Business insurance firm Beazley Group recently enhanced its healthcare line of coverage with a new focus: ICD-10 liability.
With the compliance date two weeks away, it’s a good time to take a gut check and really come to terms with whether physicians are documenting care with the specificity needed to support a particular ICD-10 claim, and whether physicians or staff members are consistently selecting the most appropriate ICD-10 code.
If codes come October are often being submitted at a higher payment level than Medicare, Medicaid or commercial insurers believe appropriate, they could come back and ask for reimbursement, says Kelly Webster, healthcare management liability focus group leader at Beazley.
“It doesn’t have to be intentional,” she explains. “Under the False Claims Act, you can be held liable for overbilling.” The reasons for overbilling could be that physicians or staff members were not properly educated or just sloppy, but an insurer may see that as negligence or reckless disregard. And if the payer is Medicare or Medicaid, a provider could face criminal or civil charges. Even more troubling, according to Webster, it doesn’t matter if the provider or organization was coding in good faith.
Consequently, Beazley offers ICD-10 coverage from its Employment Practices Liability line of business. For instance, a whistleblower may claim wrong codes were used or other irregularities occurred at an organization and if the employment environment is now hostile or the whistleblower was fired, a lawsuit might be filed. Or the government may come after the organization. This coverage has a $20 million limit.
ICD-10 coverage also now is part of Beazley’s Regulatory Liability line of business for any claims against an insured entity or insured persons. The coverage has a $15 million limit. Beazley is marketing both coverage business lines to hospitals, academic medical centers, long-term care facilities and group practices of 100+ physicians. More information is available here.
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