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Thursday, June 16, 2016

Callagy Law – New Jersey, New York, Arizona | Lawyers Working For You!

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Visit Callagy Law’s website for full details: www.callagylaw.com

We are skilled attorneys in several different practice areas which include: Medical Revenue Recovery / Healthcare Recovery (PIP, Workers Compensation, and Commercial Insurance), Business Law, Commercial and Business Litigation, Family Law, and Wills / Estates / Trust Law.

We’ve received several awards from AVVO as well.

Please contact us today: 201-261-1700 | inquiries@callagylaw.com | www.callagylaw.com

We are headquartered in Paramus, New Jersey (Bergen County). We have offices in New York and Arizona as well.

We also offer FREE consultations! Call today.

Friday, June 3, 2016

The Definition of “Payment” When Calculating The Statute of Limitations in PIP Arbitration Matters

The purpose of this post is to help assist those with questions they have concerning their business or medical practice. The Callagy Law team is knowledgeable in many law practice areas and will frequently post topics ranging from Medical Revenue Recovery, PIP, Workers Compensation, and Commercial Insurance. We hope to have this blog shed a light on many common questions.

The question of what constitutes payment for the purpose of calculating the Statute of Limitations in a PIP Claim for Benefits was recently addressed by our office in the Context of a PIP Arbitration filed on behalf of one of our Medical Provider’s.

The issue our Provider faced, as presented by CURE Insurance, was whether the Provider’s Claim was barred by the application of the 2 year statute of limitations period in connection to the filing of a PIP Arbitration Matter.

In relation to the calculation of the Statute of Limitations time period when filing a PIP Claim for Benefits, N.J.S.A. 39:6A-13.1(a) states:

Every action for the payment of benefits payable under a standard automobile insurance policy pursuant to sections 4 and 10 of P.L. 1972, c. 70 (c. 39:6A-4 and 39:6A-10), medical expense benefits payable under a basic automobile insurance policy pursuant to section 4 of P.L. 1998, c. 21 (c. 39:6A-3.1) or benefits payable under a special automobile insurance policy pursuant to section 45 of P.L. 2003, c. 89 (c. 39:6A-3.3), except an action by a decedent’s estate, shall be commenced not later than two years after the injured person or survivor suffers a loss or incurs an expense and either knows or in the exercise of reasonable diligence should know that the loss or expense was caused by the accident, or not later than four years after the accident whichever is earlier, provided, however, that if benefits have been paid before then an action for further benefits may be commenced not later than two years after the last payment of benefits.

(emphasis added).

Specifically, the facts of our matter showed that while there were no actual pip benefits paid by CURE, it was undisputed that CURE received the Provider’s Bill and processed the bill, applying the eligible amount (as determined by CURE) to the patient’s policy deductible.

Our office relied on the case of George C. Everett v. State Farm Indemnity Co., 358 N.J. Super. 400 (App. Div. 2002), wherein the Appellate Division found that the term “last payment of benefits” as used in N.J.S.A. 39:6A-13.1(a) is consistent with and includes the adjustment of a bill and application of that bill to the patient’s deductible.

Specifically, our office highlighted that in Everett, 358 N.J. Super. at 379, the Court found:

“since the bill was an expense caused by the accident, we conclude that the process of adjusting the bill to the fee schedule and applying the balance to the deductible constituted a ‘last payment of benefits’ under the Act, making the plaintiff’s complaint, which was filed within two years of that date, timely.”

Our office maintained that based on the determination of the Court in Everett, even though the adjustment/ processing of the Provider’s bill in this matter resulted in no more than a credit against the patient’s deductible, this was considered a benefit to the insured and therefore the date of processing of the bill sets the statute of limitations period once again.

In considering the above arguments, DRP Gary T. Lesser, Esq., in NJ-1644666 determined that based upon the Everett matter, the two-year statute of limitations commenced anew with the processing the bill and application of the payment against the patient’s deductible. As such, the Statute of Limitations period did not expire prior to the Provider’s filing of the PIP Demand for Arbitration. Therefore, as a result, the Provider had standing to Proceed with the underlying PIP Claim for Benefits.

