Dominick V. LaGravinese Jr. is an Associate at the Disability Insurance law firm Seltzer & Associates. He focuses on disability insurance contracts, long-term disability arrangements, ERISA, employee compensation, and insurance bad faith for disabled professionals. Mr. LaGravinese graduated from Ave Maria School of Law in Naples, Florida, with a Juris Doctor degree. He is a licensed attorney in the states of Florida and Pennsylvania.

Physicians and other healthcare professionals face many stresses in their careers. From long work hours, high expectations, and a heavy administrative burden, to an immersion in human suffering, the need to adapt to a rapidly changing healthcare environment, and a fear of making mistakes, it is not surprising that symptoms of depression, anxiety, and other mental health conditions are common among physicians. Even before COVID-19, there was an 

unprecedented level of burnout in the profession

 with many physicians reporting high rates of dissatisfaction with quality of life and work-life balance.

Despite these alarming trends, the medical profession as a whole has a long way to go in prioritizing physician well-being and overcoming the societal stigma around mental illness. As research is progressively demonstrating the dire consequences of ignoring physician mental health and the positive impact of a variety of interventions on physician well-being and subsequent patient care, physicians should no longer have to suffer in silence.

Many physicians who are dealing with mental health issues have questions about available resources, as well as whether they will be able to receive disability benefits for their mental health condition, and what, if any, impact seeking treatment will have on their medical license.

Mental health concerns and burnout are a real problem for American physicians

According to the American Foundation of Suicide Prevention, 300-400 physicians commit suicide every year. 

Male doctors are 1.4 times more likely to kill themselves than men in the general population; female physicians, 2.3 times more likely

 of six medical schools, nearly 1 in 4 students reported clinically significant symptoms of depression. Almost seven percent said they had thought of ending their lives in the last two weeks. According to 

, 29 percent of medical residents suffered from significant symptoms of depression.

An American Medical Association/Rand Corporation on 

Factors Affecting Physician Professional Satisfaction

found that the bureaucratic obstacles (burdensome administrative rules, regulations, and paperwork) to providing patients with high-quality care are major contributors to symptoms of burnout, including emotional fatigue, depersonalization, loss of enthusiasm, and even early retirement.

The dangers of not speaking up and seeking help

Despite what is clear evidence of the prevalence of mental health issues in the medical profession, many physicians who are suffering from symptoms of burnout, depression, anxiety, or PTSD, do not seek treatment. One well-documented reason is that, as with many high-performing occupations, many doctors are deeply uncomfortable acknowledging their own vulnerability. According to the American Foundation for Suicide Prevention, physicians report their hesitancy to draw attention to self-perceived weakness and concerns about reputation and confidentiality as the main barriers to seeking mental health care, in addition to time constraints.

 over fifteen years ago noted that the source of physician hesitancy involves fears about licensing, a medical culture that can sometimes view help-seeking behavior as a marker of weakness rather than empowerment, discrimination in hospital credentialing, and consequences pertaining to personal and liability insurance due to disclosure of mental health diagnoses.

As for the effect of physician mental illness on patient care, 

 demonstrates that unaddressed mental health conditions, in the long run, are more likely to have a negative impact on a physician’s professional reputation and practice than reaching out for help early.

The impact of the COVID-19 crisis on the mental health of physicians and other frontline healthcare workers has made painfully clear the need to address and prioritize physician well-being. Fortunately, even before the pandemic hit, there has been a shift in professional attitudes toward encouraging physicians to seek help. While some barriers still remain, there are many available resources for healthcare professionals who are dealing with mental health issues.

Resources and treatment options for health concerns facing doctors

As with most medical conditions, there are a variety of treatment options for mental health conditions. Depending on the severity of the issue, as well as whether it is chronic or acute, physicians can take advantage of easily accessible online education programs for physicians, reach out for help through support lines specifically established for physicians, or make changes to their workplace to encourage wellness. In addition to one or more of these treatment options, if your mental state is impacting your ability to provide care for your patients, you should seek help from a mental health professional.

In 2015, the American Medical Association launched its 

 series to address physician burnout to “provide strategies for physicians to revitalize their medical practices and improve patient care.”

