Start Your Own Medical Practice/Urgent Care Center or Self Standing ER

Start Your Own Medical Practice/Urgent Care Center

or Self Standing ER

By Zagreb global group

Practice Startup

Reduce Stress and Achieve Early Profits for Your Medical Practice Startup

Your Startup Strategy Will Impact Profits for Years to Come

Knowing and overseeing the thousands of details required for a successful medical practice startup is not the only key to success. The key is to achieve the tasks in the proper sequence and to know which tasks are prerequisites for others. This helps keep your startup on schedule, avoids costly delays, and prevents you from delaying important decisions that impact profits.

The Real Cost of a DIY Practice Startup

It is really easy to become tempted by the idea of saving a few dollars with a do-it-yourself practice startup. It can be done, however, this often costs physicians tens of thousands of dollars in missed revenue over the first few years of their practice. For example:

  • If you do not get credentialed with the right carriers, it can cause you to miss two additional new patients per day for the first three months, which translates to $300 per day, or up to $6,000 per month of missed revenue.
  • With the right marketing plan, you might bring in three more patients per day for the first two or three years. Without it, you could cost yourself tens or even hundreds of thousands of dollars.

These examples are the price of relying on a standard practice startup checklist. Even the most comprehensive list can’t convey the timing and order in which certain tasks must occur, nor can it convey the value that comes with the experience of having set up medical practices for physicians in just about every specialty.

A Proven System for Success

Our team at Zagreb Global Group has refined the process to help ensure a successful practice startup. We can help you in any stage of your startup, including:

  1. Conduct a feasibility study
  2. Determine parameters for facility size and location
  3. Evaluate and establish your site location
  4. Identify practice and financial objectives
  5. Assistance with securing financing
  6. Obtain credentialing and contracting
  7. Establish operations, compliance and HR procedures
  8. Assistance with your marketing plan and patient loyalty development

From Feasibility to Ribbon Cutting…

You can choose the level of service that provides what you need wherever you are in the process. Our medical practice startup professionals know what needs to be done and how to do it effectively and efficiently. We can even work with you after the initial medical practice startup to help keep you moving into higher levels of professional success.

Office Based Surgery Startup

Gain Control Over Your Schedule And Increase Surgery Revenue

The single largest regret our clients have once their office-based surgery (OBS) center is up and running is that they didn’t startup sooner!

For physicians seeking ways to offset declining revenues with services that enhance the patient experience, office-based surgery services are an ideal solution. With improvements in equipment, technology and techniques, physicians can now perform complex surgical invasive procedures in their own office-based suite while maintaining the highest standards of patient safety.

As a full-service consulting firm that employs experienced healthcare professionals, we have developed a system for surgical center success that avoids wasted time and missed revenue. From the scope of services and level of physician involvement to licensure and staffing needs, we reduce the time to build and start up an efficient, scalable infrastructure to support your immediate and long-term goals.

Whether you are just getting started or interested in taking your existing center to new levels of efficiency, compliance and profitability, our team can help. We manage every aspect of setup including the development of surgical service line offerings based on patient demographics. We provide support for navigating state guidelines, protocols and procedures for consent, compliance management, policy manuals, infection and safety controls, and emergency management. You also receive customized risk management and compliance manuals, employee manuals, staff training, marketing recommendations and guidance, as well as the option for ongoing management services to promote continued growth.

Provider Enrollment Services / Medical and Physician Credentialing Services 

Rid yourself of all the headaches, mounds of paperwork, and confusion with the insurance companies!

Who We Work With:

  • Physicians
  • PAs/ NPs
  • Hospitals
  • Podiatrists (DPM)
  • Chiropractors (DC)
  • Ambulatory Surgery Centers (ASC)
  • Urgent Care Facilities
  • Dentists/ Orthodontists
  • Many More

What Enrollment and Physician Credentialing Services We Help with:

  • Commercial Insurance Provider Enrollment and Credentialing (ie. Aetna, Anthem, BCBS, CIGNA, Tri Care, Humana, UnitedHealthcare, Many More!)
  • Medicare and Medicaid Provider Enrollment and Credentialing
  • Medicare and Medicaid Revalidation
  • CAQH Registration
  • NPI Registration (Type I and Type II)
  • Reimbursement Issues
  • Managed Care Contracting Issues
  • Hospital Privileging

Why Use Experienced Consultant ?

