London, UK – May 2, 2024 – A distinctive specialist insurance plus reinsurance broker, BMS has recently introduced a completely fresh global healthcare liability arm. The unit will be headed by Rob Wendin — an industry veteran — with more than forty years under his belt in insurance, reinsurance, and healthcare insurance marketplace.
This move underscores BMS's dedication to the growing healthcare insurance marketplace. The division seeks to offer full-fledged solutions and counsel to the clientele of healthcare providers as well as their insurers. In an expanded area of the healthcare liability space with a wider array of services and products: this introduction implies we strive to meet more needs for our clients.
Wendin, who was hired by BMS in the month of December 2023, has been able to compile a team consisting of six professionals with more on the way soon. This team is going to be the most number wise and experience wise big team related to medical malpractice in the London healthcare insurance marketplace among other teams as stated by a communication from BMS. "We are thrilled to announce the launch of our new global healthcare liability division," said Andrew Wheeler, president and CEO at BMS Re. "Rob’s unparalleled experience across both insurance and reinsurance will be a huge asset to BMS as we continue to grow our industry-leading medical professional liability practice."
Leadership positions have been part of Wendin's rich history, including being the managing director of healthcare at Guy Carpenter and a senior partner at JLT's Healthcare Risk Partners and also as a managing director at Marsh's EMEA Healthcare Practice. The establishment of this new unit that is under his leadership guarantees wealth from such knowledge that will be used to foster innovation plus risk management strategies for clients in the healthcare industry.
Collaboration means a new partnership between BMS Re's treaty healthcare liability team — which has been long-established and is led by Clare Stenson — with high-quality service delivery assured for hospitals, integrated systems, and captives. This collaboration underscores BMS’s commitment to its clients as it continues providing quality services through this core aspect of their operation.
Stenson and her team were the pioneers of this new development, a global division in healthcare that has brought a wealth of expertise not only in insurance but also reinsurance, treaty and facultative arrangements without any restrictions geographically or organizationally.
“It shows no sign of slowing down because it puts colleagues first— as well as clients,” he said with enthusiasm.
The introduction of the new division is a clear indication of BMS's strategic priority to develop and widen its presence within the healthcare insurance marketplace. BMS, with specialized services and the guidance from industry leaders like Wendin, positions itself excellently to find a place as one of the major contributors in the changing health insurance marketplace, which aims at providing support for business in the healthcare field.
A large healthcare organization with over 100 providers is looking to improve efficiency by adopting a comprehensive suite of solutions from eClinicalWorks.
American Medical Administrators (American Medical Administrators), a fast-growing healthcare organization with more than 100 providers, recently disclosed a partnership strategy with eClinicalWorks, a top provider of ambulatory cloud EHR solutions. This collaboration is designed to ensure efficiency reaches its peak and that patient care is taken to a new level across American Medical Administrators’ networks using eClinicalWorks' comprehensive unified healthcare IT solutions.
The partnership has put one of its major focuses on empowering American Medical Administrators' revenue cycle management capabilities. With this powerful solution— eClinicalWorks' fully integrated intelligent Cloud EHR which comes along with strong revenue cycle management features— American Medical Administrators will be able to bring down claim processing by leaps and bounds which in return lightens the workload for the staff administratively as well as improve cash flow. Automation through Robotic Process Automation (RPA) with revenue cycle management functionalities will eliminate time-consuming tasks during revenue cycles, further helping the optimization process by automating tasks like statement processing and payment posting.
"We are in pursuit of a healthcare IT solution that is adaptive and tailored to ensure optimal service delivery to our practice and patients," mentioned Dr. Manzer, Chief of Staff at American Medical Administrators. "eClinicalWorks — partnering with us — has developed an all-in-one solution which will enable us to operate more efficiently as well as take care of patient needs throughout our network."
