Providers Beware: North Carolina Medicaid Re-Enrollment Process Contains Traps for the Unwary
BY PATRICIA A. MARKUS, J.D.
Is your practice considering enrolling for the first time in the North Carolina Medicaid program, or has it been three years since you last submitted a North Carolina Medicaid enrollment application? If so, read the following article very carefully before you finalize and submit your application to CSC, the Enrollment, Verification, and Credentialing vendor for the Division of Medical Assistance ("DMA"), which administers the North Carolina Medicaid program. The application contains a page on which applicants must answer a series of questions about exclusions or sanctions that have been applied to the applicant or related persons or entities, and failure to accurately respond to the questions can have serious, long-standing consequences for physicians and their practices.
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Did You Get the Call? The Electronic Records & Electronic Communications Questionnaire Phone Interviews
BY KELLY CLAY, J.D. AND DESTIN TRACY, J.D. OF WOMBLE CARLYLE SANDRIDGE & RICE, LLP
Every medical practice is, or soon will be, creating, storing and communicating Electronic Health Records (EHRs), and attempting to safeguard them within a digital world of expanding communication options, including the hugely popular and widely accessible social media. Add to this the new North Carolina rules for the discovery of electronic documents in litigation, and the practitioner's need for educational resources is clear.
In conjunction with Medical Mutual's ongoing efforts to provide timely risk management educational resources, Medical Mutual retained the law firm of Womble Carlyle Sandridge & Rice, LLP ("Womble") to assist in the development of resource guides for the handling of digital media. The e-communications resource guide is being developed in order to help medical professionals manage the risks inherent in the inevitable friction between the use of digital media, the treatment of patients and the law.
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Texting? Weigh your options.
BY DAVID BROOKS, CO-FOUNDER & EXECUTIVE VICE PRESIDENT OF MARKET STRATEGY, QLIQSOFT, INC
For the health care professional, texting represents a simple choice between doing either what is immediate but risky, or what is deliberate yet secure. Expressing it any other way is overcomplicating the issue.
Unfortunately, where health care is concerned, it's also unsecure. If you use it in a professional capacity, you cannot text sensitive protected health information (PHI). If you do, you're violating HIPAA and HITECH privacy and security regulations. It's that simple.
Yet, anecdotal evidence suggests that SMS texting is common, if not rampant, across health care. Does this suggest people are flagrantly violating government regulations?
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HIV, Stigma & Confidentiality
BY CAROLYN MCALLASTER, B.A., J.D.
WHAT WOULD YOU DO?
You enter a patient room or curtained area in the emergency department to discuss the patient's care. The patient is HIV positive. The patient has two visitors and they are having a calm, friendly conversation.
Do you? - Ask the patient if it is okay to speak about her care with others present.
- Ask the visitors to leave the room before speaking to the patient.
- Start talking about her HIV medications with the visitors present.
The Duke Legal Project has represented many clients whose HIV statuses were inadvertently disclosed by physicians in emergency department waiting rooms or curtained exam areas. Although unintended, these unauthorized disclosures of HIV status have devastating consequences for our clients—your patients.
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2011 Closed Claim Summary Now Available on Our Website
The 2011 closed claim summary is available for review in the Members Only section of our website.
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Is Defense a Good Offense? Or Just Offensive?
BY LISA BANKER, MD, FACP
Have you ever ordered an unnecessary diagnostic test or prescribed an unneeded pharmacologic therapy?
Have you ever avoided a high-risk procedure?
Have you ever refused to care for a complicated patient in an attempt to avoid malpractice litigation?
If so, you are not in the defensive medicine boat alone. Recent national surveys have suggested that over 90% of physician respondents believed that physicians order more procedures and tests than indicated due to fear of litigation.
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Medical Mutual’s Risk Assessment Process Earns Recognition from A.M. Best
A.M. Best recognized Medical Mutual for its state-of-the-art Risk Assessment Process for Improving Patient Safety Outcome and featured the project in the Innovators Showcase, published in the January 2012 issue of Best's Review.
