Medical Malpractice

With the increase in the use of technology and the extended reach of the internet and computers, the medical insurance sector also had to advance. While the information technology makes it easy for the insurance houses and the healthcare providers to do their jobs, risks like data theft, identity theft and misuse of information have also increased. This prompted the United States government to frame the Health Insurance Portability and Accountability Act (HIPAA) in 1996, to give the patient greater control over his insurance cover and medical information. Additionally it also regulates the working of the insurance houses and the healthcare centers, making them more accountable.

As the patients get more control now, the organizations providing the insurance covers and the organizations providing HIPAA training or the "covered entities" have to do a balancing act. The insurance cover can be pulled up for various listed violations under HIPAA and can face serious charges. The covered entities should take the right measures and respect the law. Listed below are a few things you can do as representative of the covered entity to stay clear of trouble and keep your organization out of trouble.

• Review policies and procedures related to patient privacy

As per HIPAA, the privacy rule clearly states that the patient can control who accesses his or her records. The covered entity should appoint a privacy officer who can scrutinize the policies and procedures related to the patient privacy and policies. The organization should time and again communicate with the patient and explain the privacy policy of the organization.

• Review policies and procedures related to patient health insurance security

The insurance cover is required to review all the policies listed by HIPAA that deal with all the aspects of the patient health insurance security (PHI). A security officer is appointed by the covered-entity who heads the security systems of the organization, making sure there are no glitches in the system that can lead to leakage of PHI. An occasional report compiled by the Security Officer should be sent to all the patients. The PHI should be password protected and the system should be foolproof.

• Educate the staff about HPAA in detail

The staff of the covered entity should undergo a training process periodically. The latest HIPAA policies should be studied in detail and the law should be understood in detail. Once it is understood by the trainers, it can be passed on effectively. If the covered insurance skips this step, the patient can take them to the court for non clarity of policies.

• Agreements with business associates

All professional organizations and individuals in business relations with the covered insurance must enter into a business agreement to reduce the risk of any malpractices.

• Respond to patient requests and queries

Patients will have queries, doubts and questions. Always address their concerns timely, the time frame being within 30 days of receiving the request.

HIPAA is a very beneficial act which can benefit the patients. However, the covered entity should not get into trouble for policy and procedural issues. Constantly reviewing, analysis, in house training, up to date security measures and communicating with the patients can reduce the risk of violations.

Although background checks are usually performed in relation to business, this could also be possible in the medical field. If someone wants to see a doctor or somebody heard that he is a doctor, most of the time a great trust is placed because of the reason that they are doctors. And this holds true to others who put their full trusts to people because they are doctors. Most often than not, people never have to think twice of trusting their doctors with MD attached to their name. It gave the impression that this certain person is qualified to do the job. But unfortunately others had the unfortunate experience of putting their whole trust in a doctor that was not actually a doctor or simply not qualified to do the things that they were supposed to accomplished.

A doctor background check may include various information, such as any legal action taken against the doctor for Medicare or Medicaid fraud; any disciplinary board actions taken; a review of any sanctions, board suspensions, or malpractice judgments; a verification of your doctor's board certification and current certification status; a review of the doctor's internships, residency, and fellowship training; information on the medical school that the doctor graduated from; licensure status; information on specialties of the physician; complete contact information; publications written by the doctor and/or any membership affiliations.

Do not be hesitant in doing Background Checks, as you can see, you can get a lot of information through doctor background checks. There are doctors for just about every specialty out there today, many of the doctors that profess to specialize in one area haven't actually had any specialized training, and you would want to know this since you are putting your body at risk! Don't hesitate doing a doctor background check on your current or prospective doctors, it will give you an increased level of comfort with them as you work to achieve great health together.

Should your young child be medically diagnosed as suffering from bipolar disease, what would be your reaction?

The first thought, other than that your child may have a complaint that is becoming more numerous in our society, is that an infant who has not yet reached full development or even puberty, cannot surely be considered to be suffering a personality disorder appropriate for adults. Their personality has not yet had the chance to reach maturity. So why are psychiatrists diagnosing many infants to have a mental disease that requires drug medication?

There is controversy amongst those in the profession who believe that this practice is actually malpractice. Those with higher standards are working to uphold ethical values.

