Physician

Physicians Expectations

• Review and sign all orders and care plans in a timely manner.

o

PCC:

"Orders Pending Signature" and "Pending Order Reviews" (monthly orders) o

Matrix:

"Unsigned Orders" and "Medical Regimen Review" (monthly orders) o Preferred Oak Medical standard is by the end of the rounding day.

• Review and update progress notes at each encounter, reflecting current condition, plan of care, and response to treatment.
• Collaborate with APPs to ensure continuity of care o Physicians complete required compliance visits, while APPs manage interim and acute issues. o Communicate with APPs with patient concerns and follow-ups. o Educate APPs and guide clinical care.
• Participate in interdisciplinary care plan meetings, as feasible.
• Ensure accuracy of diagnoses, medication lists, and problem lists in alignment with the patient's clinical status.
• Authenticate all documentation (orders, labs, therapy plans, and summaries) in compliance with CMS and facility policy.

Documentation Timeliness Documentation requirements and the consequences for delinquent records. Delays create clinical, regulatory, and financial risk for both the provider and Oak Medical.

Timely documentation is essential for:

• Safe and accurate patient care
• CMS and Wisconsin DHS compliance
• Billing integrity and audit protection
• Effective communication with nursing, therapy, and APPs Documentation Deadline All documentation must be completed by the end of the next business day after the encounter. Anything past this point is delinquent. Delinquency Process Day 2: Medical Records sends physician a reminder Day 3+: Provider becomes non-compliant
• CMO is notified
• Provider is placed on payment hold o If documentation is not completed by Day 3, all physician payments are paused. o Payments are only released once all delinquent notes are fully completed. Documentation Completed
• After completing all overdue documentation, providers must notify the CMO (Keshni Ramnanan) and CFO (Brad Anderson).
• Payment holds are lifted only after verification.

Implementation Date:

January 1, 2026 Documentation Accuracy With the use of AI in healthcare, we want to reinforce expectations regarding physician documentation accuracy.

Please ensure every note:

Reflects the actual encounter that occurred

• No cloned or templated sections that were not performed
• No copying forward assessments or plans without updating them
• Changes in clinical status must be clearly documented Supports the level of service billed
• Documentation must align with the E&M level billed
• Time-based coding requires accurate start/stop time OR total time
• Psychotherapy, care coordination, or prolonged services require specific elements Accurately documents who performed the service
• Physicians cannot bill for work performed entirely by an APP
• Document only services you personally performed o If a wound is healed but you did not evaluate the wound, then you must state where this information came from. Contains patient-specific details
• Avoid generic statements ("continue meds, stable") without context
• Tie medical necessity to the problem(s) addressed
• Include rationale for tests ordered, tests considered but not ordered, medication changes, or monitoring plans Billing We had a billing presentation for the APPs on Thurs Dec 4. Please look out for tan email with the link to this presentation for your review. Regulatory Visit Requirements Initial H&P / Admission Visit o Must be completed within 30 days of admission (CMS Tag F712).

• Subsequent/Monthly Compliance Visits:

  o First 90 days: Seen at least once every 30 days. o After 90 days: Seen at least once every 60 days thereafter.
• Physician or APP may perform alternating required visits after the physician's initial H&P per CMS delegation rules (F713).
• Additional visits should occur as medically necessary or if there's a change in condition.

Missed Compliance Visits If you're unable to complete a scheduled H&P or compliance visit because the patient is unavailable (e.g., at dialysis, at an appointment, out with family, etc.), please document the attempted encounter either in the facility EHR or within Ethizo. A brief note stating that the patient was unavailable for evaluation and that you attempted to see them is sufficient. This documentation is important for regulatory compliance and ensures there's a record of your attempt if the required visit window is missed. Schedule Change Expectations Physicians are required to notify the Oak Medical office/scheduler at least one week in advance of any schedule changes. Last-minute changes or cancellations create significant operational, clinical, and compliance risks, including:

• Facilities not being informed, resulting in confusion and patient/facility dissatisfaction o Many facilities plan around physician rounding days to obtain signatures, address physician-specific concerns, or complete paperwork. o Some facilities adjust staffing to ensure a nurse is available to round with the physician or assist with orders.
• Reduced care coordination with DONs, administrators, therapy, and interdisciplinary teams.
• Disruptions to the overall provider schedule and workflow o APPs are assigned to specific buildings on specific days.

When a physician changes their rounding day, the APP schedule must be altered-either shifting visits to the physician or reassigning the APP to another facility, which then disrupts that building's operations. o These changes can delay acute follow-ups and impact timely patient care.

• Missed CMS compliance timelines (30
• 60-day visits) o Compliance dates are tracked closely; shifting a visit by even 1-2 days can move a required visit out of compliance and place the facility and provider at regulatory risk.

Because of these impacts, schedule changes with less than one week's notice are strongly discouraged and may not be approved. New Physician Call Coverage Rotation Beginning January 1st 2026, we will be implementing a shared call rotation for our physician group. Each physician will be assigned one month of call coverage per year. Why We Are Implementing This Since Oak Medical started, Sarfraz and I have been covering nearly all after-hours APP support and Ethizo task coverage for physicians who take time off. As the practice has grown, this is no longer sustainable or equitable. Distributing these responsibilities across the physician group will help us:

• Maintain safe, timely coverage for our NPs and facilities
• Prevent burnout and support long-term sustainability of our leadership team
• Ensure continuity of care for our patients when a physician is away Call Responsibilities When you are on call, your responsibilities will include:
• Supporting off-site/after-hours APPs o Answering clinical questions from the off-site/after-hours APPs during nights, weekends, and holidays. o Typical volume is 0-5 calls per month, based on our experience to date.
• Covering Ethizo tasks o Reviewing and completing any Ethizo tasks for physicians who are off during your assigned month o e.g., medication refills, death certifications, CTI, and other time-sensitive clinical items that cannot wait until the physician returns. Expectations While On Call
• Be reasonably available by phone and/or secure messaging during your call period. o Ensure your phone volume is on and not on silent or vibrate.
• Respond to APP calls in a timely manner (e.g., within 15-20 minutes).
• Sarfraz and I will be your back-up if you don't answer the call/text or if you have questions while on-call. Scheduling
• The office will assign each physician one month of call per year.
• Only physicians who work on average 3 days a week or more will be included in the call schedule.
• Your assigned call month will be added to your Oak Medical Outlook calendar, so it's clearly visible.
• For each call day, the office will also note which off-site APP is on so you know who may be contacting you.
• Switching your assigned month o If the month assigned to you does not work (vacation, travel, etc.): § Please arrange a switch directly with another physician, AND § Notify Ariel ( ariel.melius@oakmedgroup.com ) of the change so she can update the calendar and communicate any necessary adjustments.
• Only physicians who work on average 3 days a week or more will be included in the call schedule.

BLS Certification All physicians are required to maintain an active and up-to-date Basic Life Support (BLS) certification. (ACLS certification is acceptable.) This ensures providers are prepared to respond to emergent situations within our facilities and meet regulatory and organizational standards. Proof of current certification must be submitted to Oak Medical's Credentialing Coordinator Wendy Steadter at wendy.staedter@oakmedgroupcom to be kept on file Physicians are responsible for renewing their certification prior to expiration.