In May 2020, in response to the COVID-19 crisis, a group of psychiatrists launched a free, national 

. The volunteer psychiatrists who staff the support line offer empathetic, active listening and provide a safe, supportive, emotional space for physicians who are often declaring their emotions and feelings for the first time. According to one of the psychiatrists who established the support line, Smita Gautam, MD of Northwestern University,

“we do some live interventions, some breathing techniques and help them problem-solve certain scenarios with cognitive behavioral therapy models...We are not telling them what they need to do. We’re helping them come to their own answer and to help them process their own emotions.”

For physicians working at hospitals, there may be resources available in-house to encourage physician well-being. Some facilities offer support groups, peer counseling, and sessions to teach physicians how to manage stress by meditating or keeping journals. Physician discussion groups incorporating elements of mindfulness, reflection, shared experience, and small-group learning have been shown to lead to an increase in empowerment and engagement.

 created a “reset room” where physicians and other healthcare professionals can retreat if they need a moment to recover from a traumatic event or just to get away for a moment. The hospital, which developed an Office for Professional Worklife and created a wellness committee, also implemented scheduling (last appointment slot of the day changed from complex to routine care) and environmental (installing locally sourced art, often from the hospital staff) changes. A wellness center and a plan to streamline EHR are in the works. 

Disability insurance as a resource and treatment option

If you are suffering from a mental health condition and are considering submitting a disability claim, there are certain steps you should take to ensure that your claim is accepted. If you apply for disability due to “burnout” and do not have supporting documentation from a mental health professional detailing a diagnosable condition, you may face an uphill battle with your insurance carrier.

Importantly, under most private disability policies sold to physicians, the insurance company must pay benefits if you are unable to perform the “substantial and material duties” of your occupation. Thus, generally speaking, if you suffer from a 

 that is interfering with your ability to practice medicine safely, you should be able to collect 

To increase the likelihood that your disability claim will be granted, the first thing you should do is consult with a mental health professional to determine whether or not you have a diagnosable condition. Be sure it is the type of provider your insurance company will accept (some policies require a doctorate-level practitioner). Next, when you report your conditions and limitations to your insurance carrier, you must be precise. To receive disability you will have to report a specific condition on the claim form and include documentation to support the diagnosis.

Lastly, with the dramatic rise in physician burnout, many insurers are placing limitations on how long policyholders can collect benefits for mental health claims (some companies entirely exclude mental health claims from coverage) to limit their liability for these types of claims.

The effects of nurse practitioners replacing physicians

Addressing licensing concerns for mental health treatment

Many physicians who suffer from mental health issues are often reluctant to seek treatment because they fear it might jeopardize their license to practice medicine. According to a 

, in the states where licensure applications ask the most sweeping questions about mental illness, physicians are most likely to be reluctant to seek treatment.

Liselotte N. Dyrbye, MD, who led the study, argued that rather than asking an unfairly broad question such as, ‘have you ever been treated for a mental health condition?’ the application should focus on the physician’s ability to perform the job today. A more reasonable question would be, ‘are you currently suffering from any condition, mental or physical, that keeps you from doing your job?’

Unfortunately, the Mayo Clinic study found that, despite the fact that groups including the American Medical Association, American Psychiatric Association, and the Federation of State Medical Boards recommend against it, two-thirds of states ask the broader form of the question. This could be causing physicians to forego treatment.

Although it is illegal under the Americans With Disabilities Act (ADA) to revoke licensure or otherwise prevent a physician from working due to a mental disorder, medical licensing boards get away with it because, as Dr. Dyrbye points out, states are caught between protecting the public from impaired doctors and a physician’s right to make a living.

Currently, only 13 states have no mental health questions or 1-2 “current impairment” questions that do not mention mental health. Connecticut, Hawaii, Michigan and New York are the most physician-friendly of all states with no mental health or impairment questions. Pennsylvania asks only about drug-related impairment. The worst states, which have highly invasive mental health questions not linked to current impairment and contain confusing, punitive, or adversarial language, are Alabama, Alaska, Delaware, Florida, Mississippi, Rhode Island, and Washington

In any event, physicians whose licensure is questioned by their state medical board due to their seeking treatment for mental illness should challenge the board based on arguments that it is a violation of the ADA to discriminate on the basis of disability and that the mental health condition does not impact the physician’s ability to care for patients.

