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Tag Archives: Medical

The Medical Necessity Hot Button

Clearing up the confusion surrounding Medical Necessity!

by Lori-Lynne A. Webb, CPC, CCS-P, CCP, COBGC, CHDA  (originally printed through HCPro March 2017)

Understanding and determining medical necessity can be very complex for physicians, clinicians, coders, and billers.A physician or clinical provider of care may have a completely different understanding, interpretation, and definition of medical necessity than the patient or a patient’s family member. A third-party insurance payer may also have another completely different understanding and application of the term.

Defining medical necessity

So what is medical necessity? Coders or billers struggle to understand and sort out as the term, which leads to misinterpretation and misunderstanding of what needs to be communicated in a variety of areas.

CMS provides a specific definition under the Social Security Act:

… no Medicare payment shall be made for items or services that are not reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member.

In essence, the diagnosis drives medical necessity. Coders need to understand the diagnosis itself, as well as what services or treatment options are available to the provider.

Third-party payers add more confusion

Medical necessity can also be confusing when it comes to who is going to pay for the procedure or services. Many third-party payers have specific coverage rules regarding what they consider medically necessary or have riders and exclusions for specific procedures. Third-party payers may have a specific exclusion for procedures that they consider experimental, unproven for a specific diagnosis, or cosmetic.

One example is a surgeon using a daVinci robotic surgical device to perform a laparoscopic surgery. Upon pre-authorization for the surgery, the insurance payer states it will not pay for the surgery if the daVinci is used. The insurer’s policy includes a rider that deems the daVinci as an experimental surgical device. However, if the physician uses a traditional laparoscopic or open procedure, the third-party payer would reimburse. In this case, the insurance carrier is not stating that the surgery is not medically necessary, just that it will not reimburse for this surgery if the robotic device is used.

Even if a particular procedure or service is considered medically necessary, some payers impose limits on how many times a provider may render a specific service within a specified time frame. For Medicare and Medicaid, these limitations are known as National Coverage Determinations (NCD) and Local Coverage Determination (LCD). Private payers may simply refer to this type of limitation as a policy guideline or policy exclusion or rider.

Within these guidelines, payers may define where or when they will cover a specific service, but may limit coverage to a specific diagnosis. For example, insurance policies may have a wellness or preventive care benefit, but may only cover one such visit per year. Some payers may only reimburse for a single Prostate-Specific Antigen (PSA) test per year. The payer may require a documented screening diagnosis in coordination with the test.

If the patient underwent a PSA test January 1, 2012, for screening, his insurance may not pay for another test until 365 days (or one calendar year) have elapsed. However, if the patient undergoes a PSA blood test for screening and the test results are abnormal, the clinician may decide another PSA test is needed. The coder must submit that claim as a PSA blood test with the appropriate diagnosis for a sign, symptom, or abnormality, not as a screening.


Documenting medical necessity
Medical necessity continues to be open for interpretation by all parties involved. Many third-party payers have created lists of criteria they use to interpret medical necessity. These lists do not necessarily reflect all options, but payers include this reference in their policy guidelines.

Most providers have not developed a comprehensive listing of medically necessary qualifiers, so coders and clinicians must focus on good documentation and coding accuracy to communicate the medical necessity of services accurately to payers. If third-party payers deny reimbursement for medical services, physicians, clinicians, and coders need to rely on the formal appeal process.

Medical necessity documentation from a physician or provider should include the following:

§  Severity of the “signs and symptoms” or direct diagnosis exhibited by the patient. This is our diagnosis driver, and multiple diagnoses may be involved.

§  Probability of an adverse or a positive outcome for the patient, and how that risk equates to the diagnosis currently being evaluated. This is the medical risk vs. gain.

§  Need and/or availability of diagnostic studies and/or therapeutic intervention(s) to evaluate and investigate the patient’s presenting problem or current acute or chronic medical condition. In other words, does the facility, office, or hospital have what the provider or clinician needs to render care?

These bullet points reflect the basics of evaluation and management (E/M) guidelines that are currently in place from CPT®: the history, exam, and medical decision making processes. Coders will have an easier time evaluating medical necessity from this aspect. Of course, a good understanding of this integration of medical necessity within the E/M guidelines makes communicating this same principle to the providers much easier. Coders should encourage providers to continually enhance their documentation to improve overall coordination between the medical record, coding accuracy, and third-party payer reimbursement.

