Callagy Law’s Legal Fact of the Day is a daily post to help all of our readers and followers get fun legal facts for the day, week, and month. You can see more on the Callagy Law blog page here.
The shoplifting ratio of women is higher than men.
I have learned over the years that when one’s mind is made up, this diminishes fear. –Rosa Parks
Callagy Law’s quote of the day is a daily post to help all of our readers and followers get the motivation they need to get through the day, week, and month. You can see more on the Callagy Law blog page here.
Callagy Law’s quote of the day is a daily post to help all of our readers and followers get the motivation they need to get through the day, week, and month. You can see more on the Callagy Law blog page here.
“Never mistake motion for action.”–Ernest Hemingway
Callagy Law’s Legal Fact of the Day is a daily post to help all of our readers and followers get fun legal facts for the day, week, and month. You can see more on the Callagy Law blog page here.
In 1869, Ada H. Kepley became the first woman in the United States to graduate from law school.
Callagy Law’s quote of the day is a daily post to help all of our readers and followers get the motivation they need to get through the day, week, and month. You can see more on the Callagy Law blog page here.
“Indecision and delays are the parents of failure.”– George Canning
Callagy Law’s Legal Fact of the Day is a daily post to help all of our readers and followers get fun legal facts for the day, week, and month. You can see more on the Callagy Law blog page here.
In 1869, Arabella Mansfield was the first woman admitted to the bar in Iowa.
On October 1, 2015, ICD-10 will go into effect, displacing ICD-9, which has been in place for 30 years. ICD-10 will introduce greater detail and therefore greater complexity to medical billing and coding practices. Indeed, In excess of 150,000 new procedure and diagnosis codes will be introduced. As a result, it is safe to say that disagreements with carriers and controversy in interpretation will be commonplace for some time to come. Because of this, medical providers need to brace themselves for what is sure to be increases in denials from carriers with a concomitant reduction in revenue. Although these denials of course can and should be challenged at every turn, medical provider cash flow in the short run will certainly be impacted.
This is especially true in light of the fact that ICD-10 is not being mandated, thus far, at the state level. Hence, PIP and WC claims can still be processed under ICD-9. This gives PIP and WC carriers perhaps an additional opportunity for denial—they might request a bill submitted under ICD-9 to be re-submitted under ICD-10 and vice versa—anything to cause delay or denial in reimbursement.
Medical providers need to be especially vigilant and aggressive in their refusal to accept these denials and delays at face value, and should prepare themselves financially for a reduction in revenue, at least in the short run.
If you have questions regarding ICD-10, or any other legal questions, please feel free to contact Callagy Law today! If you are a medical provider, please refer to our Medical Providers page on our website.
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New and existing small businesses have to consider if they will offer health insurance and if so the owner must pick the specific benefits for the company. Under the Affordable Care Act individuals and businesses have new rights and responsibilities regarding health care insurance.
The ACA has instituted new requirements involving various parts of employer-sponsored health care insurance including waiting periods, tax credits, and disclosure rules for employees. Owners and managers of small businesses should be aware of the legal requirements surrounding these regulations to ensure compliance.
Waiting Periods
Under current law, employers who offer health insurance cannot have waiting periods longer than 90 days. Employers occasionally use waiting periods before issuing health insurance to employees. These waiting periods can be to avoid providing costly health insurance to probationary employees before they are hired permanently. Alternatively, waiting periods are sometimes used for employees who are in training periods or have started on a part-time or temporary basis but are moving to a full-time role. Of course, employees must still meet other eligibility criteria in order to obtain the employer-based health insurance.
Tax Credits
For small employers, with fewer than 25 full-time equivalent employees, the Federal government may provide tax credits. Businesses that pay average wages below $50,000 and contribute 50% or more to its employees health insurance premiums, and buy insurance through the small business insurance marketplace may be eligible for the tax credits. The tax credits may equal up to 50% of the employer’s insurance premium costs.
Notably, employers do not have to provide coverage to employee dependents or to part-time employees.
Alternatively, employers who fail to meet IRS requirements with regard to offering health insurance, may face financial penalties.
Disclosures
Employers are now required to provide employees with summary of benefits documents that explain the benefits of the health insurance plan, such as what is covered and what the cost sharing between the employer and employee are under the plan. The coinsurance, copays, and deductibles for individual services as well as annual and lifetime levels are likely going to be included in the summary documents.
