Archive for October, 2011

You Suck or You Fill

October 31, 2011

You Suck

…the air out of a room when you make it all about you.

…the life out of everyone around you when you make it all about you.

…the joy out of every endeavor when you make it all about you.

…the lightness out of every quest when you make it all about you.

…the potential out of every business when you make it all about you.

You fill
…every room,
…every person,
…every endeavor,
…every quest,
…every business with life, with energy, with potential,
When you make it all about them.
The challenge is to serve, solve and delight from a place of genuine personal interest without relying on the experience to complete you.
copied from an original blog post by Jonathan Fields


October 27, 2011

“The secret of getting ahead is getting started. The secret of getting started is breaking your complex overwhelming tasks into small manageable tasks, and then starting on the first one.” – Mark Twain

The difference between an RN vs LVN

October 24, 2011

Registered Nurse (RN) is a nurse who has graduated from a nursing program at a university or college and has passed a national licensing exam. A registered nurse helps individuals, families, and groups to achieve health and prevent disease. They care for the sick and injured in hospitals and other health care facilities, physicians’ offices, private homes, public health agencies, schools, camps, and industry.  A registered nurse’s scope of practice is determined by each state’s Nurse Practice Act. It outlines what is legal practice for registered nurses and what tasks they may or may not perform.

The term Licensed Vocational Nurses (LVN) or Licensed Practical Nurse (LPN) is used in much of the United States and most Canadian provinces to refer to a nurse who cares for “people who are sick, injured, convalescent, or disabled under the direction of registered nurses and physicians.

Equivalent professions outside the United States are “Registered Practical Nurse” (RPNs) in the Canadian Province  of Ontario, “enrolled nurses” (ENs) in Australia and New Zealand, and “State Enrolled Nurses” (SENs) in the United Kingdom.

The Texas Nursing Law and Rules may be viewed here.


October 20, 2011
“You can’t have a better tomorrow if you’re thinking about yesterday.” – Charles Kettering, Inventor

What is Professional Liability Insurance?

October 17, 2011

Professional Liability Insurance (PLI), also called Professional Indemnity Insurance (PII) but is also commonly known as Errors & Omissions Insurance (E&O), is a form of liability insurance that helps protect professional advice- and service-providing individuals and companies from bearing the full cost of defending against a negligence claim made by a client, and damages awarded in such a civil lawsuit. The coverage focuses on alleged failure to perform on the part of, financial loss caused by, and error or omission in the service or product sold by the policyholder. These are potential causes for legal action that would not be covered by a more general liability insurance policy which addresses more direct forms of harm. Professional liability coverage sometimes also provides for the defence costs, including when legal action turns out to be groundless. Coverage does not include criminal prosecution, nor a wide range of potential liabilities under civil law that are not enumerate in the policy, but which may be subject to other forms of insurance. Professional liability insurance is required by law in some areas for certain kinds of professional practice (especially medical and legal), and is also sometimes required under contract by other businesses that are the beneficiaries of the advice or service.

Professional liability insurance may take on different forms and names depending on the profession. For example, in reference to medical professions it is called Malpractice Insurance, while Errors and Omissions (E&O) Insurance is used by consultants, brokers and lawyers. Other professions that commonly purchase professional liability insurance include accounting , financial services, construction and maintenance (general contractors, plumbers, etc., many of whom are also surety bonded), and transport. Some charities and other nonprofits are also professional-liability insured.

The primary reason for professional liability coverage is that a typical general liability insurance  policy will only respond to a bodily injury, property damage, personal injury or advertising injury claim. Other forms insurance cover employers, public and product liability. But various professional services and products can give rise to legal claims without causing any of the specific types of harm covered by such policies. Common claims that professional liability insurance covers are negligence, misrepresentation, violation of good faith and fair dealing, and inaccurate advice.

Professional liability insurance policies are generally set up based on a claims-made basis, meaning that the policy only covers claims made during the policy period. More specifically, a typical policy will provide indemnity to the insured against loss arising from any claim or claims made during the policy period by reason of any covered neglect, error or omission committed in the conduct of the insured’s professional business during the policy period. Claims which may relate to incidents occurring before the coverage was active may not be covered, although some policies may have a retroactive date, such that claims made during the policy period but which relate to an incident after the retroactive date (where the retroactive date is earlier than the inception date of the policy) are covered.