The third-party payers employ a wide spectrum of policies defining medical necessity is and should encompass. Physicians, clinical providers, and coders should review what these payers have established within their guidelines. Someone within the physician office, hospital, or medical facility should thoroughly scrutinize these guidelines before establishing a contractual relationship with a particular third party payer. This up-front communication will help avoid claim denials in the future.

Here are some examples of what some third party payers are currently including in their medically necessary verbiage:

§  Treatment is consistent with the symptoms or diagnosis of the illness, injury, or symptoms under review by the provider of care.

§  Treatment is necessary and consistent with generally accepted professional medical standards (i.e., not experimental or investigational).

§  Treatment is not furnished primarily for the convenience of the patient, the attending physician, or another physician or supplier.

§  Treatment is furnished at the most appropriate level that can be provided safely and effectively to the patient, and is neither more or less than what the patient is requiring at that specific point in time.

§  The disbursement of medical care and/or treatment must not be related to the patient’s or the third party payer’s monetary status or benefit.

Documentation of all medical care should accurately reflect the need for and outcome of the treatment.
Treatment or medical services deemed to be medically necessary by the provider of those services,(e.g., physician, therapist, clinician, etc.) does not imply or infer that the service(s) provided will be covered by or deemed a medically necessary service payable by a third-party insurance payer.

Medical Necessity Q&A

Q:  Could you give me some guidance on how I can instruct my MD’s on avoiding vague and/or subjective clinical documentation?
A:.  Ask your providers to adequately describe his/her skilled care providedand give a clear picture of the treatment and/or “next steps” to be taken.
Do not use vague or subjective descriptions like “tolerated treatment well,” “improving,” “caregiver instructed on med management,” or “continue with plan of care.”   “patient is here for follow up”
examples of more complete and compliant statements:
1.     Patient tolerated ROM exercises with a pain level of 6/10.
2.     Patient was able to verbalize understanding and importance of checking their blood sugars prior to administering insulin.
3.     Plan for next visit: to continue education on importance of daily inspection of feet for diabetic patient, provide wound care, etc.
Q  I work in dermatology and need to know what documentation is required for excisions?  We are struggling with getting paid  
A:  The provider should include the actual “size” of the lesion/mass they are going to excise.  Then they should document the area of the excision which needs to include the lesion + any margins.  (Height, Width, Depth) and if circular/elliptical etc… and denote the “why” it was performed that way.    If you have to appeal, the problem with using strictly the sizes from a pathology report, is that tissue “shrinks” once it is excised, and the would “enlarges” once the tissue is excised. 
Q.  What is the BEST way to document our time spent… the CPT codes state a vague “time” amount but the doctors struggle with this..  
A.  Notation of Time in/Time out is always very helpful…  it is also helpful if the provider “explains”  the time.  Eg -  spent 20 minutes of our 30 minute visit discussing how to properly use their new asthma inhaler.  Or  I was requested by Dr. Doe for “standby” for a possible cesarean section during vaginal delivery.  I entered the delivery room at 0800 and departed at 0915 status post a successful vaginal delivery.

Coders must understand the complex relationships between the physician, the patient, the medical record documentation, the coder, the biller, the insurance payer, and the communication between all of these entities to successfully guide the interpretation of medical necessity.

Lori-Lynne’s Coding Coach Blog

How-to-Craft-a-Formidable-Personal-Statement-for-Your-Review-Site-Profile

Online Review Sites: A Guide to Creating Compelling Physician and Medical Practice Profiles

 

How to Craft a Formidable Personal Statement for Your Review Site Profile

A Guide to Creating Compelling Physician and Medical Practice Online Profiles

Word-of-mouth referrals have long been the bread and butter of growing and maintaining a practice’s patient panel. Instead of face-to-face conversations though, much of this process now takes place publicly through online physician review sites like Vitals, ZocDoc, and Healthgrades.