Insurance carriers will draft the benefit summary document, which may be based off of a standardized document for small group insurance plans or it may be customized for a particular business. Employers should familiarize themselves with the documents to ensure that they comply with the contract that the business signed with the carrier and so that they can communicate knowledgeably with employees who may have questions about benefits under the health plan.
Employers should note that they may face penalties for failing to comply with the disclosure requirement.
Contact a knowledgeable Lawyer for Assistance
Treading into the field of Federal and local regulatory law can be confusing for busy business owners. The experienced and dedicated attorneys at Callagy Law are ready to help answer your questions about forming a business or ensuring that your existing business is in compliance with the law. Contact the team here at Callagy Law today for legal guidance.
You may also be interested in these Callagy Law Blogs:
Medical Provider, Heal Thyself: Information on the Affordable Care Act
Citizens United and Hypocrisies
Is Obamacare in the Supreme Court Again?
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Callagy Law’s quote of the day is a daily post to help all of our readers and followers get the motivation they need to get through the day, week, and month. You can see more on the Callagy Law blog page here.
“While one person hesitates because he feels inferior, the other is busy making mistakes and becoming superior.”– Henry C. Link
Callagy Law’s Legal Fact of the Day is a daily post to help all of our readers and followers get fun legal facts for the day, week, and month. You can see more on the Callagy Law blog page here.
95 percent of pending lawsuits end in a pre-trial settlement. – The Law Dictionary
Callagy Law’s Legal Fact of the Day is a daily post to help all of our readers and followers get fun legal facts for the day, week, and month. You can see more on the Callagy Law blog page here.
According to payscale.com, the average pay for an attorney is $76,999 per year.
Callagy Law’s quote of the day is a daily post to help all of our readers and followers get the motivation they need to get through the day, week, and month. You can see more on the Callagy Law blog page here.
“Your reputation is more important than your paycheck, and your integrity is worth more than your career.” — Ryan Freitas, About.me co-founder
Callagy Law’s quote of the day is a daily post to help all of our readers and followers get the motivation they need to get through the day, week, and month. You can see more on the Callagy Law blog page here.
“Nature does not hurry, yet everything is accomplished.” Lao Tzu
Here is another book the Team at Callagy Law recommends!
START by Jon Acuff.
Callagy Law’s quote of the day is a daily post to help all of our readers and followers get the motivation they need to get through the day, week, and month. You can see more on the Callagy Law blog page here.
“Do not fear mistakes. You will know failure. Continue to reach out. ” Benjamin Franklin
Callagy Law’s quote of the day is a daily post to help all of our readers and followers get the motivation they need to get through the day, week, and month. You can see more on the Callagy Law blog page here.
“I’d rather have one percent of the efforts of 100 people than 100 percent of my own efforts.”– J. Paul Getty
Today was a fun day at Callagy Law! When you give our staff a few freebies, we go a little crazy on social media!
We wanted to share a bit of our fun, and hope you enjoy!
Medical doctors enter medicine to practice medicine, not to be bill collectors, but running a medical practice is far from inexpensive today. From medical malpractice insurance, personnel costs, operational costs, rent, and other administrative costs, the everyday costs of running a practice can be quite high.
Also, under many laws at either the state or Federal level, as well as under insurance carrier in-network contracts with doctors, providers are required to bill patients for their portion of a bill. So, patients are expected to pay for co-pays, coinsurance, and deductibles as required under their insurance plans.
Medical doctors are required to bill patients for the patient’s portion of the cost of medical care. If a doctor does not do so, he may face legal and financial penalties from regulators and insurance carriers. For example, an insurance carrier may reduce a provider’s payment by the percentage of the payment that the provider failed to bill the patient for. For example, if the provider billed a service at $100 with the insurer paying $80 and the patient to pay $20, but the patient was never charged, then the insurer may request a reimbursement of 20% of the $80 since the insurer only agreed to pay 80% of the total bill.
ERISA
The Employee Retirement Insurance Security Act (ERISA) is a Federal law that establishes minimum standards for employer-sponsored retirement plans as well as health insurance plans. While ERISA puts many requirements on employers regarding how they administer plans for their employees, providers may also be subject to ERISA.
Under ERISA health care plans, employers must provide their employees with health insurance plan information. As such, employees are expected to know and adhere to their responsibilities in paying for their share of the medical bill, such as coinsurance, copays, or deductibles.
