advice is not intended or written to be used, and it cannot be used by the recipient or any other taxpayer, for the purposes of avoiding Federal tax penalties, and was not written to support the promotion or marketing of the transaction or matters discussed herein.

The information contained in this report is for informational purposes only. Any calculations have been made using techniques we consider reliable but are not guaranteed. Please contact your tax advisor to review this information and to consult with them regarding any questions you may have with respect to this communication.

MEDIQUS Asset Advisors, Inc. does not provide tax, legal or accounting advice. This material has been prepared for informational purposes only, and is not intended to provide, and should not be relied on for, tax, legal or accounting advice. You should consult your own tax, legal and accounting advisors before engaging in any transaction.

Articles

Emergency funds, retirement accounts, and more. 

2021 year-end financial planning checklist

Employing non-physician practitioners (physician assistants, nurse practitioners, clinical nurse specialists, etc.) is an effective way to increase productivity in a physician office. However, under Medicare rules, covered services provided by non-physician practitioners (NPPs) are reimbursed at a reduced rate (85 percent of the fee schedule amount).

The “incident-to” billing rules provide an exception, allowing 100 percent reimbursement for non-physician services that meet the requirements detailed in the Medicare Benefit Policy Manual, Chapter 15, Section 60 (Services and Supplies Furnished Incident To a Physician’s/NPP’s Professional Service).

There are six basic requirements to meet the incident-to guidelines for Medicare payment:

The Basics of Incident-To billing

Services meeting all of the above requirements may be billed under the supervising physician’s NPI, as if the physician personally performed the service. Documentation should detail who performed the service, and that a supervising physician was in the office suite (although not necessarily the same room), at the time of the service.

Remember: Incident to applies only to Medicare. Further, the requirements do not apply to services with their own benefit category. Diagnostic tests, for example, are subject to their own coverage requirements. “Depending on the particular tests,” the Benefit Policy Manual explains, “the supervision requirement for diagnostic tests or other services may be more or less stringent than supervision requirements for services and supplies furnished incident to physician’s or other practitioner’s services.”

Similarly, pneumococcal, influenza, and hepatitis B vaccines do not need to meet incident to requirements. MLN Matters Number: SE0441 elaborates:

Must a supervising physician be physically present when flu shots, EKGs, Laboratory tests, or X-rays are performed in an office setting in order to be billed as “incident to” services?

These services have their own statutory benefit categories and are subject to the rules applicable to their specific category. They are not “incident to” services and the “incident to” rules do not apply.

Additional rules apply for incident to physician’s services in clinic, and services incident to a physician’s service to homebound patients under general physician supervision. These can be found in the 

Medicare Benefit Policy Manual, Chapter 15, Section 60

Slideshows

Here are six basic requirements to meet incident-to guidelines and get properly reimbursed for your care.

The Basics of Incident-To Billing

Podcasts

Physicians Practice® spoke with Kristina Hutson, a product line developer at Availity, about surprise billing events in independent healthcare practices and what owners and administrators can do to reduce the likelihood of their occurrence. 

How to reduce surprise billing in your practice

, discusses how patient data collection has changed since he first started practicing medicine.

Videos

Quality hasn’t always followed technological advancements.

How patient data collection has changed over the course of one doctor’s career

Staff Salary Survey 2021: Staffing trends

, JD, MBA, advises clients on compliance and transactions in healthcare, cybersecurity, corporate and securities law, while representing plaintiffs in False Claims Act and Dodd-Frank whistleblower cases. She also teaches bioethics at Baylor College of Medicine in Houston. Rachel can be reached through her website, 

January 1, 2022 is just around the corner. On December 2, 2020, the Centers for Medicare and Medicaid Services (CMS) published new provisions and exemptions related to the Stark Law (85 Fed. Reg. 77492) and simultaneously, the Department of Health and Human Services – Office of the Inspector (HHS-OIG) published new provisions and safe harbors related to the Anti-Kickback Statute (AKS) (85 Fed. Reg. 77684). Having detailed several of the changes in a 

three-part series for Physicians Practice

, there is one item that was not included in the January 19, 2021 effective date, which demands attention.

