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keep in mind the above-mentioned guidelines as they exercise their discretion.This article is presented for educational purposes only and should not be taken as a substitute for legal advice, which should be obtained from personal legal counsel. Nevertheless, the FMA hopes that the information provided here and in its other publications continues to assist physicians in answering many of their most common legal questions allowing them to treat patients, instead of addressing legal concerns. Last Update: March 2013 HMO REIMBURSEMENT FOR EMERGENCY CARE AND SERVICES Health maintenance organizations are governed under Chapter 641 of the Florida Statutes. Section 641.47(8), Florida Statutes, defines “emergency services and care” to mean “medical screening,examination, and evaluation by a physician or, to the extent permitted by applicable law, by other appropriate personnel under the supervision of a physician, to determine if an emergency medical condition exists, and if it does, the care, treatment, or surgery for a covered service by a physician necessary to relieve or eliminate the emergency medical condition within the service capability of a hospital.”Subsection 641.513(3)(a), Florida Statutes, states, “The health maintenance organization shall compensate the provider for the screening, evaluation, and examination that is reasonably calculated to assist the healthcare provider in arriving at a determination as to whether the patient’s condition is an emergency medical condition. The [HMO] shall compensate the provider for emergency services and care. If a determination is made that an emergency condition does not exist, payment for services rendered subsequent to that determination is governed by the contract under which the subscriber is covered.”Subsection 641.513(5), Florida Statutes, states that when emergency services and care are rendered to a patient by a non-contracted physician, the HMO must reimburse the physician the lesser of:(a) The provider’s charges;(b) The usual and customary provider charges for similar services in the community where the services were provided; or(c) The charge mutually agreed to by the HMO and the provider within 60 days of the submittal of the claim.The reimbursement must be net of any applicable copayment authorized.Note, however, if the person is enrolled in a Medicaid HMO, the HMO is allowed to reimburse the lesser of the above three choices or the Medicaid rate.Furthermore, an HMO is not allowed to conduct a post-care analysis and make its own determination as to whether such a condition was present. Once the attending physician indicates in the chart that such a condition exists, the HMO is required to pay for medical care and services rendered in treating the condition.If you are having difficulty in obtaining proper reimbursement for services rendered to an HMO patient, it is important to note that you cannot balance bill the patient. Your sole recourse for reimbursement lies with the patient’s HMO. In situations where the HMO and the physician cannot agree on the proper reimbursement rate, physicians may obtain assistance in getting their claims paid by using the Statewide Provider and Health Plan Claim Dispute Resolution Program [Section 408.7057, Florida Statutes]. Application forms and instructions on how to file claims are available from Maximus, an independent dispute resolution organization contracted with AHCA, by calling 1-866-763-6395 and asking for the “Florida Appeals Process.” You may also call AHCA’s Bureau of Managed Care at (850) 487-0640. There is a charge for reviewing claims. The charge is to be paid by the non-prevailing party.This article is presented for educational purposes only and should not be taken as a substitute for legal advice, which should be obtained from personal legal counsel. Nevertheless, the FMA hopes that the information provided here and in its other publications continues to assist physicians in answering many of their most common legal questions allowing them to treat patients, instead of addressing legal concerns. Last update: June 2010 HURRICANE PREPAREDNESS General Hurricane preparedness must be an essential part of daily life for Floridians; it is crucial not to underestimate the power of these storms. Every year Florida sits directly in the path of a hurricane and as a result, physicians must be prepared to effectively manage their offices. Physicians can mitigate damages caused by natural disasters by having effective preparedness plans that encompass both what to do before and after a hurricane. While hurricanes are almost certainly the most prevalent threat to the State of Florida, stay conscientious of other disasters such as tornadoes, floods, fire, and bomb threats. Insurance Probably one of the most important considerations in a physician’s hurricane preparedness plan is to have a comprehensive knowledge on what your insurance policy covers and in what areas the policy might be lacking. Consider whether you need flood insurance, insurance to cover payrolls or other business expenses in the event there is damage to the medical office. If one does not already exist, create an inventory of office equipment or check with your insurance provider on how to document your assets. Keep copies of your insurance policies and contact numbers in a safe location, preferably off-site or in a fireproof document box in case of an emergency. Preserving Patient Medical Records Another major concern for medical offices is how to preserve medical records when threatened by a natural disaster. After Hurricane Katrina destroyed hundreds of thousands of documents, the value of electronic medical records was realized. The loss of medical records is detrimental to both the physician and the patient, and physicians should take the necessary steps to prevent the loss of such records. Keep in mind the four phases of emergency management: mitigate, preparedness, response, and recovery. Mitigate future damages by analyzing your record keeping system now. If the practice utilizes an electronic system for medical or billing purposes, then prepare for a hurricane by developing a policy on the best way to back up the data. If the practice uses a paper system, the physician may want to consider investing in fireproof cabinets or an electronic database, storing copies off-site, or developing some other policy that will help protect medical records. Have a meeting with main employees in order to develop a response system for an imminent hurricane. This will help to alleviate any panic or chaos if physicians and employees know their role in protecting the practice.Recovery may be as simple as removing shutters or as severe as having to relocate. Create a recovery plan that encompasses both ends of the spectrum. The recovery plan should anticipate partial or full loss of medical records. This policy would include a plan on how to contact affected patients; if the contact list is destroyed, consider an ad in the local newspaper. Also determine how to reestablish crucial information such as patient medication lists. Other Considerations Perhaps a worst case scenario is the medical office is damaged to such an extent that relocation has become the only option. If this is the best option for the practice, please refer to the article titled RETIRING/CLOSING/RELOCATING A PRACTICE within this handbook.This article is presented for educational purposes only and should not be taken as a substitute for legal advice, which should be obtained from personal legal counsel. Nevertheless, the FMA hopes that the information provided here and in its other publications continues to assist physicians in answering many of their most common legal questions allowing them to treat patients, instead of addressing legal concerns. Last Update: March 2013 IMPAIRED PRACTITIONERS Not many people are aware of it but the Florida Medical Association helps staff one of the most important programs in the State of Florida. It is the Professionals Resource