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Friday, March 25, 2016

Workers’ Compensation Coverage Required for New Jersey Employers

The purpose of this post is to help assist those with questions they have concerning their business or medical practice. The Callagy Law team is knowledgeable in many law practice areas and will frequently post topics ranging from Medical Revenue Recovery, PIP, Workers Compensation, and Commercial Insurance. We hope to have this blog shed a light on many common questions.

The State of New Jersey Department of Banking and Insurance requires that New Jersey employers post notice of workers’ compensation insurance coverage or qualification as a self-insured employer. The only New Jersey employers except from the requirement of workers’ compensation coverage or the qualified self-insurance are those covered by Federal programs. Moreover, this requirement extends to out-of-state employers under certain circumstances. These situations include out-of-state employers who hire employees to perform work in New Jersey. Also included are out-of-state employers who have entered in employment contracts in the state of New Jersey. Finally, New Jersey employers must provide information to their employees regarding the procedures to be followed in the case of a worker related incident. Such information must include the following: (1) Where to seek medical treatment; (2) The proper procedure for reporting an injury while working; and (3) Information explaining workers’ compensation insurance coverage and benefits. Employees and managers should be made aware of this information upon being hired and during the course of employment.

We hope you found the information provided in this article helpful to various questions you may have had concerning the healthcare industry. For information pertaining to our services for medical providers, please click here. Please note, Callagy Law has recovered over $185,000,000 for medical providers, and that number grows daily. Please free to reach out to Sean Callagy of Callagy Law at any time for questions you may have concerning personal and business matters. Callagy Law offices are located conveniently in Paramus, NJ. Beyond the scope of information, Sean Callagy has developed multiple areas of our healthcare legal practice and business coaching. Feel free to connect with us on Facebook, Twitter or LinkedIn! Additionally you can subscribe to our daily videos on YouTube.

Workers’ Compensation Coverage Required for New Jersey Employers

Monday, January 18, 2016

A Closer Look into Amendments | Callagy Law

15 Million Civil Lawsuits Are Filed Each Year in the United States | More insight into amendments

The following article was written by Callagy Law’s Legal Team, and will focus on many common questions and concerns surrounding new developments, legal matters, and other procedures within business and commercial litigation. Our mission is to answer any questions and give knowledge to many different aspects of these matters.

According to the latest polls, 15 million civil lawsuits are filed each year. That is one lawsuit for every twelve adults in America and one filing every two seconds. One overarching flaw that a majority of these complaints and their corresponding answers have in common is that they fail to name all the proper parties or assert all the proper claims or defenses. The mechanism to fixing these mistakes is called an amendment.

In the trial level court of New Jersey, called the Superior Court, one of the rules governing amendments is 4:9-1. Specifically this rule allows a party to amend their pleading once at any time before the opposing party responds. After a party a responds, there are then only two avenues to amend: one is by consent of the other party and the other is by leave of court which “shall be freely given in the interest of justice”

The phrase “in the interest of justice” is quite broad and may leave many readers wondering what courts will look to decide if an amendment fits into this phrase. While there a handful of factors that a court analyzes in reaching this conclusion, the overwhelming consideration is the prejudice that will be suffered by the other party if the amendment is granted.

In Keller v. Pastuch, the Plaintiff, who were husband and wife, brought suit against an automobile driver after the car the wife was riding in was struck by the Defendant. 94 N.J. Super. 499, 501 (App. Div. 1967). On the opening day of trial the defendant sought leave of court to amend his answer to include a new defense. Id. Subsequently, the court granted a mistrial and heard, later on that same day, oral arguments on whether the amendment should be granted. Id.

The plaintiffs argued that they would be substantially prejudiced due to the lateness of the defendant’s proposed amendment. Id. In response, the defendant argued that he did not know this defense was available to him until a recently conducted interview. Id. at 503. The court sided with the plaintiff and held that the defendant could have asserted the defense earlier, which in turn would have allowed the plaintiff’s to preserve their rights.

