Medical Billing Errors Are On The Rise

Does Your Carrier Offer Medical Billing Coverage?

Not Many Carriers Can Offer You Coverage For Medical Billing.

We Have A New Market That Can AND Will Consider Accounts That Have Had Issues In The Past.

 

Healthcare Providers and Facilities that can be considered include:

Chiropractors, Dentists, Podiatrists, Medical Directors, Nurse Practitioners, Physicians and Most Healthcare Facilities

Since the formation of the False Claims Act (FCA) allegations of healthcare fraud and abuse have consistently grabbed the headlines. In 2017 alone, The U.S. Department of Health and Human Services (HHS) made approximately $90 billion in improper payments to Medicaid and Medicare programs.

For healthcare providers, navigating this challenging, and oftentimes confusing, set of reimbursement guidelines has commonly led to the rise of billing errors in excess of 30 percent. From Telehealth services conducted at non-rural originating sites, to the widespread distribution of medically unnecessary drugs, including opioids, the allegations of healthcare fraud and abuse by government entities and private payers are more prevalent and diverse than ever before.

DEFENSE COSTS OF ACTUAL OR ALLEGED BILLINGS ERROR

Anyone with a national provider identification number is susceptible to a physical or electronic data mining audit. Allegations of improper billings can range from a lack of medical necessity, to incorrect coding, and even insufficient documentation. Our carrier’s policy provides defense in respect of these allegations utilizing reputable and experienced claims managers.

SHADOW AUDIT EXPENSES

Appeals against violations can be a long and costly process, often stretching over two years if they reach a Federal Court. Our carrier’s policy provides coverage for the expenses arising out of an independent audit on your billing practices following allegations of fraud by a government entity or private payer.

REGULATORY FINES AND PENALTIES

Our carrier offers reimbursement for fines and penalties arising out of a range of medical regulatory violations, including HIPAA-related fines and penalties, Stark law (triggered by physician referrals), EMTALA (ensuring public access to emergency services regardless of ability to pay) and Federal False Claims and Social Security Acts.

CYBER AND PRIVACY

These insuring clauses have been tailored to address healthcare companies’ specific cyber exposures. They include specific references to HIPAA and HiTECH legislation, and they offer a separate section for extortion to address the growing threat of ransomware, as well as incident response service with a NIL deductible.

LIMITS, DEDUCTIBLES AND PREMIUMS 

Maximum limit————————- $5,000,000

Minimum Deductible ——————Nil

Minimum premium——————–$1,500

WHO’S IT FOR

  • Dialysis Centers
  • Drug and Alcohol Rehabilitation Centers
  • Emergency and Non-Emergency Ambulance Services
  • Hospitals
  • Long Term Care Facilities
  • Medical Imaging Clinics
  • Medical Testing Labs
  • Occupational, Speech and Physical Therapy Clinics
  • Pain Management Clinics
  • Physician Groups
  • Pharmacies (including those offering compounding and opioid prescriptions)
  • Telemedicine Providers
  • Solo Physicians
  • Urgent Care Clinics

 

WHAT DOES IT COVER?

  • Defense costs for actual or alleged billing errors.
  • Professional fees to conduct an audit of billing records.
  • Payment for regulatory fines and penalties (HIPAA, EMTALA, Stark proceedings).
  • Cyber and privacy coverage tailored to healthcare companies.

 

OPTIONAL EXTRAS

  • Defense of license proceedings.
  • Blanket additional insured coverage.