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Many cheap Med Mal offers are coming my way. How can I go wrong when I am saving so much? Print E-mail
Written by Matt Gracey   
Tuesday, 13 September 2011 15:47


Florida doctors are now enjoying a very "soft" buyer-centered market cycle, although I believe this is close to ending.  Back in 2000 we were in a similar market cycle, which led to many insurers pulling out of the state and the others dramatically increasing their malpractice-insurance rates a year or two later.  My advice as we enter the end of this soft market is to find a stable, well-funded, Florida-committed malpractice insurer so that you will lessen the chances of your coverage being canceled by your insurer when the going gets tough soon. 

When deciding which insurer will handle your coverage, remember that not all malpractice insurers are created equal, by any stretch of the imagination.  This is contrary to what you might read and hear from slick marketing folks and what you might like to believe so you feel can feel more comfortable and secure just price shopping. As with every important purchase decision, a risk/reward calculation is useful.  If a new, unrated insurer is promising great coverage and superb defense against claims, all for a price much below the rest of the marketplace, then there is a very high probability that they are just luring you in with unsustainable marketing promises.  In the last malpractice-insurance crisis of the early 2000s, over 50 insurers stopped insuring Florida doctors and left many facing expensive "tail" purchases, so choose very carefully as we come to the end of this buyers'-market part of the never-ending cycle.

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Matt Gracey is a Medical Malpractice Insurance Specialist in Delray Beach with Danna-Gracey, Inc. He actively lectures and writes educational material to help doctors and legislators around the state understand the malpractice insurance issues facing doctors today. You can reach him at (800) 966-2120 or

Last Updated on Thursday, 22 September 2011 09:47
Revenue Cycle Management: Enhance Cash Flow with Improved Efficiency Print E-mail
Written by Todd D. Demel, MBA   
Wednesday, 24 August 2011 17:45


While healthcare providers typically rely on conventional revenue cycle management methods to ensure financial performance, most are not collecting all of the potential revenue they have earned. Whether due to pricing, charges, or coding, considerable amounts of reimbursement are being lost daily. Today, providers must do more with fewer resources. Therefore, it is critical that practices effectively identify and address the root causes of lost revenue.   


All of this comes down to establishing a better way of managing the business of providing healthcare. And accomplishing this requires the proper processes, tools, and related expertise. While there has been an increased emphasis placed on technology and automating part of the revenue cycle management process, improved financial performance must also incorporate proper compliance measures and appropriate documentation.

Technology can certainly improve efficiencies and reduce some administrative burdens, but the reimbursement ultimately received by the practice correlates with and is a reflection of the data that was initially entered into the system. Just as important, if a practice is cited for noncompliance due to inappropriate or inaccurate documentation, cash flow could be reduced to the point of devastating a practice due to a review or audit that entails a hold being placed on payments. 


Rather than backend processes, the source of inadequacies is typically people and technology on the front-end. Accounts receivable decreases in value as it ages. Therefore, in cases where a claim is not paid the first time it is submitted, the chances of the practice ever receiving payment drops significantly. This is why it is so important to catch potential denials before claims are submitted.  

is also a key factor and therefore staff should be aware of:
  • Whether the claim has been transmitted;
  • Where the claim is in the process;
  • Whether the claim is complete;
  • Whether there are any factors that may delay transmission of the claim;
And, when the practice can expect payment to be made.


While less emphasis has been placed historically on patient receivables (as opposed to insurance receivables), annual increases in health insurance premiums have caused consumers to search for plans that require higher out-of-pocket responsibility in order to offset costs. Since this trend is likely to continue, equal attention must be given to this area of the revenue cycle as well. 


The goals for the practice administrator should include:
  • Increasing the first pass resolution rate;
  • Speeding-up the collections process;
  • Reducing workload and increasing efficiencies of staff;
Other factors to consider include the chargemaster or fee schedule, and payer contract management. Establishing a team environment at the practice where everyone is clear on their functions and responsibilities will go a long way towards creating efficiencies. Work distribution should be well thought out, and staff should be educated on best practices for pricing, charging, and coding. There must also be an awareness of compliance risks, accountability, and the possible consequences of noncompliance. 
ABOUT THE AUTHOR:  Mr. Demel is Senior Executive of Physician Management Services at MF Healthcare Solutions.  Possessing both operational and financial backgrounds, the MF Healthcare Solutions management team has vast experience in a range of healthcare industry settings. Combined expertise enables the firm to offer specialized physician practice managementservices. For more information, please visit: or contact Todd Demel at (954) 475-3199.
Last Updated on Wednesday, 31 August 2011 17:26
Pay-Per-Call Marketing: Twenty First Century Marketing Programs Impeded by Twentieth Century Rules Print E-mail
Written by Jeffrey Segal, MD, JD and Michael J. Sacopulos, JD   
Wednesday, 17 August 2011 12:53

Remember the days when a doctor took out a half page ad in the Yellow Pages - and we quaintly called that marketing. The world has changed. One 21st century marketing program, pay-per-call, is being embraced by doctors across the country.

