Friday, January 29, 2016

Education Law Blog | Callagy Law

A closer look into the world of education law. 




The following article was written by Ben Light, Partner at Callagy Law, and will focus on many common questions and concerns surrounding new developments, legal matters, and other procedures within the practice area of School / Education Law. Our mission is to answer any questions and give knowledge to many different aspects of these matters.



 


 


Welcome to the initial entry of the Education Law blog.  Simply put, Education Law is the body of federal and state constitutional, statutory and common law that governs and affects your child’s education through the age of 21 – and even through college is some cases.  Some of the laws at issue are the Individuals with Disabilities Education Act (IDEA) and Section 504 of the Americans with Disabilities Act.  Education Law includes: special education; disability, race and sexual discrimination; student discipline; student bullying and other cases.


 


Your author is an education attorney with fifteen years of experience in the field.  I have relationships with some of the best pediatric specialists in the area and operate a non-profit dedicated to filling the gaps in the special education system for emotionally disturbed children.  I have tried many special education due process positions before the Office of Administrative Law both in Newark and Trenton.  I have also handled student discipline and student sexual abuse cases in Federal Court.


 


As we all grow older, we realize that the early experiences and education we had have shaped us into who we are.   As a parent of child having some sort of conflict in the education system you are probably worried about the long-term effect of the outcome of this dispute.  You should.  Being a parent is the single most important thing you will ever do so the pressure is natural.  One of my favorite feelings is seeing a client realize that time is going much slower in reality than it is in their heads.  That is not to say you should wait if you feel there is a problem, but once you start working on the problem, your child’s situation will improve within a few months if you continue to act.


 


Because of a recent case am I going to discuss student discipline in this initial entry.  A client came to me with a son at a very competitive university.  The student had been caught with an old flip phone in his pocket during an exam and the university had imposed an ethical sanction in his record, which would forever prohibit government and other employment.  All because he had an old cell phone in his pocket which he used as an alarm clock and to keep his schedule.  The university conceded that he was not cheating or attempting to cheat with the phone.  Patently ridiculous, right?


 


The client said, “Ben, this university has been sued 24 times to reverse a discipline decision and has never lost.  I think if I pay you to fight them it will be a waste of money.  Why do you think you can win?”


 


I told him we would win because we were right.   I guess I convinced him.  Thirty days later the university had rescinded the discipline because it was unlawful disability discrimination based on the student’s ADHD, as I described in the single letter I drafted on the case.


 


So here’s the initial lesson:  Your limiting beliefs are probably not an accurate predictor of any outcome unless you let them prevent you from acting.   Just because something has been wrong for a long time does not make it become right.


 


Through this blog I will address one topic at a time.  If you have any topics that you would like to see addressed, please e-mail me and I will either get back to you or write about it.


 


Next week I intend to address the issue of the appropriate metric to apply to assess educational progress by special education students and I think you will see that school districts are advocating for a very low bar.



 


 


The Team at Callagy Law hopes the information in this article was helpful in either your personal or professional life.. Callagy Law, is a multidisciplinary law firm, headquartered in Paramus, NJ owned and operated by Sean Callagy. We practice law in the areas of healthcare recovery, business law, litigation, school / education law, family law, and more! We are committed to providing legal representation and advice to our clients at additional law offices located across the United States. Please note that the information posted here should not be used as a legal argument of defense. If you find yourself needing legal advice pertaining to your unique situation, you can contact us at here. Feel free to search us on Facebook, Twitter or LinkedIn! Additionally you can subscribe to our daily videos on YouTube.



 


 


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Education Law Blog | Callagy Law

Wednesday, January 27, 2016

Medical Provider Applications In New Jersey Workers’ Compensation Courts

The Effect of the 2012 Amendment




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.



 


The New Jersey Workers’ Compensation courts provide a forum for healthcare providers to challenge inadequate reimbursements from workers’ compensation insurance carriers where the underlying claim is for a patient injured within the course of their employment.  It was not until 2012 that the New Jersey Workers’ Compensation courts gained exclusive jurisdiction over these types of claims.  The majority of cases that are filed in the Workers’ Compensation courts involve the injured worker’s (i.e. Petitioner) claim against his/her employer’s workers’ compensation insurance carrier (Respondent).