So much so, that a recent survey by an online medical reviews firm Software Advice found that 84 percent of patients use online reviews to evaluate physicians. And a surprising 77 percent use these reviews as their very first step in scouting out a new physician.

To really harness the power of these online platforms and attract new patients, physicians have to be proactive and find a way to stand out.

Making Your Profile Stand Out

Medical Practice Online ReviewsWith so many patients flocking to online review sites, physicians need to create profiles that rise above the rest. One way to do this and leave a lasting first impression is to customize the physician and practice profiles as much as possible.

For example, there is often a part of the profile called the “practice statement” or “physician’s biography.” If these are optional fields — which is frequently the case — it can be tempting to skip over them and leave them blank. But filling these in can actually give prospective patients an insider view of your practice and personality — all things that can be the difference between them calling you first or someone else.

A Guide to Creating Captivating Profiles

Our friends over at InboundMD have just released a step-by-step guide for physicians interested in crafting powerful online profiles and personal statements. In it, you’ll find all of the information you need including:

  • The benefits of claiming your online profiles;
  • How to identify what makes your practice unique;
  • Do’s and don’ts of writing personal statements that actually connect with patients;
  • Adapting your message for each review site’s platform; and
  • A simple checklist covering the best practices for online review sites.

 

Why Choose You?
When it comes to writing a compelling, meaningful statement about you and your practice it’s best to think of your patient’s point of view – why should they choose you? Remember your writing should impress patients, not your peers.

How-to-Craft-a-Formidable-Personal-Statement-for-Your-Review-Site-Profile-Book-Cov

Download the Guide

You can download InboundMD’s complete guide How to Craft a Formidable Personal Statement for Your Review Site Profile for free here.

Have you claimed your online physician and practice profiles? How did you customize them? Please join the conversation below.

 

— This post Online Review Sites: A Guide to Creating Compelling Physician and Medical Practice Profiles was written by Manny Oliverez and first appeared on Capture Billing. Capture Billing is a medical billing company helping medical practices get their insurance claims paid faster, easier and with less stress allowing doctors to focus on their patients.

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Medical Symptoms Medical diagnosis With regard to Asthma

Asthma can be an issue that creates lack of breath and it is characterized by a coughing seem. This article offers you a quick and also to the point go through the health care signs or symptoms, diagnosis, brings about and also therapies linked to this specific typical inhaling disorder.

Bronchial asthma

Symptoms of asthma Signs typically begin in years as a child; nevertheless you will find instances of person onset. Signs incorporate frequent attacks associated with upper body tightness and also tough breathing in. Any wheezing sound is normally heard when the asthma suffering affected person is exhaling. The person might hint onward within an straight placement in an attempt to ease the particular breathing trouble. Some people may go through a new coughing, specially during the night, as well as the skin color may become bluish. A severe invasion can be extremely stressful as well as frightening for the person in addition to these all-around them.

Symptoms of asthma is actually the effect of a spasm with the bronchi, which can be the particular tubes transporting atmosphere in the lungs or simply by puffiness with the mucous filters coating the bronchi. This specific spasm response may possibly result of a good Hypersensitive reaction with an allergen including pollen, airborne dirt and dust, molds, foods, or perhaps canine dander. Some other triggers add a respiratory an infection (my spouse and i.at the. Respiratory disease), or perhaps problems for instance smoking or perhaps substances. Aspirin may well trigger a good start symptoms of asthma in most persons.

In the event the previously mentioned symptoms appear it could be important to seek an assessment by a medical professional straight away. The particular analysis can include a physical assessment, torso x-rays, blood checks, hypersensitivity exams, or perhaps lung operate analysis.

As for remedy severe attacks might have to have unexpected emergency medical help. If your start of symptoms of asthma was in the course of the child years, 50% of these sufferers will outgrow the actual dysfunction normally. Pertaining to treating asthma attack problems, doctor may possibly suggest the expectorant for you to release mucus secretions; bronchodilators to broaden airways; or even propose holding a nebulizer, that is medicine consumed simply by use of a tool that produces a great apply.

