Physician - Medical Reviewer?

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avenger
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Physician - Medical Reviewer?

Post by avenger »

I am a physician employed by a local government. My liability insurance is provided by my employer and does not cover activities outside that scope of practice.

I recently applied to be a medical reviewer. Before moving forward, I am wondering if there are any liability concerns I should consider?

For what it’s worth I’m in Illinois and the medical review company is in another state.
cheers ... -Mark | "Our life is frittered away with detail. Simplify. Simplify." -Henry David Thoreau | [VTI, VXUS, BND, VTEB, SV fund]
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RickBoglehead
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Re: Physician - Medical Reviewer?

Post by RickBoglehead »

Pretty clearly there could be liability here. I would look for professional medical liability insurance.
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tenkuky
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Re: Physician - Medical Reviewer?

Post by tenkuky »

Do you also have your own LLC?
Will you be paid as a 1099 contractor?
Do you have to be licensed in the state you are conducting reviews in?
hachiko
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Re: Physician - Medical Reviewer?

Post by hachiko »

There is absolutely liability. And you may even be required to have malpractice insurance by the state board if you're doing medical work outside the scope of your other insured activities.
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neurosphere
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Re: Physician - Medical Reviewer?

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You'll have to define medical reviewer. If you are doing insurance reviews for example, I would think there is essentially no liability as you are providing an opinion to another party, similar to being an expert witness. I did insurance reviews for an independent review organization for a short while as an experiment of sorts (to see the "other side" if you will). I never worried about liability, but perhaps I should have, I don't know. :shock:
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avenger
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Re: Physician - Medical Reviewer?

Post by avenger »

Thanks all for the replies.

The degree of compensation is quite low on a hourly basis for my specialty.

I don’t think it’s worth pursuing further.
cheers ... -Mark | "Our life is frittered away with detail. Simplify. Simplify." -Henry David Thoreau | [VTI, VXUS, BND, VTEB, SV fund]
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avenger
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Re: Physician - Medical Reviewer?

Post by avenger »

neurosphere wrote: Tue May 18, 2021 8:20 am You'll have to define medical reviewer. If you are doing insurance reviews for example, I would think there is essentially no liability as you are providing an opinion to another party, similar to being an expert witness. I did insurance reviews for an independent review organization for a short while as an experiment of sorts (to see the "other side" if you will). I never worried about liability, but perhaps I should have, I don't know. :shock:
Yes it will be for insurance claims reviewing.
cheers ... -Mark | "Our life is frittered away with detail. Simplify. Simplify." -Henry David Thoreau | [VTI, VXUS, BND, VTEB, SV fund]
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Re: Physician - Medical Reviewer?

Post by Jack FFR1846 »

If you are reviewing cases for facilities in another state, you'll need to be licensed in that state. DW does this on the nurse reviewer level for a reviewer company, for Medicare reviewing cases at a hospital in a neighboring state. Her job is from home, reviewing records, determining criteria and appropriateness of stays. She had to get a license in the state where the hospital is located (not our state) along with her own. Was quite time consuming with Covid having offices everywhere shut down.

Her insurance shows all states she is licensed in and covers her for these.
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neurosphere
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Re: Physician - Medical Reviewer?

Post by neurosphere »

Jack FFR1846 wrote: Tue May 18, 2021 8:55 am If you are reviewing cases for facilities in another state, you'll need to be licensed in that state. DW does this on the nurse reviewer level for a reviewer company, for Medicare reviewing cases at a hospital in a neighboring state. Her job is from home, reviewing records, determining criteria and appropriateness of stays. She had to get a license in the state where the hospital is located (not our state) along with her own. Was quite time consuming with Covid having offices everywhere shut down.

Her insurance shows all states she is licensed in and covers her for these.
Licensing depends on the particular job. I was a reviewer for 6+ independent orgs, and none required me to be licensed in the state of the employer, provider, insurance company requesting the review, etc. State law likely comes into play more directly in Medicaid reviews. I assume Medicare review laws are more uniform from state to state. Just a guess. Individual facilities (i.e. hospitals) will also hire an independent reviewer to give guidance about a particular situation. For example, I was contacted by a hospital simply to ask "what would you have done in this case" and "what do you think is reasonable for the average non-subspecialist to do". They didn't need me to licensed in their state, because this wasn't a situation subject to state laws regarding the practice of medicine.
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Re: Physician - Medical Reviewer?