The 2012 Amendment to N.J.S.A. 34:15-15 effected a significant change in the rights of medical providers who have provided authorized treatment to injured workers in New Jersey. As a recent addition to the Workers’ Compensation Act, however, the language of the Amendment has not been interpreted in any prior decision in New Jersey.  The full text of the Amendment provides:


 


Fees for treatments or medical services that have been authorized by the employer or its carrier or its third party administrator or determined by the Division of Workers’ Compensation to be the responsibility of the employer, its carrier or third party administrator, or have been paid by the employer, its carrier or third party administrator pursuant to the workers’ compensation law, R.S.34:15-1 et seq., shall not be charged against or collectible from the injured worker. Exclusive jurisdiction for any disputed medical charge arising from any claim for compensation for a work-related injury or illness shall be vested in the division. The treatment of an injured worker or the payment of workers’ compensation to an injured worker or dependent of an injured or deceased worker shall not be delayed because of a claim by a medical provider.


 


N.J.S.A. 34:15-15.


 


Prior to this Amendment, the state of the law in New Jersey with respect to medical provider claims in workers compensation matters was extensively reviewed by the New Jersey Supreme Court in Univ. of Mass. Mem’l Med. Ctr., Inc. v. Christodoulou, 180 N.J. 334 (2004). As discussed in Christodoulou, while the Workers Compensation Act with limited exceptions provides an exclusive remedy to employees injured the course of their employment, the Act “does not purport to establish an exclusive remedy for a hospital or physician that, pursuant to a contract, has provided medical services to a patient who may or may not have suffered a job-related injury.” Id. at 346. Thus, medical providers asserting claims arising from treatment provided to injured workers previously had the option to pursue their claims either in the Division of Workers Compensation, as authorized by N.J.S.A. 34:15-15, or in a common law collection action in Superior Court. Id. at 353. If a claim by a medical provider was asserted in Superior Court while a related claim by an injured worker was pending in the Division, the medical provider action was to be transferred to the Division to facilitate the resolution of all claims in a single forum. Id. at 352.


 


The 2012 Amendment to N.J.S.A. 34:15-15 changed existing law by vesting exclusive jurisdiction for any disputed medical charge arising from any claim for compensation in the Division, thus eliminating the option to pursue a common law collection action in Superior Court. The 2012 Amendment also changed existing law by providing that fees for treatments authorized by a workers’ compensation carrier shall not be charged against or collectible from the injured worker. Prior to the 2012 amendment, there was no statutory prohibition against a medical provider asserting its common law contractual right to payment for services provided.  In the event the workers compensation carrier failed to make payment, or as is more common, made only a partial payment, and the petitioner settled its compensation claim without providing for payment of outstanding medical bills, the petitioner was exposed to potential liability for the balance.  The 2012 amendment eliminated the practice of “balance billing” by requiring the medical provider to seek payment exclusively from the workers compensation carrier, with no contribution from the employee.  With respect to medical provider claims covered by the 2012 Amendment, the statute thus significantly altered the medical provider’s rights by making a claim against the employer and its workers compensation carrier in the Division pursuant to N.J.S.A. 34:15-15 the exclusive remedy of the medical provider, supplanting its right to pursue its common law remedies in Superior Court.



 


 


Learning from others and seeking to find information is the first step to success. Whether you need questions answered about Medical Revenue Recovery, PIP, Workers Compensation, and Commercial Insurance., Callagy Law is here to assist you every step of the way. We are headquartered in Paramus, NJ and we are full service law firm that specializes in serving businesses, healthcare providers and individuals. Sean Callagy has assembled a team of attorneys that are exceptional leaders in their legal expertise and have been commended for providing exceptional legal services at every level. If you need a true hands of experience with a legal team, feel free to contact us at here and come meet with Sean Callagy himself. There is no substitute when it comes to working with a lawyer and law team that cares deeply about their clients. Feel free to search us on Facebook, Twitter or LinkedIn!



 


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Medical Provider Applications In New Jersey Workers’ Compensation Courts

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?




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.



 


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.



 


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Codes Not On ASC Fee Schedule Possibly Reimbursement | Callagy Law

Friday, January 22, 2016

Is Ted Cruz “Born To Run?” | Callagy Law

The Controversy over Ted Cruz’s Eligibility for President and the Vicissitudes of Constitutional Law




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.



