You are served with a complaint involving a high-profile patient, in this case a professional athlete. You performed surgery on her and she claims she can no longer run and jump like she used to, prior to your surgical correction. Your first reaction is to call a friend that works for [...]
continue readingMost physicians who treat close friends or relatives don’t keep detailed charts, if there are charts at all. No matter the patient, accurate and complete records must be kept- a lesson the physician in the following example learned the hard way. The physician in this case, a dermatologist, was sued for [...]
continue readingWhen a third party conducts an audit, they get to keep a percentage of the money they recover. They may even claim that some of their audits result in discovering that you are underbilling. This would theoretically result in you getting more money from the carrier. Please, raise your hand if [...]
continue readingPlease note the significant difference between evidence in medical malpractice trials and administrative licensure hearings within most states: Administrative licensure hearings generally admit hearsay; while trial courts usually do not admit hearsay. Remember, an experienced healthcare law attorney can use this to your advantage as admission of hearsay; this works both [...]
continue readingSince 2005, all Medicaid providers that make at least $5 million dollars annually, are required to have a written compliance program. Have a Happy and Healthy New Year!
continue readingYou should periodically review your own bills and medical records to make sure that you know what is leaving your office under your signature. Please remember, that when you sign an insurance form electronically or otherwise, you are certifying what is above your signature is true. Whenever possible, please have one [...]
continue readingIncreasingly, we are seeing health care providers being subject to video evidence taken in public areas of hospitals and healthcare facilities. On more than one occasion, during the investigation by a state or federal agency, video evidence was used to disprove a provider’s contention that they were not in a certain [...]
continue readingDelays in response or non-response to your complaints in lack of coverage: Constantly kicking the can down the road, is not a legitimate response. Making you, the provider go in circles, is not a sign of good faith. Refusing to pay the claim prior to a real investigation: The insurance company, [...]
continue readingSome insurance companies are taking certain procedures and refusing to pay out claims by labeling them as investigative. By doing so, this takes the claim out of certain types of appeals that is normally mandated by many states. Again, it is the insurance company who uses the label which has the [...]
continue readingFor those of you that take UDT, urine drug tests, be aware that you must justify the frequency of the tests. Is your patient a low, medium, or high risk to be a drug abuser? Additionally, you must research what a particular insurance plan may require to approve whatever your UDT [...]
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