Articles

What physicians should know about available resources and benefits. 

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David Cohen, chief product and technology officer of 

, discusses the benefits and challenges involved with integrating a telehealth system with an EHR.

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The benefits and challenges involved with integrating a telehealth system with an EHR.

Benefits and challenges of integrating telehealth with an EHR

Ericka L. Adler, JD, LLM has practiced in the area of regulatory and transactional healthcare law for more than 20 years. She represents physicians and other healthcare providers across the country in their day-to-day legal needs, including contract negotiations, sale transactions, and complex joint ventures. She also works with providers on a wide variety of compliance issues such as Stark Law, Anti-Kickback Statute, and HIPAA. Ericka has been writing for Physicians Practice since 2011.

The following is a question from a physician reader:

Can a practice legally refuse to treat a patient if they have an unpaid balance but they haven’t been officially dismissed from the practice?

: This issue was touched upon in an earlier blog in which I discussed 

. In all patient challenges, the most important goal is to avoid a claim of patient abandonment and assure that patient care is not neglected. Regardless of the reason for your issues with a patient, whether it’s unpaid bills, failure to follow advice, or mistreatment of staff, the same advice applies:

Discharging Patients with Unpaid Balances

, JD, LLM has practiced in the area of regulatory and transactional healthcare law for more than 20 years. She represents physicians and other healthcare providers across the country in their day-to-day legal needs, including contract negotiations, sale transactions, and complex joint ventures. She also works with providers on a wide variety of compliance issues such as Stark Law, Anti-Kickback Statute, and HIPAA. Ericka has been writing for Physicians Practice since 2011.

A physician asks whether he can legally refuse treatment to a patient with an unpaid balance. Here are five legal considerations.

Can You Discharge Patients with Unpaid Balances?

, JD, MBA, advises clients on compliance and transactions in healthcare, cybersecurity, corporate and securities law, while representing plaintiffs in False Claims Act and Dodd-Frank whistleblower cases. She also teaches bioethics at Baylor College of Medicine in Houston. Rachel can be reached through her website, 

As an attorney whose practice focuses on healthcare, six laws come to mind, which every healthcare industry participant should know: the Anti-Kickback Statute (AKS), the Stark Law, the False Claims Act (FCA), the Health Insurance Portability and Accountability Act of 1996 (HIPAA), the Social Security Act, and the Affordable Care Act (ACA). The rationale is that 

government investigations/enforcement actions

 often include one or more of these laws.

Of course, there are a plethora of other healthcare and criminal laws which are relevant and may carry significant legal and financial harm if violated. One of those laws is the Travel Act of 1961, 18 U.S.C. § 1952 (Travel Act). The Travel Act was passed during the Kennedy Administration and is often considered a wire fraud statute and anti-bribery statute. Fundamentally, 

 makes it “illegal to travel or ‘use mail or any facility’ in interstate or foreign commerce with the intent to (1) distribute the proceeds of unlawful activity, (2) commit violent crime in furtherance of unlawful activity, or (3) ‘otherwise promote, manage, establish, carry on, or facilitate the promotion, management, establishment, or carrying on, of any unlawful activity.’”

It may seem obvious that a kickback is often viewed as a bribe. The 

, is a criminal law “that prohibits the knowing and willful payment of ‘remuneration’ to induce or reward patient referrals or the generation of business involving any item or service payable by the Federal health care programs.” A key difference between the AKS and the Travel Act is that the AKS only applies to federal programs, whereas the Travel Act extends beyond conduct involving government programs and into the realm of private insurance and programs. In light of this, as well as recent indictments of healthcare providers and professionals under the Travel Act in cases such as 

United States of America v. Bernard Greenspan

 (N.D. Tex.) (“Forest Park Case”), the healthcare industry should re-evaluate its conduct and compliance programs to avoid a similar fate.