The eClinicalWorks platform, an integration system, contains numerous tools besides revenue cycle management that play a role in enhancing healthcare delivery significantly. These tools include CCM, RPM, and value-based care functionalities which are designed to support American Medical Administrators in the provision of proactive care along with coordinating care for their patients. On another note, easy accessibility of patient information plus the generation of reports (coupled with data extraction capabilities) fosters better practice management efforts as well as clinical decision support.
The matchless partnership with the American Medical Administrators perfectly resonates with their belief in autonomy and control over practice. The features inherent in the design of eClinicalWorks are user-friendly which means that they will not dictate how physician-led practices should be run but rather empower them to make independent decisions on what is best for efficient operations alongside high-quality patient care while ensuring the best outcome.
"Through our innovative eClinicalWorks revenue cycle management service, fully supported by a smart, cloud-based EHR, American Medical Administrators will not only be able to thrive in a value-based care model but also elevate their existing operations and care models for future growth," said Girish Navani, Chief Executive Officer and Co-founder of eClinicalWorks.
eClinicalWorks and American Medical Administrators are looking to introduce AI across all practices including AI-powered medical scribe solutions like Sunoh.ai. This can streamline workflows: one step after another by simply introducing the right technology at the right place — making it easier for people working on healthcare outcomes for patients. By having advanced AI capabilities: implemented more widely than ever before; introduced earlier than expected; and delivered faster than planned — organizations can achieve better efficiency and effectiveness.
eClinicalWorks' technological solutions are revolutionary. American Medical Administrators can significantly improve revenue cycle management’s operational efficiency and quality care. With the adoption of eClinicalWorks' technology, American Medical Administrators are on the way to transforming how they do business.
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A new Telehealth Accreditation Program (TEL) was recently introduced by The Joint Commission Organisation, a major independent body in the healthcare industry that tailors its programs toward telehealth providers. The launch date for this program is July 1, 2024, and the objective of the Telehealth Accreditation Program is to create a standardized model for delivering care through telehealth systems— which are intended to be safe and of high quality.
Telehealth is being increasingly adopted especially in the wake of COVID-19 which is what led the Joint Commission Organisation to come up with this program. "In the United States, the number of telehealth providers surged by 154% during the early days of the pandemic," shared Jonathan B. Perlin, MD, PhD, who serves as the president and CEO of The Joint Commission Organisation. He further added, "With telehealth still on its evolutionary path, this new program pledges that patient safety will always take precedence no matter where care is provided."
While the telehealth providers accreditation program keeps hold of many existing Joint Commission Organisation accreditation standards — like leadership, information management & medication management alongside patient identification, documentation, and credentialing — it introduces a set of novel requirements specific to telehealth.
The Joint Commission Organisation has a viewpoint that telehealth providers' accreditation can provide value to telehealth entities. Based on this belief, the specific requirements may differ from one telehealth modality and the service provided through another. Accreditation signifies that a telehealth organization is committed to meeting standards which will promote them as an organization holding a good reputation — marketable as well. Additionally, it would act as part of due diligence efforts by showing evidence of legal compliance with some regulations set forth for the operation of telehealth services.
Mark your calendars for May 2024. It is during this month that The Joint Commission Organisation will publish the official TEL program requirements on its website. We strongly advise all eligible telehealth providers to keep an eye out for the program specifics and ponder over seeking accreditation— a move that guarantees alignment to top-tier standards of quality and safety in the realm of telehealthcare provision.
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The Department of Health and Human Services (HHS) has recently taken a step forward towards ensuring the confidentiality of reproductive healthcare data concerning the patient by issuing an administrative rule on 22 April that will safeguard this data against misuse in criminal investigations. This rule effectively confers similar federal privacy protections upon lawful reproductive healthcare services, including abortions, as other healthcare data covered by the Health Insurance Portability and Accountability Act (HIPAA).
To that end, this regulation is introduced to address fears patients as well as healthcare providers may have about possible misuse of medical records. One important consideration OCR Director Melanie Fontes Rainer made was to ensure that people don’t hide necessary medical details due to privacy concerns or fear of the law.
