R&R Insurance Blog

In 2009, medicare reclaimed $2.51 billion from physicians and other health-care providers which is a 29% increase over the prior year. Over $441 million in federal medicare money was returned in 2009 which was a 29% increase over 2008.

R&R Insurance offers protection for your practice and reputation with FFActs Regulatory Compliance Insurance. Coverage Includes:

• Protection from Alleged Medicare/Medicaid Overpayment and Commercial Payor Audits (including RAC)
• Alleged Violations of HIPAA (Patient Privacy), STARK (Patient Referral) and EMTALA (Emergency Room Treatment)
• For Medicare Commercial Payor audits, Regulatory Insurance covers penalties, fines, defense and consulting work up to $1 million for a single claim
• provides experience legal experts and consultants
• Offers protection from six year Medicare look back period
• Board of Medical Examiners review coverage included

For more information about Regulatory Compliance Insurance, contact a knowledgebroker.

You undoubtedly encounter a wide range of people on the job, some of whom are easy to get along with and others you want to avoid at all costs. It’s only human nature to avoid contact with people whose personality traits set your teeth on edge, but there is one type of person who cannot safety be ignored: a co-worker who verbally or physically threatens others. In the aftermath of a violent incident, it’s not uncommon for people to say that the person who harmed others was a time bomb waiting to explode. The question here that begs an answer is: why would people do nothing and wait for that to happen?

While no employee in any setting is immune to workplace violence, knowing what and what not to say and do can have a tremendous impact on a worker’s personal safety at work. Here are some do’s and don’ts:

Do:

• Take verbal threats seriously. All threats should be reported to security or the appropriate manager.
• Report any suspicious person or vehicle to security personnel, especially at night. The suspect could be casing your workplace for a break-in. Or the person could be stalking someone at your workplace.
• Watch for unauthorized visitors who seem to have legitimate business at your plant. Crimes have been committed by people posing as employees, contractors and repair persons.
• Always wear your identification badge at all times.
• Observe your company’s rules prohibiting drugs and alcohol at work. Many violent incidents at work can be traced to the use of these substances.
• Learn how to contact help in an emergency. Speed-dialing numbers should be programmed into phones and emergency numbers should be listed at each phone.
• Adopt some distress signals, including predetermined code words that can be used to alert other workers to dangerous customers or visitors without tipping off the suspect.
• Act on your instincts. If you sense something is wrong, report it.

Don't:

• Pick fights. Loud and aggressive arguments can easily escalate into physical fights.
• Pick up hitch-hikers under any circumstances if your job involves driving. The most important reason for this rule is your personal safety.
• Ignore threats or disturbing changes in a co-worker’s behavior, such as an obsession with weapons or violence or someone talking about a "hit list" of co-workers he or she would like to see dead.
• One’s personal security, whether on or off the job, can never be guaranteed. However, the risks can be greatly reduced by having a plan and reacting to warning signs.

For more information contact the knowledgebroker John Brengosz.

In preparation for a recent seminar I presented, I came across this great article regarding corporate data breaches and the costly ramifications by Tim Wilson of Dark Reading. Everything's more expensive these days -- and experiencing a major corporate data breach is no exception.

2010 Annual Study: U.S. Cost of a Data Breach reveals that the average organizational cost of a data breach increased to $7.2 million and cost companies an average of $214 per compromised record. The sixth annual Ponemon Cost of a Data Breach report is based on the actual data breach experiences of 51 U.S. companies from 15 different industry sectors.

Interestingly, companies who responded quickly to data breaches ended up paying 54% more per record than companies that moved more slowly, according to the study. 43% of companies notified victims within one month of discovering the breach, up seven points from 2009. In 2010, these quick responders had a per-record cost of $268, up 22% from 2009; companies that took longer paid $174 per record, down 11%.

Malicious or criminal attacks are the most expensive breaches, the study says, and are on the rise. In this year’s study, 31% of all cases involved a malicious or criminal act -- up seven points from 2009 --and the cost of these compromises averaged $318 per record, up 43% from 2009.

