Background: Big Changes from 2021
The Evaluation and Management (E/M) codes have been based on the 1995 and 1997 E/M Guidelines for what seemed like forever. The E/M codes were based upon three key components: 1) the history, 2) the examination, and 3) medical decision making all performed at the proper levels. On January 1, 2021, everything changed. The changes were specific to Evaluation and Management services that were performed in the office or other outpatient places of service only. Clinicians are now able to use either time or medical decision making to select an E/M code. There is no required level of history or examination for the E/M codes.

Now: Highlights for 2023
On January 1, 2023, the changes that were made to E/M services that were performed in the office or other outpatient places of service were expanded to the other places of service. The E/M codes include a medically appropriate history and/or examination, when performed. The nature and extent of the history and/or physical examination are determined by the treating physician or other qualified health care professional reporting the service. The care team may collect information, and the patient or the patient caregiver may supply information directly (e.g., by electronic health record HERR) portal or questionnaire that is reviewed by the reporting physician or other qualified health care professional. The extent of history and physical examination is not an element in the selection of the level of these E/M codes.

Time is defined as total time spent, including non-face-to-face work done on that day and no longer requires time to be dominated by counseling. It includes time regardless of the location of the physician or other qualified health care professional (e.g., whether on or off the inpatient unit or in or out of the outpatient office). It does not include time spent in the performance of other separately reported service(s).

The definitions of medical decision making (MDM) are the same as the definitions of medical decision making that went into effect for office and other outpatient places of service on January 1, 2021.

While most healthcare providers are compassionate and want to provide optimal care to their patients, everyone has biases and knowledge gaps that may hinder the provision of quality healthcare. These biases and knowledge gaps can lead to:

• Barriers to care
• Miscommunications
• Misdiagnosis
• Lack of trust

As the United States continues to become more diverse, cultural awareness and competence are key for healthcare providers.

Finding yourself in a situation where a patient is unhappy with their treatment and asking for a refund, what should be your response? For example, you may feel that your work is satisfactory, and you are unwilling to provide a refund to the patient considering all the time you spent on their care. Or you may be seeking a quick resolution to the situation. In this article, we’ll take a closer look at how to handle patient refunds.

We recently received two questions regarding electronic health records (EHR) or electronic medical records (EMR) and thought we’d share the answers in case you’ve asked yourself these questions too. Here they are:

What is the Role of Empathy in Healthcare?

Empathy is the ability to understand and share the feelings of another. It combines intellectual perspective with emotional understanding. Empathy is a skill that has not been historically emphasized in medical schools. However, it plays a crucial role in healthcare.

In a word, yes. Many podiatrists significantly underestimate how much a breach will cost, and think they can self-insure it. Outlining what will happen in the event of a breach is very useful when understanding the value of cyber liability coverage. Below are a variety of claims scenarios that help illustrate the severity of cyber claims, and how widespread cyber breach activities are throughout the healthcare industry.

You’re a very busy podiatric physician. With so much to do in a limited amount of time, you may only think about malpractice insurance once a year—at your renewal. You may even say to yourself, “I provide the best possible care to my patients and my records are impeccable. I’m not going to get sued, so why do I have to pay for malpractice insurance?”

You can practice the best of care, follow every protocol and keep meticulous records, but that still won’t prevent a claim being filed against you. Yes, all those measures may reduce your risk, but ultimately, it’s out of your control and in the hands of your patient. Simply put, claims are filed every day; some are legitimate and others are frivolous. You shouldn’t live in fear of being sued, but you also shouldn’t ignore the fact that it’s a real possibility.

You may believe that if you’re uninsured or “go bare,” you’re less of a target of being sued. You may even think that when your patient’s attorney finds out you don’t have malpractice insurance, he/she will drop the case because there’s less potential for substantial financial gain if the case is won. While this may happen in very rare instances, the fact is that the attorney can still go after your personal assets, livelihood and reputation.

Another factor to consider is that a malpractice claim can be filed against you after you retire. Imagine if you were traveling the world and then came home to find out that you were being sued by a patient you treated before your long-awaited retirement. Everything you worked so long and hard for and all the finances you saved to cover your expenses during retirement could be in jeopardy. However, if you had a claims-made policy while you were practicing and purchased tail coverage after the policy was terminated, but the incident happened during the time the policy was active, the policy may protect you against that claim.

As you can see, a patient can file a malpractice claim against you whether or not you carry malpractice insurance. It doesn’t matter whether you are an actively practicing podiatric physician or retired--the threat of a lawsuit is still a concern. This can seem daunting, but there’s a simple solution that can give you peace of mind–a solution that’s not only necessary, but essential to the success of your practice. It’s to continuously carry malpractice insurance while you’re actively practicing and obtain tail coverage when you retire. With malpractice insurance, you can rest assured that you have a team of professionals helping protect you and your practice should a claim arise.

Don’t let one lawsuit take away the practice, reputation and lifestyle you worked tirelessly to build. The price of a malpractice policy is minimal compared to the financial loss a lawsuit can bring. Ask yourself this question, “Can I afford to be uninsured?”

If you don’t have malpractice insurance with PICA, now is the time to obtain coverage. PICA has been the leader in providing malpractice insurance to podiatric physicians for over 40 years and is the only insurer lead by a podiatrist. Our claims specialists and defense attorneys specialize in podiatry malpractice claims. Our team of knowledgeable professionals is readily available and happy to help you. At PICA, we’re with you. Every step of the way.

Contact us today for coverage information or fill out our online form to get a no-obligation quote.

You’ve seen the term “Administrative Defense Coverage (ADC),” but do you really know what it is and understand why it’s so important to your practice?