Post by neurosphere »

avenger wrote: Tue May 18, 2021 8:21 am Thanks all for the replies.

The degree of compensation is quite low on a hourly basis for my specialty.

I don’t think it’s worth pursuing further.
Yes, the compensation stinks, and I wonder why physicians do this. For some cases, I would get paid as little as $35. $50-$75 was common. Some firms pay on time and can vary by specialty. The highest I saw for pediatric neurology was $250/hour. But the work is disruptive, sporadic, and each firm has it's own system and interface and it's somewhat like learning a new EMR. I enjoyed it at first because I was learning how the insurance denial/appeal process worked and that helped me advocate for my patients when appropriate.
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avenger
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Re: Physician - Medical Reviewer?

Post by avenger »

When I voiced concern about liability with the recruiter, this is the explanation I got:

“I wanted to make sure you had a chance to review the FAQs attached as they address our most commonly asked questions regarding the contract. One of the questions in the FAQ is regarding the need for additional malpractice insurance. Company provides coverage through an Errors and Omissions policy and additional malpractice insurance is not required. Based on laws and regulations for IROs, such as Company, the Errors and Omissions policy is sufficient and there is no personal liability on your part as you are not directly seeing patients and are providing an opinion based on chart notes provided in relation to policy or medical literature/standards of care.”
cheers ... -Mark | "Our life is frittered away with detail. Simplify. Simplify." -Henry David Thoreau | [VTI, VXUS, BND, VTEB, SV fund]
toofache32
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Re: Physician - Medical Reviewer?

Post by toofache32 »

When your job is to deny medical coverage, the liability has to be very significant.
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Re: Physician - Medical Reviewer?

Post by scorcher31 »

toofache32 wrote: Tue May 18, 2021 10:27 pm When your job is to deny medical coverage, the liability has to be very significant.
https://afmc.org/afmc-reviewnews/utiliz ... liability/

Seems to essentially say you should be good. I would also think the insurance company is right it isn't an issue of malpractice because they aren't your patient. There may be other liability which it sounds like they cover. I know if you are an insurance company employee the insurance company would be the large target. Regardless I'm not a lawyer and don't have experience with this so get other opinions.
toofache32
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Re: Physician - Medical Reviewer?

Post by toofache32 »

scorcher31 wrote: Tue May 18, 2021 10:43 pm
toofache32 wrote: Tue May 18, 2021 10:27 pm When your job is to deny medical coverage, the liability has to be very significant.
https://afmc.org/afmc-reviewnews/utiliz ... liability/

Seems to essentially say you should be good. I would also think the insurance company is right it isn't an issue of malpractice because they aren't your patient. There may be other liability which it sounds like they cover. I know if you are an insurance company employee the insurance company would be the large target. Regardless I'm not a lawyer and don't have experience with this so get other opinions.
Malpractice is only one area of liability. The insurance company will likely have contracts that protect themselves and not the physician. Similar to other employed scenarios such as hospitals who employ physicians. They are happy to hand the physician out to dry while protecting themselves. Especially when there is a line of physicians waiting to take their place.
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Re: Physician - Medical Reviewer?

Post by scorcher31 »

toofache32 wrote: Tue May 18, 2021 10:48 pm
scorcher31 wrote: Tue May 18, 2021 10:43 pm
toofache32 wrote: Tue May 18, 2021 10:27 pm When your job is to deny medical coverage, the liability has to be very significant.
https://afmc.org/afmc-reviewnews/utiliz ... liability/

Seems to essentially say you should be good. I would also think the insurance company is right it isn't an issue of malpractice because they aren't your patient. There may be other liability which it sounds like they cover. I know if you are an insurance company employee the insurance company would be the large target. Regardless I'm not a lawyer and don't have experience with this so get other opinions.
Malpractice is only one area of liability. The insurance company will likely have contracts that protect themselves and not the physician. Similar to other employed scenarios such as hospitals who employ physicians. They are happy to hand the physician out to dry while protecting themselves. Especially when there is a line of physicians waiting to take their place.
Right but thats why there is an errors and omissions policy which is different than a malpractice policy and that is provided. I know people that are full time insurance company employees and the physician is protected and the insurance company would be the target. I just don't know if it relates to the ops situation where he's probably not an employee
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Re: Physician - Medical Reviewer?