By contrast, in Sheppard v. Braun the court granted plaintiff’s motion to amend to add two new parties. No. ATL-L-1900-05, 2005 WL 2560782, at *1 (N.J. Super. Ct. Oct. 7, 2005). The plaintiff, a car accident victim, sought to add the Borgata Hotel after he recently learned that the hotel may have been serving alcoholic beverages that contributed to the accident. Id. The court summarily granted the motion, due to the fact that it was unopposed and no trial or arbitration date had been set. Id.

Thus, as a litigant it is important to act swiftly when amending a pleading, so as to ensure that the opposing party is not prejudiced and thereby causing the court to deny the amendment.

Sean Callagy, the owner and President of Callagy Law is an attorney, business coach, public speaker, and entrepreneur; and is dedicated to the personal and business growth. Please reach out to us here with any questions or comments regarding personal or business matters. We will to continue to provide daily updates with helpful information on our website and social media. Please feel free to contact Callagy Law at anytime. Feel free to connect with us on Facebook, Twitter or LinkedIn! Additionally you can subscribe to our daily videos on YouTube by clicking here.

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A Closer Look into Amendments | Callagy Law

Tuesday, December 29, 2015

A Closer Look into Bundling & PIP Regulations | Callagy Law

The Bucket 4 “Carve Out”

After searching various sources, we have found many people have questions when it comes to Medical Revenue Recovery, PIP, Workers Compensation, and Commercial Insurance. The following article was written by Callagy Law’s Legal Team, and will focus on many common questions and concerns surrounding new developments, legal matters, and other procedures within the field of healthcare law and medical revenue recovery. Our mission is to answer any questions and give knowledge to many different aspects of these matters

This blog is a little bit “inside baseball,” in that it’s a hyper technical explanation look at a concept in the world of bundling. If you’re a PIP practitioner, however, or deal with ASCs and Hospitals, this is an important concept that could lead to a much larger amount of recovery/reimbursement for ASCs or Hospitals

When DOBI updated the PIP regulations (effective 1/4/13) the update included a new section on the “bundling” of outpatient surgical services. Specifically, N.J.A.C. 11:3-29.5(a)(1-8) and N.J.A.C. 11:3-29.5(b) (which incorporates (a)(1-8)) inform providers and carriers which services are considered “bundled” and are not separately reimbursable.

The code, in relevant part, reads as follows:

11:3-29.5 Outpatient surgical facility fees

ASC facility fees are listed in Appendix, Exhibit 1, by CPT code. Codes that do not have an amount in the ASC facility fee column are not reimbursable if performed in an ASC. The ASC facility fee include services that would be covered if the services were furnished in a hospital on an inpatient or outpatient basis, including:

Use of operating and recovery rooms, patient preparation areas, waiting rooms, and other areas used by the patient or offered for use to persons accompanying the patient;

All services and procedures in connection with covered procedures furnished by nurses, technical personnel and others involved in the patient’s care;

Drugs, biologicals, surgical dressings, supplies, splints, casts, appliances, and equipment;

Diagnostic and therapeutic items and service. Appendix, Exhibit 1 indicates those CPT codes that, according to Medicare (see: www.cms.gov/ASCPayment/ASCRN/list.asp, CMS-1504-FC, Exhibit AA), are considered ancillary services that are integral to surgical procedures and are not permitted to be reimbursed separately in an ASC. Appendix, Exhibit 7 indicates those services that, according to Medicare are considered ancillary services that according to Medicare (see: https://www.cms.gov/HospitalOutpatientPPS/Downloads/CMS1506FC_Addendum_

D1.pdf) are integral to surgical procedures and are not permitted to be reimbursed separately in a HOSF;

Administrative, recordkeeping, and housekeeping items and services;

Blood, blood plasma, platelets, etc.;

Anesthesia materials, including the anesthetic itself, and any materials, whether disposable or re-usable, necessary for its administration; and

Implantable DME and prosthetics.