Innovators Showcase, in conjunction with its panel of insurance industry experts, recognized insurance organizations that developed "forward-thinking projects that have a fundamental impact on critical processes, as well as outcomes for a company and its clients." Regarding the merits of Medical Mutual's Innovators Showcase submission, an insurance industry expert wrote, "Risk identification and analysis are key first steps in determining a company's risk exposures. Medical Mutual Insurance Company of North Carolina has created a process for health care clients that achieves both. It is a winner."
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New Risk Management Resources
Medical Mutual's Risk Management Department has been developing new offerings for members and we are pleased to announce that the following resources are now available online.
North Carolina Risk Management Handbook
This reference guide is full of organized, easy-to-follow advice for the most common malpractice risk questions that arise in the medical office.
All of the practical information in each state-specific handbook was submitted for legal review by teams of health care compliance and defense attorneys. This approach provides the most comprehensive guidance for your practice.
Physician Extender Toolkit
Physician extenders, including physician assistants and nurse practitioners, play a valuable role in many medical practices. As a result, Medical Mutual created the Physician Extender Toolkit to help practices understand their legal obligations and to encourage them to be proactive in minimizing their risk.
Informed Consents
The Risk Management Department has been busy increasing their Informed Consent offerings to Medical Mutual members. There are now 130 consent documents available online at www.medicalmutualgroup.com. The department also partnered with a national certified translation company to convert the top 25 most popular informed consent forms into Spanish.
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Medical Mutual Develops Electronic Renewal Questionnaire
You now have a convenient new electronic format for updating your underwriting record using Policyholder Services (PHS). Medical Mutual has developed a new Renewal Questionnaire (RQ) to gather updated underwriting information, replacing the Current Practice Profile (CPP) used in the past.
The new questionnaire will enable you to provide us with your most current practice information to insure that our files are up to date and that your policy is revised accordingly. We will distribute email notices to each policy administrator six months in advance of their renewal. This should provide sufficient time for return of the questionnaire and to complete revisions prior to issuing the renewal. The renewal questionnaire will be initiated every three years.
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2011 Interactive Annual Report Soon to be Released
We are pleased to announce that we will soon release our interactive 2011 Annual Report and special video message from Dale Jenkins (CEO). In addition to providing an overview of our financial performance and Company highlights, the report features photos and testimonials from distinguished physician members and practice administrators.
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Managing Work-Related Injuries and Workers Compensation Costs
According to OSHA, approximately five million U.S. workers experience work-related injuries and/or illnesses every year, with more than 50% of those incidents resulting in employee leaves of absence. While overall occupational injuries and illnesses are down significantly, (almost 42% in the past 30 years), there is still room for improvement. Many organizations, such as OSHA offer proactive safety programs which can help businesses avoid or fix hazards before injuries occur. But while being proactive can help prevent many accidents; some workplace injuries are simply unavoidable. So what can practices do to help manage these situations when incidents do occur?
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We’ve Got You Covered with Enhanced e-MD Protection!
The per claim limit for Data Recovery Costs is being increased from $5,000 to $50,000.
Effective with all renewals and new business as of July 1, 2012, the Data Recovery Cost Limit will be increased to $50,000. The increased limit will make the per claim limit consistent with the other e-MD coverage parts.
To provide you with better value and additional protection, Medical Mutual has increased the limit for this key component of the e-MD coverage. And the good news is that e-MD coverage is automatically included in your medical professional liability policy - safeguarding your practice from network security and privacy exposures.
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The Legacy Fund Continues to Grow with a $23.2M Allocation in 2012!
Our physician-led Board of Directors has allocated an additional $23.2 Million to The Legacy Fund and $1.8 Million in cash dividends to members. Since 2009, Medical Mutual has allocated over $64.4M to the program, which benefits qualifying members in North Carolina, Virginia, and Georgia.