  • Save you on average at least 2 months of time and over 100 or more hours of work!
  • Take away all the headaches due to the mounds of paperwork and endless applications!
  • Increased patient referrals!
  • Get you paid by the insurance companies faster!
  • Contracts and applications are setup right the first time and we will not stop until the process is 100% completed!
  • Dedicated project manager assigned to your project!
  • We make all the phone calls, follow-ups, and submit all applications, e-mails and faxes for you!
  • The service is typically provided at a cost less than it would be for you to hire your own provider enrollment or credentialing team and we can handle any volume you have! 

What you get with our Provider Enrollment and Physician Credentialing services:

  • An “All Purpose” credentialing manager to represent you with commercial and government payors.
  • We complete all applications and necessary paperwork on your behalf with the chosen payor networks and government entities.
  • Status reports so you know where you are in the process with each payor.
  • Maintain and update CAQH profile.
  • Complete all necessary credentialing requirements for each payor and follow through to completion.
  • Follow all payor contracts through to contract load date and provide copy of fully executed contract and fee schedules to your practice or billing company.

Mr.Marijan Pavisic MS SPHR is a Seasoned HR Executive with a proven track record.

Start Your Own ASC

Start Your Own ASC

Market Conditions are Right

In today’s rapidly changing healthcare environment, patients recognize that they have choices when it comes to their medical care. They are looking for high-quality physicians, state-of-the-art equipment, positive outcomes and convenient care – all at affordable prices. These market drivers have resulted in an increase in both the number of ambulatory surgery centers and surgical hospitals that are opening up across the United States. In fact, our research has uncovered the following:

  • 170+ new ASCs are opening up each year.
  • 60% of hospitals have an ASC within walking distance.
  • Most physicians who staff ASCs are former hospital employees seeking equity in the service they provide – especially those who provide services with specialties that have a greater access to reimbursement now versus prior years.
  • The “hospital experience” is becoming a less desirable option for patients who have a choice.

Our Typical De Novo ASC Opportunity

The Partners Surgical Difference

When you partner with Zagreb Global Group, you are choosing an experienced team that has consistently demonstrated success in a variety of de novo opportunities. We handle all of the start-up and ongoing burdens of site selection and construction, equipment purchasing, personnel hiring and payroll, infrastructure creation and design, day-to-day management, regulatory oversight, financial planning and capital support, compliance and marketing – virtually all of the details involved in getting your center up and running. Our turn-key approach allows you to focus on what you do best – providing the highest level of patient care available.

Whether you are an individual physician, part of a group of physicians, or interested in starting an ASC in conjunction with a hospital, Zagreb Global Group can structure the right ASC for you

ASC Operational Services

Operational Support

The ASC market is an exciting and growing sector in healthcare. Patients are demanding a choice – and the ASC model delivers the convenience, quality and positive outcomes they expect.

However, simply leasing an office and filling it with medical equipment and staff is not a sound model for success. In order to succeed in the ASC arena, or any medical sector for that matter, it takes a high level of healthcare experience and fundamental commitment to excellence across the board.

Operational Support Excellence

The leadership of qualified consultant will develop a plan to support your ASC with all of the operational planning, protocols, infrastructure, guidance and day-to-day management that you will need to keep your de novo or existing ASC profitable in both the short-term and long-term. Our best practices, formed over decades of ambulatory surgery center experience, will ease your operational burdens and ensure that your patients receive the highest level of care available.

Rely on Consultant to deliver industry-leading standards for:

  • Planning, Management and Operational Support
  • Compliance, QC and Regulatory Oversight
  • Infrastructure Development and Maintenance
  • Information Technology and Data Services
  • Turn-Key Marketing Planning and Support

ASC Financial Support

Financial Strength

Good consultant will provide the highest level of client care for each ASC partner. However, without sound business and financial principles, available capital, smart purchasing and managed growth plans, sustainable success is almost impossible. In order to continue to deliver quality patient care for the long-term, maintaining the financial health of the ASC is critical.

