Physician's Coding Strategist-New insurance offered for billing risks

Also protects against technology threats

Your risks against technology threats and billing mistakes are increasing. Have you thought about protecting your organization?

The American Hospital Association (AHA) in Chicago recently tackled the problem and endorsed two insurance products. The first, E-Comprehensive, offers a combination of insurance and embedded risk management and loss control. It was developed in collaboration with Underwriters at Lloyd's in London and Information Risk Group of Raleigh, NC.

"E-Comprehensive is the only product of its kind that we are aware of," says Kathleen Stiens, marketing communications supervisor for the AHA Insurance Resource. AHA Insurance Resource is the insurance and financial service subsidiary of the AHA; it evaluates the marketplace and collaborates with insurance companies to create products and services for health care companies.

Providers soon will have a lot more to lose through technology threats, with the Health Insurance Portability and Accountability Act (HIPAA) of 1996 not only legislating strict guidelines on the privacy, security, and confidentiality of electronically transferred information, but also imposing strict penalties on providers who fail to protect it.

E-Comprehensive covers losses including those caused by fraudulent and malicious acts committed by employees or third parties against an insured's computer systems, electronic computer programs, or electronic information and records, as well as those caused by computer viruses that attack or close down the operations of the insured. Financial losses resulting from fraudulent input into computer systems also are covered, as are losses resulting from accidental alteration or destruction to electronic information and records.

Additional features include coverage for:

• loss of intellectual property when trade secrets are copied or recorded;

• extortion when someone threatens to introduce a computer virus into the computer system or threatens to divulge, disseminate, or use information held on the computer systems;

• business interruption and extra expense caused by a computer virus or accidental or malicious destruction of the electronic information inside the computer system;

• costs of loss control services rendered by information security experts to mitigate loss;

• multimedia liability such as libel, slander, invasion of privacy, infringement of copyright, plagiarism, and false advertising;

• computer systems liability such as prevention of authorized access, including denial of service, damage to a third party's computer system, breach of security, theft of information, hosting, or breach of duty;

• expenses for legal fees in defense of a claim;

• rehabilitation expenses to reestablish reputation and market share after loss or claim.

Limits are available up to $50 million, with a minimum deductible of $15,000 and minimum premium of $20,000. A satisfactory survey of an insured's computer systems is required within 45 days of the policy inception.

Guard against fraud investigations

The second insurance program, FFActs, protects providers that have made unintentional coding and billing mistakes in spite of their "good faith compliance efforts, " according to the AHA Insurance Resource. This program also helps buffer providers against the financial costs incurred through the defense of an investigation.

Other policies do exist in the marketplace, but most are considered too expensive for small- to medium-size hospitals, says Kathleen Stiens, marketing communications supervisor.

Anthony J. Burke, CEO of AHA Insurance Resource, says AHA chose the FFActs program because of its flexibility in pricing, deductibles, and limits. FFActs combines technical coverage, risk engineering, and legal expertise to create a risk management program. An upfront risk management assessment is conducted using risk profiling software to measure an insured's risk exposure. Based on the results of the risk assessment, limits and deductibles are determined.

Additional features include:

• limits up to $100 million;

• deductible options as low as $25,000;

• retroactive coverage for defense and indemnity;

• tailored risk profiling at no additional costs;

• discounts on shadow audit work and compliance software;

• access to specialized network of legal experts;

• automatic subscription to the AHA Health Care Compliance Service.

[Editor's note: For more information about either of these programs, contact John Stein, marketing manager of AHA Insurance Resource, at (800) 242-4677, ext. 2530.

Also another popular billing errors and omissions policy is offered to providers by Chubb Executive Risk in Simsbury, CT. The company can be reached by telephone at (860) 408-2000 or e-mail at info@execrisk. com.]