Coverage does not include criminal prosecution, nor all forms of legal liability under civil law, only those specifically enumerated in the policy.

Some policies are more tightly worded than others and while a number of policy wordings are designed to satisfy a stated minimum approved wording, which makes them easier to compare, others differ dramatically in the coverage they provide.

Coverage is usually continued for as long as the policyholder provides covered services or products, plus the span of any applicable statue of limitations. Cancelling the policy before this time would in effect make it as if the insured never had coverage for any incidents, since any client could bring any case with regard to any such services or products that occurred before the statute of limitations cut-off point. A break in coverage could result in what is called a “gap in coverage,” which is the loss of all prior acts.

Need Professional Liability Insurance coverage? Check out the Texas Department of Insurance list of carriers for Texas.


October 13, 2011

“Minds are like parachutes, they function only when open.”  – Anonymous

Questions asked by New Providers

October 10, 2011

What is a National Provider Identification Number (NPI) and where can I obtain one? NPI is a National Provider Identification (NPI) number. If you do not have one, you can apply for one with the National Plan & Provider Enumeration System (NPPES).  If you don’t know if you have already completed this process, you can search the NPI Registry with NPPES here.

Do I need a Medicare number to be participating? Yes, you will need a Medicare number if you are going to provide any services for members with Medicare. Some health plans require that you have this number to participate with any of their products.  You must obtain a Medicare Number before you will be issued a Medicaid Number.

Do I need a Medicaid number to participate Medicaid programs? Yes, you will need a state Medicaid number if you are going to provide any services for members covered under any of the state Medicaid programs.  If you see a member of a Medicaid program and you are not participating, you can not bill this member unless you have had them sign the form stating you are not a contracted provider and will not be billing their insurance for these services.

What is Professional Liability Insurance (aka Malpractice Insurance)? This is the insurance that pays if the provider is sued by a patient for wrong treatment, etc. This is different than general liability insurance that covers your building in case of a fire or in case someone falls and is injured on your property.

How much Professional Liability Insurance is required? The requirements are set by the State you practice in.  Typically a minimum of $100,000 per occurrence / $300,000 in aggregate is required. Many health plans require higher limits.

What does CV mean and is it required? CV means curriculum vitae (pronounced ker-ik-u-lum vee-tae). It is similar to a resume and contains a summary of your educational background, work history, professional license, and any other special training you may have taken. It is important to keep one of these updated so that you have it ready if requested.  Many insurance companies require this as a part of the application and credentialing process.

What is ERISA? ERISA is a specific government regulation for certain kinds of insurance-like benefit plans. Usually “ERISA plans” are created by large employer groups that are considered “self-insured” to provide health care benefits for the employees and families of that employer.


October 6, 2011
“High expectations are the key to everything.”  – Sam Walton, Wal-Mart Founder

Questions regarding Credentialing

October 3, 2011

How long will it take to process my Credentialing application? Credentialing generally takes 45-120 days for completion.  It may take longer if you submit an incomplete application or if requested attachments are not submitted with the application.  Also depending on the backlog of a carrier, it can take additional time for processing.

I received a letter that my Credentialing application is missing some information. What do I do? You should follow the directions provided. If you have questions you should contact the person who sent the request.  These should be followed up on promptly.

How often are providers Re-Credentialed? Providers are required to complete the Credentialing every three years based on their initial Credentialing date (unless their state has other requirements). A provider must successfully complete Re-Credentialing in order to remain a participating provider.

What happens during Re-Credentialing? After you have been in the network for about 2 ½ years you will receive notification for Re-Credentialing. The notification will include instructions specific to your specialty. If your application is on CAQH and is kept updated, you may not need to take any action at the time of Re-Credentialing.

What if the Credentialing Committee denies my initial application for participation or my Re-Credentialing application? Depending on the reasons why the committee made that decision, you may be offered the opportunity to submit additional information and/or submit an appeal. Your denial or termination letter explains your rights and the timelines you must follow.

What is the submission deadline for the Credentialing/Re-Credentialing forms? There is no deadline to submit an initial Credentialing application but you can’t become a network provider until you have successfully completed the Credentialing process. Re-Credentialing applications should be completed as soon as possible after you receive the notification. If you do not submit a complete Re-Credentialing application, your network participation will be terminated, and you may not be eligible to reapply for two years.