Archive for April 2008
Automobile Accident Insurance - How Does It Work?
Posted on Friday, April 25, 2008 at 2:25 PM by Editor
NC Automobile Insurance for Accidents and Injuries - Get The Basics
Handling an auto insurance claim is more complex than a health insurance claim as there is a variable on “who was at fault in the accident” that determines how coverage comes into play. In North Carolina, the two types of coverage that most often come into play when a healthcare provider treats an auto accident victim is the medical payment (Med Pay) and the Bodily Injury Liability (BI)/Personal Injury (PI). To ease understanding in this document the term PI will be used.
What is Med Pay Coverage?
Med Pay covers direct medical bills and funeral expenses in an auto accident regardless of who is at fault for the accident. It will cover the drivers’ injuries and those injuries sustained by passengers in the car or while a person is driving someone else’s car with their permission. Injuries sustained as a pedestrian are also covered. The insured who purchases the auto policy selects the amount of Med Pay coverage. Medical bills submitted by healthcare providers are paid according to the “fair and reasonable” standard which is very much like the Health Insurance term, “usual, customary and reasonable.”
What is PI Coverage?
Personal injury covers injuries or death to other people that is caused by an insurance company’s driver. It also provides a legal defense if any injured/deceased party sues the responsible driver. A PI claim can include several kinds of loss including medical bills, loss of income, pain and suffering and disability due to an injury. When a claim for PI is settled by the insurance company it is usually referred to as a “settlement”. This is a negotiated financial amount between the insurance company and the injured party that reimburses them for the losses mentioned above.
Edited on: Monday, April 28, 2008 6:16 AMPosted in Insurance (RSS), Insurance DC (RSS), Insurance MD (RSS)
Nationwide Insurance - Chiropractic
Posted on Friday, April 25, 2008 at 1:44 PM by Editor
Members who have experienced denials of hot packs, treatment of infants and re-evaluations: take note. Nationwide does not have blanket claim policies to deny these services. If an adjuster tells you there is a corporate policy to deny care for infants under 2 years old, it is incorrect. If the adjuster insists on this position, please ask him or her to refer the case to Nationwide's medical review staff for assessment.
Hot packs are normally covered for 30 days; however, if there is a compelling reason why the patient cannot manage hot packs at home, send this information to the adjuster and ask for a medical review determination.
Adjusters who deny patient re-exams may have done so incorrectly. The medical review staff at Nationwide indicates that they prefer to see periodic re-assessments so the patient benefits from a change in care or a referral if the current treatment is not improving the patient's health status. Be sure to include information in the clinical record about the results of the re-exam, patient improvement or regress, and your treatment plan.
Posted in Insurance (RSS), Insurance DC (RSS)
ACA meets with Senate on Proposed Medicare Cuts
Posted on Friday, April 25, 2008 at 1:31 PM by Editor
Medicare Cuts Proposed for 2010On Friday, April 11, 2008 ACA was among the physician groups invited to attend a roundtable discussion with Senate Finance Committee Chairman Max Baucus (D-MT). Among other items, the chairman outlined his proposal for delaying cuts to the Medicare physician fee schedule that are expected to go into effect on July 1, 2008. Sen Baucus proposes a potential 1.1% increase in payments through the end of 2009. He also stated that he would prevent the drastic 21% payment cuts physicians face in 2010. By delaying the cuts for 18 months, he is hopeful that Congress can address the physician payment methodology on a broader scale.
Sen Baucus also outlined a few other provisions that he would like to include in the bill. One would give physicians incentives for using electronic prescribing and other types of electronic health records. Another would increase or expand the Physician Quality Reporting Initiative (PQRI), which increases payments to providers who report quality data. Baucus added that he wants to link reimbursements to quality of care in Medicare, a proposal that he plans to have on the Senate floor by mid-May. ACA lobbyists are on Capitol Hill closely monitoring this initiative and others like it.
Posted in Insurance (RSS), Insurance DC (RSS)
Cell Phone Policies Make A Difference
Posted on Sunday, April 20, 2008 at 7:24 AM by Editor
Employers can be liable for road accidents caused by worker cell phone use.
