DULAC, Inc. Medical Malpractice Claims - Integrity. Experience. Innovation. Service

The Centers for Medicare and Medicaid Services (CMS) posted a new alert dated May 1, 2012 regarding Non Group Health Plan (NGHP) MMSEA Section 111 reporting. The Alert advises that restrictions on additional file submissions have been lifted. The full text of the Alert is available at the following link: https://www.cms.gov/Medicare/Coordination-of-Benefits/MandatoryInsRep/Downloads/Copy-1-of-NGHP_RestrictionsOnSubmissionsLifted05012012.pdf _________________ Our solution to [...]

The Cleveland Metropolitan Bar Association’s 28th Annual Health Care Law Institute commences on Friday, April 27, 2012. DULAC, Inc., is pleased to be an exhibitor and to have the opportunity to be a sponsor of this program. We will also be an exhibitor at the CMBA seminar “Introduction to Health Care Law” on Thursday, April [...]

BAYFRONT PHYSICIAN INSURANCE SOLUTIONS LAUNCHES WEBSITE We are pleased to have been selected to provide medical malpractice claims administration for Bayfront Physician Insurance Solutions. A comprehensive and dynamic website for physicians has been launched by the program. It not only provides a user-friendly application process, but also features ongoing loss prevention and quality improvement information. [...]

The National Practitioner Data Bank (NPDB) publishes an extremely informative monthly newsletter. It typically contains helpful substantive and logistical information to assist medical malpractice claims administration programs with the NPDB reporting process. The April 2012 edition is headlined by the announcement of the first all-electronic installment of Data Bank News. The NPDB advises that it [...]

An important element of an overall medical malpractice claims administration program is the efficient and effective management of litigation costs while concurrently establishing a proactive approach to mitigating exposure. Alternative dispute resolution is key to this protocol, with binding arbitration an effective tool. We had the opportunity to discuss arbitration issues with Bryan Rotella, Esq., [...]

We are pleased to be a Sponsor of the 28th Annual Health Care Law Institute of the Cleveland Metropolitan Bar Association (CMBA). The seminar begins on the afternoon of April 26, 2012 with presentations on “Introduction to Health Care Law”. The full day program continues on April 27, 2012 with the Health Care Law Institute. [...]

We have written on Medicare Secondary Payer (MSP), the overall concept ensuring that Medicare shifts the obligation for payment of medical expenses on behalf of Medicare beneficiaries to Responsible Reporting Entities (RREs) in claims involving liability insurance (including self-insurance), workers’ compensation, and no-fault. The mandates of MMSEA Section 111 reporting and implementation of Medicare Set [...]

An important element of an overall medical malpractice claims administration program is the efficient and effective management of litigation costs while concurrently establishing a proactive approach to mitigating exposure. Alternative dispute resolution is key to this protocol, with binding arbitration an effective method. We had the opportunity to discuss arbitration issues with Bryan Rotella, Esq., [...]

An important element of an overall medical malpractice claims administration program is the efficient and effective management of litigation costs while concurrently establishing a proactive approach to mitigating exposure. Alternative dispute resolution is key to this protocol, with binding arbitration an effective tool. We had the opportunity to discuss arbitration issues with Bryan Rotella, Esq., [...]

A member of outside defense counsel panel has informed us of a ruling by the District Court of Appeal of Florida, Fourth District, that states that a hospital can be held liable for the alleged negligence of an Emergency Department physician under a non-delegable duty theory. Counsel suggests that, “…the Court holds that in the [...]

The January 2012 newsletter of the National Practitioner Data Bank contains detailed information on upgraded reporting features. These features will streamline medical malpractice claims reporting protocols. In particular, the NPDB is in the process of implementing an electronic protocol for filing NPDB reports with the related state licensing entity. The NPDB advises that, One of [...]

Alternative dispute resolution affords parties in medical malpractice claims an opportunity for self-determination and efficiency in an amicable and confidential environment. We have participated in, and directed negotiations at, thousands of mediations, voluntary and mandatory settlement conferences, and informal settlement meetings. Formal mediation is an extraordinarily useful and productive element of this medical malpractice alternative [...]

CMS has published a quick reference guide for MMSEA Section 111 Reporting. The Guide is specifically furnished for Non-Group Health Plan (NGHP) Responsible Reporting Entities (RRE). The full document is located at: https://www.cms.gov/MandatoryInsRep/Downloads/NGHPQuickRef.pdf Our solution to the logistical and substantive challenges of MMSEA Section 111 features complete reporting service. Our resources will extract and review [...]

Effective and credible claims administration requires not only substantive capabilities but also a logistical foundation. Management of files via electronic storage and administration has become an efficient and preferred methodology. One of the important considerations to establish, or accomplish transition to, electronic claims file management is the comprehensive electronic sorting of written materials. A myriad [...]