(b) HOSF fees are listed on subchapter Appendix, Exhibit 7 by CPT code. The hospital outpatient surgical facility fee is the maximum that can be reimbursed for outpatient procedures performed in an HOSF. The hospital outpatient facility fees in Appendix Exhibit 7 include services that would be covered if furnished in a hospital on an inpatient basis, including those set forth in (a)1 through (8) above.

(a)(1-8), which I’ll colloquially refer to as the “8 buckets,” essentially states that each bucket is included in the main surgical procedure that was performed in the ASC or Hospital on that particular date of service, and that the type of service described by that bucket is not separately reimbursable, since DOBI has already included reimbursement for such services in the price of the ain surgical code on the appropriate fee schedule.

There is a catch, however. N.J.A.C. 11:3-29.5(a)(4) states:

Diagnostic and therapeutic items and service.

Appendix, Exhibit 1 indicates those CPT codes that, according to Medicare … are considered ancillary services that are integral to surgical procedures and are not permitted to be reimbursed separately in an ASC.

Appendix, Exhibit 7 indicates those services that, according to Medicare are considered ancillary services that according to Medicare… are integral to surgical procedures and are not permitted to be reimbursed separately in a HOSF;

Callagy Law’s PIP attorneys have been successful in arguing that bucket 4 actually is actually a “carve out,” and should be read and interpreted differently than the other 7 buckets. Our attorneys argue that bucket 4 requires a carrier to not simply state that all diagnostic and therapeutic items and services are automatically included in the main surgical procedure; rather, the carrier must first identify the diagnostic and therapeutic items and services and then proceed to the appropriate fee schedule (Exhibit 1 for ASCs, and Exhibit 7 for Hospitals) to determine whether those services are, in fact, bundled.

There is an entire column in Exhibit 7 (The Hospital Outpatient Surgical Facility Fee Schedule – “HOSF”), for example, titled “Packaged Item; No Separate Payment.” Our argument is that DOBI is directing providers and carriers to examine Exhibit 7 to see whether the particular diagnostic/therapeutic services being provided in a particular case are marked as bundled. (see screenshot of Exhibit 7 below)

Many diagnostic/therapeutic codes on the HOSF do have indicators in the column meaning that they are bundled, but many codes either have no indicator, or do not appear on the HOSF at all. In those cases, it is the position of the Callagy Law PIP attorneys that the diagnostic/therapeutic codes ARE entitled to separate reimbursement.

These diagnostic/therapeutic codes often add up to hundreds or thousands of dollars in a particular outpatient surgery, and so mastery of this concept can mean a great deal of additional recoverable money for a particular provider. This position has been successful with several arbitrators, and the wave of momentum for this argument only seems to be growing stronger.

We hope you have found this information helpful and interesting. Please reach out to us here with any questions or comments regarding healthcare legal matters, or if you are a medical provider that has questions regarding Medical Revenue Recovery, PIP, Workers Compensation, and Commercial Insurance.. Feel free to search us on Facebook, Twitter or LinkedIn! Additionally you can subscribe to our daily videos on YouTube.

Learn More About Callagy Law Here:

A Closer Look into Bundling & PIP Regulations | Callagy Law

Tuesday, December 8, 2015

Hospital Anesthesia Services Potentially Recoverable! | Callagy Law

Are Hospitals Entitled to Reimbursement for anesthesia services?

The following article was written by Callagy Law’s Legal Team, and will focus on many common questions and concerns surrounding new developments, legal matters, and other procedures within the field of healthcare law Medical Revenue Recovery, PIP, Workers Compensation, and Commercial Insurance. Our mission is to answer any questions and give knowledge to many different aspects of these matters.

Anesthesia is a way to control pain during a surgery or procedure by using medicine called anesthetics. General anesthesia is used to ensure comfort and safety during certain types of procedures. Anesthesia effects and helps control a patient’s breathing, blood pressure, blood flow, and heart rate/rhythm, among other things.

When you get general anesthesia, in layman’s terms, “put under,” you are completely unconscious and immobilized. General anesthesia may be administered via gas, an IV line or a combination of both. Typically, major/complex procedures that require a long period of time to perform require general anesthesia.