If common sense is applied in seeking the reasons why a child may seem hyperactive or restless there are many to consider. Most of them are part of modern family life and the unsatisfactory materialistic pressures that we allow to cause us psychic stress.

We all know that peaceful home life is conducive to a peaceful, well behaved response in our children. We know that discipline is our responsibility to enforce in order to train our children. Somehow we seem to more easily acknowledge this with animals. We have lost our role and feel uneasy and possibly a little timid about enforcing discipline where our children are concerned. Perhaps we fear we will lose their affection. But we certainly lose any regard they could have for us if we don't assert ourselves as leaders.

Young people are beginning to alter the social order to dictate to their elders - to tell us what to do - and they can bully us mercilessly unless we are firm. It is being firm that eliminates the frustration and indecision that most parents feel at difficult times.

So why should our children be diagnosed as having bipolar when they are healthy and full of energy?

Perhaps they have no specific constructive areas to apply their time and efforts beyond their schoolwork. We have to take time to find out what interests them as a hobby, otherwise they sit down, stop doing any chores, use finger control only with their electronic toys, become more and more lazy and put on weight. Their inner boredom is expressed in restless behaviour and in habits that destroy rather than cultivate the qualities they will need to cope with life in a way that will guarantee positive outcomes in health, happiness and admirable character.

If your child does happen to be diagnosed with bipolar or any other mental disturbance or disease, first discuss between yourselves the best idea to remedy any problem at home or at the school. See if you can improve the situation. No doubt there will be reasons why any dissatisfaction or frustration is passed on from the child into home life. But if together you cannot work out causes, get a second opinion.

Remember, old fashioned tonics for this problem still hold.

Take a short time regularly with each child, one to one, to hear from them and also to tell them thoughts that reinforce their confidence and their feeling of total security - reading a 'good' story (without horror or violence), help them breathe evenly and rhythmically and focus their minds positively through a simple prayer before sleep. Simple things can work wonders. But no drugs!

I saw a study recently that said 97% of hospital bills are incorrect. And those errors are almost never in the patient's favor. The average error, at least in this study, was nearly $1,500. Think about that for a minute... almost every bill is off by $1,500! That is incredible!

I'm not the kind of person that listens to studies or statistical data because I think you can find a study to prove just about anything and statistics to prove just about anything. But in this case, even if you don't agree with the exact numbers in the study, anybody that's been to the hospital knows that billing errors are quite frequent and can be quite large.

So what do you do if you find that you've been overcharged? The first thing you want to do is make an appointment to talk face-to-face with the actual doctor that worked on you. Your first instinct is going to be to contact the hospital administrative staff, or the billing department. But that's the last thing you want to do because normally they don't have any idea what services you received, only the doctor can speak to those issues.

You may be mad, but don't go into the meeting angry. Be calm, be courteous, and be open-minded. Try to act with a little cooperation and try to keep the angry accusations down to nil, if at all possible. Doctors get sued all the time, and this makes them very wary. Don't go into the meeting guns blazing and tossing out words like lawsuit or malpractice because this will shut the doctors communication lines down. They won't even discuss it with you, they'll just refer the whole thing to their attorney if you take this approach.

Instead, go into the meeting as if a good-natured mistake has been made. Review the charges on your bill with your doctor ask them to go through it line by line and explain it. Your doctor should be willing to do this, but if they just won't budge and they aren't open to discussion or negotiation then you must take the next step...

The next thing you want to do is contact your local or regional medical or dental Society in writing. Sometimes these organizations can set up arbitration between you and the doctor which can save you the cost of expensive legal fees if you were to sue them. Keep in mind one important thing, medical and dental Society's work for the doctors - not you. They may be interested in "helping" if it will keep the doctors out of court, but they are more focused on that than actually helping you.

If nothing else works you may have to sue. Small claims court is a good venue for these sort of charges. You can file a small claims lawsuit without an attorney. Basically you and the doctor simply go before a judge and state your cases in ordinary language. If the doctor cannot quantify the charges on your bill, a judge may throw them right out.

No matter what, stand up for your rights. Just because they are a doctor doesn't give them the right to take advantage of you. Be courteous but be firm and you'll do just fine.