While external breaches are on the increase, negligence remains the most common threat, Ponemon says. The number of breaches caused by negligence edged up one point to 41% and averaged $196 per record, up 27% from 2009.

System failure dropped nine points to 27% in 2010. "This trend indicates organizations may be more conscientious in ensuring their systems can prevent and mitigate breaches through new security technologies and compliance with security policies and regulations," Ponemon says.

Encryption and other technologies are gaining ground as post-breach remedies, but training and awareness programs remain the most popular, the study says. 63% of respondents use training and awareness programs after data breaches, down four points from 2009. Encryption is the second-most implemented preventive measure as a result of a data breach, with 61%. Both encryption and data loss prevention (DLP) solutions have increased 17% since 2008.

The study takes into account a wide range of business costs, including expense outlays for detection, escalation, notification, and after-the-fact (ex-post) response. The study also analyzes the economic impact of lost or diminished customer trust and confidence as measured by customer churn or turnover rates.

"Churn is still the highest cost that we see," Ponemon said. "There's an attitude out there that users no longer care about their privacy as much, but our data shows that they really do."

The U.S. Cost of a Data Breach Study was derived from a detailed analysis of 51 data breach cases with a range of nearly 4,200 to 105,000 affected records. The study found there is a positive correlation between the number of records lost and the cost of an incident. Companies analyzed were from 15 different industries.

For more information on how to protect your company against the cost of a data breach or anything regarding cyber liability, contact a knowledgebroker.

A four-physician cardiology group in Mississippi was targeted by the Center for Medicare Services (CMS). After an initial review of 159 claims, CMS determined that 30 were improperly paid. Based on the error rate, CMS demanded more than $2.4 million be repaid to the Medicare program within 30 days.

Fortunately, the group had purchased the Regulatory Compliance Insurance coverage and immediately reported the audit. The response to CMS resulted in the overpayment amount being reduced to less than $3,000. The cost of the expert defense work was significant, but was fully covered by the insurance policy minus a small deductible. The cost of the insurance was less than $7,000 for the group.

With half of 2011 already gone and virtually every region of the country stricken to some degree by natural disasters, this year is shaping up to be one of the most unique—and costly—in many years. Natural disasters play a key role in insurance premium rates - specifically property & casualty.

Because of our central location, Wisconsin has been somewhat protected from price increases due to "coastal" losses, but not anymore. America's mid section, long popular with insurers because of the lack of big coastal risk exposures, is proving conventional wisdom wrong and ringing up as much as $7 billion in losses from the May string of record-breaking tornadoes alone.

Missouri's state insurance department said on June 30 that insurance companies report receiving 14,910 claims on homeowners, commercial and vehicle insurance policies so far. They have paid out $509 million on those claims. The state agency says insurance companies expect total claims from the tornado to reach nearly 17,000. The department also says some of the claims already received were probably partial, with more money likely to be paid on them. Insurance director John Huff says the Joplin tornado will be the largest insurance payout in Missouri history, reaching $1.5 billion to $2 billion.

In addition to the tornadoes in Missouri, disasters ranging from flooding along the Missouri River to wildfires in Texas and Arizona have damaged, destroyed or otherwise impacted scores of businesses, jobs and crops this year. And, we have the rest of the 2011 hurricane season ahead of us.

It's not only the U.S. natural disasters that will affect our premium rates moving forward. Of course there's the world's costliest natural disaster, $300 billion (and counting) in Japan (see rebuilding before and after photos at the bottom of this post), and e-coli outbreaks in Europe still being reported, three quakes in New Zealand and the floods in Australia, gave world-wide reinsurers their worst spring ever. The toll was twice what reinsurers counted on losing for the entire year and erased half the world’s excess reinsurance capacity.

