DULAC, Inc. Medical Malpractice Claims

Shoreline Blog – Medical Malpractice Claims | National Practitioner Data Bank

Paul Masterson — Sat, 11 Feb 2012 20:42:10 +0000

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 the main new features coming to the Data Bank in January will eliminate the need for reporters to mail a copy of Data Bank reports to their relevant State Licensing Board. Reporters of Medical Malpractice Payments, Clinical Privilege, and Professional Society actions must print and mail a copy of the report to the appropriate State agency. Now, the Data Bank will make it easier for reporting organizations to comply with this requirement by enabling them to transmit reports electronically to State Licensing Boards that opt to participate in the new feature.

The automatic report forwarding option requires dual authorization-first by State Boards that must elect to participate, and subsequently by reporters at the time they submit each report. Electronic forwarding will not occur unless both sides agree to the exchange. To take advantage of this feature, each State Board that opts for report forwarding will verify the health care practitioner types they license or certify and agree to receive the reports electronically….Reporting organizations will choose to electronically forward their reports to the relevant agency on a report-by-report basis. Electronic report forwarding facilitates compliance with the law, and reporters who take advantage of it no longer need to remember to print and mail paper reports to State Boards.

In cases where a State Board declines to participate, or if a reporting organization prefers not to use the new feature for submitting a report, reporters remain responsible for sending a copy of the Report Verification Document to the appropriate State Board. The new service will be available initially through the Integrated Querying and Reporting System (IQRS). All State Boards will have a new State Board Profile button on the Administrator Options page, where they may enroll in the service, withdraw their agreement to participate, or modify their profile at any time.

The full text of the information, as well as additional enhancements, is located at:

http://www.npdb-hipdb.hrsa.gov/news/newsletters/jan2012Newsletter.jsp#User

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The strategic partnership of DULAC, Inc. and RiskQual Technologies, Inc., provides innovative and advanced solutions to the risk management, medical malpractice claims administration, and MMSEA Section 111 issues that confront hospitals and health systems in an ever evolving regulatory and compliance environment.

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Shoreline Blog – Medical Malpractice Claims: New Mediation Rules Adopted for Florida Claims

Paul Masterson — Mon, 30 Jan 2012 12:54:25 +0000

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 claims resolution approach.

Outside panel counsel have advised that the Florida Supreme Court has adopted new rules pertaining to the conduct of formal mediations for all claims, including medical malpractice. Among other changes, counsel notes that the attendance by representatives with “full authority” is not only more specifically defined but also there is a provision requiring advance notice, in the absence of a stipulation by the parties otherwise, of the identity of the person or persons who will attend and the certification of full authority. The Committee Notes to RULE 1.720 indicate that,

2011 Amendment. Mediated settlement conferences pursuant to this rule are meant to be conducted when the participants actually engaged in the settlement negotiations have full authority to settle the case without further consultation. New language in subdivision (c) now defines “a party representative with full authority to settle” in two parts. First, the party representative must be the final decision maker with respect to all issues presented by the case in question. Second, the party representative must have the legal capacity to execute a binding agreement on behalf of the settling party. These are objective standards. Whether or not these standards have been met can be determined without reference to any confidential mediation communications. A decision by a party representative not to settle does not, in and of itself, signify the absence of full authority to settle. A party may delegate full authority to settle to more than one person, each of whom can serve as the final decision maker. A party may also designate multiple persons to serve together as the final decision maker, all of whom must appear at mediation.

New subdivision (e) provides a process for parties to identify party representative and representatives of insurance carriers who will be attending the mediation conference on behalf of parties and insurance carriers and to confirm their respective settlement authority by means of a direct representation to the court. If necessary, any verification of this representation would be upon motion by a party or inquiry by the court without involvement of the mediator and would not require disclosure of confidential mediation communications. Nothing in this rule shall be deemed to impose any duty or obligation on the mediator selected by the parties or appointed by the court to ensure compliance.

The concept of self determination in mediation also contemplates the parties’ free choice in structuring and organizing their mediation sessions, including those who are to participate. Accordingly, elements of this rule are subject to revision or qualification with the mutual consent of the parties.

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The strategic partnership of DULAC, Inc. and RiskQual Technologies, Inc., 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.

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Shoreline Blog – Section 111 Reporting | CMS Publishes Quick Reference Guide

Paul Masterson — Sun, 29 Jan 2012 15:43:02 +0000

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 necessary data, place the data into required format, and file a timely and complete Section 111 report. We manage all feedback loops from CMS.

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Shoreline Blog – Medical Malpractice Claims Administration

Paul Masterson — Thu, 12 Jan 2012 13:59:31 +0000

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 of documents are generated during the life of a file and represent different categories or types. Counsel evaluation reports, legal documents, correspondence, notes, and closed claim reports are but a few examples. In order to furnish ease of reference and access, it is imperative to designate documents to appropriate categories. We have established category codes for document processing and upload to a claim file.

RiskQual, Inc.’s Healthcare Advisor Series (HAS) additionally provides the capability to attach a brief description of the individual document within the category. Upon file review, all attachments can be accessed and then “sub-sorted” by an array of prompts to quickly bring into focus the individual document. An access prompt arranges the materials by date, category, etc., that facilitates efficient file review. Our protocol establishes broad electronic categories that essentially mirror traditional sections of a claim file: Notes, Correspondence, Legal, Billing, Coverage, and so forth. Further, HAS flexibility enables the creation of additional categories that substantially enhance ease of access and review. For example, we have established correspondence categories that differentiate between the source of the correspondence: defense or plaintiff counsel, claims department, and the like.