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Medical License Verification to Minimize Medical Negligence and Medical Malpractice

A 1984 Harvard study of more than 30000 records from 51 randomly selected hospitals in New York found that adverse medical events occur in the more than 3.7% of patients admitted and that more than a quarter of these were due to medical negligence. Close to 14% of the adverse medical events were fatal and 2.6% resulted in severe disability. When extrapolated to the 2.7 million patients discharged from New York hospitals that year about 13,450 people died and 2250 were seriously injured. (When Doctors Kill By Stephen J. Cina, Joshua A. Perper).

These are the stats which are showing the medical malpractice and medical negligence issues of the most prominent and advanced city of the world. After reading those horrible figures one can understand that the world is suffering from medical malpractice and negligence on a much higher scale and the prevention only lies when we background check our doctor or medical practitioner through primary source verification, medical credentialing and by medical license verification.

Investigation and verification of medical license can assure you the safety and integrity of the doctor or a medical practitioner you are going to get treated. To practice medicine, a practitioner must obtain a license from the appropriate state licensing agency (i.e. state medical board). A physician usually applies for a state license after completing medical school and passing an examination that established his or her knowledge in the basic sciences.

When a medical professional is suspected of a board violation, he or she will likely be investigated to determine if disciplinary action is necessary. The conditions for discipline vary from board to board and state to state, but there are some rules that are adopted by all or almost all professional boards. Some of the common grounds for discipline include:

• License registration or renewal fraud

• Verify license, expiration date, and sanctions or limitations.

• Medical practice misconduct, fraud, or negligence

• Committing a health law violation

• Practicing while a license is pending or suspended

• Practicing while under the influence of alcohol or drugs

• Alcohol or drug dependency

• Committing a criminal offense

• Qualifying as mentally unstable or insane

Core Criteria for Medical License Verification

The core criteria followed by different international organizations like joint commission international for medical license verification is performed at the time of initial appointment, and at the time of each reappointment and/or re-privileging, and is recommended at the time of license expiration. The following points must be considered while performing medical license verification:

• Date and time of the license issuance.

• State of licensure, license number, date of original licensure and expiration date.

• Name (first and last) of the person initiating the verification call

• Name (first and last) of the person verifying the information

• Are there any current, past, or pending restrictions on the license?

• Are there any current, past, or pending disciplinary actions against the practitioner?

Peer Referencing is Essential for Medical License Verification

Peer Referencing is very important when medical license verification process is live. A peer must be someone who knows the doctor or medical practitioner from past three to five years. If the applicant is finished training during past three to five years the peer referencing letter must be from his/ her training program director. And at least one reference from the practitioners specialty which marks the reputation and competency factors.

What to verify:

1. Relationship of peer to the applicant (Training director, colleague practitioner, etc).

2. How the peer is aware of applicant’s current clinical competency.

3. Validation and confirmation by the peer of the applicants request for clinical privileges.

Potential verification Method: Send a letter, and a questionnaire directly to the peer reference.

Conclusion

Every medical professional must be licensed in order to legally practice medicine. Licensing boards are run at the state level and dictate the licensing requirements and conditions for all physicians or nurses within a particular state. These boards oblige all licensed individuals to meet certain criterion in order to remain in good standing. If a medical practitioner whether a doctor or nurse acts in a way that violates the code set by the board, he or she could be put on probation or could have his or her license revoked altogether.

Muhammad Saad Khan is a Research Analyst at Q2 Group. Q2 is specialized in medical credentialing, primary source verification, and medical license verification according to the standards of joint commission international.

