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Silver Lining for Jackson? Print E-mail
Written by Jeffrey Herschler   
Wednesday, 30 March 2011 15:39

University of Miami/Jackson Memorial Medical Center has been ranked No. 1 in Miami--Fort Lauderdale in U.S. News & World Report's first-ever Best Hospitals metro area rankings, posted online this week. Of the 69 hospitals in the Miami--Fort Lauderdale area, only 18 made the new ranking.  Outgoing CEO, Dr. Eneida Roldan stated “This is an incredible achievement for us, as we beat out all of our local competition in South Florida.  Despite our current fiscal challenges, this accolade is quite a testament to the unparalleled, quality medical care we provide here each and every day.”  To view the report, please click the link below:

Last Updated on Wednesday, 13 April 2011 15:21
New Administration Looking to Overhaul Florida's Workers' Comp Print E-mail
Written by Tom Murphy   
Wednesday, 30 March 2011 08:38

2011 Workers' Compensation Update

Even before he ever took office it was clear that Governor Rick Scott was serious about changing Florida's legislative and regulatory landscape. One of his campaign pledges included reducing workers' compensation costs by 35%. He recently renewed this pledge to the Florida Council of 100 shortly after taking office. This could be a formidable task given the fact that Florida rates have decreased by 64.7% since the major legislative reform in 2003.

Recently, Florida Insurance Commissioner Kevin McCarty approved a 7.8% rate increase that went into effect on 1/1/11. The reasons for the current rate increase are changes in claims experience and frequency. The dramatic decline in claims between 2003 and 2007 appears to have slowed, leading some experts to assert that the 2003 reforms have run their course.

Many industry leaders believe that the only possible way to cut workers' compensation costs further would be to change benefits or reforms associated with prescription drug benefits. One specific recommendation is legislation that would apply the pharmaceutical fee schedule to repackaged or relabeled drugs. Additionally, the legislature may find itself dealing with other issues, such as apportionment, that involve separating costs associated with pre-existing injuries.

One thing is clear. Nobody knows how the current legislature will respond to Governor Scott's ambitions to further reduce Florida's workers' compensations costs. Undoubtedly, he will push forward for these changes that will be welcomed by medical practices and all Florida businesses and vehemently opposed by injured workers and their attorneys

Tom Murphy is a medical malpractice and workers' compensation insurance specialist with Danna-Gracey, a boutique insurance agency specializing in medical malpractice and workers compensation for Florida's medical community. To contact him call (561) 276-3553 or (800) 966-2120, or e-mail

Last Updated on Wednesday, 06 April 2011 14:26
Miami Physician Featured in Medical Economics Print E-mail
Written by Jeff Herschler   
Saturday, 12 March 2011 16:18

Bernd Wollschlaeger, MD of North Miami Beach is featured in the current edition of Medical Economics.  I've known Bernd for almost a decade, feature his blog in FHIweekly and often run his op-ed pieces on  I am pleased to share this link:

Bucking Convention: Bernd Wollschlaeger, MD 

March 2011 - Medical Economics 

Last Updated on Wednesday, 30 March 2011 08:37
Japan Hit By Earthquake & Tsunami Print E-mail
Written by Jeffrey Herschler   
Saturday, 12 March 2011 15:25


View the Pictures

Editor's Note

This is an incredible slide show, particularly image #1 which depicts houses in Japan engulfed by tsunami while simultaneously burning. 

These are big, high resolution pictures so be patient awaiting download; it's worth it.  - JH

Source: , 3.11.11 

Last Updated on Tuesday, 22 March 2011 17:24
"RACaphobia" Print E-mail
Written by Bill Gompers   
Saturday, 05 March 2011 15:04

RACaphobia is defined as an intense and persistent fear of an RAC Audit.  As we have all become aware, RAC is an acronym that stands for Recovery Audit Contractor.  These contractors are charged with the responsibility of implementing the Centers for Medicare & Medicaid Services' (CMS) program to mitigate overpayments to providers.  In addition to physicians, virtually all healthcare providers who bill Medicare and Medicaid, such as hospitals, durable medical equipment companies, home healthcare organizations and nursing homes, are the targets of these audits.

The RACs are extremely motivated to uncover overpayments to the healthcare providers they audit because a large part of their remuneration is based on the amount of improper payments they unearth.  In fact, many sources have likened RACs to "bounty hunters" being paid a contingency fee of between 9% and 12% on the recovered overpayments.

Among the findings reported during the demonstration program conducted in Arizona, California, Florida, Maine, New York and South Carolina were:

  • Nearly $1 billion of overpayments were identified based on about 525,000 overpayment determinations.
  • Approximately 20% of the overpayment determinations were appealed, with less than 5% of the reviews being overturned.
  • Only $38 million of underpayments were identified.
  • The costs for running the program were about 20% of the funds recouped.

Because of the demonstration program's great success, the RAC program was mandated across all 50 states in 2010.  As part of the 2010 Patient Protection and Affordable Care Act, the RAC program has been expanded to include Medicare Part C, Medicare Part D and Medicaid.

In order to limit exposure, many experts recommend the following:

  • Know what the RACs are looking for and assess whether these issues occur within your practice. This information can be found on each governing RAC website.
  • Conduct internal audits to identify potential overpayments and develop a corrective action plan to reduce the risk of future overpayments.
  • Consider moving toward and utilizing an Electronic Medical Record (EMR).
  • Utilize certified billing and/or coding experts on a yearly or biennial schedule to conduct reviews, ensure compliance, update templates and train staff on issues involving coding and billing.
  • Make sure your billing staff is properly qualified, trained and provided with continual training/updates as to the audit process, applicable Medicare and Medicaid guidelines, and coding and billing practices.
  • Select a higher-level point person within your practice who will handle all RAC requests and future communications. This will ensure that the process goes more smoothly.
  • Understand the appeal process in order to ensure that no deadlines are missed.

As part of their planning process, many providers are looking for ways of defraying the costs of legal defense, fines and penalties associated with RAC Audit determinations.  Insurance coverage to help meet this need can now be purchased in the marketplace.  This coverage is very inexpensive and should be considered to alleviate sleeplessness associated with "RACaphobia."

After a year of audit expansion, providers can expect to see increased audit activities as we move further into 2011. Since almost all providers will be involved with an RAC audit, it is important that they prepare and address these issues with their trusted advisors

Bill Gompers is a medical malpractice insurance specialist with Danna-Gracey, a boutique insurance agency specializing in medical malpractice and workers compensation for Florida's medical community. To contact him call (305) 775-1960 or (800) 966-2120, or e-mail

Last Updated on Wednesday, 23 March 2011 08:13
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