There is company legal liability for accidents caused by employees using
cell phones for work-related calls behind the wheel.
- In 2001, the city of Honolulu agreed to pay $1.5 million to a man who suffered permanent brain damage after being struck by a city employee who was talking on a cell phone at the time of the accident.
- Similarly, a jury ordered an employer to pay more than $20 million when its salesman killed a motorist while using his cell phone between sales appointments.
- The large investment firm Salomon Smith Barney paid a $500,000 settlement to the family of a motorcyclist killed by one of its employees making a work-related call after hours on his own personal cell phone.
It doesn't matter if the call is being made during regular office hours or not; what matters is that the call is work related. Employers may be found liable for any damages caused by an employee acting within the scope of his or her employment. What's more, employers could also be found negligent if they fail to provide an adequate cell phone use policy, proper training, or safe equipment to its employees. With the recent increase in state statutes banning or restricting cell phone use while driving, the potential liability for employers has increased.
Employers should consider the benefits and risks of employee cell phone use, as well as any state cell phone driving statutes. To effectively reduce the risk of liability, such a policy should prohibit any work-related cell phone calls while driving. If the company feels that is unenforceable, the policy should, at the very least, require the use of a hands-free device. The policy should also state that if an employee is in an accident, any costs, fees and fines will be solely the responsibility of the driver.
Personal calls -- whether made on a cell phone or not -- are especially distracting, while text messaging takes away from an employee's productive time. Accordingly, employers may require that personal cell phones be turned off or silenced during working hours, unless employees use them for business purposes. Such a policy should also provide that personal cell phone calls or text messaging is prohibited during work hours and are only allowed during breaks or lunches.
It may be important for certain employers to prohibit employees from photographing important business assets, such as documents or equipment. Additionally, there may also be privacy concerns if an employee photographs another in the workplace without his or her knowledge or permission.
Credit Inc.com
Posted in Business News (RSS)
Small Business Owner Be Aware of Funding Scams
Posted on Sunday, April 20, 2008 at 6:45 AM by Editor
The Better Business Bureau has issued a warning to small business owners who could fall victim to fraud schemes.The Dayton BBB has picked up on reports of a number of scams attracting attention across the country, and the bureau is hoping a warning to Dayton-area business owners will prevent them from falling for the same Internet frauds. BBB President and Chief Executive Officer John North said although much of the attention during the credit crunch has been focused on large companies, small businesses have been very susceptible to fraud, losing up to $26,000 each through Internet transactions.
"The Internet provides a perfect stage for fraud because bad actors in the
loan industry can easily portray professional images that provide
unsuspecting small business owners with a false sense of trust," North
said in a news release. The BBB identified several loan and grant offers
small business owners should be aware of when looking for funding,
including: * Mediations LLC (also doing business as Innovations Northeast
LLC) has been accused by several businesses across the country of charging
substantial up-front fees for construction loans, but not delivering on
the promised funds. Business owners have paid fees ranging from $1,500 to
as high as $26,000 and were required to pay by wire transfer or cashiers
check only. The BBB has advised small business owners to never pay large
sums of money up-front to receive loans or wire payment for services,
because there is no way to get money back from this type of scam. * The
National Small Business Alliance has been accused by business owners in 49
states of pre-approving small businesses for $8,000 credit lines for
one-time membership fees of $99 to $149. The promised loans, however, turn
out to be comprised of coupons, discounts and offers made by participating
vendors to purchase goods and services using credit terms. Business owners
have said the company continues to deduct money from their bank accounts
without permission and doesn't refund money as promised. The BBB has
advised business owners to be extremely cautious when providing bank
account numbers and insist on reviewing offer details before making buying
decisions and signing contracts.
Posted in Business News (RSS)
Turning Competitors Customers Into Yours
Posted on Sunday, April 20, 2008 at 6:19 AM by Editor
A montra for all business plan makers and marketing directors. When searching for a target market to direct our services too, it is easy to generate the first one: the customers that my competitor has would be perfect. Then it takes more research. When we are prepared to launch our program and share with our target market, the spray approach is least effective and most costly the majority of time, direct marketing tends to perform better.