The purchase of professional liability insurance is not necessarily as easy as simply realizing you need it and then calling your agent. The first step you must take is to determine what kind of coverage is right for your potential liability, your concerns and your type of business. With all the different choices out there it can be difficult to figure out what type of policy you should buy, so let's look over some of the most common options.

Industry Specific Professional Liability Insurance

The industry that you conduct business in could have its own industry-specific liability insurance requirements. For instance, those in the financial industry (in the insurance, real estate and the investing end) must have errors and omissions insurance. This insurance protects them against liabilities created if they accidentally cause financial harm to a client through an error or an omission.

Those who work in the medical industry will find that malpractice insurance is a required coverage. It protects them against claims that result from medical harm they accidentally inflict on a patient through omission of treatment or negligence.

In industries with no professional requirement for liability coverage, business owners can consider the purchase of professional liability insurance. Professional liability insurance-like the other coverages we discussed-protects professionals from liability claims stemming from neglect that causes harm to clients. It can be purchased by information technology professionals, gym owners, life coaches and others.

Non-Specific Professional Liability Insurance

There are also non-specific professional liability policies for business owners, like general liability insurance. General liability insurance primarily focuses on property damage or bodily injury sustained resulting from the operations or premises of the business. This differs from the industry specific coverage discussed above because it does not concentrate on the unique needs that arise due to professional services provided.

Professional indemnity insurance is another outstanding choice for the savvy business owner. If your business is sued for slander or libel or for breach of contract and damages, then professional indemnity insurance would help you protect your assets and keep your business running while paying the claim.

Personal versus Professional

Another confusing aspect to professional liability insurance is the overlap people feel they have through their personal insurance coverage. If you operate your business out of your home or garage and use your personal vehicle for your business, then you might think that your personal homeowners and auto coverage will cover any damage to your property or claims of injured parties as the result of accidents. Unfortunately, these claims are likely to be denied by your personal insurer and you could even risk having your policy dropped if the insurance company finds out you did not disclose your business activities on personal property. Personal risks are much different than business or professional risks and when your insurance company underwrites your policy, they must receive full disclosure about the risks involved.

Professional Liability Deductibles and Limits

No matter what types of professional liability insurance you decide are right for your business, make sure that you set realistic limits and deductibles on the policies. If you choose deductibles that are too high in order to save money on your premiums, you run the risk of losing business assets as you liquidate them to fulfill the deductible on your claims. Likewise, limits that are too low could force you out of business if an extremely large claim is awarded to someone who sues you.

Remember, your business is your present and future livelihood. It is an investment of your time, money and heart and should be protected as you would protect any other investment. Proper liability insurance coverage allows you to protect your investment and your future just by simply paying a premium.

Most already instinctively begin doctor research by asking friends what doctors they use when we are looking for someone with a certain specialty. It is important to go beyond just taking the name, however. Hopefully your friend will not refer you to someone with whom she has had a poor experience, but that does not mean that the suggested professional will be a good fit for you. Ask questions about issues that are important to you. Do you need someone who is close to you so that you can make a lunchtime appointment, or do you need an office that is kid friendly because you are likely to have kids in tow? Is an organized and timely office staff important to you? Is the blood lab on site, or will you be driving across town for blood work? Anything that slightly annoys you about the business side of the doctor's office is going to affect the doctor/client relationship. Prodding a friend for this type of information is perfectly ethical.

It is usually not within ethical codes for another medical professional to give the low down on a colleague, but it is suggested that you ask your referring physician if he thinks a certain doctor is a good fit for you. This is a great way to do doctor research. Tell him what qualities are important to you when you are receiving medical care, and he will be able to politely steer you toward someone that will fit your personality. If for some reason the doctor that you choose does not work out, it is perfectly acceptable to tell your referring physician what happened and to ask for another referral.

Lately the most utilized tools for doctor research are ratings tools that do all the research for you. You can find all pertinent information to any doctor on websites that specialize in physician ratings. You can not only find information about the undergraduate and medical schools someone attended, but you can also find licensing and certification information including if there have been any lapses or disciplinary actions taken against the person you are researching. Malpractice suits are also publicized and can be found on these sites.

