How ‘Malpractice Insurance’ Can Save You From Drowning Financially During Malpractice Law Suits

Physicians, who are generally known for highest professional integrity, often have to live with the tag of ‘malpractice’ despite clinical errors being unintentional. While patients’ have every right to get indemnified for the grievance, physicians’ sole choice of protection against monetary liability – which may vary from few thousand to many thousand dollars depending on the severity of the clinical error – happens to be 'malpractice liability’. Thus, whether you like or not, malpractice insurance is now more a necessity than an option. Moreover, malpractice insurance often needs to chosen carefully depending on the context in which physicians find themselves in –  physicians employed in a hospital may need to be insured differently from those who may be operating their clinics. Because of these inherent priorities, physicians have to aware and knowledgeable of the malpractice insurance that best safeguards them against any eventuality. 

It may be remembered that professional liability insurance can be availed as either ‘occurrence’ or ‘claims-made’ policy. While most of the policies offered by the insurers are claims-made, you can still avail opt for occurrence policies, which are relatively costlier than claims-made policies.

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Claims-Made Policies

In claims-made insurance, carrier is obligated to provide coverage only for the incidents that occur and get reported during the time of your insurance being active. Therefore, it is necessary that both the incident and the filing of the claim happen while the policy is in effect.

Suppose you discontinue with a claims-made policy, and get sued for a malpractice during the time when your claims-made was still in force, you will not be covered against any such suit unless you have kept alive your original claim-made policy with ‘tail coverage’, the term used for extended reporting endorsement. Despite tail coverage being expensive – as far as three times the value of an annual premium – it is often recommended to be active with tail coverage for any claims that could be reported years after they first happened. Tail coverage is also beneficial to physicians who change over to private practice from hospital employment where employer may have been covering them with claims-made policies alone.

Occurrence Policies

On the other hand, occurrence policies are more protective in nature, offering lifetime coverage for the incidents the incidents gets reported long after the expiry of policies. Suppose, you are sued in 2013 for a malpractice that took five years earlier when you were covered under an occurrence policy, you still are entitled to be covered under the your erstwhile occurrence policy even though it has expired.  But a major drawback with occurrence insurance is that they are apparently too costly to be borne by smaller physicians.

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While physicians may possible chose among the forms of malpractice insurance, malpractice   liability is something that is quite inescapable. The alarming increase professional liability claims does quite vindicate the significance of having some form of malpractice insurance. While it may not restore the possible loss of credibility of goodwill of your clinical practices, it could surely prevent you from drowning financially. Therefore, your choice and quantum of malpractice insurance should necessarily be tailored to your practice specialty, practice location, ability to offer collateral security, and more importantly according to state legal requirements under which you are operating.

However, you may find it hard to reconcile these multiple considerations, and possible be better off with some external advice availing malpractice insurance. Medicalbillersandcoders.com, which holds the distinction of being a premier platform for sourcing medical billing solutions, is equally adept at suggesting and securing ‘malpractice insurance’ for physicians either employed in a hospital setting or practicing independently. Our broad base of experts, knowledgeable with various malpractice insurance policies and state-specific rules can be relied upon for implementing the insurance policies that best suit your need and capability.

The Significance of Responding to Cardiology Billing and Coding Dynamics

Cardiology is one those specialties that generally perform high-cost diagnostic and curative services, and getting reimbursed for such significant services means conclusive and convincing cardiology medical billing – adhering to cardiology codes, compliance standards and coding rules. Cardiologist, who used to be comfortable with a fewer codes and compliance standards and coding rules, are now required to be abreast with period changes in cardiology codes, compliance standards and coding rules. Amongst these evolving changes, cardiologists need to be aware of acceptability of the codes assigned, modifiers to be attached, medical necessity of performing and coding a procedure, component coding, and so on.

Acceptability of the codes assigned

Contrary to overlapping cardiology codes in the past, CMS has comes up with an exhaustive list of cardiology codes, meaning virtually an independent and appropriate code for every cardiology procedure. Therefore, Medicare, Medicaid, and private insurance companies can easily verify and ascertain whether or not you have aptly coded your procedures. Moreover, attaching a lower-paying code for a relatively costlier procedure does not make sense at all.

Apart from learning evolving coding numbers and their correct assignment, cardiologists should also familiar with changes that have been introduced in codes relevant to heart catheterization, revascularization, observation services and more. Many existing codes have undergone revisions, including iliac repair, angioplasty, non-coronary stent placement, wearable ECG recording, and non-invasive physiologic changes. As of now, while billing for cardiology procedures:

• Cardiologists are required report most non-congenital procedures with a single code
• Catheterization coded for non-congenital studies cover injections, imaging supervision, interpretation and report.
• Imaging supervision, interpretation and report are included with the injection procedure and cannot be reported separately in the case of all cardiac catheterization procedures
• Cardiology-specific codes such as 93451, 93456, and 93503 are not allowed to be attached with modifier 51.

Medical necessity of performing and medical necessity of performing and coding a procedure

In certain cases, insurance payors may contest the medical necessity of certain procedures undertaken by cardiologists. Therefore, it crucial that cardiologists substantiate the necessity of those procedures that have sent coded. Otherwise, reimbursements for those procedures may be rejected for lack of sufficient proof.

