MMA News
State’s Major Payers Now Participate in Online Credentialing
Credentialing information can now be sent to all major health care payers in the state through the Minnesota Credentialing Collaborative’s (MCC) secure website.
The Minnesota Department of Human Services (DHS), the last major payer to participate, began accepting applications and updated credentials for certain providers through the online service in May. (Details about how to use the credentialing service with state- sponsored health care programs are available at www.dhs.state.mn.us/provider/MCC.)
“The MMA has worked hard to reduce the credentialing burden for its members, and the addition of DHS will further streamline the process and reduce unnecessary administrative work,” says George Lohmer, the MMA’s chief financial officer and secretary-treasurer for the MCC.
Credentialing Simplified
The MMA, Minnesota Hospital Association, Minnesota Council of Health Plans, and Minnesota Medical Group Management Association launched the online credentialing system in 2009 in response to a need to reduce the administrative burden and cost of credentialing to physicians and other providers.
A subscription to the MCC (www.MNCred.org) allows providers to electronically submit credentialing information and updates to Minnesota-based health plans and hospitals. A subscription costs $25 a year. There is no limit to the number of applications that can be sent during a year. The online credentialing system replaces a cumbersome process by which physicians had to complete a paper application for each organization at which they wished to be credentialed. Because of illegible entries, missing information, and errors, as many as half of initial applications were returned, requiring practitioners to start over with the process.
Court Sides with Clinic in Legal Fight with Malpractice Insurer
The Owatonna Clinic has prevailed in a legal battle against its malpractice insurer, which had denied payment for a claim. The U.S. Court of Appeals for the 8th Circuit ruled in favor of the clinic in May when it affirmed the U.S. District Court’s ruling on the case, which centered on whether the insurance company could deny a malpractice claim strictly on procedural grounds.
The Case
The case, Owatonna Clinic, Mayo Health System v. Medical Protective Company, called into question what constitutes adequate notice that a clinic may file a malpractice claim with an insurance company under a claims-made type of policy. Approximately 95 percent of professional liability policies in Minnesota are claims-made policies. Under such policies, a claim must be made during the policy period or the extended reporting period.
In this case, Medical Protective Company (Med Pro) issued a claims-made professional liability insurance policy to Owatonna Clinic in 1999. The policy required the clinic to provide written notice when a medical incident might result in liability. It also requested that details such as the names and addresses of the injured parties, witnesses to the event, and the time, place, and circumstances of the incident be included.
In 1999, Owatonna Clinic notified Med Pro in writing of an incident that it believed could result in a liability claim. It also verbally provided the names of parties involved and details about the incident. When a lawsuit ensued against Owatonna Clinic in 2005, Med Pro denied coverage, stating that the clinic had not provided adequate notification such as written notification of the name and address of the patient in question.
Owatonna Clinic brought a breach-of-contract claim against Med Pro in U.S. District Court. The Court sided with Owatonna Clinic, citing “the substantive adequacy of the notice” it provided to Med Pro.
Med Pro appealed the U.S. District Court’s decision to the 8th Circuit, arguing that a strict compliance standard should be used when interpreting provisions of claims-made policies.
Form versus Substance
Last August, the MMA, along with the Minnesota Hospital Association and American Medical Association, filed an amicus brief in support of Owatonna Clinic that argued that a strict compliance standard would be unfair because it would elevate form over substance and allow insurers to reject claims strictly on procedural grounds. “It was important for the MMA to weigh in on this in order to ensure that physicians remain able to easily file insurance claims without the worry that ambiguous or seemingly less significant provisions in the insurance policy could lead to their claim being denied,” says Karolyn Stirewalt, J.D., policy counsel for the MMA.
The 8th Circuit agreed and affirmed the U.S. District Court’s holding. The appeals court stated, “It is in keeping with general Minnesota jurisprudence that rejects technical and narrow objections to the existence of coverage, especially when it comes to matters of notice. … When the substantive adequacy of the notice is in issue (as it was in this case) … the law of Minnesota places a burden of inquiry on the insurer when it has notice of facts that would raise a likelihood of a claim, and we are satisfied that this case falls within the ambit of that principle.”
“This is an outstanding result,” Stirewalt says. “An adverse holding would have seriously impacted both Minnesota physicians and facilities that have claims-made medical malpractice liability policies.”
MMA in Action
- In early May, Dave Renner, MMA director of state and federal legislation, met with Rep. Tara Mack, R-Apple Valley, to negotiate changes to her proposal to amend the chiropractic practice act, such as removing the term “chiropractic physician.” Following the meeting, Rep. Mack agreed not to pursue the bill this session.
Dave Renner can be reached at drenner@mnmed.org
- Members of the MMA’s member relations team and several family physician volunteers staffed a booth at the Minnesota Academy of Family Physicians’ Spring Refresher April 14-15 to educate attendees about joining and getting involved in the MMA.
- MMA Legal Counsel Karolyn Stirewalt represented the MMA at a Death Data Quality Advisory Group meeting hosted by the Minnesota Department of Health. The group’s objective is to improve accurate reporting of causes of death. Stirewalt also represented the MMA at the Minnesota Board of Medical Practice meeting May 14.
Karolyn Stirewalt can be reached at kstirewalt@mnmed.org
- The Minnesota Medical Association Alliance, a membership organization for spouses and partners of physicians, held their annual meeting May 4-5 in Rochester. Approximately 25 members heard talks on ways to respond to the obesity epidemic among children.
- MMA President Patricia Lindholm, M.D., gave a presentation about the MMA’s physician well-being activities to the Ethics and Medical Legal Affairs Committee in May. The committee discussed current legislation relating to stem cell research and minor consent for medical treatment.
Patricia Lindholm can be reached at plindholm@mnmed.org
- On May 4, MMA President-Elect Lyle Swenson, M.D., Past-President Benjamin Whitten, M.D., Mark Liebow, M.D., and MMA Policy Director Janet Silversmith met with Blue Cross and Blue Shield of Minnesota leadership to address issues including health care homes, provider tiering, and consultation code coverage.
- Eric Dick, MMA manager of government affairs, attended a House Agriculture Committee hearing on May 11, during which a proposal to expand the availability of raw milk products was debated. The MMA and the Minnesota Chapter of the American Academy of Pediatrics sent letters to committee members opposing such an expansion because of the significant health risks associated with the consumption of raw milk and raw milk products. The legislation was tabled for consideration next year.
Eric Dick can be reached at edick@mnmed.org