Profitability, Security and Strength

While our Consulting team is loaded with heavy hitters in the healthcare arena, our bench is just as deep when it comes to financial planning, management and support.

Providing excellent care requires the right capital partner to keep both the operations running smoothly and its ASC partners working at a profit. A healthy financial return for each partner positively affects morale, performance and long-term success for every center.

Rely on the experienced financial team at to deliver:

  • Capital Support
  • Budget Preparation and Financial Reporting
  • Contract Negotiations
  • Tax Filing and Support
  • Growth Planning Strategies
  • Supply Chain Management
  • Revenue Cycle Management
  • Reimbursement Negotiations
  • Centralized Billing & Collections
  • Purchasing Strength
  • And More

ASC Clinical Services

Clinical Excellence

The demand for high-quality ambulatory surgery centers is on the rise. In fact, over the last three years, the ASC market has experienced a healthy year-over-year growth.

Patients are receiving better care than they would at a traditional hospital setting – with more convenience and at a lower cost. The market is strong for experienced groups who understand the complexities and nuances involved in building and managing quality ASCs that serve local communities. The Partners Surgical clinical team brings decades of top-notch, hands-on experience to every de novo, existing and hospital joint venture ASC partner.

More Convenience, Better Outcomes

While surgeries have been performed in a hospital setting for nearly a century, the ASC model optimizes high-acuity surgeries with a fit-for-purpose and systematic approach.

Built and operated in the communities in which patients live and work, these ASCs offer unmatched convenience and comfort to improve a patient’s overall experience.

We develop customized centers with the exact physicians and services the patients need – but without the intimidating and overwhelming feel of the hospital experience.

The consulting team team takes a professional and laser-focused approach to creating a clinical environment conducive to exceptional patient care. Our proven patient-centric ASC model delivers:

  • Clinical Best Practices and QC Reporting
  • Quality Staffing for All Clinical Support
  • Flexible Scheduling and Friendly Office Hours
  • Diagnostic and Therapeutic Procedures – Offering Continuity of Patient Care
  • Personal Service, Improved Patient Education and Thorough Communication
  • Patient Follow-Ups from an RN within 24-Hours after Procedure
  • Significantly Reduced Patient Costs versus Hospital Experience
  • Better Outcome Statistics versus Hospital Experience

ASC Human Resources Services

Human Resources

Good Consultant recognizes that a successful ASC depends on the quality of the people that are involved at every stage of the process – from physicians, RNs, clinical practitioners, and support staff. We take a comprehensive approach to fulfilling all of your human resources needs, allowing you to focus on what you do best – treating patients.

While you will have input in the process of hiring, training and rewarding your top people, PSC will take ownership of the process so you can be involved as much, or as little, as you prefer.

Comprehensive Human Resources

Managing an office of people can be challenging and rewarding at the same time. Zagreb Global Group specializes in building personnel teams in the ASC and freestanding lab settings will ensure that your staff performs at its highest level.

Rely on the HR experts at Zagreb Global Group to provide:

  • Effective Recruiting and Hiring
  • Personnel Planning and Career Development
  • HR Infrastructures, Policies and Management
  • Payroll and Tax Reporting
  • Benefits Administration
  • Federal, State and Local Compliance
  • Salary Benchmarking
  • 401k and Benefits
  • Employee Retention Plans
  • Internal Communications and Conflict Resolution
  • Enhanced Teambuilding and Employee Morale

Mr.Marijan Pavisic MS SPHR is a Seasoned HR Executive with a proven track record.

New York City Adopts Lactation Accommodation Law

New York City’s new lactation accommodation law is now in effect and imposes new requirements on employers with four or more employees. The new law adds to the obligations that employers already have under New York State’s Labor Law. Under the Labor Law, employers are required to make reasonable efforts to provide a private room or location for employees to express breast milk. The room or location must be well lit, shielded from view and in close proximity to the employee’s work area. The room or location also needs to have a functional lock or, if a lock is not available, a sign advising that the room or location is in use and not available to other employees or the public. Inside the room or location, employers must provide nursing mothers with a chair and small table or other flat surface. New York State law encourages, but does not require, employers to also provide an outlet, clean water supply and access to refrigeration.