I am fortunate to present two individuals who played vital roles in the United States Department of Justice’s prosecutions in the Forest Park Case - Andrew Wirmani, AUSA who prosecuted the case and Don Barbo, Managing Partner at VMG who served as the government’s healthcare valuation expert witness.

RR: Please share with us a bit about your background, as well as what led the Government to utilize the Travel Act in the Forest Park Case.

 Let me start by saying that my comments today are in my personal capacity and do not necessarily reflect the views of the Department of Justice, the Northern District of Texas, or any other government agency.

For the last eight-and-a-half years, I have served as an Assistant United States Attorney prosecuting complex-white collar cases, principally in the healthcare arena. Over the years, I have held various positions in the office. Prior to government service, I worked for several years at Jones Day as a trial and appellate litigator. I received my law degree in 2006 from the University of Texas and clerked for the Texas Supreme Court and the United States Court of Appeals for the Fifth Circuit thereafter.

During the investigation of the Forest Park case, it became apparent that the majority of the illicit conduct involved private insurance patients. Instead of limiting the investigation to the federal money at issue, we researched a number of bribery/kickback statutes that do not require the presence of Federal healthcare programs, including Honest Services Wire Fraud, Federal Programs Bribery, and the Travel Act predicated on state kickback or commercial bribery statutes. We ultimately determined that the Travel Act squarely applied to the facts of the case, presented a sound legal theory, and had the most jury appeal in this situation. At the time, healthcare prosecutors across the country were discussing potential use of the Travel Act in similar situations and the District of New Jersey had already successfully used the statute in its Biodiagnostic case. Our use of the Travel Act was approved within the hierarchy of Department of Justice, and the court (Judge Fitzwater at the time) issued a lengthy pretrial order affirming its applicability in healthcare cases.

RR: Since both the AKS and the Travel Act are criminal statutes, please share with us some of the key differences. Does one statute send a stronger deterrent message over another?

 The Travel Act applies to a broader payor mix than the AKS, but, at the same time, it reaches a narrower set of kickback relationships. To secure jurisdiction, the AKS requires the presence of one or more “Federal healthcare programs,” which includes, but is not limited to, Medicare, Medicaid, TRICARE, and the Department of Labor/Office of Worker’s Compensation. By contrast, the Travel Act potentially criminalizes kickback arrangements involving federal payors, private payors, or no insurance at all. In this sense, it is much broader than the AKS. But while the AKS, assuming the presence of federal payors, potentially applies to any renumeration for referrals, the Travel Act only criminalizes bribes that influence a fiduciary relationship. In healthcare cases, that is almost always going to be the doctor-patient relationship.

So, for example, while the AKS is often used to prosecute kickbacks to marketers who make referrals, the Travel Act—absent a viable aiding and abetting or conspiracy theory—is unlikely to reach that conduct. In short, you can think of the AKS as applying to kickbacks involving “Federal healthcare programs” and the Travel Act as applying to kickbacks involving fiduciary relationships.

To the extent the Travel Act has greater deterrent force, it is only because its use in healthcare cases makes clear that kickback arrangements devoid of federal payors still constitute federal crimes. In terms of penalties, the AKS, as recently amended, actually carries greater penalties, (i.e., a five-year maximum penalty under the Travel Act versus a 10- year maximum penalty for violating the AKS).

RR: The $200 million scheme was designed to induce doctors to steer patients with primarily private insurance to Forest Park Medical Center. Could a whistleblower bring a False Claims Act case that focused on this type of conduct or is this a criminal action that only the Government could bring?

 That is an interesting question. I am not aware of any such case and, as always, it would depend on the facts. But if you think of the Travel Act as being broader than the AKS in terms of payor type, then, theoretically, one FCA area that comes to mind where it might apply—where the AKS does not—is federal programs outside the scope of the AKS, such as the Federal Employee Health Benefits Program (FEHBP). You would have to look at the provider contracts of the private insurance companies that administer the FEHBP and the attestations providers are required to sign. I would note that a large portion of the “private” insurance money involved in the Forest Park case was part of the FEHBP.