Electronic claim file management might not completely eliminate the need for a corresponding hard file, nevertheless significant reductions in paper production and generation have been realized by means of a strategy to implement electronic approaches.

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Shoreline Blog- Medical Malpractice Claims Administration Informed Consent Ruling-Ohio

Paul Masterson — Fri, 09 Dec 2011 12:40:31 +0000

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 the general public and news media. Opinion summaries are not prepared for every opinion released by the Court, but only for those cases considered noteworthy or of great public interest. Opinion summaries are not to be considered as official headnotes or syllabi of Court opinions…
2010-0988. White v. Leimbach, Slip Opinion No. 2011-Ohio-6238. Franklin App. No. 09AP-674, 2010-Ohio-1726. Judgment reversed. O’Connor, C.J., and Lundberg Stratton, O’Donnell, Lanzinger, Cupp, and McGee Brown, JJ., concur. Pfeifer, J., concurs in judgment only. Opinion: http://www.supremecourt.ohio.gov/rod/docs/pdf/0/2011/2011-Ohio-6238.pdf

(Dec. 8, 2011) The Supreme Court of Ohio ruled today that the tort of lack of informed consent is a medical claim and requires expert medical testimony to establish: 1) the material risks or dangers inherent in a procedure, and 2) that an undisclosed risk or danger actually materialized and proximately caused injury. The Court further explained that it is for the trier of fact to determine whether a patient would have agreed to the procedure had the risks or dangers been disclosed…”

The release provides further discussion of the decision and, as noted, provides a link to the full court opinion. The ruling likely will have an impact on medical malpractice claims administration and selection and evaluation of experts by defense counsel.

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Shoreline Blog- Medical Malpractice Claims Coverage Analysis

Paul Masterson — Fri, 18 Nov 2011 22:16:43 +0000

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 of Ohio of insurance coverage as a specialty area, effective October 1, 2011. Coverage analysis is an essential element of liability claims management, and arises with some frequency in medical malpractice claims. Our protocol is to retain the assistance of experienced coverage counsel for thorough analysis, particularly in relatively rare circumstances in which it appears coverage might not apply.

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Shoreline Blog- Medical Malpractice Claims and Section 111 Reporting

Paul Masterson — Wed, 16 Nov 2011 20:31:37 +0000

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 the report. He noted that the inclusion of “ancillary codes” could lead to inappropriate denials of benefits to Medicare beneficiaries. For example, he noted that if there is solely a perfunctory reporting of all codes that are contained on an Explanation of Benefits (EOB) without careful review and filtering, the denials can result. This reality attaches to all claim types governed by MMSEA Section 111, including medical malpractice claims. It is clear that a substantive review of reportable ICD-9 codes is necessary to accomplish compliance and to be able to move files into final closure.

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Shoreline Blog- Medical Malpractice Claims Solutions-RiskQual Technologies and DULAC Announce Strategic Partnership

Paul Masterson — Tue, 08 Nov 2011 12:30:10 +0000

Tampa, FL — November 8, 2011

Read the Full Announcement

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 through RiskQual’s Healthcare Advisor Series (HAS™) and advanced medical malpractice claims administration through DULAC’s team of experienced professionals is an essential and valuable asset to organizations endeavoring to build efficient and effective claims management.

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Shoreline Blog- MMSEA Section 111 Risk Exposure Solutions

Paul Masterson — Mon, 17 Oct 2011 12:30:53 +0000

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 October 14, 2011, the MRSPAL policy is available:

IRONSHORE OFFERS INNOVATIVE NEW PROGRAM IN RESPONSE TO COMPLEX REQUIREMENTS FOR MEDICARE REPORTING
- Government Mandate Takes Effect January 2012 -
Hamilton, Bermuda, October 14, 2011 – IronHealth, the specialty healthcare unit of Ironshore Inc., has introduced a customized insurance program to address the institutional risk exposure created by the specific reporting requirements of Section 111 of the Medicare, Medicaid and SCHIP Extension Act of 2007 (“MMSEA”). Ironshore’s new liability policy, Medicare Reporting and Secondary Payer Act Liability (“MRSPAL”), protects against risk exposure and subsequent penalties to institutions from failing to file in a timely manner or from negligent filing of known liability payments to Medicare beneficiaries. The federally-mandated reporting obligations will take effect on January 1, 2012, with required monitoring of potential risk exposure retroactive to October 1, 2011.

The complete text of the release is contained at the Ironshore website: ironshore.com.

We participated in the conceptual development of this insurance vehicle and believe it will be of significant benefit to Responsible Reporting Entities (RREs) endeavoring to assemble a comprehensive solution to MSP issues.

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Shoreline Blog- MMSEA SECTION 111 REPORTING SOLUTIONS

Paul Masterson — Tue, 11 Oct 2011 15:25:50 +0000

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 claims reflecting Total Payment Obligation to the Claimant (TPOC) in excess of $100,000, with a TPOC date on or after October 1, 2011, are subject to mandatory reporting in the first quarter of 2012, in accord with CMS regulations. CMS also published a schedule that details the mandatory timelines that apply to TPOC claims of lesser amounts. MMSEA Section 111 reporting is of course in addition to all other obligations that existed under Medicare Secondary Payer (MSP).

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