New York City’s new law incorporates these requirements but also takes them a step further. First, the lactation room must be a sanitary place, other than a restroom, that is shielded from view and free from intrusion. Second, the room needs to have an electrical outlet, a chair and a surface upon which employees may place a breast pump and other personal items. Third, the employee must also have nearby access to running water. Fourth, employers need to provide a refrigerator suitable for breast milk storage in reasonable proximity to the employee’s work area. Finally, if the lactation room is also used for other purposes, it must only be used as a lactation room while an employee is using it to express milk, and the employer must give notice to employees that the room gets preference for use as a lactation room. While some of these features are merely suggested under New York State law, New York City now requires them.

The new law also requires employers to adopt written lactation room accommodation policies, which employers must distribute to current employees and new employees upon hiring. The policy must:

  1. State that employees have a right to request a lactation room;
  2. Specify a process by which employees can make an accommodation request;
  3. Require the employer to respond to accommodation requests within a reasonable amount of time not to exceed five business days;
  4. Include a procedure for when two or more individuals need the room;
  5. Provide contact information for any necessary follow up on conflicting needs;
  6. State the employer’s obligation to engage in cooperative dialogue if an employee’s request for a lactation room imposes an undue hardship; and
  7. State that the employer shall provide reasonable break time for employees to express breast milk pursuant to New York State’s Labor Law Section 206-c.

15 things to know about Stark Law-For My Colleges In Health Care Industry

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Enacted more than two decades ago with the simple purpose of curbing physician self-referral, Stark Law has evolved into a complex set of regulations, which some argue impede efforts to transition away from a fee-for-service system.

Here are 15 things to know about Stark Law.

1. In 1989, Congress passed the Ethics in Patient Referrals Act, which was dubbed Stark I after Rep. Pete Stark, a Democrat from California, who sponsored the initial bill.

2. The original statute was quite simple. It sought to ban physician self-referral for designated services when a patient was covered by Medicare or another government payer. Self-referral occurs when physicians refer patients for designated health services to hospitals, labs and other entities from which they or an immediate family member benefit financially.

3. Stark Law applies to the following designated health services:

  • Physical therapy services
  • Occupational therapy services
  • Outpatient speech-language pathology services
  • Radiology and certain other imaging services
  • Radiation therapy services and supplies
  • Durable medical equipment and supplies
  • Parenteral and enteral nutrients, equipment and supplies
  • Prosthetics, orthotics and prosthetic devices and supplies
  • Home health services
  • Outpatient prescription drugs
  • Inpatient and outpatient hospital services

4. The intention behind the original statute was to eliminate any financial motivation for physicians to send patients for unnecessary testing that could raise overall healthcare costs.

5. The original statute was expanded in January 1995, when Stark II went into effect. Over the next decade, CMS published a series of regulations implementing the physician self-referral law. Today, there is a sprawling group of regulations and statutes collectively named Stark Law.

6. Stark Law has numerous exceptions, each of which carries its own detailed requirements. Many of the exceptions require compensation paid to a physician to not take into account the value or volume of a physician’s referrals or other business generated between the parties to a gainsharing agreement. Many exceptions also require the arrangement to be commercially reasonable and compensation to be at fair market value.

7. Any provider organization that violates Stark must repay all Medicare funds paid under the improper arrangement, which could total tens of millions of dollars. The organization could face Medicare exclusion and False Claims Act liability as well.

8. If claims are submitted to government payers through an arrangement that violates Stark Law, the claims are rendered false or fraudulent, creating liability under the False Claims Act, according to the American Bar Association. Most of these cases are filed by whistle-blowers under the qui tam provision of the False Claims Act.

9. Whistle-blowers have a lucrative incentive to pursue these actions, as they are entitled to up to 30 percent of the government’s recovery in False Claims Act cases. The penalties authorized under the False Claims Act were raised in 2016 to a range of $10,781 to $21,563 per claim.

