Serving the Insurance Needs of Physicians, Medical Groups and Hospitals Across the USA

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An insurance policy that protects an individual or business from the risk that they may be sued and held legally liable for something such as malpractice, injury or negligence is known as Liability Insurance. It is very important for those who may be held legally liable for the injuries of others, especially medical practitioners and business owners. Business owners may purchase liability insurance that covers them if an employee is injured during business operations. Liability policies cover both legal costs and any legal payouts for which the insured would be responsible if found legally liable. Intentional damage and contractual liabilities are typically not covered in these types of policies.

Insurance that protects professionals such as accountants, lawyers and physicians against negligence and other claims initiated by their clients. It is required by professionals who have expertise in a specific area because general liability insurance policies do not offer protection against claims arising out of business or professional practices such as negligence, malpractice or misrepresentation. Depending on the profession, professional liability insurance may have different names, such as medical malpractice insurance for the medical professional, and errors & omissions insurance for real estate agents. Professional liability insurance is a specialty coverage that is not provided under homeowners' endorsements, in-home business policies or business-owners' policies. It only covers claims made during the policy period.
This insurance coverage protects health care providers against patients who sue them under the claim that they were harmed by the physician's negligent or intentionally harmful treatment decisions. Premiums are usually based on the physician's specialty and geographic location. This means that even if a physician has never been sued, he or she can end up paying extremely high premiums. The premiums can become high because of factors such as amount of coverage needed, claims severity, claims frequency, location of practice and laws in the area.
An E&O policy is a professional liability insurance that protects companies and individuals against claims made by clients for inadequate work or negligent actions. Errors and omissions insurance often covers both court costs and any settlements up to the amount specified on the insurance contract. It does not cover a medical decision.
Many types of insurance qualify as P&C policies. Some of the most common types include auto, homeowners', umbrella, workers' compensation and general liability policies. Life and health insurances do not qualify as P&C policies in most states, even when they are written for business purposes or on company executives. All commercial insurance is P&C, but P&C insurance encompasses more than just commercial policies.
BOP insurance policies are ones that combine protection from all major property and liability risks in one package. A typical business owner policy includes: property insurance, business interruption insurance, crime insurance, vehicle coverage, liability insurance and flood insurance. Depending on additional risks a business owner might face, the business owner and the insurance company can make arrangements on additional components to be added to the original package. Business Owners Policies usually target small and medium-sized businesses and typically contain business interruption insurance, which provides reimbursement for up to a year of lost revenue resulting from an insured property loss.
Workers' compensation is a state-regulated insurance program that pays medical bills and replaces some lost wages for employees who are injured at work or who have work-related diseases or illnesses. Workers' compensation will pay for the medical treatment of an injury or illness if:
  • The injury occurred at work or the disease or illness is job-related; and
  • The worker's employer has workers' compensation insurance or is certified by the Texas Department of Insurance, Division of Workers' Compensation to self-insure.
Workers' compensation will also replace some of the worker's lost wages if:
  • The injury or illness caused the worker to lose some or all income for more than seven days.
  • Texas employers may choose whether or not to maintain workers' compensation insurance. Employers who choose to have insurance may:
  • Purchase insurance policies from private insurance companies; or
  • Self-insure, if they meet the requirements of the Texas Workers' Compensation Act and are certified by the Texas Department of Insurance, Department of Workers' Compensation. Self-insured employers have the same rights and responsibilities as employers who buy policies from private insurance companies.

HIPAA: HIPAA is by definition the Health Information Portability and Accountability Act and was enacted in 1996. It is enforced by the Office of Civil Rights of the United States Government. It is a set of federal guidelines created to allow employees to take their medical insurance with them if they leave an employer, allow people access to medical insurance despite pre-existing conditions (under some conditions), and to establish privacy standards for a patient’s health information.

HITECH: The Health Information Technology for Economic and Clinical Health (HITECH) Act provides the Department of Health & Human Services (HHS) with the authority to promulgate regulations and guidance to support the development of an interoperable, private, and secure nationwide health information technology infrastructure.

EMTALA: In 1986, the U.S. federal government passed the Emergency Medical Treatment and Labor Act (EMTALA). This act requires any hospital that accepts payments from Medicare to provide care to any patient who arrives in its emergency department for treatment, regardless of the patient's citizenship, legal status in the United States or ability to pay for the services. EMTALA applies to ambulance and hospital care.

Stark Law: The Stark law named for Pete Stark is a limitation on certain physician referrals. It prohibits physician referrals of designated health services ("DHS") for Medicare and Medicaid patients if the physician (or an immediate family member) has a financial relationship with that entity. A financial relationship includes ownership, investment interest, and compensation arrangements. DHS includes clinical laboratory services as well as the following: physical-therapy services; occupational-therapy services; radiology, including magnetic resonance imaging, computerized axial tomography scans, and ultrasound services; radiation-therapy services and supplies; durable medical equipment and supplies; parenteral and enteral nutrients, equipment, and supplies; prosthetics, orthotics, and prosthetic devices; home health services and supplies; outpatient prescription drugs; and inpatient and outpatient hospital services. The law contains several exceptions, such as, in-office ancillary services, ownership in publicly traded securities and mutual funds, rental of office space and equipment, bona fide employment relationship, etc.

RAC Audits: Recovery Audit Contractor audits are done when an allegation of improper Medicare/Medicaid payments is made.

Patient Anti-Dumping improper transfer of a patient (“dumping”)

CMS: Centers for Medicare & Medicaid Services.

TMB: Texas Medical Board

EMR/EHR: Electronic Medical Records aka Electronic Health Records

OSHA: Occupational Safety and Health Administration. (“OSHA”) regulations pertaining to blood-borne pathogens.

ADA: Americans with Disabilities Act (“ADA”) concerning the physical accessibility or construction of medical office premises or refusal to provide professional services to a disabled person.