We hope you found the information provided in this article helpful to various questions you may have had concerning the healthcare industry. For information pertaining to our services for medical providers, please click here. Please note, Callagy Law has recovered over $200,000,000 for medical providers, and that number grows daily. Our team of knowledgeable PIP Arbitration attorneys are ready to help you. Please free to reach out to Sean Callagy of Callagy Law at any time for questions you may have concerning personal and business matters. Callagy Law offices are located conveniently in Paramus, NJ. Beyond the scope of information, Sean Callagy has developed multiple areas of our healthcare legal practice and business coaching. Feel free to connect with us on Facebook, Twitter or LinkedIn! Additionally you can subscribe to our daily videos on YouTube.

Learn More About Callagy Law Here:

The Definition of “Payment” When Calculating The Statute of Limitations in PIP Arbitration Matters

Monday, March 14, 2016

“A personal and professional perspective from an employee of Callagy Law” – Mark H. Winters, Jr., paralegal

Personally, the field of PIP represents a step in my career that allows me to take part in something important, something helpful, and something that can help work within a broken system for the greater good. Professionally, working in PIP at Callagy Law has exposed me to some of the brightest attorneys, who quite frankly I feel have revolutionized arbitration on a number of pertinent issues, all without cost to the clients.

In explanation of my enthusiasm in PIP, it is relevant that the first eight (8) years of my legal career I was involved largely in consumer collections litigation, a particularly dreary aspect of law. Spending so much time in that field, it begins to cloud your overall perspective on the very nature of law, people, and even yourself. Luckily, in June 2014, I took the opportunity to work in the PIP department at Callagy Law.

Now, at first, I was not even clear on what working in PIP would mean, or if anything could improve my jaded outlook of the law. However, integrating myself into the world of PIP was almost therapeutic. This was an opportunity to do something good, for the first time in my career representing the “good guys,” and it was exiting to find that the remainder of Callagy Law was likewise enthused. For, after all, who does it feel better to help than those who dedicate their lives to helping others?

Notably, in PIP we get to represent a huge variety of doctors and institutions, each of whom are essential for an immeasurable amount of car accident victims. Throughout the days and weeks, we handle cases involving everything from initial Hospital Emergency Room visits, to the initial stages of treatment (ie. chiropractic, physical therapy), then moving along to more advanced and complicated treatment providers, including specialized dental practitioners, pain management physicians. Whether it is underpayment of services, or an outright denial of necessary treatment, we argue on behalf of the treating doctors, who typically provide the patient with the necessary care even at the risk of insurance denials. It is here that my job comes in, helping those doctors get payment for the services they rendered to their patients in good faith.

In fact, one thing I did not know before starting in PIP, and what actually may make Callagy Law unique among PIP practitioners, is that we even represents pharmacies who issue prescribed medications that insurance companies nevertheless fail to pay for. I have even seen reimbursements awarded to psychologists and counselors whose post-traumatic stress therapies are denied prematurely. So, yes, I found that even such apparently ancillary providers such as pharmacies, dentists, and psychologists can benefit from an attorney’s PIP services.

In short, while I was feeling quite negative about the field and practice of law before starting in PIP, working for the benefit of the medical field to encourage fair payment, and in recovering the amounts unjustly denied, means something to me, to this firm, and, I like to think, our clients as well.

We hope you have found this information helpful and interesting. Please reach out to us here with any questions or comments regarding healthcare legal matters, or if you are a medical provider that has questions regarding Medical Revenue Recovery, PIP, Workers Compensation, and Commercial Insurance.. Feel free to search us on Facebook, Twitter or LinkedIn! Additionally you can subscribe to our daily videos on YouTube.

Learn More About Callagy Law Here:

Tuesday, February 23, 2016

Interlaminar vs. Transforminal Injections | Callagy Law

When disputing the use of a Transforaminal Injection as opposed to an Interlaminar Injection, Transforminal Injections have proven to present less risk to the patient and be more cost effective for a provider.

Specifically, regarding the differences between Interlaminar and Transforaminal Injection Approaches, studies have clearly established the following:

The interlaminar approach is the most common way of performing an epidural injection for all indications in anaesthesia […]This can be done with or without fluoroscopic guidance, but one of the many queries with regard to the varying efficacy of epidural steroid in studies has been the uncertainty of whether, by caudal or interlaminal route, the steroid has been accurately placed at the required site.

