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The
Health Insurance Portability and Accountability Act of 1996 has brought
increased attention from the government with regard to the billing practices
of physicians, specifically Medicare and Medicaid. Consequently, there have
been more investigations, fines and penalties, despite the fact that some
of
the infractions are no more than honest errors or oversights, sometimes unavoidable.
PIAM
has access to an endorsement that you may add to your medical professional
liability policy. The endorsement is available only to those physicians
and practices that do their own billing and it will respond to claims alleging
errors regarding duplicate billing, billing for services not rendered or
for unnecessary services, upcoding, billing for services that do not meet
the standard
of care, and billing for supervision of residents. If you "outsource" your
billing activity to another firm, the endorsement is not available.
The
endorsement allows for a limit of $250,000 or $500,000 and the cost for
individual physicians is $500 or $750 respectively. Groups may purchase
coverage
up to $1,000,000; these premiums are quoted individually after the insurance
carrier's risk management team assesses your current billing procedures.
The coverage includes indemnity and defense coverage, within the limit
of liability
you select, and will pay for awards, judgments, settlements, investigations
and audits, as well as provide compensation for civil fines and penalties.
It will not respond to criminal acts, or willful violations of the law.
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