"Given recent catastrophe loss events, it is clear that global underwriting results will deteriorate further in 2011. This indicates that prices are inadequate,” Daniel Staib, a co-author of the World Insurance in 2010 report. Both insurers and reinsurers are braced for larger losses, even as reduced capital makes the remaining money a more precious commodity.

With this said, it is likely over the next 12 months that we start to see an increase in premiums, a market that has been soft since 2003.

Here are some before and after photos of the progress that Japan is making on rebuilding after their triple catastrophe.

Japan continues to deal with the enormous task of cleaning up and moving forward three months after the 9.0 earthquake and tsunami that devastated the northeast coast. Local authorities are still dealing with the damaged Fukushima Daiichi Nuclear Power Plant, and now the rainy season, which could increase the risk of disease as workers clear away the debris, is approaching. These images mark the three-month point, as well then-and-now images of the destruction shot by Kyodo News via the Associated Press.

Rules governing the restricted use of patient information create an additional liability exposure for the healthcare industry. The final HIPAA regulations establish the first ever national standards for privacy of health information. Enforcement activity for non-compliance may become an additional challenge for hospitals that are governed by these regulations in the near future.

R&R Insurance offers coverage that provides defense and indemnity protection for fines and penalties levied by Federal or State enforcement agencies as a result of government allegations of HIPAA regulatory violations.

For more information about Regulatory Compliance Insurance, contact a knowledgebroker.

Centers for Medicare & Medicaid Services (CMS) Recovery Audit Contractor (RACs) conduct automated reviews of Medicare payments to health care providers—using computer software to detect improper payments. RACs also conduct complex reviews of provider payments—using human review of medical records and other medical documentation to identify improper payments to providers. Improper payments include:

• incorrect payment amounts;
• incorrectly coded services (including Medicare Severity diagnosis-related group (MS-DRG) miscoding;
• non-covered services (including services that are not reasonable and necessary);
• duplicate services.

AHA created RACTrac—a free, web-based survey—in response to a lack of data provided by CMS on the impact of the RAC program on America's hospitals. Hospitals use AHA’s online survey application, RACTrac, to submit their data regarding the impact of the RAC program. Survey questions are designed to collect cumulative RAC experience data, from the inception of a hospital’s RAC activity through the 4th quarter of 2010. Survey registration information and RACTrac support can be accessed at ractracsupport@providercs.com 1-888-722-8712.

For more information about Recovery Audit Contractor, contact a knowledgebroker.

Do you know your organization’s incidence rate....? Each year employers should not only record the number of injuries and illnesses but also calculate their incidence rate and benchmark against other like industries to determine future safety activities to decrease employee injuries/illnesses.

The calculation is simple.

Total number of injuries and illnesses x 200,000
÷
Number of hours worked by all employees
= Total recordable case rate

(The 200,000 figure in the formula represents the number of hours 100 employees working 40 hours per week, 50 weeks per year would work, and provides the standard base for calculating incidence rates.)

You can also compute the incidence rate for recordable cases involving days away from work, days of restricted work activity or job transfer (DART) using the following formula:

Number of entries in column H + Number of entries in column I) 200,000 ÷ Number of hours worked by all employees = DART incidence rate

Wisconsin business - If you would like to know how your business stacks up against your peers or competition with regard to your incident rate, contact knowledgebroker Maureen Joy at R&R for more information!

You've heard this old adage before - and it's true in the insurance world as well. The housekeeping you keep in your business is the very first impression an OSHA inspector or an underwriter will have of your entire operation. Once a negative impression of your business is formed, it's very hard to undo that damage. Make housekeeping a daily part of your business operation - it will help to reduce your premium cost in the long run.

John Brengosz, Risk Management Specialist explains more about the importance of housekeeping and why it matters.

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Special hazards are elements of an operation that create a significant fire hazard, such as sawdust or spray painting. An insurance carrier is going to to have a very scrutinizing eye when it comes to this part of your operation - be prepared to make sure that all aspects of these special hazards are contained.

John Brengosz, Risk Management Specialist explains more about containing special hazards.

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