(See, “Epidural Steroids,” by Neil Collighan and Sanjeeva Gupta MD)

On the other hand:

The transforaminal approach is a selective injection aimed at a specific level and is always done under fluoroscopic guidance. […] Both the interlaminar and transforaminal approaches can be used at the cervical, thoracic, and lumbar levels. The benefits of the transforaminal approach, when performed by an experienced clinician, may include decreased risk for dural puncture with delivery of smaller volumes of steroid to the appropriate site of considered pathology. (emphasis added). [Id.]

In fact, in one recent study, the researcher concluded:

Transforaminal injection [is] superior in its ability to reach the site of pathology while being able to use even smaller doses of steroids. While the increased technical difficulties are noted to perform this method, his study showed better outcomes after a series of epidural steroid injections [with] the transforaminal approach followed by the caudal approach as a reasonable secondary approach.”[Id.]

Additionally, there is an established difference in cost effectiveness between the intralaminar method and the transforaminal:

Evaluation of the cost effectiveness of epidural injections including transforaminal steroid injections for the management of chronic low back pain revealed […] cost effectiveness of caudal epidural steroids at $3,635.00 and transforaminal steroids at $2,927.00 per year.

(See, “Transforaminal Lumbar Epidural Steroid Injections,” by Laxmaiah Manchikanti, MD)

Furthermore, with respect to the efficacy of the various injection methods:

the transforaminal epidurals appear to be clinically effective with a favorable outcome and cost effectiveness, compared not only to blind interlaminar epidural steroid injections and fluoroscopically directed caudal epidural steroid injections but also to numerous other modalities of treatment.”[Id.]

As stated above the Transforminal approach presents less risk of a dural puncture with the delivery of smaller volumes of steroid to the appropriate site of injury. The studies also showed better outcomes after repeat series of epidural injections via the Transforaminal approach as opposed the Interlaminar approach. Based on these recent studies and that fact that Transforminal injections represent a saving of up to $800 a year clearly demonstrate that the Transforminal approach is a better option for the health of the patient and for the treating provider.

We hope you found the information provided in this article helpful to various questions you may have had concerning the healthcare industry. For information pertaining to our services for medical providers, please click here. Please note, Callagy Law has recovered over $185,000,000 for medical providers, and that number grows daily. Please free to reach out to Sean Callagy of Callagy Law at any time for questions you may have concerning personal and business matters. Callagy Law offices are located conveniently in Paramus, NJ. Beyond the scope of information, Sean Callagy has developed multiple areas of our healthcare legal practice and business coaching. Feel free to connect with us on Facebook, Twitter or LinkedIn! Additionally you can subscribe to our daily videos on YouTube.

Learn More About Callagy Law Here:

Interlaminar vs. Transforminal Injections | Callagy Law

Tuesday, January 26, 2016

Codes Not On ASC Fee Schedule Possibly Reimbursement | Callagy Law

Are CPT Codes not listed on the ASC Fee Schedule compensable in New Jersey PIP arbitration matters?

This issue of whether certain codes not listed on the ASC fee schedule are reimbursable to the ASC is currently a hotly contested one. The ASC fee schedule is located at N.J.A.C. 11:3-29.1(b), Appendix Exhibit 1, and is colloquially referred to as the ASC fee schedule. However, not all procedures performed at an ASC are listed on the ASC fee schedule. This often results in insurance carriers denying payment for such fees to these facilities.

To support their denials, the carriers refer to N.J.A.C. 11:3-29.5(a). On its face, that subsection clearly states that “codes that do not have an amount in the ASC facility fee column are not reimbursable when performed in an ASC.” Seemingly, it was DOBI’s intent to place certain codes on the ASC fee schedule that DOBI had affirmatively considered, and to also include those codes which DOBI had considered should not be performed at an ASC, but to leave those codes with no amount of reimbursement. However, for codes that do not appear on the ASC fee schedule, DOBI has not made such a consideration. Simply, DOBI has not considered such codes, and therefore, DOBI has not determined that such should not be performed at an ASC.