 


Whatever you may think about his politics or personality, Donald Trump has injected an interesting debate into the election year discourse. Although it may have been a mere distraction tactic, Trump’s questioning whether presidential candidate Senator Ted Cruz is constitutionally eligible to serve as President has generated countless headlines in the news media and has prompted the country’s foremost legal scholars to enter the fray. And, as is often the case, the only consensus appears to be that the answer isn’t clear cut. Why that is reveals a telling feature of Constitutional law.


First, background: Ted Cruz was born in Canada in 1970. His father was a Cuban-born, Canadian citizen and his mother was an American-born U.S. citizen. He held citizenship from both nations until he voluntarily renounced his Canadian citizenship in 2014.


According to Article II, Section 1, Clause 5 of the Constitution, among the requirements to be eligible to serve as President is that one must be a “natural born citizen.” The phrase sounds simple enough, but what it actually means is anything but.


On one side you have those who argue that, if the word “natural” is to have any meaning at all, the phrase must mean more than merely someone who is a citizen at birth. Otherwise, why not just say “born citizen”? Could the founders have been so carelessly verbose?


Evidence to support this view comes from the founders’ purported own understanding of the word “natural.” At the time it meant something not created by statute—i.e., not a law enacted by Congress (or, in pre-revolutionary times, the British Parliament)—as in “natural rights,” which were part of the judge-made common law stretching back through the history of England to the Magna Carta and incorporated into early American law.


At common law, “natural born” meant born within the nation’s sovereign territory. The only exception was for those born to public officials serving the nation in a foreign land—for example, the child of a diplomat serving in France. So, the argument goes, by including the word “natural” in “natural born citizen” the Founders meant that only those born within the sovereign territory of the United States or to public officials serving abroad could become President. Under this theory, then, Ted Cruz is ineligible.


On the other side you have those who argue that, because the Constitution gives Congress the authority to determine the requirements of citizenship (Article I, Section 8), a “natural born citizen” is whatever Congress says it is at any given time.


In 1970, when Cruz was born, section 301 of the Immigration and Nationality Act, which is still in effect today, provided that “a person born outside the geographical limits of the United States. . . of parents one of whom is an alien, and the other a citizen of the United States who, prior to the birth of such person, was physically present in the United States . . . for . . . not less than five years, at least two of which were after attaining the age of fourteen years” is a citizen of the United States. Under this theory, then, Ted Cruz could be the next Commander in Chief – if he gets elected, of course.


Brilliant legal minds are scattered on both sides of the debate. Harvard law professors disagree with each other while two former solicitors general – one appointed by George W. Bush, the other by Barack Obama – completely agree with one another. It’s quite a mess. But what it tells us is that the essence of the law, and Constitutional law in particular, is debate itself.


It is a debate the Supreme Court will enter only if Senator Cruz is threatened with government action against him because of the issue—for example, if a state official, believing Cruz to be ineligible on account of his birthplace, refuses to put Cruz’s name on a ballot. One recent lawsuit filed by a retired Texas federal prosecutor, suing on behalf of all registered voters, will almost certainly be dismissed for lack of standing. Until the Supreme Court decides the issue, it will continue to be a debate more academic than practical.


Regardless, the debate is important because it reveals the nebulous nature of Constitutional law and the enormous power of the Supreme Court—deciding the meaning of words written hundreds of years ago to determine who may and may not lead this country.



 


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.



 


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Is Ted Cruz “Born To Run?” | Callagy Law

Thursday, January 21, 2016

Effects of PPACA on Workers’ Compensation

A closer look into the Universal Healthcare System



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.


 


This week, Democratic Presidential Candidate Bernie Sanders unveiled his universal healthcare plan aimed to guarantee healthcare as a fundamental right for every American.  The Sanders healthcare strategy is to expand medicare and creating a single payer health care system for every American. Sanders, a supporter of the Patient Protection and Affordable Care Act (PPACA), does not feel the PPACA goes far enough to provide the nation with adequate healthcare coverage. To fund the cost of the plan, Sanders plans to increase the top marginal tax rate to 52% for income over ten million dollars and by imposing a 2.2% flat tax on all income beyond the standard deduction.