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HR|Experts Update: Giving and Managing Employee Breaks
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Employers are not required by federal law to provide breaks to employees. However, most employers find it to be good business to allow employees to take breaks. Breaks refresh employees and contribute to increased productivity, according to psychologists who say our brains become fatigued with constant effort and no breaks. Although the law doesn't require breaks, the Fair Labor Standards Act (FLSA) does state that short breaks of five to 20 minutes are for the benefit of the employer and must be paid.
Your human resources advisor, Jill Schultz with the HR|Experts program, occasionally receives calls from employers about employees who overstay their breaks and wind up stretching a 10-minute break into 15 or 20 minutes. This is an opportunity for coaching, to remind the employee of the policy.
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Medical Mutual to Host 2012 F.Y.I. Legacy Weekend at Pinehurst Resort
Medical Mutual is excited to announce the second annual F.Y.I. Legacy Weekend for our first year insured physician members in North Carolina and Virginia. The program is designed to inform newly practicing physicians about various aspects of their professional liability coverage; including legislative and regulatory issues, minimizing liability exposure, and risk management strategies.
This year's event will be an excellent educational opportunity as we will have a panel of experts on hand to address the changing health care landscape and offer insight regarding the importance of leadership in the medical community.
Once again, the F.Y.I. Legacy Weekend will kick off with recreational and social activities to provide our guests with a little down time on Friday afternoon after a week of tending to patients in their busy practices.
When: September 7th and 8th, 2012
Where: Pinehurst Resort in Pinehurst, NC
For more details, please visit our F.Y.I. Legacy Weekend web page.
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Spring 2012 Limits of Liability Report Now Available
Medical Mutual's 2012 limits of liability report is now available on our website. This report shows the current distribution of limits by specialty in North Carolina.
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NCMS Plan: 2012 Customer Survey Recap
Every year, the North Carolina Medical Society Employee Benefit Plan conducts a customer survey of participating practices. And, every year, we tout these results as an indicator of the continuing success of the NCMS Plan and the loyalty of its covered physicians and practice employees. Sure, 98% of participating practices that responded would recommend the NCMS Plan to others. And, yes, 96% of respondents agreed that their NCMS Plan agent was accessible and responsive. But the most striking statistic is that an overwhelming number of respondents (92%) agree there is a positive distinction between the NCMS Plan and other health insurers.
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NCMGM to Host Spring Conference May 9th – 11th in Myrtle Beach, SC
The North Carolina Medical Group Managers (NCMGM) spring conference, Turning Vision into Action, will be held at the Myrtle Beach Marriott Resort & Spa at Grande Dunes. This year's conference features expert speakers on a wide range of topics and is designed to take practice management to new heights.
The NCMGM and Medical Mutual will present the Administrator of the Year award on Thursday evening, May 10th, during dinner.
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Medical Mutual Recognized as One of Triangle Business Journal’s 2011 Healthiest Companies
Medical Mutual formed its Wellness Committee to encourage and promote healthy and active lifestyles among employees, including a variety of supportive activities and incentives. Activities included participation in a Consumer Supported Agriculture program featuring the weekly delivery of fresh, seasonal produce to our employees, an on-site flu shot clinic, a health fair, a physical activity reward program, a Couch to 5K training program, a Biggest Loser weight challenge and healthy food options at company functions.
As a result of the success of our wellness program, Medical Mutual was named one of the Triangle's healthiest employers for 2011 by the Triangle Business Journal (TBJ).
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Medical Mutual’s 2012 Community Outreach Agenda Features “Theme-Based” Projects
Medical Mutual is dedicated to serving the surrounding community, and to promoting and encouraging social responsibility among its employees. Its Community Service Committee creates an annual agenda of volunteer service projects to facilitate community outreach for staff members. Throughout the year, the Committee arranges events to provide employees the opportunity to donate their time and resources to help local non-profit and charitable organizations supporting those in need of our services. Medical Mutual places tremendous value on the crucial role of each employee in building a community-minded and compassionate organization, and the Community Service Committee is a vital part of this mission.
For 2012, a full year of "theme-based" community projects have been developed and employees are encouraged to become involved and share their time, talent and gifts to make a difference in the lives of those in need.
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