Before delving into the specifics of the new changes to the Stark Law, which become effective on January 1, 2022, there are a couple of important reminders concerning the Stark Law. First, unlike the AKS, Stark is not a law with both civil and criminal penalties. Stark is a civil statute. Second, it is important to appreciate what goods and services come under the umbrella of designated health services (DHS) – a term that is specific to the Stark Law. Finally, while there have been modifications to the writing requirement, they are specific and should be read closely. Bottom line is that they are still required – it’s the timing that is at issue. Having said that, I would never have a verbal agreement because of the potential compliance and litigation issues down the road.

, “[p]hysician group practices commonly rely on the in-office ancillary services exception (IOAS) to protect referrals for DHS among physicians within the practice or for ancillary services provided by the practice.” Practically speaking, so long as the practice satisfies the strict and nuanced requirements to be considered a “group practice” (42 C.F.R. §411.352), both the physicians’ ownership and compensation arrangements may be compliant with the Stark Law. As stated in 66 Fed. Reg. at 876 (Jan. 4, 2001),

Accordingly, the Congress permitted group practice members (and independent contractors who qualify as ‘‘physicians in the group practice’’) to receive shares of the overall profits of the group, 

so long as those shares do not directly correlate to the volume or value of referrals

 generated by the member or ‘‘physician in the group practice’’ for DHS performed by someone else. (emphasis added).

Subsequently, on 66 Fed. Reg. at 957 (Jan. 4, 2001), “overall profits” is defined to mean:

the group’s entire profits derived from DHS payable by Medicare or Medicaid or the profits derived from DHS payable by Medicare or Medicaid of any component of the group practice that consists of at least five physicians. The share of overall profits will be deemed 

 to relate directly to the volume or value of referrals if 

(i) The group’s profits are divided per capita (for example, per member of the group or per physician in the group).

(ii) Revenues derived from DHS are distributed based on the distribution of the group practice’s revenues attributed to services that are not DHS payable by any Federal health care program or private payer.

(iii) Revenues derived from DHS constitute less than 5 percent of the group practice’s total revenues, and the allocated portion of those revenues to each physician in the group practice constitutes 5 percent or less of his or her total compensation from the group.

(iv) Overall profits are divided in a reasonable and verifiable manner that is not directly related to the volume or value of the physician’s referrals of DHS.

changes in the definition of “overall profits”,

 which become effective January 1, 2022, are critical to a group’s ongoing compliance with the Stark Law’s permissible compensation models, as well as potentially avoiding a False Claims Act case. As of January 2022, “overall profits” was clarified to mean the profits derived from all DHS of any component of the group that consists of at least five physicians. “Split pooling” – the distribution of profits from DHS on a service-by-service basis – is expressly prohibited. The concern voiced by CMS on page 77563 of the Dec. 2, 2020 Final Rule related to comments received on “split pooling” was that “service-by-services profit shares would allow physicians to receive profits shares more closely related to the services they referred, their specialty, the services they provide, or the expenses they have personally incurred.”

Thus, beginning January 1, 2022, the “split pool” method of allocating DHS profits will no longer meet an exception. “

 DHS profits generated by sub-pools or "pods" of at least five physicians and are permitted to use different profit allocation methodologies among the pods. However, within each pod, groups must use the same compliant methodology. Some examples of permissible methodologies include allocating DHS profits on a per capita basis or based on personal professional productivity (excluding DHS revenues).” Pursuant to the Stark Law’s Final Rule all revenue and expenses from all DHS service lines need to be aggregated and then distributed using the same methodology.