The recent regulatory changes in HIPAA privacy rule have deemed it illegal to utilize protected health information (PHI) to investigate or enforce legal action against a HIPAA-covered organization regarding the sharing of reproductive healthcare data. These changes apply to all forms of reproductive care services, including IVF, birth control, and abortion. It is important to note that this regulation is applicable only if the information was legally obtained from providers who were authorized under state or federal laws to offer such services. This control is imposed by requiring that a covered entity has a signed attestation that confirms that information requested on reproductive care will not be used for illegal purposes. Violations may subject an entity to criminal penalties, while failure to secure such attestations could result in civil penalties.
The regulation comes under HIPAA privacy rule and is supposed to protect the privacy of patients, but it could bring legal issues. In this respect, Claire Marblestone, a partner at Foley & Lardner, says that scrutiny may arise because the rule speaks only of reproductive healthcare privacy as included in HIPAA privacy rule.
Notwithstanding its faults, the rule handles worries connected with interstate travel for regenerative consideration, particularly for individuals dwelling in states with prohibitive abortion laws. HHS Secretary Xavier Becerra acknowledges the ongoing challenges caused by recent legal improvements yet emphasizes the organization's commitment to ensuring reproductive rights.
In the year 2019, the Guttmacher Institute claims that there has been an immense rise in the number of people traveling to other states to get abortion services, thus reaffirming the need to bolster privacy laws. The final regulation will become effective after two months of publication in the federal register, and entities that have to comply with HIPAA privacy rule must do so within 240 days. By February 16, 2026, new guidelines should be implemented regarding notices of privacy policies to comply with these regulations.
Through the strengthening of privacy and protection against practices meant to respect patients' confidentiality, the Biden administration is striving to build trust between people and their healthcare providers, all with a view of ensuring accessibility to quality reproductive healthcare services.
The final rule may be viewed or downloaded at:
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A landmark legislative victory for Governor JB Pritzker, the Illinois House has just approved the “Healthcare Protection Act,” House Bill 5395, with an overwhelming bipartisan vote of 81-25. This legislation intends to stop some practices used by health insurance agency to control access and prices to medical coverage insurance for individual policyholders.
As an opening move, the bill initiated by Governor Pritzker in his State address last February is focused on a variety of “utilization management” methods that insurance firms use to cut costs, including the denial of claims and persuading patients to opt for low-cost alternatives for medical coverage insurance . Most importantly, it obliges insurers to follow “generally accepted standards of care” when determining coverage for doctor-prescribed treatments. In addition, it outlaws practices such as step therapy in which people have to demonstrate that a cheaper drug does not work before receiving a more effective but higher-priced medicine.
The legislation also ensures that insurance companies cannot impose prior authorization on covering the charges for hospital-based psychiatric treatment. All prior authorization requirements for medical coverage insurance should be made public on the websites of insurers. Moreover, the bill requires that all health insurance agency conduct internal audits of their provider networks to ensure adequacy and participation, and this is done regularly.
An additional provision of the act is that in Illinois, it prohibits the sale of short-term, limited-duration medical coverage insurance that do not comply with the federal minimum standards as stated in the Affordable Care Act. This law empowers the Illinois Department of Insurance to examine and affirm or deny rate hikes regarding large group insurance plans.
Governor Pritzker expressed optimism about the bill's prospects in the Senate, predicting an easy passage. He emphasized the importance of the legislation in empowering doctors and patients by returning decision-making authority regarding treatment options to their hands.
However, it's worth noting that the bill does not extend to self-insured plans regulated under federal law, nor does it apply to state-funded healthcare programs for noncitizens.
While the bill received widespread support, concerns were raised regarding its potential fiscal impact. Estimates suggest an additional $40-50 million in state expenditures, primarily towards higher Medicaid and state employee health plan costs. Representative C.D. Davidsmeyer highlighted the potential burden on taxpayers, particularly given the projected 16.5% increase in state employee healthcare costs next year.
With the House deadline met, the Senate now awaits the bill's consideration. Governor Pritzker has announced plans to advocate for the legislation statewide, underscoring its potential to save lives and reduce healthcare costs for millions of Illinoisans.