10. The complexity of Stark Law has left hospital executives, Congress and CMS struggling with the boundaries of the legislation — especially as the healthcare industry replaces traditional fee-for-service medicine with value-based care.

11. Stark Law requires physicians receive only fair-market prices for their services, and the serious costs associated with technical violations of the law have made hospitals hesitant to move forward with pay-for-performance initiatives.

12. Common technical violations of Stark Law include lack of documentation to support fair market value, failure to accurately describe services rendered and failure to change the terms in writing when compensation or duties change.

13. In early February, HHS released a report that provides observations on the effects of Stark Law and the Anti-Kickback Statute on the industry’s transition to value-based payment models. In the report, HHS said some gainsharing and similar arrangements can be structured in a way that does not violate the Anti-Kickback Statute and meets the requirements of Stark Law. However, HHS noted the current fraud and abuse laws “may serve as an impediment to robust, innovative programs that align providers by using financial incentives to achieve quality standards, generate cost savings and reduce waste.”

14. Legislators and hospital leaders have expressed concerns about Stark Law in recent years. For instance, during a Senate Finance Committee hearing last July, Chairman Orrin Hatch (R-Utah) said Stark Law has become too complex, creating obstacles in the transition from the antiquated fee-for-service model.

15. Sen. Hatch’s views were echoed by several healthcare leaders during the hearing, including Ronald Paulus, MD, CEO of Asheville, N.C.-based Mission Health. Dr. Paulus said problems with the physician self-referral law can’t be fixed by tinkering around the edges. He believes a full repeal is necessary to allow health systems to move forward with population heath efforts.

Update from feds: DOL releases opinion letters regarding FMLA, FLSA


It was a busy week for the DOL — not only did the agency release a new set of FMLA forms for employers, but it wrote four opinion letters addressing several FMLA and FLSA concerns. 

As far as the forms go, the only thing that changed is the expiration date. The updated FMLA forms are exactly the same as the previous set.

The opinion letters will be of more interest to employers, as they address tricky scenarios managers may run into when dealing with the FMLA or FLSA.

Here’s a rundown of the situations the DOL addressed in the letters:

1. Organ donation is covered under the FMLA

In FMLA 2018-2-A, an employer asked whether an employee could use FMLA leave for undergoing organ donation surgery. The DOL says yes. Even if the employee was in good health before the surgery, organ donation still qualifies as a “serious health condition,” and therefore is covered under the FMLA.

A serious health condition is defined as an illness or physical condition that requires inpatient care at a hospital. Since the typical hospital stay after organ donation surgery is four to seven days, this certainly qualifies as a serious health condition.

2. FMLA leave “freezes” no-fault attendance policies.

In FMLA 2018-1-A, an employer detailed its attendance policy. Employees would accrue points for absences, and if those absences added up to a certain number in a year, they’d be terminated. But employees could also shave some points off with consistent good attendance. The employer’s question? If an employee takes FMLA leave, does that mean they cannot accrue or lose any absence points?

The DOL said yes, employers are permitted to “freeze” the absence points of employees on FMLA leave. It’d be an FMLA violation to give employees absence points while on leave, but it’d also be an unfair benefit to remove points while employees were not working.

Note: This freezing policy must apply equally to all types of leave, such as vacation and worker’s comp.

3. Voluntary health and wellness events can be unpaid.

In FLSA 2018-20, an employer asked if employees needed to be paid for attending voluntary biometric screenings during the work day. The DOL says no. Since the event is voluntary, and is primarily for the benefit of the employee, it isn’t compensable. When an employee is attending a wellness event, they are relieved of their job duties.

4. Clarification on retail or service establishment exemption

In FLSA 2018-21, an employer wanted to know if the “retail or service establishment” exemption applied to sales reps at their business. The company sold a unique technology platform to a variety of clients, and not in large quantities. The DOL decided this type of business qualified for the exemption.

The retail or service establishment exemption says employees don’t receive overtime pay if they meet the following requirements:

  • they work at a retail or service establishment
  • their regular rate of pay exceeds one and a half times the minimum wage, and
  • more than half their earnings consist of commissions.


Marijan Pavisic MS SPHR