Alternatively, insurance carriers representing employers are required to follow certain notice and disclosure rules in working with providers in providing reimbursements. Insurance carriers must be open and transparent about their policies and payment decisions under ERISA plans. In other words, insurers cannot simply deny claims or dramatically underpay claims without a reasonable explanation.
State Prompt Pay Laws
Some states, including New York, have prompt pay laws. Under prompt pay laws, insurance carriers are required to pay “clean claims” (medical claims from providers without any missing or incorrect information) within a certain number of days, such as 45 days. So, if insurers are dragging their feet on claims by neither approving or denying them then they may be violating state law. As a result, it may be necessary for a provider to reach out to the state insurance commission, or similar agency, and file a complaint. Doing so may push the insurance carrier to improve their processes and pay in accordance with the law.
Contact a Knowledgeable Law Firm for Guidance
Creating and maintaining a business can be a daunting endeavor. The experienced and dedicated attorneys at Callagy Law are ready to help answer your questions about forming a business or ensuring that your existing business is in compliance with the law. Contact Callagy Law now for legal guidance.
More information on Callagy Law’s Medical Revenue Recovery program click here.
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Callagy Law’s quote of the day is a daily post to help all of our readers and followers get the motivation they need to get through the day, week, and month. You can see more on the Callagy Law blog page here.
“Effective performance is preceded by painstaking preparation.” – Brian Tracy
Callagy Law’s quote of the day is a daily post to help all of our readers and followers get the motivation they need to get through the day, week, and month. You can see more on the Callagy Law blog page here.
“I hire people brighter than me and I get out of their way.”- Lee Iacocca
Callagy Law’s quote of the day is a daily post to help all of our readers and followers get the motivation they need to get through the day, week, and month. You can see more on the Callagy Law blog page here.
“Outstanding leaders go out of their way to boost the self esteem of their personnel. If people believe in themselves, it’s amazing what they can accomplish.”- Sam Walton
Callagy Law’s quote of the day is a daily post to help all of our readers and followers get the motivation they need to get through the day, week, and month. You can see more on the Callagy Law blog page here.
“Passion is energy. Feel the power that comes from focusing on what excites you.”- Oprah Winfrey
Small and new businesses have a lot to think about. Producing their products, providing services, and maintaining positive relationships with customers should be the key focus of businesses, not worrying about unknowns when it comes to regulatory compliance.
To stay focused on the core business of a company, management should be aware of the major regulatory and legal requirements that businesses must comply with in their jurisdiction.
Federal Rules
The Federal government has implemented several regulations that businesses must comply with or face serious fines or legal consequences. These regulations revolve around protecting employees or the public from discrimination or unfair treatment. Two of the most significant laws are the Americans with Disabilities Act and the Federal Labor Standards Act.
Americans with Disabilities Act
The Americans with Disabilities Act protects disabled individuals from discrimination in the workplace and customers from buildings and shops without accessible areas for the disabled.
Employers with 15 or more employees generally will have to provide “reasonable accommodations” to employees with recognized disabilities that allow the employee to do his or her job but with an accommodation that mitigates the employee’s disability. Businesses that are open to the public such as restaurants or stores, generally must provide accessible areas for disabled customers (such as those in wheelchairs). So, businesses may have to provide wheelchair ramps, wide hallways, and accessible restrooms unless the business has some sort of exception, such as perhaps for a historic property.
Before renovating a business, owners should be sure to consider accessibility in their designs to ensure compliance with the Federal ADA as well as other building codes at the state or local level.
Federal Labor Standards Act
The Federal Labor Standards Act (FLSA) provides a Federal floor for compensation for employees of private businesses. Under the FLSA, most rank and file employees must be paid at least the Federal minimum wage for regular hours and must pay overtime at one-and-a-half times the employee’s regular pay for overtime over 40 hours in a week.
Employees who are “exempt” do not have to meet FLSA rules. “Exempt” employees are generally considered management or professional workers such as doctors or lawyers. Exempt workers are generally paid on a salary basis rather than an hourly basis like most rank and file employees who are considered “non-exempt.”
The FLSA also requires that employers provide posted notice to employees in a public area, such as a break room or kitchen, stating their rights under the FLSA.
Local Rules
Businesses also need to be aware of other key Federal laws as well as local laws that may have higher standards than those laid out in Federal laws. For example, some jurisdictions require that compliance with nondiscrimination rules start at just one employee.