Here's how it works. Internet marketing companies create a platform which either markets to patients (push) or serves as a magnet for prospective patients (pull). This might include an email blast to a proprietary list. Or a search-engine optimized web site with rich information.  Once a prospect is interested in the services being promoted, the company directs those prospects to healthcare providers participating in a designated geographic area. The provider pays a fee for each substantive lead - the lead being measured as a phone call to the doctor's office lasting longer than a few seconds. It's up to the office staff to convert the phone lead into an office appointment. Sounds great. A lead on the telephone is probably more valuable than an email inquiry. If the phone's ringing, what's not to like?

We hate to be the skunks at the garden party, but legacy statutes are not particularly supportive of 21st century marketing programs. The federal government has laws on its books which prevent "kickbacks" or fee-splitting. These laws predate pay-per-call marketing by many years, but these laws are still valid. The laws say a kickback is a payment designed to induce a referral for health care. On the surface, pay-per-call programs seem to contain the ingredients referenced in anti-kickback statutes.  Fortunately, there are safe harbors which don't trigger enforcement of fee-splitting penalties - such as when a doctor refers to another doctor in his multi-specialty practice - and they are both employees in the same facility. If they split profits at the end of the year, then, in a sense, the referral has generated extra fees split by all. As a safe harbor, this does not trigger any action.

On the other hand, if two unrelated doctors have a handshake agreement whereby referrals will be paid a cool $300 for every surgery - that's likely against the law. No safe harbor there. We should note that the federal anti-kickback rules apply only to Medicare-Medicaid providers. Those physicians they do not participate in Medicare-Medicaid are outside the scope of these laws. Also the laws apply to professional services. It may be possible to structure pay-per-call to fall outside the scope of federal law by limiting the scope of offers to products only. However, as these pay-per-call marketing plans typical operate, they would be in violation of federal law. Many states, though, have parallel statutes affecting fee-splitting; such as California Business and professional Code Section 650 which bars licensed physicians from offering or receiving any form of consideration in return for patient referrals.

WWDHHSD (or What Would Dept. Health and Human Services Do)...The Office of Inspector General for U.S. Dept. Health and Human Services ("OIG") issued an Advisory Opinion on a pay per call program. There, OIG concluded that a pay per lead program did indeed violate the plain language of the Anti-Kickback Statute. And, such a program did not qualify for any statutory safe harbor. That said, OIG concluded they would not enforce the statute against participants in those programs, because such programs did not promote the type of abuse the statute was meant to curtail. The federal government opined pay-per-call, as outlined in the Advisory Opinion, was kosher. 

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(Pay Per Call Mktg:  continued from top of page)  

The policy is similar to choice the federal government exercises to "tolerate" medical marijuana purchases. Medical marijuana is legal under a number of state statutes. But, medical marijuana still violates federal law. Nonetheless, the current federal policy is to look the other way.  While the above is helpful in giving a doctor comfort, a doctor making a decision whether or not to participate in a pay-per-call program must also pay attention to policies of their state professional licensing board. Most licensing boards have explicit prohibitions against "fee splitting."  

It's unclear whether state licensing boards would follow the lead of the federal government, Would they acknowledge, as Dept. H.H.S. does, that such programs violate criminal statutes with no safe harbor - but opt against enforcement? Nobody knows. We can all agree that no physician wants to be the test case. The reality today is that many Board investigations are complaint-driven. So, if patients complain to the Board for any number of reasons, an investigation might broaden to include allegations fee-splitting. Doctors who want to test the waters with pay-per-call programs would be well advised to proactively lobby their licensing bodies to update their decades-old fee-splitting policies. Medical Justice can provide you with a template of model language for revising the policy.                  

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Jeffrey Segal, MD, JD, is founder and CEO of Medical Justice Services. Mike Sacopulos, JD, is general counsel for the organization. Run by physicians for physicians, Medical Justice, is a membership-based organization that offers services and proprietary methods to protect physicians' most valuable assets - their practice and reputation. The company offers proactive services to deter frivolous medical malpractice lawsuits, prevent Internet defamation and provide strategies for successful counterclaim prosecution. Medical Justice works as a supplement to conventional professional liability insurance.

Last Updated on Wednesday, 24 August 2011 17:57
Why Ratings Matter in Evaluating Medical Malpractice Insurance Companies Print E-mail
Written by MATT GRACEY   
Wednesday, 27 July 2011 16:40

MED MAL Q & A    

Q. Why is a rating of a malpractice insurance company so important?  Are some rating agencies considered better than others?

