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The Sentinel: September 2017

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An Analysis of Ophthalmology Closed Claims

Specialty Spotlight  |  Shelly Weatherly, JD

A review of paid Ophthalmology claims from 2008-2016 revealed that inappropriate surgical technique and failure to diagnose were the most common allegations advanced.   Often times the failure to timely diagnose was not the result of lack of clinical judgment or medical expertise, but rather, was th...

Importance of Effective Communication

Closed Claim Review  |  Jamie Wyatt, JD

 “A time comes when silence is betrayal.”  -  Martin Luther King, Jr., The Time to Break Silence, 1967 We are bombarded with reminders of the importance of effective communication skills in our daily lives, whether the setting is professional or personal.  The importance ...

Jousting

Risk Pearls  |  Julie Loomis, RN, JD

The adage about “people who live in glass houses” still holds true. Jousting usually occurs when another healthcare professional intentionally or unintentionally either verbally or in the medical record makes disparaging comments about other providers, nursing staff, equipment, EHR or administrat...

Commercial Payers Changing the Rules for APP Billing

Practice Management  |  Elizabeth Woodcock, MBA, FACMPE, CPC

The reimbursement of services provided by advanced practice providers is a complex issue. Guidelines may vary based on the type of APP, and the rules surrounding APPs are impacted by federal and state regulations, facility-imposed standards of care, and billing requirements. The latter may include payer-speci...

New Medicare Cards with New Numbers: 3 Changes You May Need to Make

Practice Management  |  Elizabeth Woodcock, MBA, FACMPE, CPC

The Medicare Access and CHIP Reauthorization Act of 2015 requires CMS to remove Social Security Numbers (SSNs) from all Medicare cards by April 2019. CMS will begin mailing new Medicare cards with a new Medicare number (currently called the Medicare Claim Number on cards) to your patients in April 2018. You m...

Disgruntled or Dishonest Employees May Be the Source of a Security Breach

Cyber Security  |  Susan Decareaux, CPCU, RPLU, CISR

With all of the security breaches in the news recently, many medical practices have taken extra steps to keep their patient records safe. Employee training and awareness, installation of virus and malware protection, regular data back-up, purchase of a cyber security insurance policy, and hiring an IT person ...

Overpayments

Practice Management  |  Laura Watkins, FACMPE, CPC

When was the last time your credit balance report was reviewed and worked thoroughly? Working the report on a regular basis is an essential step in the revenue cycle. Understandably, many practices focus on the collection of insurance and patient payments portion of the revenue cycle. Overpayments are often ...

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