, JD, MBA, advises clients on compliance and transactions in healthcare, cybersecurity, corporate and securities law, while representing plaintiffs in False Claims Act and Dodd-Frank whistleblower cases. She also teaches bioethics at

in Houston. Rachel can be reached through her website,

On December 2, 2020, CMS published new provisions and exemptions related to the Stark Law (85 Fed. Reg. 77492) and HHS-OIG published new provisions and safe harbors related to the Anti-Kickback Statute (AKS) (85 Fed. Reg. 77684. 


Reminder: Important Stark Effective Date and Physician Group Practices

is a traveling physician who is board certified in family practice/OMT and lifestyle medicine. He has practiced as a 

 locum tenens physician for four years. Zhu is an international speaker and the author of "

Thrive Medicine: How To Cultivate Your Desires and Elevate Your Life

Masterclass series, an online resource for healthcare professionals and students on learning how to thrive

If you are doctor struggling with your work and social life, there is a way to find balance between the two. However, it's not as easy as reading this article. Just like any routine or habit, it takes practice, commitment, and consistency.

It is important to set aside some time for yourself. Create a schedule and do it on a regular basis. Don’t give yourself breaks just because you have the free time. Instead, make time to fully enjoy these well-deserved breaks.

How you want to spend your “me” time will be entirely up to you. Engage in activities that can help you feel relaxed and revitalized. Do things that will take care of your mental, physical and emotional health.

It’s important you create this kind of schedule and stick to it. Remember that you can’t take care of your patients unless you take care of yourself first.

Being an on-call doctor could make it difficult to take your mind off work. Seeing many patients in a day or serving long shifts can take a toll on your emotional and physical health. It may not be an option for everyone to reduce their hours; however, if you can make an adjustment, even if it’s just temporary, working fewer hours can help you get back on your feet and connect with other people and give you the breather you need.

When you’re facing issues with your patients, make sure you’re not thinking about problems at home. Similarly, don’t bring your patient’s problems home when you’re not at work. Be mindful and stay in the present. Otherwise, you might not be performing your best at work, and you could miss something important with your loved ones.

Is there any pastime you used to do in college? If you didn’t have a hobby back then, try and explore new experiences. You could learn a new instrument, join a community, or grow your own garden. It could be anything that takes your mind off work and helps you feel relaxed and refreshed.

While there’s nothing wrong hanging around with colleagues and clinicians all day, have a break and call that one friend from the past. We all have that friend whom we’ve always wanted to call but didn’t’ because we were just too busy.

Take a minute and make that phone call. Schedule a quick coffee or join the next reunion! Either way, your social life shouldn’t be limited to your professional circle.

Just because physicians are medical superheroes, that doesn't mean they don’t need help. If you are struggling with a patient or any issue, ask for help. Learn from the experiences of other doctors. It doesn’t only help you solve your patients’ problems more effectively, but it also strengthens your social circle at work.

Physicians play a critical role in our society, primarily for taking care of others. But who takes care of them? As a physician, it’s important to take these much-needed breaks and to prioritize self-care. Treat yourself once in a while. Do that thing that makes you feel happy and rejuvenated. Get moving or consider meditation. Connect with people and start building sustainable relationships. When you take some time to relax, you’ll have more enthusiasm and energy to do better in your profession.

Masterclass series, an online resource for healthcare professionals and students on learning how to thrive.

Just like any routine or habit, it takes practice, commitment, and consistency.

Maintaining a social life as a working physician 

, JD, has practiced law exclusively in the areas of asset protection, risk management and wealth preservation for the last 16 years. He helps protect a national client base with more than $5 billion in personal assets, including several thousand physicians. He is a contributing author to multiple books for physicians and a frequent medical conference speaker and CME presenter. 

Our last installment provided some details and 

 about tax planning, including who is responsible for the information on your tax return, details about what income you have to report, and a look at the sales techniques promoters of tax evasion use to get you to pay for their services. When it comes to clarifying questions of tax law and what crosses the line from legal 

 I always start with the I.R.S., which provides the following detail about these specific scams that the Office of Promoter Investigations (OPI) is prosecuting participants and promoters of abusive tax avoidance transactions for using. 