RR: The criminal indictment also referenced various fraudulent activities were committed by the defendants under FPMC’s out of network business models involving commercial insurance payers, including FPMC waiving or substantially reducing out of network co-pays and deductibles from patients, and instructing patients to not discuss this with their commercial insurance plans to avoid alarming the commercial payers. Did the government or the commercial payers impacted bring any specific criminal or civil actions against the defendants for this?

 No. Outside the context of FPMC, private insurance companies have brought civil fraud claims based on the upfront, undisclosed waiver or reduction of out of network copays and coinsurance with varying degrees of success. And in the Nexthealth pharmacy fraud case I prosecuted, the government alleged the waiver/self-funding of copays as healthcare fraud in the context of money laundering charges in an information and plea deal. In FPMC, the waiver of out-of-network coinsurance was instrumental to the crime in that surgeons receiving bribes could not fulfill their end of the bargain by referring patients to the hospital if the costs to the patient were prohibitive. But rather than basing independent charges on this conduct, the government alleged the upfront, guaranteed waiver or reduction of coinsurance as a manner and means of the kickback/bribery conspiracy. So we presented evidence of the conduct to prove the conspiracy, but the fraudulent waiver of coinsurance was not the object of the conspiracy, and the jury was not asked to determine whether the practice constituted fraud.

RR: Let’s take a peek behind the curtain. Experts play a vital role in any case. What did areas of traditional healthcare law did you and Don focus on in order to determine the facts at issue?

 Some of the defendants had agreements that recited that the payments at issue were fair market value and commercially reasonable. Don’s job was to explain those concepts to the jury so we could argue that these recitations were not true in practice and that the agreements were just used to conceal the illegal conduct.

For valuation and commercially reasonable purposes, I focused on applying FMV/GMV and CR relative to the Stark Law and AKS.

RR: Don has served as an expert on both sides of the aisle. What areas of valuation were focused on in the Forest Park Case? And, what made the conduct an outlier in terms of what other entities typically do?

I was asked to study the subject market services agreement between FPMC and various physicians and offer my opinions at trial whether the marketing fees paid to the physicians were within a fair market value range, and if the arrangements were commercially reasonable, relative to the services being performed by the physicians. Based on my analysis, I could not determine if the fees were within a reasonable FMV range due to the contractual services being overly broad, vague, and open-ended in nature. Also, a key service required from the physicians under their market services agreements was the development of a marketing plan, and a related budget, and on-going services to implement and monitor the market services, with FPMC’s marketing staff. However, the marketing plans were never delivered, and the related marketing services required were not performed. In spite of this, the marketing fees continued to be paid by FPMC to the physicians. Therefore, the arrangements were not commercially reasonable, which I also testified to.

RR: From a compliance standpoint, what are the main take-aways from the Forest Park Case from both a healthcare valuation standpoint, as well as legal liability vantage point, that providers and other entities should consider when structuring arrangements?

 It is critical for those operating in the health care arena to not just seek legal advice, but to follow that advice in practice. Providers need to make sure that their healthcare lawyers understand the negotiations that led to the agreement and what the parties intend to do in practice and how that conforms to the agreement. For example, you can have a contract that is legitimate on its face, but if there are email or other communications that indicate the deal is really for referrals, then the agreement is pretty much worthless. In fact, because many healthcare agreements recite that the payments are not for referrals, those agreements can actually became evidence of a defendant’s willful violation of the law where there is contrary evidence.

FMV and CR opinions should be obtained for contractual arrangements involving hospitals and physicians. In my opinion, this should be done not just for business models involving DHS and governmental payers, but also for business models focused on commercial payers, to ensure proper and consistent business arrangements are being conducted.

The contractual arrangements, once approved by qualified healthcare counsel and properly executed by the parties, need to be closely and timely monitored to ensure that the required services and related fees are being performed in a contractually compliant manner.