Stay tuned for further updates as the Healthcare Protection Act progresses through the legislative process.
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The Arizona Health Care Cost Containment System (AHCCCS) recently updated its Medical Policy Manual (AMPM) 510. These revisions focus on improving coordination and collaboration between primary care providers (PCPs) and behavioral health providers (BHPs). This change aims to ensure patients enrolled in AHCCCS programs receive more integrated and effective care.
The updated AMPM 510 policy outlines specific requirements for enhanced communication between PCPs and BHPs. This includes better information sharing about a patient's medical and behavioral health needs. By working together, PCPs and BHPs can develop a more comprehensive treatment plan that addresses both physical and mental health concerns.
The revised AMPM 510 applies to various healthcare providers and programs within the AHCCCS network. This includes:
These changes will directly impact how healthcare professionals coordinate care for patients enrolled in these specific AHCCCS programs.
A more collaborative approach between PCPs and BHPs can lead to several positive outcomes for patients. Here are some potential benefits:
Earlier identification of behavioral health issues: PCPs may be better equipped to recognize signs of depression, anxiety, or other mental health conditions through improved communication with BHPs.
More effective treatment plans: By working together, PCPs and BHPs can develop treatment plans that address both physical and mental health needs simultaneously. This can lead to improved overall health outcomes for patients.
Reduced healthcare costs: Early intervention and integrated care can potentially prevent more costly complications down the line.
The updated AHCCCS AMPM 510 policy signifies a commitment to improving the delivery of integrated healthcare within the AHCCCS system. This collaborative approach between PCPs and BHPs has the potential to significantly benefit patients by ensuring they receive comprehensive and coordinated care.
Previously, denied claims were automatically reprocessed. However, under the new system, participants will need to submit a formal claim reconsideration request if their claim is denied.
What You Need to Do:
Why the Change?
This new process allows for a more thorough review of denied claims. By submitting a reconsideration request, you have the opportunity to provide additional information or documentation that may support your claim.
What to Look For:
If your claim is denied due to non-registration with the 21st Century Cures Act, you'll see one of these denial codes on your remittance advice:
| Denial code | Denial code description |
| QSA | Billing Provider validation issue |
| QSC | Rendering Provider validation issue |
| QSG | Servicing Provider validation issue |
| QSJ | Attending Provider validation issue |
| QSL | Operating Provider validation issue |
Taking Charge of Your Healthcare
By registering for the 21st Century Cures Act (if applicable) and following the new claim reconsideration process, New Jersey Medicaid beneficiaries can ensure their claims receive a proper review and maximize their chances of receiving the coverage they deserve.
The Michigan Dental Association (MDA) issued a reminder to its members today about the importance of complying with antitrust laws. These laws are in place to ensure fair competition in the dental marketplace, and violating them can lead to serious consequences for dentists.
The warning comes amid a history of the U.S. Department of Justice (DOJ) and the Federal Trade Commission (FTC) cracking down on anti-competitive practices in the healthcare industry, including dentistry. These actions often target activities like collective price-fixing or coordinated refusals to participate in certain insurance plans.
What Dentists Need to Know:
The Sting of Non-Compliance:
Violating antitrust laws can have serious repercussions. The DOJ and the state of Michigan can pursue criminal charges, potentially leading to jail time and hefty fines. Additionally, private parties may sue for damages.
Staying on the Right Side of the Law:
By understanding and adhering to antitrust laws, Michigan dentists can protect themselves from legal trouble and ensure they operate in a fair and competitive market that benefits both dentists and patients.
In a bid to address the critical shortage of primary care providers in underserved regions, the Biden-Harris Administration has announced a significant increase in loan repayment incentives.
The U.S. Department of Health and Human Services (HHS), working through the Health Resources and Services Administration (HRSA), unveiled a 50% increase in the initial loan repayment amount for primary care providers. This initiative targets medical doctors, nurse practitioners, certified nurse midwives, and physician assistants who commit to serving in areas facing significant shortages of healthcare professionals.