"We are stepping up our enforcement against abusive arrangements," 

. "Don't be lulled into these shady deals. The IRS recommends that anyone who participated in one of these abusive arrangements should consult independent counsel about coming into compliance."

These aggressively marketed abusive arrangements wrap up the IRS's annual "

" list and include the following red flags:

, in which promoters take a provision of tax law for conservation easements and twist it through using inflated appraisals of undeveloped land and partnerships. These abusive arrangements are designed to game the system and generate inflated and unwarranted tax deductions, often by using inflated appraisals of undeveloped land and partnerships devoid of a legitimate business purpose.

 risk management tools for qualifying practices and their owners, but abusive "micro-captive" structures, promoters, accountants or wealth planners persuade owners of closely held entities to participate in schemes that lack many of the attributes of insurance. For example, coverages may "insure" implausible risks, fail to match genuine business needs, or duplicate the taxpayer's commercial coverages. But the "premiums" paid under these arrangements are often excessive and used to skirt tax law. Recently, 

 against a variation using potentially abusive offshore captive insurance companies domiciled in Puerto Rico and elsewhere.

Potentially abusive use of the US-Malta tax treaty

Though the U.S.-Malta Income Tax Treaty (Treaty) exists, some U.S. taxpayers are relying on an aggressive interpretation to take the position that they may contribute appreciated property tax free to certain Maltese pension plans and that there are also no tax consequences when the plan sells the assets and distributes proceeds to the U.S. taxpayer. Ordinarily, gain would be recognized upon disposition of the plan's assets and distributions of the proceeds. The IRS is evaluating the issue to determine the validity of these arrangements and whether Treaty benefits should be available in such instances and may challenge the associated tax treatment.

As such, I suggest that this strategy, if employed, is done so only by high-net worth and ultra-high net-worth individuals with the help of highly experienced legal and tax counsel that will help ensure your strict compliance with the letter of the law.

Improper claims for research and experimentation credit generally involve failures to participate in, or substantiate, qualified research activities and/or satisfy 

the requirements related to qualified research

expenses. To claim a research credit, taxpayers must evaluate and appropriately document their research activities over a period of time to establish the amount of qualified research expenses paid for each qualified research activity. Taxpayers should carefully review reports or studies to ensure they accurately reflect the taxpayer's activities.

Taxpayers seeking to defer capital gains upon the sale of appreciated property may be advised to organize 

. These transactions occur when an intermediary purchase appreciated property from a seller in exchange for an installment note, which typically provides for payments of interest only, with principal being paid at the end of the term. In these arrangements, the seller gets the lion's share of the proceeds but improperly delays the gain recognition on the appreciated property until the final payment on the installment note, often slated for many years later.

, JD, has practiced law exclusively in the areas of asset protection, risk management and wealth preservation for the last 16 years. He helps protect a national client base with more than $5 billion in personal assets, including several thousand physicians. He is a contributing author to multiple books for physicians and a frequent medical conference speaker and CME presenter. Learn more at

Part two of our look at abusive tax planning schemes that are heavily promoted doctors at year-end. We examine specific schemes to avoid, including those that the I.R.S. is making a special effort to crack down on. 

Specific tax fraud traps physicians should avoid

Kate Othus earned her MHA at Oregon Health & Science University and spent the bulk of her career in an administrative and CEO role for private practices. She is currently CEO and President of the healthcare services organization, Health Professionals Alliance (HPA), and the Founder and CEO of the software company DataDx; both of which are based in Lake Oswego, Oregon.

You know there is a serious problem in healthcare when seasoned physicians no longer 

 to become the doctors of tomorrow. During my decades-long career as a healthcare administrator for various specialty practices, I have witnessed the strong independent practitioner of my youth increasingly struggle to maintain autonomy in their business. It wasn’t long ago that a young physician could start a nice size practice on their own and count on their closest friends and colleagues to keep the patient referrals flowing. The modern era of medicine, however, calls for a fresh approach to private practice.