, JD, MBA, advises clients on compliance and transactions in healthcare, cybersecurity, corporate and securities law, while representing plaintiffs in False Claims Act and Dodd-Frank whistleblower cases. She also teaches bioethics at

in Houston. Rachel can be reached through her website,

Viewed through the lens of the prosecutor and the government’s expert

Lessons from the Forest Park Case and the revitalization of the Travel Act

Lead Gastroenterologist, Modernizing Medicine

The dissemination of coronavirus vaccines has brought the end of the pandemic into sight, with most U.S. adults expected to become eligible by May. While a year of social distancing has left many with cabin fever, a year without preventative care has enormously impacted both patients and their care team.

Because many patients delayed routine care during the pandemic, 

 is predicting that the lull in cancer screenings will increase the number of deadly colorectal cancer (CRC) cases in the next five years. Screening delays of just seven to 12 months are projected to result in a 29 percent increase in advanced stage CRC (stages III-IV) among the over 50 population.

The pandemic has already hit specialties like gastroenterology  particularly hard, as it experienced the 

 in utilization and revenue, coming in just marginally behind oral surgery. Now, these physicians face yet another pandemic challenge: efficiently screening a high volume of patients in the shadow of a pandemic that exacerbated the already high rates of physician burnout.

Measurable metrics to review medical practice staff

Technology as a Solution to Prevent Burnout

According to Medscape’s recent report on 

, burnout for gastroenterologists is already high risk in normal climates, with rates topping 35 percent for the specialty—and much higher if a physician owns his or her own practice. In addition, 81 percent of gastroenterologists reported being happy outside of work prior to Covid-19, but this number plummeted to just 54 percent as the pandemic wore on. Though most gastroenterologists reported that their burnout preceded the pandemic, the stresses of the past year have certainly exacerbated it.

Medscape’s survey also found that, among GIs who reported burnout, 60 percent attribute it to bureaucratic tasks. This is unsurprising, as the 

 reported that almost half of the average doctor’s work day is spent on administrative work, while only 27 percent is spent on direct clinical care. 

As gastroenterologists and physicians in general look for ways to manage the increase in patient volume while reducing administrative tasks and maintaining work life balance, using a specialty specific EHR system can be integral to an effective return to care strategy, offering the greatest opportunity for efficiency. Instead of saddling clinicians with additional tasks, an EHR platform should be intuitive, easy to use, and automatic. An effective solution will facilitate patient reminders, insurance claim processing, inventory management, and other administrative tasks through automatic processes that reduce the number of clicks and streamline overall workflow.

Having a telehealth solution that is integrated within the EHR can reduce clumsy workarounds in visit documentation and help streamline patient communication. While telehealth visits will likely decrease in the coming months, having it as an option can speed efficiency for patients and physicians alike by letting them conduct some visits remotely. For patients who are unable or unwilling to come in for an office visit – or in the event of a Covid-19 spike requiring local office closures -- telehealth can help ensure continued care and reduce the patient influx once offices reopen.

Digital tools can also streamline the cumbersome process of patient recall– a function that will be particularly important in the coming months. When completed manually, patient recall can require multiple employees across multiple departments communicating frequently and analyzing tremendous amounts of patient data. Additionally, turnover can cause breaks in a workflow and a disconnect in the patient’s care team. As practices juggle higher patient volumes, it’s critically important that patients don’t fall through the cracks, potentially further delaying the ability to catch CRC in its early stages.

2021 Remote Patient Monitoring Changes: 10 key takeaways for practices

The importance of quickly returning to regular CRC screenings cannot be overstated. While there is no “one-size-fits-all” solution to overcoming the challenges brought about by the pandemic, digital tools can help physicians save time and increase productivity. By investing in operational support designed for gastroenterology, these tools help reduce burnout, enhance patient care, and support physicians in building and maintaining a successful practice in the face of enormous challenges. From pre-screening and post procedure visits via 

 to minimal contact office visits, technology can help deliver a reasonably safe clinical GI experience while reducing the burden on physicians.

How will physicians manage the increasing demand as patients return to care without getting burned out in the process?

Returning to care in a “Not-Quite-Post Pandemic” world

Managing director of King, Edward with a focus in pharmacy and healthcare.

Revenue cycle management (RCM) describes the part of healthcare administration that focuses on tracking and optimizing revenue collection. While RCM encompasses a number of processes, it is commonly thought of in terms of software systems.