Post by MrsBDG »

I enjoyed it at first because I was learning how the insurance denial/appeal process
That seems like some valuable knowledge to gain!
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avenger
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Re: Physician - Medical Reviewer?

Post by avenger »

I was able to get the review company to significantly increase the reimbursement. So this is something I am pursuing.
So I’m looking into general liability insurance just to cover my bases. I also occasionally do expert witness work and feel like I should be covered as well.
An agent at “The Doctors’ Insurance Agency” told me usually the most basic coverage runs about $3000/year which I think is reasonable.
Anyone ever do something like this and have some general Boglehead advice?
Any pitfalls I should look out for?
Thanks in advance!
cheers ... -Mark | "Our life is frittered away with detail. Simplify. Simplify." -Henry David Thoreau | [VTI, VXUS, BND, VTEB, SV fund]
hachiko
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Re: Physician - Medical Reviewer?

Post by hachiko »

I would probably take a look at white coat investor and see if there's any insurance information there (not instead of, but in addition to, this site).
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Re: Physician - Medical Reviewer?

Post by White Coat Investor »

avenger wrote: Sat Aug 14, 2021 4:23 am I was able to get the review company to significantly increase the reimbursement. So this is something I am pursuing.
So I’m looking into general liability insurance just to cover my bases. I also occasionally do expert witness work and feel like I should be covered as well.
An agent at “The Doctors’ Insurance Agency” told me usually the most basic coverage runs about $3000/year which I think is reasonable.
Anyone ever do something like this and have some general Boglehead advice?
Any pitfalls I should look out for?
Thanks in advance!
Not sure you need malpractice insurance, more like E&O insurance or general business liability insurance. You're not practicing medicine here. I bet you could get insurance for $500-2000 a year for this.
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avenger
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Re: Physician - Medical Reviewer?

Post by avenger »

White Coat Investor wrote: Sat Aug 14, 2021 9:05 am
avenger wrote: Sat Aug 14, 2021 4:23 am I was able to get the review company to significantly increase the reimbursement. So this is something I am pursuing.
So I’m looking into general liability insurance just to cover my bases. I also occasionally do expert witness work and feel like I should be covered as well.
An agent at “The Doctors’ Insurance Agency” told me usually the most basic coverage runs about $3000/year which I think is reasonable.
Anyone ever do something like this and have some general Boglehead advice?
Any pitfalls I should look out for?
Thanks in advance!
Not sure you need malpractice insurance, more like E&O insurance or general business liability insurance. You're not practicing medicine here. I bet you could get insurance for $500-2000 a year for this.
Yes this is what I’m looking at.
Any other companies you’d recommend?
cheers ... -Mark | "Our life is frittered away with detail. Simplify. Simplify." -Henry David Thoreau | [VTI, VXUS, BND, VTEB, SV fund]
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Re: Physician - Medical Reviewer?

Post by White Coat Investor »

avenger wrote: Sat Aug 14, 2021 9:07 am
White Coat Investor wrote: Sat Aug 14, 2021 9:05 am
avenger wrote: Sat Aug 14, 2021 4:23 am I was able to get the review company to significantly increase the reimbursement. So this is something I am pursuing.
So I’m looking into general liability insurance just to cover my bases. I also occasionally do expert witness work and feel like I should be covered as well.
An agent at “The Doctors’ Insurance Agency” told me usually the most basic coverage runs about $3000/year which I think is reasonable.
Anyone ever do something like this and have some general Boglehead advice?
Any pitfalls I should look out for?
Thanks in advance!
Not sure you need malpractice insurance, more like E&O insurance or general business liability insurance. You're not practicing medicine here. I bet you could get insurance for $500-2000 a year for this.
Yes this is what I’m looking at.
Any other companies you’d recommend?
I had a policy from these guys for a while, but it was a different business than yours.

https://www.chubb.com/us-en/

Never had a claim though; just paid premiums.
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