Mutual Matters

Medicare Update - Appropriate Use Criteria 

Posted by Hoyt Torras, MPA, MHA on Jan 19, 2018 12:05:00 PM

This summary is based primarily on the Medicare Physician Fee Schedule CY2018, Final Rule – Published in the Federal Register November 15, 2017.

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Topics: Billing and Reimbursement

Sexual Harassment Complaint Prevention and Response Checklist

Posted by MagMutual Patient Safety Institute on Jan 11, 2018 11:50:00 PM

A clear and effectively implemented anti-harassment policy and complaint procedure helps employers prevent sexual harassment complaints; encourages employees to come forward when they experience harassment; serves as a road map for responding to harassment complaints; and provides an effective defense in litigation over sexual harassment claims.

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Topics: Employment Issues and Workplace Management

Data Breach of Nearly 500,000 Health Records Reported in Sept. 2017

Posted by Michael Bertoncini, JD, Jackson Lewis on Jan 4, 2018 11:50:00 AM

A recent report indicates that nearly 500,000 individual health records were breached in September 2017. This figure is taken from the 39 healthcare data breaches involving more than 500 records that were reported to the Department of Health and Human Services’ Office for Civil Rights in September 2017. 

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Topics: HIPAA and Cybersecurity

Misdiagnosed Ectopic Pregnancy – Another Example of Cognitive Bias?

Posted by Bill Kanich, MD on Dec 28, 2017 1:15:00 PM

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Topics: Patient Care and Interaction

Is Thrombolysis Only for a Crisis?

Posted by Marshaleen King, MD on Dec 21, 2017 1:00:00 PM

Indications for Thrombolytic Therapy in Patients with Acute Pulmonary Embolism

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Topics: Patient Care and Interaction

Communication Breakdown Contributes to Shoulder Dystocia Claim

Posted by Marshaleen King, MD on Dec 14, 2017 2:24:58 PM

The Case

A 29-year-old female patient (G2, P1) presented with a past history of shoulder dystocia in her first delivery. Her estimated delivery date (EDD) was 4/24/14. At her next prenatal visit on 4/5/14, she was seen by a certified nurse midwife (CNM). At that time, the patient weighed 226 pounds and the clinical assessment estimated the fetal weight to be over 8 pounds.

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Topics: Patient Care and Interaction

Don’t Complicate your Complication, a surgical complication case study

Posted by Marshaleen King, MD on Nov 30, 2017 1:00:00 PM

Case Scenario

A 64-year-old woman presented to the emergency room (ER) with right sided abdominal pain. Her ER evaluation revealed cholelithiasis with thickening of the gall bladder wall. The patient was admitted by the surgical team on call and underwent laparoscopic cholecystectomy. 

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Topics: Patient Care and Interaction

Reducing Medical Errors by Improving the Diagnostic Process

Posted by Marshaleen King, MD on Nov 16, 2017 1:30:00 PM


Medical errors remain a major cause of morbidity and mortality and recent estimates indicate that it is likely the third leading cause of death in the US, [1] with some sources reporting an incidence of 210,000 to 400,000 deaths annually due to errors among hospitalized patients.[2]

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Topics: Patient Care and Interaction

Billing Under Another Provider's Number Can Land Physicians in Hot Water

Posted by Emma Cecil on Nov 7, 2017 11:29:00 AM

An Oklahoma physician agreed on August 28, 2017 to pay the government $580,000 to resolve allegations that he violated the False Claims Act by submitting claims to the Medicare program for services he did not provide or supervise. According to the government, the physician allowed a company that employed him and in which he had an ownership interest, to use his national provider identification (NPI) numbers to bill Medicare for physical therapy evaluation and management services that he did not provide or supervise. The government further alleged that after he separated from the company and deactivated his NPIs associated with the company, he reactivated those NPIs so that the company could use them to bill Medicare for services he neither performed nor supervised.

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Topics: Billing and Reimbursement

Lack of Medical Necessity & the Criminalization of Clinical Decision Making

Posted by Emma Cecil on Oct 31, 2017 11:00:00 AM

In 2010, Georgia nursing home owner and operator, George Houser, was charged in a federal indictment with conspiracy to commit healthcare fraud on the theory that he had billed Medicare and Medicaid for services that were so inadequate or deficient that they were essentially “worthless.”

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Sharing Insight on Mutual Matters

Here we share some basic insights on matters that are important to physicians, hospitals and healthcare professionals.

Topics include:

  • Legislative updates that affect healthcare professionals
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