Component Coding 

 

Cardiologists’ services may often involve certain technical components, and there are specific coding ruling depending on the criticality of each of such technical components. A higher technical component should always be accompanied by a higher value code so as to maximize the eventual reimbursement. In cases where there are several technical components involved on the same, the lowest component should be singled out to prevent the mandatory 25 percent deduction being charged to any other higher paying technical components.

All of these evolving cardiology codes, standards, and rules may limit cardiologists’ ability to realize their reimbursement in full. Therefore, irrespective of you being interventional cardiologists, diagnostic cardiologists, electro-physiologists, nuclear cardiologists or cardiovascular/ cardiothoracic physicians, you may eventually need an effective revenue cycle management solution in place that is integrated with the right technology, processes and people to respond to Cardiology Billing and Coding dynamics.

Medicalbillersandcoders.com offers and mediates resource deployment for integrated solutions in medical billing Revenue Cycle Management to diverse medical practices across the 50 states in the U.S. Our capability in cardiology medical billing is driven by a nation-wide resource base of expert cardiology medical billers and coders familiar with cardiology-specific medical billing, technology, and processes. With access to such talent-pool of professionals, cardiologists across the U.S. should be able to respond to cardiology billing and coding dynamics.

Ascertaining Cardiologists’ Medical Billing Needs Even as They Migrate From Private Practices to Hospitals

Till recently, cardiologists who were happy with their private practices have suddenly started exploring avenues to align themselves with hospitals. The change has been so dramatic that already around 15 percent of cardiologists across the U.S. have left their private practices in search of more secure positions in large clinics and hospitals. As per reliable industry sources, the exodus might well cross 70 percent in a couple of years. This shift may have not come about without valid reasons – increased regulations on private practices, stricter reimbursement environment, and a series of healthcare reforms calling for healthcare to be made more affordable may have triggered the swift turn of events.

Impact of revised cardiology fee schedules Like in other clinical disciplines, cardiologists too are feeling the heat of significant cuts in their fee schedules. The recent revision to cardiology fee schedule is so hard on cardiologists that it is virtually difficult even to operate on minimal operational margins. While a certain double digit cut to reimbursement from Medicare is expected, there is also apprehension that private payors may also follow suit. The consolation from the likely swell in patient numbers may not still be able to off-set revenues losses completely.

Stricter federal regulations on private practices Although the recent health care reforms are generally aimed at optimizing the quality of medical care across the nation, private practices may feel rules and regulation emanating from such reforms to be rather harsh or difficult to comply with. Affordable care model, mandatory EHR compliance, and the ensuing ICD-10 billing regime may be both exhausting and expensive. Therefore, cardiologists in private practice may deem it apt to mitigate such burden by abandoning their private practices, and practice in hospitals where they focus solely on cardiology efficiency.

Lure of hospitals Certain hospitals too are laying out baits to cardiologists with promise of lucrative benefits and vertical promotions. Hospitals feel that they can improve the quality with a large pool of experts under one umbrella. And, as for the cardiologists, it may be an opportunity to expand their professional expertise without additional overheads.

Immunity from administration burden One of the significant reasons behind cardiologists opting for larger clinics and hospitals is the perceived burden of administration, which is likely to be even more laborious in the aftermath of the recent health care reforms and the ensuing ICD-10 billing regime

While this migration may clinically and operationally be prudent for cardiologists who do not want to risk practicing amidst volatile conditions, it may not be good for the industry which has always thrived on proper mix of sole practitioners, clinics, and large cardiology specialty hospitals. The fear with this unprecedented exodus is that it may deprive instant access to primary cardiology points. Therefore, cardiologists need to be assured of operationally viable practices. And, there is no better way of doing this than easing cardiology medical billing burden of their shoulders.

Medicalbillersandcoders.com has been a premier source for medical billing, coding, and revenue cycle management services. Practices of varied sizes and disciplines across the 50 states in the U.S. have found our services to be reassuring at times of major operational dilemma. And, now at a time, when cardiologist across the U.S. are losing faith in private practices, our cardiology-specific billing, coding, and RCM solutions may just help them focus on their clinical priorities without being unduly worried about operational issues.

Eliminating Skilled Nursing Facilities’ (snfs) Medical Billing Complication

Medical billing for Skilled Nursing Facilities has undergone metamorphic changes ever since the Balanced Budget Act of 1997 came into effect 1998. One of the significant requirements under the new legislation is that Skilled Nursing Facilities are not permitted to unbundle services that are administered by contracted healthcare providers. As a result, most of the services provided to Medicare beneficiaries are to be bundled together and billed by SNFs under Prospective Payment System (PPS) in one consolidated claim. The SNF concerned is then responsible to pay for contracted services out of the per diem rate that it earns for caring a Medicare beneficiary.