LATEST NEWS ABOUT MEDICAL FIELDS

Sweat suits
A sweat suit is commonly associated with sports. But it can be also used in different occasions. A sweat suit is nothing but a simple suit which is made up of a thick material. It is usually made of cotton and polyester. As these suits are worn during physical exercise, the term ‘sweat’ comes along with it. The popularity of these swim suits has started during 70’s and 80’s and still continues intact. And these sweat suits can be used as slim suites. People who are wearing sweat suits are working out in a nylon jumper with the goal being to sweat profusely. While sweating, many toxins will be removed from our body. An example of a sweat suit that can be used to reduce weight is sauna sweat suits. Sauna sweat suits are designed to suit the needs of fitness trainees and for people who are engaged in body building. The results of sauna sweat suit is said to be rapid.
Nurse uniform
A nurse uniform is compulsory for nurse; this is for their hygiene and for their proper identification. The traditional nurse uniform consists of a dress, apron and cap. But nowadays, a lot of variants are there, but the basic style has remained recognizable. The first nurse uniforms were derived from nun’s habit. One of the Florence Nightingale’s students, Miss VanRensealer has designed the original nurse uniform for the first time for the students at Miss Nightingale’s school of nursing. The clothing consists of mainly blue outfit.
Medical scrubs
Medical scrubs are the shirts and trousers or gowns worn by nurses, surgeons and other operating personnel for “scrubbing in” for surgery. Scrubs are designed to be simple with minimal places for dirt to hide, easy to launder and cheap to replace if damaged or stained. The wearing of scrubs has been extended outside of surgical room in many hospitals. Nowadays, any medical uniform consisting of a short-sleeve shirt and pants is known as “Scrubs”. Scrubs may also include a waist-length long sleeved jacket with no lapels and stockinette cuffs known as warm-up jackets. Scrubs worn in surgery are always colored solid light green, light blue or a light-green blue shade; also some medical centers have switched to pink as a theft different. Surgical scrubs are rarely owned by the wearer, due to concerns about home laundering and sterility issues, these scrubs are usually hospital owned or hospital-leased through commercial linen service.
Non-surgical scrubs comes in wider variety of colors, patterns, ranging from official issue garments to custom made whether by commercial uniform companies or by home-sewing using commercially available printed patterns. Some hospitals use scrub color to differentiate between patient care personnel, unlicensed assistive personnel, and non-patient care support staff. Hospital may also extend the practice to differentiate non-staff members/visitors. Scrubs featuring cartoon characters and cheerful prints are common in pediatrician’s office and children’s hospitals, while prints for various holidays can be seen throughout the year. Some scrubs are seen in custom colors too.

Nursing scrubs of all types and colors are available on our website, order complete nursing uniforms for your hospital.

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Medical Diagnosis Sets

I think most of the people will always take the good old method of diagnosis that running to the nearest hospital, but generally speaking, a total new trend of self-diagnosis has spread out and gained prominence. With the large number of home health test kits, patients are offered a quicker result, relevant for a specific physical condition. Probably the best known and the first to find wide acceptance on the market were the home pregnancy tests, but that was just the beginning. Now, one can test for a huge range of illnesses and ailments from urinary tract infections, heart disease, diabetes and food allergies to HIV, drug addiction, cholesterol and fertility.
What are the real advantages of self-diagnosis using the diagnosis sets? First of all, given the fact they carry some form of medical certification, home health test kits provide 99% accuracy provided that all usage conditions are met. Then, the user benefits from low costs, confidentiality and the comfort of not going straight to the doctor. Inhibition is a key-factor when trying to explain and understand the success of home health test kits; many people could be embarrassed by a specific health problem, and before exposing themselves they want to make sure that the symptoms they’re experiencing are actually indicating disease.

Diagnostic medical set are specifically designed to let both medical practitioners (e.g. doctors and nurses) and ordinary individuals use them with ease and comfort. Their product line includes stethoscopes, electronic blood pressure machines, ECG machines, otoscope and ophthalmoscope, diagnostic sets and kits, and many more. Diagnostic instruments sets are rugged, durable, and dependable. Normally these kits are beneficial for the medical students as well as the doctors
It’s really very important for many people, especially those afflicted with serious health problems, to secure home monitoring devices. These will help a lot in checking if there are signs of progress or worsening of their health condition. It also helps alert doctors and caregivers of any impending attacks or formation of other health complications.

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Medical School Interviews

Why Do You Want to Be a Doctor?

Many premeds worry about the content of the medical school interview. The most important content to conquer is about you. You already know all about yourself but the key is figuring out how to present that to the interviewer.

Start your interview prep by answering this question:

“Why do you want to be a doctor?”

Simple, huh? Go ahead and try to answer it right now.

Harder than it seems, isn’t it?

This question will be asked in some form in every interview. You answered it in the AMCAS primary essay, but interviewers want to hear it again. It is the essential question, right?

Your goal is to answer the question clearly and concisely with no more than three talking points. Tying these three reasons to brief anecdotes will help the interviewer remember your reasons.