The Office of Public Information of the Supreme Court of Ohio published the following release on December 8, 2011: “Court Rules Expert Testimony Needed to Show Undisclosed Medical Risk Actually Caused Injury Where Patient Claims ‘Lack of Informed Consent’ to Medical Procedure Please note: Opinion summaries are prepared by the Office of Public Information for [...]

DULAC, Inc. is pleased to be an advertising sponsor of the Bar Journal of the Cleveland Metropolitan Bar Association. The November, 2011, issue features articles by various authors on class actions, federal pleading standards, and an introduction to the newly-formed Insurance Law Section. The latter is particularly apropos given the adoption by the Supreme Court [...]

During the course of its Town Hall Teleconference on November 16, 2011, a representative of CMS reiterated the importance of accurate reporting of applicable ICD-9 Codes on MMSEA Section 111 reports. He indicated that Responsible Reporting Entities (RREs) should only include injury codes that are related to the underlying claim that is the subject of [...]

Tampa, FL — November 8, 2011 DULAC, Inc. and RiskQual Technologies, Inc. announce the formation of a strategic partnership that provides innovative and advanced solutions to the risk management, claims administration, and MMSEA Section 111 issues that confront hospitals and health systems in an ever-evolving regulatory and compliance environment. The convergence of advanced data management [...]

The requirements of MMSEA Section 111 are an integral element of the overall mandates of Medicare Secondary Payer (MSP). A comprehensive approach to MSP compliance includes substantive review of reporting elements, utilization of Medicare Set-Aside Arrangements (MSA), and consideration of insuring ancillary risk exposure. As noted in this excerpt from the Ironshore press release of [...]

We are pleased to be an advertising sponsor of the Bar Journal of the Cleveland Metropolitan Bar Association, October 2011 edition. We feature links to our complete MMSEA Section 111 reporting services. This is a topic of current urgency as the Centers for Medicare and Medicaid Services (CMS) advised that Section 111 reporting on liability [...]

MMSEA Section 111 reporting remains a significant logistical and substantive issue for liability insurers. CMS published a series of Alerts on Friday, September 30, 2011, immediately prior to the commencement of the existing timeline pertaining to reporting of liability claim Total Payment Obligation to the Claimant (TPOC). Perhaps the Alert of the most significant general [...]

The September, 2011 issue of the Bar Journal of the Cleveland Metropolitan Bar Association has been published. Once again, we are pleased to be an advertising sponsor of this excellent publication and organization. Our solution to the logistical and substantive challenges of MMSEA Section 111 features complete reporting service. Our resources will extract and review necessary [...]

CMS advises that the newest edition of the MMSEA Section 111 User Guide (Version 3.2) has been posted to the website.  The Guide, and other materials relevant to MMSEA Section 111 reporting, can be located at:  www.cms.gov/mandatoryinsrep We are in the process of reviewing the updated edition, and will look forward to posting more information. [...]

We are pleased to be an advertising sponsor of the Annual Meeting edition (July/August, 2011) of the Journal of the Cleveland Metropolitan Bar Association.  We feature our complete MMSEA Section 111 reporting services as well as medical malpractice claims administration. Our solution to the logistical and substantive challenges of MMSEA Section 111  features complete reporting service.  Our [...]

Our continued discussion addresses areas of ancillary risk exposure that result from incorrect MMSEA Section 111 reports, above and beyond the Civil fines and penalties.   Even though the RRE has the nexus with the agency as far as the obligation to file reports, we nevertheless see that there is privity in essence between the RRE and [...]

The Centers for Medicare and Medicaid Services (CMS) website indicates the scheduling of Town Hall Teleconferences for MMSEA Section 111 reporting as follows: August 24, 2011  NGHP Policy September 21, 2011 NGHP Technical October 19, 2011  NGHP Policy The website also has the schedule for GHP teleconferences. Our solution to the logistical and substantive challenges of [...]

The purpose of MMSEA Section 111 reporting is to assist with the collection of information that the  Coordination of Benefits Recovery Contractor (COBRC) will use to determine primary versus secondary payer status of Medicare in situations of payments made to Medicare beneficiaries by Applicable Plans, otherwise defined as Responsible Reporting Entities (RRE).  The reporting requirements are in addition [...]

CMS conducted its most recent Town Hall Teleconference on June 29, 1011.  A check of the CMS website does not show a schedule of future sessions for 2011.  We expect that more teleconferences will be added and will look for publication of an Alert from CMS with an enhanced schedule.  CMS has indeed been diligent [...]

The MMSEA Section 111 Reporting Agent Educational Forum, a LinkedIn group we established on October 9, 2009, has now reached a membership of 250. We  founded the group to facilitate dialogue on the substantive and logistical aspects of the MMSEA Section 111 reporting obligations, which are quite complex and subtle.  We are most appreciative of [...]

We  took part in the development of a new and robust Medicare Reporting and Secondary Payer Act Liability (MRSPAL) Insurance Policy underwritten by a major North American insurance company.  Our efforts focused on the conceptual foundations of the policy, designed specifically to insure the risks associated with MMSEA and MSP.  In addition to the Civil Fines [...]