While this imposition may have helped reduce potential fraud and abuse due to double billing by healthcare providers, SNFs have certainly had a hard time in understanding:

What services are covered under consolidated billing What is billable under Medicare Part A What is billable under Medicare Part B State-specific Medicaid protocols and methodologies for SNFs Medical Billing Commercial health insurance plans and their dynamics

Though most the services offered to a resident under Medicare Part A are allowed to be included in the consolidated billing, certain services deemed costly or requiring specialization must not be appended with the consolidated billing. Generally, physician's professional services; certain dialysis-related services, including covered ambulance transportation to obtain the dialysis services; certain ambulance services, including transporting the beneficiary to the SNF initially, transporting from the SNF at the end of the stay (other than when involving transfer to another SNF), and transporting round-trip during the stay temporarily offsite to receive dialysis or certain types of intensive or emergency outpatient hospital services; erythropoietin for certain dialysis patients; certain chemotherapy drugs; certain chemotherapy administration services; radioisotope services; and customized prosthetic devices are excluded.

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The services that are excluded under Medicare Part A should be billed under Medicare Part B, which allows medically necessary services to be reimbursed under ‘Fee For Service’ (FFS) system. It is possible that SNFs may have not entirely been thorough with these procedures, resulting in billing inefficiencies.

Even as most of the SNFs need to bill Medicare Part A and Part B, there could be SNFs that operate under state-specific Medicaid ambit. And, because each of the 50 states in the U.S. may its own Medicaid program, SNFs should invariably have to bill under their state-specific Medicaid rules and regulations. This regions-specific compliance too may have had a considerable impact on SNFs billing.

Outside the public health insurance plans, SNFs encounter the second largest health insurance providers in commercial health insurance carriers. While CMS has set a uniform standard for reimbursements across the board, commercial plays may still have their own individualistic methods of SNF reimbursement. Thus, SNFs medical billing may have suffered from having to adapt to these multi-payer dynamics.

These SNF-related medical billing concerns necessitate the significance of SNF medical billing specialists that certified and competent to maneuver SNF medical billing executions under Medicare Part A, Part B, state-specific Medicaid programs, and commercial health insurance environment. Medicalbillersandcoders.com has been versatile enough to solve medical billing issues regardless of location, size, or medical disciplines; practices across the 50 states in the U.S. continue to rely on us for remedial and transformational medical billing services. With our nation-wide resource-base adept at multi-component and multi-payer health insurance environment, SNFs should be able to put their medical billing complication to rest.

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Reforming Nursing Facilities Medical Billing Amidst Dwindling Reimbursements

Nursing facilities across the U.S. have somehow endured a series of Medicare/Medicaid cuts thus far, but the latest move by CMS to reduce reimbursement for so-called Medicare “bad debt” – Medicare co-payments not made by beneficiaries or state Medicaid programs – may bring them on the threshold of a major operational crisis. The new legislation has effectively brought down reimbursement rate for bad debts to 65 percent from what used to be 100 percent of unpaid co-payments under dual-eligible beneficiaries, and 70 percent for other Medicare bad debts. With most of the nursing facilities encountering dual-eligibles (Medicare & Medicaid beneficiaries), and federal law allowing Medicaid programs to opt out of making co-payments in most cases, it may be difficult to sustain quality and operationally viable nursing services amidst shrinking Medicare and Medicaid reimbursement rates.

Therefore, it is not unusual for nursing facilities adopting contingency plans to safeguard their operational viability. Amongst several options available to nursing facilities, the following seem to have been deemed strategically more sensible:

Laying off direct service staff Many nursing facilities operators believe that they would be able to off-set the effect of irrevocable bad debts with a reduction in their direct service staff. While they may be able to save considerable overheads, they may also be limiting their ability to sustain service quality. Putting new hiring on hold With limited scope for generating or increasing practice revenues, it may be difficult for nursing facilities operators expand their staff beyond their capacity. That is why most of them are inclined to putting new hiring on hold, and optimize operational efficiency with existing capacity. Here again, they may either be limiting their scope of operation or quality against a likely increase in Medicare or Medicaid patients. Pruning benefits Another plan that may increasingly be adopted is ‘pruning employment-related benefits’ – bonus, increments, promotion, and other amenities. While it may help substantially reduce cost, you could be harming staff’s morale and motivation. Deferring or cancelling expansion plans Reduction in reimbursements may curtail nursing facilities ability to expand with new ventures, and be forced to continue with current capacities despite demand generated by growing Medicare or Medicaid population.

While these plans may be effective to a certain extent, they will certainly be limiting nursing facilities’ ability to sustain quality, motive staff, and look beyond myopic operational strategies. That is why, rather than protective plans, operators would do well to explore alternatives that can keep their facilities responsive to quality and growth demands. Medical Billing is the area which has answers to most of the operational issues. Therefore, operators should look at making their nursing facility medical billing as effective and efficient as possible. Significantly, operators will need to align their billing practices to Medicare/Medicaid’s policy on reimbursing bad debts from disowned co-payments or deductibles.

Medicalbillingandcoders.com remains the most comprehensive source for medical billing solutions, more so for Medicare and Medicaid billing. With a resource base of medical billing experts spread across the 50 states in the U.S., nursing facilities can look forward to instant, effective, and efficient nursing facilities medical billing that can help them sustain quality and grow with evolving demand for nursing facilities.

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