Under this program, eligible providers could receive up to $75,000 in loan forgiveness in exchange for a two-year service commitment in high-need or rural communities. The move aims to alleviate the financial burden faced by healthcare professionals and attract them to areas where their services are most needed.
Moreover, HRSA is offering an additional $5,000 in loan repayment to National Health Service Corps participants who demonstrate fluency in Spanish and commit to practicing in areas serving patients with limited English proficiency. This initiative acknowledges the importance of linguistic and cultural competence in delivering quality healthcare, particularly in communities with diverse populations.
The announcement comes amidst Secretary Xavier Becerra's Latino Health Tour, highlighting the administration's dedication to improving healthcare access and outcomes for underserved communities.
HRSA Administrator Carole Johnson emphasized the significance of ensuring access to primary care, especially in rural and historically underserved areas. The administration recognizes the pivotal role of primary care in promoting health and wellness, managing chronic conditions, and enhancing coordination across healthcare teams.
This initiative builds upon previous efforts by the Biden-Harris Administration to bolster the primary care workforce. Investments have been made in training programs, including community-based residency programs and the expansion of primary care residency slots in rural communities. Additionally, emphasis has been placed on providing training for practicing healthcare providers to address mental health conditions and substance use disorders.
The administration's commitment extends to enhancing access to care for patients with special needs and promoting culturally and linguistically appropriate healthcare for individuals with limited English proficiency.
By expanding loan repayment incentives and investing in training programs, the Biden-Harris Administration aims to strengthen the primary care workforce and improve healthcare access for all Americans, particularly those in underserved communities.
For further updates and information on this initiative, visit the HRSA News Room at newsroom.hrsa.gov.
Sources:
https://www.hrsa.gov/about/news/press-releases/support-primary-care-workforce
California's health care landscape is set for a significant shake-up as the state rolls out new measures aimed at reining in costs and promoting alternative payment models (APMs). The recently proposed statewide health care cost targets and standards, along with goals for APM adoption, spell out greater challenges ahead for health care entities across the state.
Under the HealthCare Quality and Affordability Act (HCQA), the newly formed Office of Health Care Affordability (OHCA) has put forward ambitious targets for curbing the growth of health care expenditures. These targets, including a proposed statewide cost target of 3% annually starting in 2025, are designed to align with the average annual increase in median household income over the past two decades. However, with health care spending historically outpacing income growth, meeting these targets presents a formidable task for providers already grappling with pandemic fallout and inflationary pressures.
Notably, the HCQA empowers OHCA to enforce compliance with these targets, signaling a departure from similar programs in other states. Failure to meet cost targets could result in penalties and other enforcement measures, adding urgency to the need for providers to recalibrate their approach to payer negotiations and cost management.
In tandem with cost containment efforts, OHCA is driving a push towards APMs, which incentivize quality care delivery while controlling costs. With a statewide goal aiming for at least 75% of members enrolled in commercial, Medi-Cal, and Medicare Advantage plans to be under APM arrangements within the next decade, providers can expect heightened pressure from payers to transition away from traditional fee-for-service models.
While some health care entities, such as integrated provider networks, may be better positioned to navigate these changes, others, including hospitals, face a steep learning curve in adapting to APMs and managing financial risk. The transition necessitates a new skill set and support infrastructure, from actuarial expertise to legal contract drafting.
Moreover, OHCA's oversight extends to material changes in provider networks, potentially complicating growth strategies through mergers and acquisitions. Providers must navigate OHCA's review processes to mitigate barriers to expansion.
As the implementation of these measures looms, California's health care providers are urged to closely monitor OHCA's directives and proactively strategize for the evolving landscape of payer-provider dynamics. Adapting to the dual imperatives of cost containment and APM adoption will be critical for ensuring long-term viability and sustainability in the state's health care ecosystem.
Sources:
https://www.jdsupra.com/legalnews/california-health-care-providers-to-5133209/