 


The PPACA, also known as “Obamacare”, was enacted in 2010. Obamacare had no direct affect on the United States’ workers’ compensation system. The PPACA is targeted at health insurance, which provides coverage for non-work injuries and illness.  The act also does not make any changes to the control states have over their workers’ compensation system. However, some experts believe that the PPACA will have long term indirect effects on the workers’ compensation system. The first of these effects is a decrease in fraudulent workers’ compensation claims. The reasoning behind this effect is that as health care is made more available there will be less motivation to cheat the workers’ compensation system into paying for non-work related injuries. A second effect is that in theory a healthier US population would be less likely to suffer work injuries and, thus, the number of workers’ compensation claims would decrease. Additionally, those workers that do file workers’ compensation claims would need less treatment due to improved overall health. A final and concerning indirect effect is that an increased in the number of insured individuals may overwhelm the healthcare industry and cause greater delays in treatment.


 


According to a report by the Centers for Disease Control and Prevention there were roughly 11.4 million uninsured Americans as of 2014. Senator Sanders’s “Medicare for All” plan would cover these individuals. Like the PPACA, there seems to be no mention of any direct effects on workers’ compensation but due to the additional number of participants in the system, the indirect effects are likely to be magnified.



 


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.



 


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Effects of PPACA on Workers’ Compensation

Tuesday, January 19, 2016

Reimbursement For Fewer Than All CPT Codes Billed | Callagy Law

IS THIS PERMISSIBLE UNDER NEW JERSEY PIP REGULATIONS?



 


After searching various sources, we have found many people have questions when it comes to Medical Revenue Recovery, PIP, Workers Compensation, and Commercial Insurance.. Do you have questions pertaining to reimbursement? Do you know what to do if problems arise? With articles written by Callagy Law’s law team, this blog will focus on many common questions and concerns surrounding legal matters which can arise in the field of healthcare law.



 


Let’s say someone injured their right knee in a motor vehicle accident and underwent physical therapy but still had residual pain and deficit of function.  The patient went to an orthopedist, who recommended and performed a right knee arthroscopic surgery.  The doctor billed two CPT arthroscopic knee surgery codes, Codes 29875 (limited synovectomy) and CPT Code 29877 (debridement/shaving of articular cartilage, or chondroplasty).   The Operative Report even shows both these procedures were performed as part of the knee surgery.  Why, then, did the PIP insurer only reimburse the doctor for treatment under CPT Code 29875?  Isn’t the doctor entitled to separate reimbursement for the procedures performed under CPT Code 29877?  The short answer is no, as discussed below.


Reimbursement under New Jersey PIP law is generally governed by N.J.A.C. 11:3-29.4,  “Application of medical fee schedules.”  This regulation states providers and payors shall use the National Correct Coding Initiative (NCCI) Edits as updated by CMS (The Centers for Medicare & Medicaid Services.)   Under the NCCI Edits, one CPT Code may be considered bundled into another Code, and payment will only be due for the one Code.  Other times, a modifier may be required in the billing of the second Code and documentation to show the second procedure was “over and above” the treatment provided under the first Code.  Other times, Codes are listed but there is no conflict and no barrier (from this perspective) to separate reimbursement for both Codes.


More specifically, the governing PIP regulation, N.J.A.C. 11:3-29.4 (g)(1) states:


Artificially separating or partitioning what is inherently one total procedure into subparts that are integral to the whole for the purpose of increasing medical fees is prohibited. Such practice is commonly referred to as “unbundling” or “fragmented” billing. Providers and payors shall use the National Correct Coding Initiative (NCCI) Edits, incorporated herein by reference, as updated quarterly by CMS and available at http://www.cms.hhs.gov/NationalCorrectCodInitEd/. Modifier 59 and other NCCI-associated modifiers should not be used to bypass an NCCI edit unless the proper criteria for use of the modifier are met. Documentation in the medical record must satisfy the criteria required by any NCCI-associated modifier used. For more information on the criteria for the use of modifiers, see the NCCI Policy Manual and Modifier 59 Article referenced in (g) above.


 


Therefore, to determine if a medical provider is entitled to separate reimbursement for multiple CPT Codes, the NCCI Edits must be reviewed.  Information on NCCI Edits may be found at https://www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/index.html.


A pair of codes must be looked up to determine if there is an NCCI edit.  If the codes do appear on the list of NCCI edits, check if the edit was in effect the date the treatment was performed.  There is a column for “effective date,” as well as “deletion date.”


Let’s assume your pair of codes are on the NCCI edit list and the edit was in effect when the treatment was provided.  The next issue is whether the edit is designated a “0”, a “1” or a “9.”  If your pair has a “9” designation, there is no conflict.  If your pair has a “0” designation, you are not entitled to separate reimbursement for both codes.  If, however, your pair has a “1” designation, you may be entitled to separate reimbursement if the conditions for separate reimbursement are met.  The conditions are billing with a proper modifier (often a -59 modifier) and having the proper documentation to support separate reimbursement.  The type of documentation generally required for separate reimbursement is proof the second treatment was “over and above” or “separate and distinct” from the treatment provided under the first code.