This firm takes the position that the ASCs should be entitled to UCR when hosting a procedure that is not listed at all on the ASC fee schedule. In accordance with N.J.A.C. 11:3-29.4(e) “the insurer’s limit of liability for any medical expense for any service or equipment not set forth in or not covered by the fee schedule shall be a reasonable amount considering the fee schedule amount for similar services or equipment in the region where the service or equipment was provided. … Only when there is no similar service in the fee schedule does the regulation state that “the insurer’s limit of liability for any medical expense benefit for any service or equipment not set forth in the fee schedule shall not exceed the usual, customary and reasonable fee.” Therefore, an ASC should be reimbursed at the usual, customary and reasonable (“UCR”) fee for codes that do not appear on the ASC fee schedule.

Several awards from arbitrators support our position, including the most recent award from DRP Nanci Stokes. In the matter of Gloucester Surgery Center a/s/o C.S. v. Plymouth Rock Assurance of New Jersey, NJ-1628906, DRP Stokes agreed with the ASC claimant’s position, whereby she found the following:

In this matter, I find that the claimant is entitled to reimbursement for CPT 24665… the overwhelming scheme of reimbursement as to an ASC is based upon Medicare’s determination and judgment relative to patient safety. This is specifically acknowledged by the Appellate Division in upholding the regulation at issue… The regulation specifically advises that CPT codes appearing on the Physician and ASC Fee Schedule …that do not have an amount in the ASC facility fee column are not reimbursable. The code at issue is not listed on the fee schedule. As such, there is no clear prohibition for reimbursement in the actual wording of the regulation regardless of the Department’s response relied upon by respondent. Accordingly, given Medicare’s allowance of CPT 24665 in an ASC and acknowledgment by the Department that Medicare’s determination adequately “ensures the safety of patients and the quality of services”, I find reimbursement is permitted.

As the code is not contained on the fee schedule, reimbursement is subject to a usual customary and reasonable analysis.

This firm completely agrees with DRP Stokes’ analysis, as well as similar rulings from some of her DRP brethren which also found that codes which are not listed on the ASC fees schedule are still reimbursable to ASCs.

This is still an evolving issue, but so far, the majority of DRPs have agreed with the Claimant’s position. As such, this firm is thrilled to be able to recover additional money for our ASC clients.

We hope you found the information provided in this article helpful to various questions you may have had concerning the healthcare industry. For information pertaining to our services for medical providers, please click here. Please note, Callagy Law has recovered over $185,000,000 for medical providers, and that number grows daily. Please free to reach out to Sean Callagy of Callagy Law at any time for questions you may have concerning personal and business matters. Callagy Law offices are located conveniently in Paramus, NJ. Beyond the scope of information, Sean Callagy has developed multiple areas of our healthcare legal practice and business coaching. Feel free to connect with us on Facebook, Twitter or LinkedIn! Additionally you can subscribe to our daily videos on YouTube.

Learn More About Callagy Law Here:

Codes Not On ASC Fee Schedule Possibly Reimbursement | Callagy Law

Monday, January 18, 2016

Upcoming Shortage of Physicians | Callagy Law

Difficulties Facing the American Healthcare System – What You Need To Know!

There are many difficulties facing the American healthcare system, but perhaps chief among them is a possible shortage of physicians. The Association of American Medical Colleges (AAMC) predicts that an approximate shortage of 90,000 – 130,000 physicians will occur in the US by the year 2025. There are many factors contributing to this problem, including inadequate enrollment in medical schools.

Many new allopathic (M.D. granting) and osteopathic (D.O. granting) medical schools have been established in recent years, with overall medical school enrollment expected to increase by 30% by 2019. New Jersey has recently started Cooper Medical School of Rowan University and Seton Hall School of Medicine to help meet the health care needs and many other states are following suit.

While increasing the number of medical schools would help to alleviate this shortage, perhaps a more important and overlooked issue is reduction in the fund of residency positions. A residency is a multi-year education program medical school graduates must complete before they can become practicing physicians or surgeons. In 1997, Congress capped the number of Medicare-supported residency positions. In other words, even if we add medical school graduates by increasing the number of medical schools, we will not add to the number of practicing physicians unless we also add to the number of residency training programs. A bill was introduced that would increase residency positions in 2012, but Congress has yet to act on the bill.