Contact a Skilled Lawyer for Help
Treading into the world of Federal and local regulatory law for businesses can be confusing for busy business owners. The experienced and dedicated attorneys at Callagy Law are ready to help answer your questions about forming a business or ensuring that your existing business is in compliance with the law. Contact Callagy Law today for legal guidance.
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Callagy Law’s quote of the day is a daily post to help all of our readers and followers get the motivation they need to get through the day, week, and month. You can see more on the Callagy Law blog page here.
“When we truly need to do is often what we most feel like avoiding.” – David Allen
Callagy Law’s quote of the day is a daily post to help all of our readers and followers get the motivation they need to get through the day, week, and month. You can see more on the Callagy Law blog page here.
The question isn’t who is going to let me; it’s who is going to stop me. –Ayn Rand
Busy business owners and procurement officials frequently enter into many contracts with suppliers, customers, landlords, and many other individuals as well. Most of these contracts will likely go off without a hitch. But, some of the contracts may not work out and lead to disputes over payments, production, or services, that may even lead to litigation. Contracts, as legally binding documents, are very important for businesses to execute wisely.
What Does the Contract Actually Say?
In negotiations between a buyer and seller, there are often various promises and assurances made on both sides. However, the final contract may not necessarily contain those oral promises either by accident or on purpose to deceive the other party. As such, it is critical that each party carefully read and understand what is being proposed in the contract itself and what recourse each party has to make the other party perform or to obtain damages from non-performance.
Contract Disputes Can Be Very Costly
Contract disputes can be huge headaches for businesses in the monetary cost, business productivity, and just as a general distraction for management and staff. In New Jersey, a contract dispute over the type of document used in a contract bid (a letter versus a customary form) has resulted in protracted litigation that has gone all the way to the New Jersey Supreme Court.
Litigation can be quite costly and time-consuming (sometimes lasting several years) and may not even lead to satisfactory results. A business may obtain monetary damages if another party fails to fulfill its contractual obligations, but it may not truly make the business whole if it suffered losses to its core business or even lost customers for good as a result of the contract’s breach.
Catching Issues Before There is A Dispute is Easier than Litigation
Even though it may take more time to carefully review an agreement and discussing the terms with the other party before signing it, doing so helps to ensure that both parties understand the contract and agree to what is in the contract, rather than some other notion of what the deal supposedly is going to do.
Also, negotiators should realize that contract language can vary from industry to industry and legal requirements or expectations can differ also depending on the nature of the agreement. For example, a software license will probably look totally different than a consultant agreement, and the terms that are most important for each party in those different agreements will also be quite different.
Businesses should have standard procedures or checklists to facilitate contract review and approval to ensure that contracts are consistent across the organization to the extent possible.
Contact a Skilled Lawyer for Help
Treading into complex and dense contract language can be confusing for busy business owners. The experienced and dedicated attorneys at Callagy Law are ready to help answer your questions about forming a business or ensuring that your existing business is in compliance with the law. Contact Callagy Law today for legal guidance.
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Callagy Law’s quote of the day is a daily post to help all of our readers and followers get the motivation they need to get through the day, week, and month. You can see more on the Callagy Law blog page here.
“Simplicity boils down to two steps: Identify the essential. Eliminate the rest.” Leo Babauta
Callagy Law’s quote of the day is a daily post to help all of our readers and followers get the motivation they need to get through the day, week, and month. You can see more on the Callagy Law blog page here.
“Your mind is for having ideas, not holding them.”David Allen
Callagy Law’s quote of the day is a daily post to help all of our readers and followers get the motivation they need to get through the day, week, and month. You can see more on the Callagy Law blog page here.
Discipline is the bridge between goals and accomplishments – Jim Rohn
Callagy Law’s quote of the day is a daily post to help all of our readers and followers get the motivation they need to get through the day, week, and month. You can see more on the Callagy Law blog page here.
“The way we measure productivity is flawed. People checking their BlackBerry over dinner is not the measure of productivity.”– Timothy Ferriss
Callagy Law’s quote of the day is a daily post to help all of our readers and followers get the motivation they need to get through the day, week, and month. You can see more on the Callagy Law blog page here.
“There is no waste in the world that equals the waste from needless, ill-directed, and ineffective motions.” -Frank Bunker Gilbreth, Sr.