Medical School Interviews – The First Twelve Inches

To help you pull it all together on your interview day, etiquette experts have a simple rule to ensure you are looking your best. It’s the first 12 inches that matter most (head, hands, feet):

Head

Hair clean and well-groomed
Be clean-shaven
Check nothing is stuck in your teeth

Hands

Groom the nails short and clean
No chipped nail polish

Feet

Polish the shoes
Guys – be sure your socks match
Ladies – no runs in panty hose or stockings
Medical School Interviews – Hair and Accessories

The medical school interview season is not the time to experiment with that mohawk you always wanted. Keep the hair clean and simple. Men with long hair do not need to cut it all off, just keep it clean and out of your face. The same rules apply to women.

As for jewelry, earrings in men are always a point of controversy. If your earring is an important part of who you are, leave it in. But if it’s just a piece of jewelry, I would take it out. Body piercings that show (nose ring, tongue ring, eyebrow ring, etc) fall under the same general guidelines as earrings. Wear it if it is a huge part of who you are. Lose it for a day if it isn’t.

MDadmit provides medical school admissions consulting services to anyone considering applying to medical school whether you are a freshman in college

Medical Malpractice For South Carolina

The vast majority of medical and health care providers including primarily hospitals, surgeons, doctors, pharmacists, physicians, nurses and emergency medical technicians (“EMTs”)do offer excellent care that will help us to recover from a personal injury or medical condition. However, some providers fail to meet the requisite standard of care, and, under such circumstances, may be guilty of medical malpractice. Medical malpractice, commonly called “medmal” for short, generally occurs when a negligent, careless or reckless act, mistake, error, or omission by a doctor or other medical professional causes damage or harm to a patient

 

COMMON TYPES OF MEDICAL MALPRACTICE

It has been estimated that almost 98,000 people die in hospitals in the United States each year, and that medication errors injure approximately 1.3 million people per year. Medical malpractice errors or negligence typically occur in the diagnosis or treatment of a patient, and may include, but are not limited to:

>Failure to treat
>Wrong treatment
>Delay in diagnosis
>Failure to diagnose
>Failure to rule out causes or conditions
>Misdiagnosis
>Failure to test
>Failure to obtain informed consent
>Surgical injury
>Wrong prescription of drugs
>Patient abandonment
>Use of defective medical products

A patient’s right to recover compensation for medical malpractice is generally governed by common law as well as statutes and regulations which have been promulgated to protect patients who have been subjected to medical malpractice or medical negligence. Medical malpractice suits are usually complex, time-consuming, expensive to litigate, dependent upon expert testimony, and vigorously defended by health care providers and their insurers.

 

ELEMENTS OF A MEDICAL MALPRACTICE OR MEDICAL NEGLIGENCE CLAIM

The medical malpractice personal injury victim is commonly referenced as a “plaintiff” and the person or entity that caused the harm is commonly referenced as a “defendant.” The South Carolina Supreme Court has set forth the elements of negligence with regard to a medical malpractice personal injury claim that a plaintiff has to prove as follows:

>A physician-patient relationship exists
>The generally recognized and accepted practices and procedures that would be followed by average, competent practitioners in the defendants’ field of medicine under the same or similar circumstances >That the defendant departed from the recognized and generally accepted standards
>The defendant’s departure from such generally recognized practices and procedures was the proximate cause of the plaintiff’s alleged injuries and damages

 

Thus, the medical malpractice lawyer and his client must present evidence to meet each of the foregoing elements at trial.

A physician commits malpractice by not exercising that degree of skill and learning that is ordinarily possessed and exercised by members of the profession in good standing acting in the same or similar circumstances. Durham v. Vinson, 360 S.C. 639 (2004). A plaintiff and his attorney must proffer expert testimony to prove both the required standard of care and the defendant’s failure to conform to that standard, unless the subject matter lies within the ambit of common knowledge so that no special learning is required to evaluate the conduct of the defendants.