A.  An insurer with a high rating from A.M. Best could be considered the equivalent of a doctor being board certified, experienced, and considered competent in their chosen specialty by an outside peer review group.   For some years now, many doctors and their administrators seem to have forgotten the vital importance of their malpractice insurer having a solid financial rating from one of the major rating agencies, including A.M. Best and Fitch.  Malpractice insurance is one of the most important purchasing decisions doctors make each year.  With such a potentially long time between deciding on an insurer and a potential multimillion-dollar payout to satisfy a judgment, the stakes are high for making an astute decision.  Insurance is a strange beast in that policyholders are essentially purchasing a promise from an insurer to pay an undetermined amount of money at an undetermined future date.  With Florida's bad-faith laws the payout could be many times the policy limits purchased, and in a multidefendant, complex lawsuit a judgment could be awarded up to ten plus years after a claim is first filed.  The significance of that is that an insurer that looks marginally healthy today when a doctor is making a decision on his or her insurer could well be gone in those ensuing years, and in Florida such seems to happen with rather regular frequency.  Unrated, financially fragile insurers also tend to settle more lawsuits, thus providing compromised claims defense.  That is why doctors must get back to fundamentals of financial decision making by determining which prospective insurers hold a high rating from A.M. Best or Fitch.  Some doctors with serious claims histories, however, might not have the luxury of being insured with a highly rated company, but most still do, particularly in our present "soft" market conditions when underwriting is much looser than in "hard" market conditions.  In previous times, Florida's widely variable malpractice insurance cycles have resulted in doctors having few choices and ratings at times had to be overlooked, but in the current market's conditions doctors with good claims histories and normal practice profiles have the ability to find fair pricing from highly rated insurers without taking the risk of purchasing coverage from unrated insurers. 

Other rating agencies have been formed in recent years to help newly formed insurers or those who choose for strategic reasons not to ask the more highly regarded agencies for a rating, so be diligent to ask about and understand the rating agencies' differences.   Some unrated insurers also tell their prospects that their reinsurers are all highly rated, but reinsurers are only a backup to the insurers' risk and can decide not to continue their participation with any insurer in any given future year at their own reinsurance policy's renewal.   
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Matt Gracey is a Medical Malpractice Insurance Specialist in Delray Beach with Danna-Gracey, Inc. He actively lectures and writes educational material to help doctors and legislators around the state understand the malpractice insurance issues facing doctors today. You can reach him at (800) 966-2120 or

Last Updated on Wednesday, 03 August 2011 13:14
Hospital-Physician Alignment Print E-mail
Written by Todd Demel, MBA   
Monday, 20 June 2011 00:00


During a time when we are seeing a cyclical change towards hospital employment of physicians, there has been an increased focus on strategies for achieving successful physician/ hospital alignment. Although similar such efforts failed in the early 1990s, hospitals today are adopting a different approach to employing practices. While the primary difference has to do with the structure of physician compensation, there are best practices that can be employed to increase the likelihood of successful relationships.


The trend toward hospital employment has come about for a number of reasons. Among these, it has become increasingly challenging for physician practices to go it alone. Most physicians expect at least some sort of increase in compensation when teaming-up with a hospital. In addition, malpractice liability insurance along with certain administrative functions is often assumed by the hospital, thus giving physicians an added sense of security.  In an increasingly competitive environment, hospitals may employ physicians to gain market share, to support Emergency Department call, or increase referrals to their facility. The hospital may also seek out particular specialists in order to assure strength in strategically important clinical services.  


With new pressures being exerted on providers, such as quality/outcomes reporting, reductions in professional and technical fee reimbursement, and increased regulatory requirements, the need for clinical integration has become more pronounced. A recent development that both supports and encourages integration is the collaborative effort between hospitals and physician practices in establishing an electronic medical record (EMR).


Previous federal policy that enacted a 'Safe Harbor' related to Stark Regulations has allowed hospitals to donate EMR hardware, software, training and support services to physicians. While practices must contribute 15 percent toward the donor's cost of the items and services provided, this still represents a significant savings for physicians. Due to impending deadlines beginning in 2011 on financial incentives associated with the Health Information Technology for Economic and Clinical Health Act (HITECH Act), there has been increased focus on the establishment and use of EMR systems. This type of shared technology goes right to the foundation on which hospital-physician integration should be based: the care of patients and patient information. And the sharing of patient clinical data provides the opportunity for providers to improve the quality and effectiveness of care delivery as well as achieve the long-range goal of cost reduction.       


With discussions regarding Accountable Care Organizations (ACOs) front and center, it is also important for hospital-owned practices to maintain a culture of accountability. This translates into physicians being involved in the strategic decision-making of the practice, and the new entity retaining the ethos of the private practice in spite of the changes in management and standardization of certain processes. Allowing physicians to retain some control, involving them in governance and operations, and providing incentives can contribute to the success and longevity of the newly-formed relationship.

By empowering the physicians, they become accountable for the success of the practice rather than relying on or blaming the hospital for their successes or failures. Promoting participation of physicians on boards, governing councils, and oversight committees, for example, is also likely to reduce physician turnover. This type of collaborative effort fosters a team approach wherein the hospital/ physician partnership becomes aligned.  

ABOUT THE AUTHOR:  Mr. Demel is Senior Executive of Physician Management Services at MF Healthcare Solutions.  Possessing both operational and financial backgrounds, the MF Healthcare Solutions management team has vast experience in a range of healthcare industry settings. Our combined expertise enables us to offer specialized and effective physician practice management services. For more information, please visit: or contact Todd Demel at (954) 475-3199.

Last Updated on Wednesday, 29 June 2011 16:36
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