To be clear, it can be very frustrating to deal with the bureaucracy of Medicare, (translates as the government) but from a billing standpoint, this is not the case in my experience.

I find customer service very knowledgeable, the remits are easy to read with even denial codes explaining what is wrong with a claim. The phone numbers to contact either a person or an automatic information system are very clear. The website is cumbersome, but someone will walk you through it while they remain on the line with you. There are forms for everything if you cannot accomplish something by phone and while it is true the every “I” has to be dotted and “T” has to be crossed, the work I put in yields results. I cannot always say that about the other plans. Sometimes I wonder where the other plan’s rules come from – like a 90 day timely filing limit with NO room for appeal, explanation, or human error. Medicare’s timely filing deadline is one full year! And even after the year, there is another level of payment available with only 10% taken off the top; that seems fair to me in assigning mutual responsibility instead of simply throwing out the claim and forcing me to write an appeal usually in vain.

I know that a major argument against Medicare is the fee schedule, but if you examine your others plans closely, you will find there are non-Medicaid plans that pay the same or LESS than Medicare. And some of those plans make you jump through hoops to get certain procedures authorized, most of which do not require authorizations by Medicare. And there are also many codes that are bundled with non-Medicare plans but the proper use of modifiers can get you paid for each code with Medicare. Even when Medicare sends you a request for information, they have a standard system in place to process your response.

Finally, Medicare replacement plans have become popular of late mostly because it eliminates people from having to carry a secondary insurance. I am very opposed to them not only for the reasons that I like Medicare, but because these plans have wreaked havoc with beneficiaries. The replacement plans are not properly explained to retirees. So not only are doctors having more plans for which they have to obtain authorizations, I have been the bearer of bad news to patients when I have had to tell them that they must have signed some paper that transferred their health insurance to a replacement plan when that was not their intention.

The bottom line is that if you work within the process of Medicare you can spend more time caring for your patients and less time arguing with their insurance.

Fran Glucroft
Medical Office Manager
Fairfield, CT

Show me why I need some type of insurance protection, and I’ll listen carefully at least. Of course I have life insurance, mostly term life insurance. But I have some whole life insurance too because I hope to outlive my term insurance and still leave my family enough money to bury me and pay off my debts. My father did NOT believe in life insurance, preferring instead to put his money in the stock market. He passed away last year, before the market tanked (thank goodness) and all I can tell you is his stocks didn’t do so well. I’m still working… but I digress as usual.

I also have disability insurance, good car and homeowners insurance, and an umbrella policy to cover what the other policies won’t cover. I’m considering a policy for Errors and Omissions since starting PrivatePractice.MD, but that policy is more for corporate board members I think. There are all sorts of specialized insurance products so be sure to ask your agent to review your business risks and determine if those risks can be mitigated with insurance.

You work hard to start and build your business and you don’t want it taken from you due to some preventable or unfortunate event. Business Liability insurance should protect you from those sorts of risks. If you have partners you might also consider having the medical practice buy life policies for each partner which pays the surviving spouse for that partner’s equity ownership in the practice in the event the partner dies. Otherwise your new partner may be the spouse! I can see how that might cause some problems for the daily office routine (but again I digress).

Here are some key provisions that need to be considered when acquiring medical malpractice coverage:

Do the expenses from defending a claim erode the per claim limit?

In an effort to provide an option for doctors to keep their costs down, insurance carriers will have the expenses accrued from the claim deduct the amount of money available for a potential settlement or verdict and depending on the complexity of a claim as well as the injury to the patient, the amount of insurance money available could become an issue in whether or not a claim gets defended or settled.

Will you have consent to settle?

A lot of physicians understandably want to defend their professional reputation and can control whether or not a case gets settled if they have a consent to settle provision in their policy. If they don’t have consent, a carrier can settle their case without their approval and with that settlement, a report to the National Practitioner’s Data Bank will be required.

Will you have coverage to retain an attorney in the event you have to give a deposition or are required to respond to a complaint registered with your state board registry?

Having a ‘proceedings’ option on your policy will provide you with the ability to hire an attorney to prepare and present you for a deposition. The concern surrounding a deposition [without an attorney] is the possibility of answering questions erroneously and then you can wide up getting amended into that case.

Board complaints cannot be taken lightly either and if there isn’t a proper response, you may find yourself with an action against your license. Having an attorney available who has dealt with the regulatory boards can minimize and possibly eliminate any potential disciplinary rulings against you.

Your best bet is to tell your broker what you desire in a policy. Eroding limits, consent to settle clauses and coverage to hire an attorney for legal proceeding issues may not seem important, but you should still ask for a complete explanation as to what your policy covers and then determine what options are best. You may find out that the additional benefits and the extra cost to add such benefits are well worth it.

Todd M. Biondo, CPCU
Assistant Vice President – Healthcare Claims
Darwin National Assurance – an Allied World Company
9 Farm Springs Road
Farmington, CT 06032