Using friends and family, doctors with whom you have an established relationship, and physician research and rating tools together is likely to find you the best doctor possible for your specific needs. The ultimate test certainly is to undergo a few medical appointments with the chosen physician, and though it is possible that even massive research and a positive referral can dead end, it is likely that your time and effort will be well spent.

Every business has its own special terminology, but many financial terms are the same across all businesses. Here are some basic words and their definitions as they relate to healthcare financial management.

1. Cash Basis Accounting. This was a question on a management test I took a long time ago! In this method when you pay a bill it is accounted for and when you receive payment, it is accounted for. Your receivables are recorded when you make deposits and your payables are recorded when you generate your payments online or by checks. Most physician-owned practices use the cash method of accounting, give the doctors a draw against their earnings, then distribute any additional earnings on a quarterly basis. To smooth out expenses, any bills that are quarterly (malpractice sometimes is) or annual (profit-sharing usually is), are accounted for to make sure money is not distributed prematurely.

2. Accrual Accounting. In the accrual method, when you receive a bill, it is accounted for, and when you bill someone, it is accounted for at that time instead of when you are paid. Your receivables are recorded when you charge the patient and your payables are recorded when you receive a bill. (I've never worked in a practice that used this method of accounting.)

3. Allocation. The process of deciding how each expense should be attributed, whether to the practice at large or to an individual physician. For example, individual physicians may be allocated expenses for specific staff, or allocated overhead for resources that only they use.

4. Amortized expenses. The costs for assets such as medical equipment and computers, which are depreciated (expensed) over time to reflect their usable life.

5. Cost/benefit analysis. A form of analysis that evaluates whether, over a given time frame, the benefits of the new investment, or the new business opportunity, outweigh the associated costs. This could be an analysis for a new lab machine, or a new satellite office.

6. Gross Collection Ratio. The total collections divided by the total charges gives a gross collection ratio, but this number usually is not meaningful as most practices make significant adjustments for contractual rates with payers.

7. Net Collections Ratio. The total collections divided by the charges less contractual write-offs gives a net collection ratio. The number should be meaningful, and ideally is not decreasing in this high-deductible, medical bankruptcy, high-unemployment economy. Collections ratios are the least useful when used for a monthly analysis, and most useful when used to evaluate charges and collections over a year or more.

8. Revenue Cycle. The process of collecting insurance and billing information from the patient, collecting any monies due at the time of service, documenting the medical service provided, translating the service into ICD9 and CPT codes, filing the claim and collecting the contracted amount from the payer.

9. Equipment lease. A contract to purchase or rent equipment and/or purchase service over a period of time. The monthly cost includes the purchase price and interest and although the cost over the life of the lease is significantly more, it allows the practice to avoid a significant cash investment all at one time.

10. Capital expenses. The purchase of a piece of equipment, furniture or sometimes software (usually $500 or more) that will be expensed through depreciation. A capital budget is one that includes all large expenditures the practice anticipates making during the year.

11. Operating expenses. Expenses that occur in operating a business, for example employee salaries, benefits, rents, utilities and marketing costs. An operating budget is one that includes all expenses incurred in the daily running of the business.

12. Revenue Budget. A budget that estimates the revenue the practice expects to collect based on physician and ancillary productivity and applying the previous year's average collection percentage to the anticipated charges.

13. Benchmarks or Key Indicators. Indicators such as cost per RVU (relative value unit), cost per case in surgery, or days in A/R (accounts receivable) allow practices to compare their performance to the performance of successful practices.

14. Return on investment (ROI). A financial ratio measuring the cash return from an investment relative to its cost. You may calculate the ROI on an automated appointment reminder system and calculate the cost of the system versus the reduction in no-show appointments over several years.

15. Time value of money. The principle that a dollar received today is worth more than a dollar received at a given point in the future. Even without the effects of inflation, the dollar received today would be worth more because it could be invested immediately, thereby earning additional revenue. This is important in collections, as getting a partial payment from a patient today may have more value than getting a full payment from a patient in 2 years.

16. Variable Costs. Costs/expenses that are incurred in relation to providing services to patients. Examples include the cost of medical consumables, patient education materials and merchant services fees for taking credit cards. As the volume of patients increases, the expenses increase.

17. Fixed Costs. Costs/expenses that are incurred regularly regardless of patient volumes. Examples include rent, utilities, and liability insurance.