The AAMC urges all Americans to rally for support of this bill, and while it will not entirely fix the projected physician shortage, it seems to be a step in the right direction.

Sources

http://www.ama-assn.org/ama/pub/news/news/2015/2015-03-05-ama-applauds-congress-modernize-graduate-medical-education.page

https://www.aamc.org/newsroom/newsreleases/305476/120928.html

https://www.congress.gov/bill/112th-congress/house-bill/6562

https://www.aamc.org/newsroom/newsreleases/431036/20150430.html

Photo Credit: www.vox.com

We hope you found the information provided in this article helpful to various questions you may have had concerning the healthcare industry. For information pertaining to our services for medical providers, please click here. Please note, Callagy Law has recovered over $175,000,000 for medical providers, and that number grows daily. Please free to reach out to Sean Callagy of Callagy Law at any time for questions you may have concerning personal and business matters. Callagy Law offices are located conveniently in Paramus, NJ. Beyond the scope of information, Sean Callagy has developed multiple areas of our healthcare legal practice and business coaching. Feel free to connect with us on Facebook, Twitter or LinkedIn! Additionally you can subscribe to our daily videos on YouTube.

Learn More About Callagy Law Here:

Upcoming Shortage of Physicians | Callagy Law

Wednesday, December 16, 2015

Must Know Info For Medical Providers | Callagy Law

Providers Making The Most Out of Recovery

The following article was written by Callagy Law’s Legal Team, and will focus on many common questions and concerns surrounding new developments, legal matters, and other procedures within the field of healthcare law Medical Revenue Recovery, PIP, Workers Compensation, and Commercial Insurance. Our mission is to answer any questions and give knowledge to many different aspects of these matters.

Medical Providers are busy people, as are their patients. Doctors are (and should be) more preoccupied with treating their patients and increasing the quality of their lives, rather than dealing with administrative paperwork. That is why medical providers rely upon their office staff for assistance. In the hustle and bustle of day to day treatment of patients, some doctors pay less and less attention to the underlying business aspects of their practice. However, it is important that medical providers themselves stay informed as to how to optimally recover money for the treatment and procedures they provide.

Insurance carriers will deny a claim for many reasons – need for additional records, amended bills, etc. It could take over a year in some cases for a medical provider to be reimbursed. Obviously, this has a detrimental impact on a medical providers’ expected cash flow.

So what can a medical provider do to overcome these denials and delays? A medical provider should be aware which procedures are covered by the patient’s insurance policy. More information is also available on http://www.cms.gov and/or on the insurance carrier’s website. For instance, Medicare makes payment for an assistant at surgery when the procedure is authorized for an assistant and the person performing the service is a physician, physician assistant, nurse practitioner or clinical nurse specialist. A medical provider should try to get pre-authorization from the insurance carrier, while also being mindful of other denial issues, such as a perceived lack of medical necessity.

If a medical provider wants to proceed on a non-covered procedure, they should be aware in advance that the insurance carrier will deny payment. If a medical provider is considering charging the patient, they should be sure to have an agreement with the patient in writing prior to surgery. Billing after surgery is not always the best business policy for medical providers and may even be in violation of a contract if they are in-network with particular insurance carriers. Moreover, balance billing the patient in most cases is not permitted in PIP (Personal Injury Protection) and Medical Provider Workers’ Compensation claims.

The medical provider should specific services he or she performs in its operative report, ensuring that every CPT code in the bill correlates with the operative report. Insurance carriers will usually reference the operative report to confirm this information and will sometimes request the assistant surgeon’s medical records. A medical provider should be prepared to get involved and file multiple appeals in order to be reimbursed.

However, the most important step in the entire process occurs in the pre-surgery stage– don’t be afraid to communicate with the insurance carriers about what documents and information they need to efficiently and effectively process the claim, what procedures are authorized, and what is the expected reimbursement rate. Be sure to thoroughly document these conversations, or better yet, get it in writing.

Of course, it is very important to hire a law firm to review claims, handle appeals and proceed to litigation, as doctors are very busy with treating their patients – which is what matters most.

