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Insurance is inexpensive, and it can be retroactive
Regulatory insurance is becoming more popular with health care providers, says Chip Goen, vice president of sales with MAG Mutual Insurance Agency (MMIA) an insurance company in Atlanta. The company writes about 10 regulatory policies a month, up significantly over the past few years.
MMIA offers regulatory insurance that is retroactive for six years, with legal representation and coverage for audits, fines, and penalties. The policy would cover the cost of hiring an independent auditor to conduct a "shadow audit" alongside RAC or other auditors, Goen says.
The policy covers HIPAA, EMTALA, and Stark investigations, as well as audits and commercial payer inquiries. Restitution for overbilling is not covered, Goen says.
Policy caps will vary depending on the provider. A solo physician's cap would be $1 million, for instance, but a large practice or hospital would have a limit of $5 million, he says.
"The underwriters love to see a compliance program in effect, and they do give premium credits to small practices for having one," Goen says. "It would be a requirement for a hospital or a large practice, but not for smaller providers."
The regulatory insurance product is getting more attention because providers are realizing that "it's not a matter if they're going to get audited; it's a matter of when," Goen says.
Coverage costs about $1,000 per year per physician in a practice group. Hospital premiums are determined by the number of beds and annual revenue. A 300-bed hospital probably would pay about $50,000 per year for coverage, he says.
Chip Goen, Vice President, Sales, Mag Mutual Insurance Agency, Atlanta. Telephone: (404) 842-5584. E-mail: firstname.lastname@example.org.