 

INFORMED CONSENT CLAIM

A physician’s failure to obtain a patient’s “informed consent” with regard to a procedure or treatment is a form of medical malpractice. The term “informed consent” means that a physician must tell a patient all of the potential benefits, risks, and alternatives involved in any surgical procedure, diagnostic procedure, medical procedure, therapeutic procedure, or other course of treatment, and must obtain the patient’s written consent to proceed. Under Informed consent law, a physician who performs a diagnostic, therapeutic, or surgical procedure has a duty to disclose to a patient of sound mind, in the absence of an emergency that warrants immediate medical treatment, (1) the diagnosis, (2) the general nature of the contemplated procedure, (3) the material risks involved in the procedure, (4) the probability of success associated with the procedure, (5) the prognosis if the procedure is not out, and (6) the existence of any alternatives to the procedure. Thus, the plaintiff and his lawyer must present evidence of the physician’s breach of the foregoing elements of an informed consent claim in order to prevail at trial.

 

BREACH OF CONTRACT OR WARRANTY CLAIM

While most health care providers will not guarantee or warrant a particular outcome, there are times when they do, and a failure to successfully provide the outcome may give rise to a breach of contract or breach of warranty claim. These type cases usually involve plastic surgery wherein the patient is told that his or her post-surgery physical appearance will be the same as demonstrated on a computerized enhancement of the patient’s photograph. Thus, much like a business breach of contract claim, the plaintiff and his lawyer must present evidence of the physician’s breach of the stated warranty or guarantee by the preponderance of evidence in order to prevail at trial.

 

COMPENSATION IN MEDICAL MALPRACTICE CASES

In a medical malpractice personal injury lawsuit, a victim seeks compensation for the injury or injuries he or she has suffered. Compensation can include past and future medical expenses, disability or deformity, loss of income, emotional and mental anguish, loss of a spouse’s comfort and society, past and future pain and suffering, and an amount which would be necessary to make the person whole as respects a permanent personal injury. McNeil v. United States, 519 F.Supp. 283 (D.S.C. 1981). In cases where the defendant acted recklessly, maliciously or willfully, punitive damages may also be awarded. Punitive damages in medical malpractice lawsuits are intended to punish the responsible party and deter others from committing the same acts. Gamble v. Stevenson, 305 S.C. 104, 406 S.E.2d 350 (1991). If a wrongful death results from the medical malpractice, the decedent’s beneficiaries are entitled to compensation.

 

CAPS ON MEDICAL MALPRACTICE DAMAGES

For medical malpractice cases arising on or after July 1, 2005, which placed caps on non-economic damages a patient could recover from a liable defendant health care provider. S.C. Code § 15-32-220(a) limits the civil liability for non-economic damages of the health care provider to an amount not to exceed $ 350,000 for each claimant regardless of the number of separate causes of action on which the claim is based. S.C. Code § 15-32-220(a) provides an exception to the foregoing cap where the health care provider is proven to be grossly negligent, willful, wanton or reckless and that conduct was the proximate cause of the claimant’s non-economic damages. S.C. Code 15-32-220(b) provides that the $ 350,000 cap is limited to each claimant. S.C. Code 15-32-220(c) allows a claimant to stack his claim, and provides that up to three health care providers may be subject to the $ 350,000 cap per claimant, for a total of $ 1,050,000 per claimant.

 

The non-economic damage cap of $ 350,000 per medical entity or practice or person does not apply to economic damages and does not apply to punitive damages. Effective for medical malpractice cases arising on or after July 1, 2005, S.C. Code 15-32-230 further limits liability with regard to emergency obstetrical or emergency department situations. This section eliminates liability on behalf of any person providing emergency care or emergency obstetrical care to a person in immediate threat of death or an immediate threat of serious bodily injury while in an emergency room, obstetrical or surgical suite, unless the health care provider is proven to be grossly negligent. Other caps or limitations may be applicable to a medical malpractice case as well.

 

STATUTE OF LIMITATIONS

The plaintiff’s attorney must timely bring a medical malpractice suit within the required timeframes. There are time limits on bringing a personal injury lawsuit in the state of South Carolina known as statutes of limitations. See S.C. Code 15-3-530(5); 15-3-535. While a medical malpractice personal injury suit is generally subject to a three year statute of limitations, there may be exceptions depending on the circumstances, such as a medical malpractice case where the negligent conduct may be covered by a concept known as the “discovery rule.” See S.C. Code 15-3-545; Wilson v. Shannon, 299 S.C. 512, 386 S.E.2d 257 (Ct. App. 1989).