We hope you found the information provided in this article helpful to various questions you may have had concerning the healthcare industry. For information pertaining to our services for medical providers, please click here. Please note, Callagy Law has recovered over $175,000,000 for medical providers, and that number grows daily. Please free to reach out to Sean Callagy of Callagy Law at any time for questions you may have concerning personal and business matters. Callagy Law offices are located conveniently in Paramus, NJ. Beyond the scope of information, Sean Callagy has developed multiple areas of our healthcare legal practice and business coaching. Feel free to connect with us on Facebook, Twitter or LinkedIn! Additionally you can subscribe to our daily videos on YouTube.

Learn More About Callagy Law Here:

Must Know Info For Medical Providers | Callagy Law

Friday, November 13, 2015

Why Is an Assignment of Benefits So Important? | Callagy Law

The purpose of this post is to help assist healthcare providers and owners with questions they have concerning their business or relevant knowledge in the field. The Callagy Law team is knowledgeable in many law practice areas and will frequently post topics ranging from Medical Revenue Recovery, PIP, Workers Compensation, and Commercial Insurance. We hope to have this blog shed a light on many common questions.

When it comes to pursuing PIP/No-Fault claims, also known as Motor Vehicle Accident (MVA) claims, obtaining an Assignment of Benefits (AOB) from a patient is absolutely essential. This is also true of Commercial Insurance (CI) claims. An AOB is a document by which a patient transfers their rights under their insurance policy to the medical provider who is treating them. Why is this so important?

A medical provider in the context of PIP or CI has no contractual relationship with the insurance carrier. If a patient sees a medical provider and that provider, with nothing else, bills the patient’s carrier, there is nothing binding the carrier to pay the medical provider. The AOB places the medical provider in the shoes of the patient as far as the patient’s insurance policy is concerned, enabling the provider to be paid directly. If you are a health care provider, seeing a PIP or CI patient, and wish to be paid directly for covered services from an insurer, you must obtain an executed AOB.

You might be wondering why I do not include Workers Compensation (WC) claims along with PIP and CI claims in terms of the necessity of an AOB. AOB’s are not critical to WC claims. The reason for this is that the patient does not have an insurance policy in the WC context. Their employer does. So, there is no insurance policy with which the patient has direct involvement. What is critical is the authorization. The authorization is what creates the legal relationship between the carrier and the medical provider.

In short, obtaining a properly executed AOB should always be on the top of any medical provider’s list when rendering services to a PIP or CI patient.

Learn More About Callagy Law Here:

Why Is an Assignment of Benefits So Important? | Callagy Law

Friday, October 30, 2015

The Ten Commandments of Being a Quality Client Liaison in Medical Recovery

The purpose of this post is to help assist healthcare providers and owners with questions they have concerning their business. The Callagy Law team is knowledgeable in many law practice areas and will frequently post topics ranging from Medical Revenue Recovery, PIP, Workers Compensation, and Commercial Insurance. We hope to have this blog shed a light on many common questions.

The responsibilities of a client liaison for medical provider revenue recovery are threefold:

To assist in the identification and assembly of claims to be pursued either in PIP (No-Fault) arbitration (injuries related to motor vehicle accidents), Worker’s Compensation (WC) litigation, or Commercial Insurance (CI) litigation.

To be a responsive and considerate supporter of the Firm’s attorneys and their staffs in the above areas.

To be an integral part of the customer service, sales and marketing efforts of the Firm.

To perform these functions at the highest level, client liaisons should always adhere to the following Ten Commandments.

To exhaust the file output of each and medical every provider as soon as possible. This ensures that providers will receive the most money possible as quickly as possible.

To do whatever is in your power to meet monthly goals, without sacrificing quality in any way, shape or form. Monthly goals are not an end in and of themselves. They are a measuring stick for your performance. Meeting goals in some artificial or manipulative way is not only dishonest, it is the opposite of effective performance.

If you do not have a sufficient number of medical providers to achieve monthly goals, to obtain additional providers as soon as possible in order to do so, and to speak with your supervisor about getting them. Seek out what you need in order to make your objectives. If it is a wider customer base, go get it.