When we think of targetting our competitors market, it often seems like
an impetrable fortress, and there is no trojan horse to directly get in.
A company has taken on the task of getting Starbucks customers, and are
doing a good job of it. Fon, based out of Madrid, Spain, has taken on
targetting Starbucks WiFi Market. The service in Starbucks is provided
by T-Mobile around the world. Starbucks customers pay $10/day for
internet service; a ridiculous amount.
Fon found their target market to offer internet service and they searched out and found a trojan horse to directly market to them. They go to every Starbucks and find another business, apartment, or home and offer them FREE internet service if the person will use the Fonbucks router. Their specially designed router takes an internet signal and splits into a "personal use" and "public use" signal. The personal use is for the resident near the Starbucks, the public for $2/day is for the market of Starbucks. T-mobile hasn't made any comments, yet they must be prepping a response.
The numbers here in the U.S. alone are staggering. Fon has over 44,000 subscribers in the US alone. How big of a jump have they made we ask? They targetted their market and have gone from 17,000 to 44,000 subscribers in two months.
When we start out today, searching for market to directly market to our target population, slide on our creative hat. If you have the product / service that is fills the need, you are competitive or in this case just not too greedy ($2 versus $10) then their is a way to get in, because the people (the target market) will want you in.
Edited on: Sunday, April 20, 2008 6:24 AMPosted in Business News (RSS)
CNC Watch
Posted on Sunday, April 06, 2008 at 9:14 PM by Editor
CNC HCPCS Replacements or Additions for 2007
|
L0100 Replaced with A8002 or A8003 |
L0110 replaced with A800 or A8001 |
|
L3902 replaced L6624 |
A8000 - Helmet, protective, soft prefab |
|
L1001 Cervical thoracic lumbar sacral orthosis, immobilizer |
L3806 - Wrist-Hand-Finger Orthosis includes elastic bands, turnbuckles includes joints |
|
L3808 Wrist-Hand-Finger Orthosis rigid without joints |
L3815 - Wrist Hand Finger Orthosis includes joints, similar to L3806 |
Posted in Insurance (RSS), Insurance DC (RSS)
Cigna Watch
Posted on Sunday, April 06, 2008 at 9:14 PM by Editor
April 6, 2008
Cigna Preventive Care Services
Directly from the Cigna newsletter; "most Cigna Healthcare plans cover the full cost of preventive care services". Here are there recommendations:
Well-Person Exam ICD9: V7x.x CPT:99381-99387 / 99391-99397
Routine Immunizations: ICD9: V03.x CPT: 90632-90600 / 90669 / 90680 / 90700-90716 / 90718-90723 / 90732
Prostate Cancer Screen (over 50 or risk factors) ICD9: nothing specific exist, use general V7x.x CPT: G0XXX prostate screening: 841XX / 851XX, 84152, 84154
Cervical Cancer Screen (every 3 years age 19-64) ICD9: V76.2 CPT: 88141-88148 / 88150-88155 / 88164-88167 / 88174-88175
Breast Cancer Screening (age 40, or risk factors) ICD9: V76.X CPT: 77051 / 77052 / 77055 77056 77057
Colorectal Cancer Screen (routinely at 50) - Colonoscopy every 10 years,
Sigmoidoscopy every 5 years, Fecal Occult Blood annually, or Barioum
Enema every 5 years:
ICD9: V76.X CPT: 45378 / 45330 / 82270 / 74270
Chlamydia Screening for sexually active females under 25, Osteoporisis
screening (Women over 65 or over 60 with risk factors), AAA by US for
men 65-75 who smoked.
ICD9: V73.X, V82.8X, V82.X CPT: 87270 / 87320 /
87490 / 87491 / 76070 - 76071 / 76076 - 76077 / 76700 / 76705 / 80061 /
82465 / 83718-83721 / 84478 / 82947