 

The statutes of limitations are different for negligence suits against a South Carolina state government agency pursuant to the South Carolina Tort Claims Act (“TCA”) and the federal government pursuant to the Federal Tort Claims Act (“FTCA”). Under the TCA, a suit must generally be filed within two years, unless a verified claim is filed within a year of the injury, then the statute of limitations is three years. S.C. Code § 15-78-110. Under the FTCA, an administrative tort claim must generally be presented to the subject federal agency within two years. Once a timely administrative tort claim has been filed, there is no statute of limitations on bringing a suit unless the federal agency denies the claim, in which case a suit must be brought in federal court within six months after the denial. 28 U.S.C. 1346(b), 1402, 2401, 2675.

 

NECESSITY OF AN EXPERT

South Carolina Code 15-79-125 requires, on medical malpractice cases arising on or after July 1, 2005, that before a medical malpractice suit can be filed, a plaintiff has to simultaneously file both a notice of intent to file suit and an affidavit of an expert witness subject to the affidavit requirements established in 15-36-100 in a county in which venue would be proper for filing or initiating the action. Statutory mediation of any such medical malpractice case is required as well, and, there are time limits for filing suit should the attempted mediation fail. As noted above, an expert’s testimony is necessary at trial to prove a breach of the standard of care and proximate cause of the injury, and the medical malpractice lawyer should retain a medical expert early on to assess the case and to be prepared to testify at trial.

 

Medical malpractice suits in South Carolina are difficult to pursue. Before undertaking a med-mal suit, the injured client would be well advised to consult with a lawyer with medical malpractice experience.

 

Joseph P. Griffith, Jr., Esquire
Joe Griffith Law Firm, LLC
7 State Street
Charleston, South Carolina 29401
(843) 225-5563 (tel)
(843) 722-6254 (fax)
http://www.joegriffith.com

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Getting Greater Good Quality Exam Table For Greater Medical Care

Examination is the basic of patient cure procedure. By doing thoroughly examination, a doctor will be able to make correct diagnosis of patient health condition. The doctor will be able to know what kind of treatment is the best for a patient after doing examination of the patient on the exam table. That is why examination table can be considered as the most important equipment in medical field.

Consider about the comfort level of examination table. It is important to make the patient feels comfortable since you never know what kind of disease and pain that the patient endures. You should not choose medical examination table that is too soft or too hard because the patient might feel discomfort.

Eventhough wellness and healthcare is not fully associated with disabled people. It is important to pay attention at this issue since not all people can move their body easily. Some people have disabilities that make them hard to reach the examination table. You can participate in promoting better healthcare by getting the right exam table that can be good for disabled people. Do not forget to ask the patient about the best and most comfortable position for your patient with disability.

Though, it is hard to get the right examination table for people with disability, you can discuss how to get the right one with your disabled patients. They will surely help you to find the correct one since you have good enthusiasm in providing better healthcare equipment for your patients. Speak directly to your patient and not the guardian in order to get clear information about the most comfortable examination table position for your patient.

During examination, you need to take notes of your patient problem. It is beneficial to remember the details of your patient health record. Before the visit ends, make sure that you ask again the details of your patient health record to know whether what you write is accurate or not. Be sure to remind the patient about the best recovery method that can increase their health.
We can find people with disabilities live longer than in the previous cases. People with disabilities now receive better treatment than in the past. If you want to contribute in making them living in better condition, you can start by getting better exam table that can be good to treat people with disabilities. Ask your patient about the best healthcare that can suit their need. It is essential to make them able to experience better live just like people with no disability.

Perform thoroughly and detailed examination to know the health condition of your patient. If you have got the right examination table for people with disabilities, you will be able to perform medical diagnosis better than the other doctors who do not have the right examination table for people with disabilities. That is why we can consider that examination table is one of the most important things to support medical examination.

In case you are interested in better health care, you can consider of getting exam table. There are varieties of exam table available on the market. You might want to take a look at exam room table that can be useful for medical examination.

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