RCM software is big business. One industry observer 

 the RCM software market size to be over $52 billion, expected to grow to $114 billion by 2025.

Revenue cycle management is most commonly seen in the healthcare industry specifically because of the extreme and increasing complexity of healthcare billing and reimbursement.

Passive real estate investing is ideal for physicains

There are two primary benefits of an effective RCM system.

First, there are significant cost reductions associated with automating and digitizing a practice’s claims, billing, and reimbursement functions. The Council for Affordable Quality Healthcare (CAQH) reports that healthcare businesses 

 from strearmlining administrative processes like revenue cycle management in 2020. There are further benefits to exploit as well; for example, CAQH also estimates that another $16 billion in savings could be realized just by fully automating nine common transactions.

A second set of revenue cycle management benefits come from improving revenue collection both from insurance companies and from patients. This responds to 

the #1 concern identified by hospital administrators

in a comprehensive survey: reimbursement. The best RCM software will minimize claim denials, deliver invoices more quickly for faster turnaround, and provide exception-based reporting when manual intervention is required.

While there are no benchmarks for the benefits of RCM software for individual clinics, data from one 

 suggests that extremely significant revenue increases of 27% to 45% can be achieved.

While RCM software is most commonly thought of as relating to claim submission, insurance denials, and payment collection, administrators can and should expect that an RCM system provides end-to-end management of the patient/revenue process. For example, RCM software should:

Gather patient insurance and demographic information before they arrive at the point of care and confirm this information at the time of the patient’s appointment.

 Many claim denials can be prevented by ensuring complete and accurate collection of patient and insurance data from the beginning.


Verify the patient’s insurance information and coverage with respect to the recommended course of treatment.

 Many RCM systems are set up or can be customized to verify insurance coverage automatically, replacing time-consuming phone calls and faxes.


Collect patient co-pay based on insurance information and recommended treatment.

Properly code and submit claims to payers using CPT and ICD codes.

 High-quality RCM software should come pre-loaded with templates to allow for efficient claim submission to common payers such as insurance companies.


Manage the claims processes, including addressing insurance denials and executing follow-up billing to the patient as appropriate.

 Quickly appealing denials (when appropriate) 

Provide customizable reporting and analysis tools.

 These tools will become increasingly important, 

according to the University of Illinois in Chicago

, as the healthcare system moves from a purely fee-based model to one incorporating more value-based reimbursement. The data provided by an effectively implemented RCM system can allow providers to achieve higher reimbursement rates.


Choosing an outsourced RCM system can be a challenge. Once a system is deployed and staff are trained on its use, it can be difficult to decide to change course. This places pressure on administrators to make the right decision the first time.

Unfortunately, it is not always easy to evaluate something as complex as an RCM from demos alone. While imperfect and subject to manipulation, software review sites such as 

 can add to the due diligence process, combined with recommendations from similarly-sized comparable providers.



Ways to play the prior authorization game

As noted above, industry observers expect the RCM software market - a proxy for use of RCM systems - to continue to grow rapidly, fueled by the significant benefits that these systems bring to physicians, clinics, and hospitals.

It is likely that the benefits of RCM will increase in coming years. As many medical administrators can confirm, the claims reimbursement process tends to increase, rather than decrease, in complexity over time. As payers, including insurance companies, themselves digitize and automate their processes, providers and administrators relying on legacy systems risk being left behind.

What physicians and practice managers need to know.

Revenue Cycle Management: Benefits and best practices

, a leading health information technology and services provider.

In this video, David Cohen, chief product and technology officer of 

, discusses the concept of integrated telehealth solutions and how this impacts workflows.

The concept of integrated telehealth solutions and how this impacts workflows. 

Integrated telehealth solutions

Even the best physicians face the possibility of a lawsuit on an almost daily basis. However, research shows that many lawsuits today are not about medical errors, but about poor communication and misunderstanding.

Ensuring effective communication should become a systematic and integrated approach into overall efforts to minimize errors, improve outcomes, control med-mal costs, maintain contracts, and manage the reputation of your practice.