The medical industry of today is far more complex with ever-evolving technology, higher compliance standards, and a billing structure that can penalize providers as well as patients. All of this has contributed to a flurry of physicians opting out of independent practice with the false notion that selling to a private equity firm or working for corporate medicine will reduce their headaches. Unfortunately, nothing could be further from the truth and these trends have only exasperated the growing projections of future healthcare provider shortages. My experience working side-by-side with physicians has given me an opportunity to identify revisions that will bolster independent practice in innovative ways doctors are often too overwhelmed to notice.

If I was a fresh medical school graduate, I’d have a hard time finding clear messaging on my best path forward into practicing medicine. With mounds of student loan debt staring me in the face, it could seem crazy to invest further into myself by becoming a practice owner or partner rather than employed in an academic medical center. That said, a lot of good data shows that is exactly what young doctors should be doing. Why?

Physicians working independently from the corporate healthcare machine have much higher job satisfaction rates and there are several reasons for that. For one, private practice doctors treat their patients with a level of autonomy that ensures they can believe in the care they provide rather than being forced to cut corners. Not only does this contribute to lower costs for higher quality of patient care, but it also creates a better work environment. When a physician works within a giant healthcare system, there’s a tremendous amount of waste that can tie the hands of well-meaning providers and negatively impact patient care. Doctors working in this environment feel a community disconnect and their daily work-life suffers.

Becoming a practice owner doesn’t have to be as cumbersome as it seems if you allow yourself to evolve beyond the old model. There are three essential ingredients to build a successful modern healthcare practice:

Having a technology-enabled practice means more than investing in a popular Electronic Health Record (EHR) platform and some accounting software. You need those systems to work seamlessly together and create reports that give you real-time analysis of your business. Your practice is producing an enormous amount of data, and your administrative team can benefit from the automated options that are available.

For whatever reason, physicians often overlook the value of strategically outsourced services such as payor contracting, credentialing, and growth advising, which can curtail their sustained profitability. Every healthcare administrator is routinely under water with a long list of to-dos and burnout is a growing problem. For that reason alone, it is in every doctor’s interest to find a good service partner. Not only will outsourcing save you the hassle of replacing a well-seasoned administrator, but it can have a positive effect on your revenue stream.

Many physicians who have been in practice for a few years feel better working with their long-time colleagues. For the modern healthcare practitioner, alliances like that do not have to take decades of golf and martinis to build. Technology has given us new avenues for collaboration with doctors from all over the country that help resolve local issues within your community. That’s part of why it is so worthwhile to seek out physicians' groups that share your values. This endeavor offers an outlet for brainstorming and networking that will foster continued growth for your practice.

Whether you decide to go out on your own or buy into an established practice, the goal is to plan your days spent treating patients your way. My hope is physicians realize there are organizations out there building resources for them to enjoy private practice again and flourish. I believe that collectively, we can turn the tide on job dissatisfaction trends plaguing physicians and doctors will once again tell their sons and daughters about the great opportunities that lie ahead if they choose a career in medicine.

is the CEO and president of Health Professionals Alliance and the founder and CEO of DataDx.

We can turn the tide on job dissatisfaction trends plaguing physicians and doctors will once again tell their sons and daughters about the great opportunities that lie ahead. 

Building the next generation of doctors

Do you tend to keep your cell phone in your pocket (when it’s not in your hand) throughout the workday? Do your employees do the same? And how often do you see them texting or tapping away when they’re supposed to be working?

Here are some points to consider when rethinking your employee cell phone policy”

Six tips for your employee cell phone policy

Regardless of whether our cell phones are recognizable in another 10 or 15 years (imagine the iPhone 25!), personal technology is here to stay, and so is employers’ ever-increasing burden for proactive compliance with employment laws and safety/security regulations. Keeping our employee policies up to date is a necessity, not an option - especially in healthcare.

A smartphone can be a distraction to staff members and also a potential HIPAA violation waiting to happen. Here are tips to avoid that at your practice.