A patient may present to an Ambulatory Surgery Center (ASC) or a Hospital facility to undergo these types of major/complex procedures. In a case where a patient presents to a Hospital facility to undergo a procedure, the Hospital provides the anesthesia and necessary supplies. The hospital provides the equipment, supplies and sometimes staff required to safely and effectively deliver anesthesia services during the procedure. The specific resources that the hospital provides vary depending upon the type of anesthesia the patient requires and the patient’s particular medical condition. The staff will also vary according to the hospital. Sometimes the staff are outside anesthesiologists working in the hospital, and sometimes, they are hospital employees.

So how is this billed to the insurance carrier? In the case of the outside anesthesiologist, they will bill separately for his or her professional services, as will your surgeon and the other physicians who provide services for you while you are hospitalized. They will bill for part of the services, called the professional component. The hospital will issue a separate bill for all of the services and items the hospital provided during your hospitalization and that bill will include charges for the hospital’s role in the delivery of anesthesia services based on the specific type anesthesia services a patient receives. The hospital’s bill is for what’s called the technical or facility component.

An insurance carrier may attempt to argue that the Hospital improperly submitted what constitutes duplicate billing of anesthesia for the date(s) of service that are at issue. Usually, this is based upon the fact that the anesthesiologist, who administered the anesthesia services on the date(s) in question, had already submitted his/her independent bills for the “same” instance of anesthesia services for the procedure. This is incorrect, as both the anesthesiologist and hospital are each billing only for their portion of the services provided.

The insurance carrier may also attempt to argue that pursuant to N.J.A.C. 11:3-29.4(o)(7) anesthesia materials, including the anesthetic itself, and any materials, whether disposal or reusable, necessary for its administration are not entitled to a separate charge. As such, the Hospital facility would not be entitled to reimbursement for anesthesia because anesthesia services were “bundled” into the main surgical code. However, this is not always the case.

There are several arguments that Callagy Law has successfully advanced where arbitrators in NJ No-Fault (PIP) arbitrations have determined that such anesthesia services are separately reimbursable to the hospital. Namely, if the procedure was an inpatient procedure, if it was an emergency procedure, or if it was an outpatient surgical procedure, where the main surgical code billed was not on the Hospital Outpatient Surgical Facility (HOSF) fee schedule. In each of these examples, there are strong arguments to be made that the technical/facility portion of anesthesia should have been reimbursed to the Hospital, despite the carrier’s arguments to the contrary.

Therefore, Hospital facilities are sometimes entitled to separate reimbursement for anesthesia services in addition to the anesthesiologist’s separate and distinct bill for his/her own personal services.

We hope you have found this information helpful and interesting. Please reach out to us here with any questions or comments regarding healthcare legal matters, or if you are a medical provider that has questions regarding Medical Revenue Recovery, PIP, Workers Compensation, and Commercial Insurance.. Feel free to search us on Facebook, Twitter or LinkedIn! Additionally you can subscribe to our daily videos on YouTube.

Learn More About Callagy Law Here:

Hospital Anesthesia Services Potentially Recoverable! | Callagy Law

Tuesday, October 27, 2015

The Litigation Funding Business: A Closer Look

The litigation funding business consists of hundreds of companies throughout the country which purchase portions of the anticipated recoveries of plaintiffs in pending lawsuits. In return for these cash advances, the funding company receives a contingent interest in the potential post-judgment proceeds of the plaintiff’s case. The nonrecourse nature of these transactions distinguish litigation funding from traditional loans, which require absolute repayment— i.e., in litigation funding, if the plaintiff fails to recover, the funding company receives nothing in return for its cash advance. It is only in scenarios where a plaintiff recovers on his or her claim, that litigation funding companies receive any return on its investment.