Below is a practical guide, based on 28 years of experience working with physicians, to minimize liability claims stemming from communication oversights and misunderstandings.

Ways to avoid a malpractice suit

, CPCU, RPLU, is president and chairman of the board of The MGIS Companies, a leading national provider of physician insurance products. With nearly 30 of experience, Brunken is an expert on physician protection. 

Slideshows

Here is a practical guide to minimize liability claims stemming from communication oversights and misunderstandings at your medical practice.

Part two of our look at stories from current headlines puts abstract conversations about asset protection, insurance, compliance, and risk management issues into the real-life context of current national headlines.

 we have previously advised you to manage proactively including social media, employment law and the COVID-19 vaccine. The headlines of the last few weeks are no less varied in the lessons they can provide.

Identity Theft Is Spiking – And Now They Probably Have Your Cell Number

We’ve discussed that both medical practices and their physician owners are popular and frequent targets for cybercriminals and some of the 

 protecting yourself requires. Things got a little harder this year as the identifying details of hundreds of millions of Facebook users was made available for free. As 

Over the weekend, news broke that a hacker had published online

a database containing the personal information of 533 million Facebook users

, including email and physical addresses, phone numbers, birthdates and more. While the data was stolen in a 2019 breach and Facebook long ago plugged that hole, it’s the first time this huge trove was made available for free.

What this means for consumers is that you will need to be extra vigilant about 

, using two factor authentication and carefully screening any 

 as likely phishing attempts, which are already increasing by using this information. Be extra leery of anything with a link or an attachment and look out for common scams including fake package and Amazon delivery updates.

Reconsider Business, Personal Security, and Your Need for Privacy

Physical security issues that can pose a risk to life and business takes many forms and we’ve examined the need for your practice to consider 

, a gun policy and heavy levels of several kinds of insurance in areas including 

. There has been a public shooting reported in different parts of the country 

 and his family by a patient. In this case, unlike the majority of other incidents involving medical professionals that are usually 

, the attack took place at the physician’s 

 and spilled over to other family members. This tragedy highlights the need for situational awareness and security precautions at all times as well as the need for physicians to take efforts to keep their residential addresses private by using trusts and other legal devices to legally keep their names out of public records. Having something like, “Dr. Sheila Smith and husband Bill Smith Just purchased this lovely contemporary home in located at 2345 East. Mountain Top Lane for $2.5MM” published in your local paper on the internet is a bad idea for many reasons. Think about your need for privacy and security well before closing on any real estate purchase.

Due Diligence in All Things Financial is Still Vital

You may have noticed a spike in reporting on investment fraud cases—it’s real and it affects a variety of industries and types of investment opportunities. Pushed by fears about the economy and uncertainty about taxes, investors are looking for opportunities and scammers are taking advantage of that in many ways.

All the basics of due diligence still apply from 

checking your investment advisor’s record

 and background to being conscious of the risks of private placements and investments, especially those that don’t use 

 or who promise outsize returns that other alternatives can’t match. One recent scam involved a Hollywood actor pushing a movie distribution deal that 

. It can also be a much smaller front-end scam that leads to a huge exposure, like 

 and discovering your agent wasn’t actually using your premiums to insure you, leaving you 

Doctors have always loved private aircraft, but we’ve seen a big increase in the number of clients interested in buying a private plane, spurred at least partially by COVID. Owning or flying an airplane carries 

 that can be fatal to you or others. Make sure you have professional help in how to own and insure the plane and 

, including life insurance, estate planning and asset protection in solidly place before you are wheels up.

, JD, has practiced law exclusively in the areas of asset protection, risk management and wealth preservation for the last 16 years. He helps protect a national client base with more than $5 billion in personal assets, including several thousand physicians. He is a contributing author to multiple books for physicians and a frequent medical conference speaker and CME presenter. Learn more at

Asset protection, insurance, compliance, and risk management.

2021 Asset Protection Lessons in the News, Part Two

Dr. Reena Pande, Chief Medical Officer of 

, shares her thoughts on how physicians can remain updated with standards of care as they continue to evolve in this heightened era of telehealth.

How physicians can remain updated with standards of care.