 


In our example above, CPT Code 29877 is not separately reimbursable from CPT Code 29875.  The NCCI edit conflict is set forth below, and contains a designation of “0,” meaning no modifier and documentation will overcome the bundled designation of the second code.








Column 1Column 2* = In existence prior to 1996Effective DateDeletion Date

*=no data
Modifier

0=not allowed

1=allowed

9=not applicable

 








2987529877*20030401*0

 


 


An example of a “1” designation is billing for an arthroscopic shoulder surgery under CPT Code 29827 (rotator cuff repair) and 29825 (lysis and resection of adhesions).  The pair of these codes has a “1” designation.  Use of a -59 modifier with adequate documentation justifying the second code may result in separate reimbursement.


 








298272982520030701*1

 


 


It is important to be familiar with current NCCI Edit conflicts and requirements to obtain separate reimbursement, when applicable.



 


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.



 


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Reimbursement For Fewer Than All CPT Codes Billed | Callagy Law

Monday, January 18, 2016

A Closer Look into Amendments | Callagy Law

15 Million Civil Lawsuits Are Filed Each Year in the United States | More insight into amendments




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 business and commercial litigation. Our mission is to answer any questions and give knowledge to many different aspects of these matters.



 


 


According to the latest polls, 15 million civil lawsuits are filed each year. That is one lawsuit for every twelve adults in America and one filing every two seconds. One overarching flaw that a majority of these complaints and their corresponding answers have in common is that they fail to name all the proper parties or assert all the proper claims or defenses. The mechanism to fixing these mistakes is called an amendment.


 


In the trial level court of New Jersey, called the Superior Court, one of the rules governing amendments is 4:9-1. Specifically this rule allows a party to amend their pleading once at any time before the opposing party responds. After a party a responds, there are then only two avenues to amend: one is by consent of the other party and the other is by leave of court which “shall be freely given in the interest of justice”


 


The phrase “in the interest of justice” is quite broad and may leave many readers wondering what courts will look to decide if an amendment fits into this phrase. While there a handful of factors that a court analyzes in reaching this conclusion, the overwhelming consideration is the prejudice that will be suffered by the other party if the amendment is granted.


 


In Keller v. Pastuch, the Plaintiff, who were husband and wife, brought suit against an automobile driver after the car the wife was riding in was struck by the Defendant. 94 N.J. Super. 499, 501 (App. Div. 1967). On the opening day of trial the defendant sought leave of court to amend his answer to include a new defense. Id. Subsequently, the court granted a mistrial and heard, later on that same day, oral arguments on whether the amendment should be granted. Id.


The plaintiffs argued that they would be substantially prejudiced due to the lateness of the defendant’s proposed amendment. Id. In response, the defendant argued that he did not know this defense was available to him until a recently conducted interview. Id. at 503. The court sided with the plaintiff and held that the defendant could have asserted the defense earlier, which in turn would have allowed the plaintiff’s to preserve their rights.


 


By contrast, in Sheppard v. Braun the court granted plaintiff’s motion to amend to add two new parties. No. ATL-L-1900-05, 2005 WL 2560782, at *1 (N.J. Super. Ct. Oct. 7, 2005). The plaintiff, a car accident victim, sought to add the Borgata Hotel after he recently learned that the hotel may have been serving alcoholic beverages that contributed to the accident. Id.  The court summarily granted the motion, due to the fact that it was unopposed and no trial or arbitration date had been set. Id.


 


Thus, as a litigant it is important to act swiftly when amending a pleading, so as to ensure that the opposing party is not prejudiced and thereby causing the court to deny the amendment.



 


Sean Callagy, the owner and President of Callagy Law is an attorney, business coach, public speaker, and entrepreneur; and is dedicated to the personal and business growth. Please reach out to us here with any questions or comments regarding personal or business matters. We will to continue to provide daily updates with helpful information on our website and social media. Please feel free to contact Callagy Law at anytime. Feel free to connect with us on Facebook, Twitter or LinkedIn! Additionally you can subscribe to our daily videos on YouTube by clicking here.



 


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A Closer Look into Amendments | Callagy Law