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Provider Compensation

*Base Compensation
<ACADEMIC Providers ONLY>

Report the amount paid as routine or regular compensation, regardless of the provider’s funding
sources or productivity. This amount is guaranteed by the hospital, practice, medical school, practice
plan, or Veterans Administration to the provider.
Do not include:

  • Incentive payments, honoraria, bonuses, profit-sharing distributions, expense reimbursements,
    fringe benefits paid by the medical school or department such as life and health insurance,
    retirement plan contributions, automobile allowances, or any employer contributions to 401(k),
    403(b), or Keogh Plan.

*Total Compensation

Please read all instructions first to find which scenario fits your medical practice. There are separate
instructions for how to report total compensation depending on your medical practice’s tax status.

For C corporations (under United States federal income tax law, this refers to any corporation that is taxed separately from its owners), state the dollar amount reported as direct compensation in Box 5 (Medicare wages and tips) from the provider’s W-2.
Include:

  • Total Medicare wages – this includes on-call compensation;

  • On-call compensation – included in total Medicare wages;

  • 401(k);

  • Life insurance; and

  • Any other pre-taxed deductions (Employee contributions).

Do not include:

  • Expense reimbursements;

  • Fringe benefits paid by the medical practice;

  • Flex spending accounts (FSA);

  • Health insurance; or

  • Employer contributions.

For partnerships (or LLCs that file as a partnership) state the dollar amount reported as direct compensation in Box 1 plus Box 4 minus Box 12 minus Box 13 from the provider’s K-1 form 1065. 
Include:

  • In box 13: Codes A through W (this includes 401(k))

For S corporations (or LLCs that file as an S corporation) state the dollar amount reported as direct
compensation in Box 5 (Medicare wages and tips) from the provider’s W-2 PLUS Box 1 minus Box
11 minus Box 12
from the provider’s K-1 form 1120S (combine amounts from both forms). 
Include:

  • In box 12: Codes A through S (this includes 401(k))

 

*First Year Guaranteed Compensation
<New Hires Only>

Report the first year guaranteed contract dollar amount.
Do not include:

  • The dollar value of a signing bonus and other dollar amounts received through a bonus system
    such as production-based bonuses; or

  • The dollar value of expense reimbursements, fringe benefits paid by the medical practice such as
    retirement plan contributions, life and health insurance or automobile allowances or any employer contributions to a 401(k), 403(b) or Keogh Plan.

*Indicate the percentage of each method that is used to compensate the provider:

Indicate the percentage of each method for the provider’s compensation plan utilized in your
practice. Provide the whole-number proportion that each method makes up of the entire plan,
ensuring that all percentages add up to 100.

*% of Total Compensation based on Straight or Base Salary: Compensation is a fixed, guaranteed salary.

*% of Total Compensation based on Productivity or Equal Share of Compensation Pool:
Productivity measures volume of physician work RVUs, collections, etc. This also includes equal
share of compensation pool. A “compensation pool” is equal to the total practice revenues net
of practice overhead expenses. Such plans generally treat practice overhead as a cost of doing
business that is borne by the group as a whole and not allocated to individual physicians (with the
potential exception of physician-specific direct expenses). Such plans may be referred to as “team”
or “group-oriented” compensation methods.

*% of Total Compensation based on Quality and Patient Experience Metrics: Examples of
quality measures include, but are not limited to, clinical process/effectiveness, patient safety, care
coordination, patient and family engagement, efficient use of healthcare resources, population/
public health and patient satisfaction.

*% of Total Compensation based on On-Call Compensation: Compensation based on “on-call” time.
*% of Total Compensation based on Other Metrics: A compensation plan metric that is not listed here (medical directorship stipend, honoraria, etc.).

*Method by which the Provider was Compensated for On-Call Coverage

From the options listed, select the period for which the compensation amount was paid for
each provider.

Hourly Rate: The provider is paid a defined amount for each hour spent providing on-call coverage.
Daily Stipend: The provider is paid a defined amount for each day spent providing on-call coverage.
Weekly Stipend: The provider is paid a defined amount for each week spent providing on-call coverage.
Monthly Stipend: The provider is paid a defined amount for each month spent providing on-call
coverage.
Annual Stipend: The provider is paid a defined amount for the entire year for all time spent
providing on-call coverage.
Per Work RVU: The provider is paid a defined amount for each work RVU generated while providing
on-call coverage.
Per Procedure: The provider is paid a defined amount for each procedure completed while
providing on-call coverage.
Other Compensation Method: If the provider is compensated based on a method other than those
listed above, select "Other Compensation Method" and describe the compensation method in the
"Other" box.
No Additional Compensation: The provider is not paid additional compensation for providing
on-call coverage.
Not Applicable: The options provided do not pertain to the provider for type of compensation for
on-call coverage.
*Amount Compensated per On-Call Compensation Method
On-call is the scheduled state of availability to return to duty, work ready, within a specified period of time. List the amount compensated per provider, per the method that was selected in the "Method by which the Provider is Compensated for On-Call Coverage" question. Perform a blend if different rates are paid at the practice, hospitals, or for different days, excluding holiday or weekend pay in the blend. For example, if the provider is compensated $600 at the practice and $700 at the hospital, report $650 as the on-call compensation.
*Number of Hours per On-Call Compensation Method
Indicate the number of hours spent on-call per method (from the "Method by which the Provider is
Compensated for On-Call Coverage" question). For example, if the provider is compensated a "Daily
Stipend," indicate the number of hours the provider works per day for on-call coverage. If the on-call
coverage method was "no additional compensation", please provide the number of hours per week.
Holiday On-Call Compensation Amount (per day)
List the amount compensated per day for holiday on-call coverage, even if the holiday on-call
compensation is part of the provider's overall compensation.
Weekend On-Call Compensation Amount (per day)
List the amount compensated per day for weekend (i.e. Saturday or Sunday) on-call coverage, even
if the weekend on-call compensation is part of the provider's overall compensation.

Method by which the Medical Directorship was Compensated:

Hourly Rate: The provider is paid a defined amount for each hour spent performing medical directorship duties.
Daily Stipend: The provider is paid a defined amount for each day spent performing medical
directorship duties.
Weekly Stipend: The provider is paid a defined amount for each week spent performing medical
directorship duties.
Monthly Stipend: The provider is paid a defined amount for each month spent performing medical
directorship duties.
Quarterly Stipend: The provider is paid a defined amount for each quarter spent performing medical
directorship duties.
Annual Stipend: The provider is paid a defined amount for the entire year for all time spent
performing medical directorship duties.
Deferred Compensation: The provider receives some type of deferred compensation, which is paid
after the regular pay period, such as an annuity or pension plan, for time spent performing medical
directorship duties.
Other Compensation Method (please specify): A method that is not described by one of the above
methods. Please provide a brief description.
No Additional Compensation: The provider is not paid additional compensation for performing
medical directorship duties.
Not Applicable: The options provided do not pertain to the provider for additional compensation for
performing medical directorship duties.

*Directorship Compensation per Method

State the amount the provider is compensated per method selected under "Method by which the
Medical Directorship is Compensated."

Directorship Hours per Week

Indicate the number of hours the physician works on directorship duties during a normal (typical)
workweek.

*Total Annualized Directorship Compensation

Enter the total compensation for medical directorship duties earned for the fiscal year. This figure should only be for medical directorship duties and annualized to represent a full 12-month period.

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