In Opinion 691 of “Referral of Personal Injury Client to Third-Party Factor Which Will Purchase an Interest in the Case,” Referral of Personal Injury Client to Third-Party Factor Which Will Purchase an Interest in the Case, 2001 WL 169754, the Supreme Court’s Advisory Committee on Professional Ethics (the “Committee”), explains the fundamental purpose of the litigation funding business and how it operates. The Committee explains that the purchase of a portion of a “potential personal injury settlement or judgment” involves a great degree of risk being assumed by the possibility that a plaintiff’s claim could fail completely, or yield insufficient awards unable to cover the original investment. Id. at p. 2. Further, litigation funding companies often represent the only option available to plaintiffs, to address their immediate personal financial needs, and relieve the pressure “to accept a settlement offer not in the client’s best interests simply in order to survive financially.” Id. at p. 3. The Committee concludes that, “… a lawyer may ethically refer a client to a factor concerning a possible advance against an anticipated personal injury judgment or settlement, provided that the standards and limitations [as to independence of the lawyer’s judgment, etc., were] followed. Id. at p. 6.

Opinion 691 also acknowledges that litigation funding companies have been visible and accepted in the legal setting for years. By providing such funds, litigation funding and the pre-settlement finance industry as a whole, helps to level the playing field in many cases where cash-strapped plaintiffs would otherwise be forced to accept inadequate and unfair settlement offers made by large companies that have the resources to out-litigate and ultimately out-last individual victims of their insured’s’ tortious conduct. On a final note, while some may be skeptics of the litigation funding business, pre-settlement finance companies take great risks in these business ventures and are often a plaintiffs only opportunity to maintain personal financial viability while his or her case works itself through the legal system to a fair and just resolution.

The team at Callagy Law hopes the information in this article was helpful in either your personal or professional life. Businesses and people are multi-dimensional and at times may need a guiding light. The legal world pertains to all walks of life and businesses, therefore, we aim to provide information which will help you navigate through your life. Callagy Law, is a multidisciplinary law firm, headquartered in Paramus, NJ owned and operated by Sean Callagy. We are committed to providing legal representation and advice to our clients at our law offices located in New York, New Jersey and Arizona. Please note that the information posted here should not be used as a legal argument of defense. If you find yourself needing legal advice pertaining to your unique situation, you can contact us at by writing us here. Feel free to connect with us on Facebook, Twitter or LinkedIn! Additionally Callagy Law has had some great reviews and is working hard to be a leader in multiple fields of the legal profession.

Related Blog: NY Litigation Funder Awarded $33.5M In Kickback Suit

The Litigation Funding Business: A Closer Look

Friday, September 25, 2015

How Do Businesses Ensure Compliance When Picking Healthcare Plans?

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?

Learn More About Callagy Law Here:

How Do Businesses Ensure Compliance When Picking Healthcare Plans?

Wednesday, March 11, 2015

Best Practices for Protecting Electronic Business Data

With the data breach at Sony in in the news and their high-value data exposed for all to see—including their clients who compete for big-ticket entertainment contracts—the risk of cyber hacking has experts to recommend best practices for protecting electronic business data, which is increasingly being compromised by cyber-criminals who know how valuable this information is. Is your data at risk? –

Callagy Law, LLC

While there is likely no foolproof way for companies to protect themselves against the most innovative and nefarious cyber hackers, companies must be able to proactively detect cyber security breaches as soon as possible to minimize the damage in the face of such a threat. Develop a plan. Even the best systems need to be actively monitored, so it is important that a company’s database is managed by cyber security to be able to detect and stop an attack as soon as possible. A company should do this by creating or improving upon existing policies, including the use of data encryption; employee training; limiting sensitive data to only those who need it; the implementation of security software on all devices; and instituting policies on how to choose and when to change passwords, among other in-house and outsourced policies and programs. Most important, companies should restrict the use of e-mail as it is a treasure trove of information for cyber criminals. As employees frequently communicate anything and everything via e-mail, access to this information could be most detrimental to your organization and clients. Adopt a “if it should never be made public, it shouldn’t be communicated on e-mail” posture regarding all e-mail communication.

See more at: http://commercemagnj.com/best-practices-for-protecting-electronic-business-data/#sthash.BUot613D.dpuf

Best Practices for Protecting Electronic Business Data