To never lose a provider by virtue of anything you did or did not do effectively. A good liaison views losing any client as a shortcoming in his or her efforts. A liaison should always be looking to satisfy a client while at the same time managing expectations appropriately.

To minimize any inconvenience to your providers, and, accordingly, take care of office requests yourself as much as possible. A provider upset at being asked to perform functions they do not regard as their responsibility is not a good thing.

To never have a provider voice a single complaint about you or your performance. A provider complaint directed at you or your performance is never trivial, never petty, never excusable.

To do everything you can to make easier the job of other office personnel, so they can operate more efficiently. Treat those to whom you hand-off work as if they too are your customer. Colleagues are customers. Treat them with care and consideration.

To help the settling team as best you can to facilitate settlements. Settlements ensure the quickest recovery for medical providers and should always be regarded as a priority.

To assist the attorneys as best you can to facilitate awards. This is the bread and butter of the Firm. The Firm exists ultimately by virtue of the success of the attorneys.

To recognize and pursue sales and marketing opportunities wherever they exist. This is last but hardly least. All employees, but particularly liaisons, are ambassadors for the Firm and should at all times behave as such. Liaisons, moreover, are out in the field and should always be on the lookout for business development opportunities.

These Commandments have relevance for all people in the customer service / sales / marketing arenas, not just those attached to a law firm specializing in recovering money for medical providers against insurance carriers.

Learn More About Callagy Law Here:

The Ten Commandments of Being a Quality Client Liaison in Medical Recovery

Friday, September 18, 2015

Pursuing Medical Debt From Insurers | Medical Revenue Recovery

Medical doctors enter medicine to practice medicine, not to be bill collectors, but running a medical practice is far from inexpensive today. From medical malpractice insurance, personnel costs, operational costs, rent, and other administrative costs, the everyday costs of running a practice can be quite high.

Also, under many laws at either the state or Federal level, as well as under insurance carrier in-network contracts with doctors, providers are required to bill patients for their portion of a bill. So, patients are expected to pay for co-pays, coinsurance, and deductibles as required under their insurance plans.

Medical doctors are required to bill patients for the patient’s portion of the cost of medical care. If a doctor does not do so, he may face legal and financial penalties from regulators and insurance carriers. For example, an insurance carrier may reduce a provider’s payment by the percentage of the payment that the provider failed to bill the patient for. For example, if the provider billed a service at $100 with the insurer paying $80 and the patient to pay $20, but the patient was never charged, then the insurer may request a reimbursement of 20% of the $80 since the insurer only agreed to pay 80% of the total bill.

ERISA

The Employee Retirement Insurance Security Act (ERISA) is a Federal law that establishes minimum standards for employer-sponsored retirement plans as well as health insurance plans. While ERISA puts many requirements on employers regarding how they administer plans for their employees, providers may also be subject to ERISA.

Under ERISA health care plans, employers must provide their employees with health insurance plan information. As such, employees are expected to know and adhere to their responsibilities in paying for their share of the medical bill, such as coinsurance, copays, or deductibles.

Alternatively, insurance carriers representing employers are required to follow certain notice and disclosure rules in working with providers in providing reimbursements. Insurance carriers must be open and transparent about their policies and payment decisions under ERISA plans. In other words, insurers cannot simply deny claims or dramatically underpay claims without a reasonable explanation.

State Prompt Pay Laws

Some states, including New York, have prompt pay laws. Under prompt pay laws, insurance carriers are required to pay “clean claims” (medical claims from providers without any missing or incorrect information) within a certain number of days, such as 45 days. So, if insurers are dragging their feet on claims by neither approving or denying them then they may be violating state law. As a result, it may be necessary for a provider to reach out to the state insurance commission, or similar agency, and file a complaint. Doing so may push the insurance carrier to improve their processes and pay in accordance with the law.

Contact a Knowledgeable Law Firm for Guidance

Creating and maintaining a business can be a daunting endeavor. The experienced and dedicated attorneys at Callagy Law are ready to help answer your questions about forming a business or ensuring that your existing business is in compliance with the law. Contact Callagy Law now for legal guidance.

More information on Callagy Law’s Medical Revenue Recovery program click here.

Learn More About Callagy Law Here:

Pursuing Medical Debt From Insurers | Medical Revenue Recovery