Federal Out-of-Network Balance Billing Legislation: Context and Implications for Radiology Practices.

Out-of-network (OON) balance billing, commonly known as surprise billing but better described as a surprise gap in health insurance coverage, occurs when an individual with private health insurance (vs a public insurer such as Medicare) is administered unanticipated care from a physician who is not in their health plan's network. Such unexpected OON care may result in substantial out-of-pocket costs for patients. Although ending surprise billing is patient centric, patient protective, and noncontroversial, passing federal legislation was challenging given its ability to disrupt insurer-physician good-faith negotiations and thus impact in-network rates. Like past proposals, the recently passed No Surprises Act takes patients out of the middle of insurer-physician OON reimbursement disputes, limiting patients' expense to standard in-network cost-sharing amounts. The new law, based on arbitration, attempts to protect good-faith negotiations between physicians and insurance companies and encourages network contracting. Radiology practices, even those that are fully in network or that never practiced surprise billing, could nonetheless be affected. Ongoing rulemaking processes will have meaningful roles in determining how the law is made operational. Physician and stakeholder advocacy has been and will continue to be crucial to the ongoing evolution of this process. © RSNA, 2021.

The medico-legal implications in medical malpractice claims during Covid-19 pandemic: Increase or trend reversal?

The Covid-19 pandemic caused a marked increase in admissions to intensive care units. The critically ill patients' condition from the infection resulted in their deaths. The healthcare facilities have got into trouble because of the pandemic. In fact, they had to create additional beds in a very short time and to protect health workers with personal protective equipment. Healthcare professionals fear that there will be an increase in complaints and medico-legal malpractice claims and hence they have urged politicians to discuss this. The Italian Parliament recently debated the topic of medical liability and passed the Decree-Law no. 18 of 17 March 2020 (DL - so called Cura Italia) by which they want to extend the concept of "gross negligence" to healthcare facilities. Several Extended Care Units have suffered from outbreaks of Covid-19, so the Prosecutor's Office of several cities initiated investigations against them. This situation has reached Sicily, where the Prosecutor's Office of Palermo has opened an inquiry against an Extended Care Unit. Simultaneously, the Covid-19 pandemic may change patients' attitudes towards healthcare professionals, who are risking their lives daily. So the Italian medico-legal community is debating these questions, with one last pending question remaining: is the number of medico-legal claims likely to increase or trend down?

Adherencia a la dieta mediterránea en pacientes diabéticos con mal control / Adhesion to the Mediterranean diet in diabetic patients with poor control

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Rules and Regulations Relating to Roles of Nonphysician Providers in Radiology Practices.

Nonphysician providers (NPPs) in radiology practices include nurse practitioners, physician assistants, and radiologist assistants. The number of NPPs has been increasing both within and outside of radiology departments. In order for leaders in radiology departments to incorporate NPPs effectively into their practice, they require nuanced knowledge of appropriate coding and billing for services these professionals render. Furthermore, the existing body of literature suggests that with a defined and appropriate scope of practice and proper supervision, NPPs can provide care that is at least equivalent to that provided by attending physicians for narrowly defined tasks. A broader understanding of the rapidly evolving NPP workforce both within radiology practices and throughout other health care specialties will inform practice leaders who are adapting to a health care system that is moving rapidly toward value-based incentive payment models. ©RSNA, 2018.

[Analysis of final judgements in cases of medical negligence occurred in Ukraine].

OBJECTIVE: Introduction: The peculiarities of the disadvantages of providing medical care in Ukraine are not well-known abroad. The aim: To study the peculiarities of court decisions in cases of unfavorable consequences of medical activity. PATIENTS AND METHODS: Materials and methods: The article analyzes the official data of the General Prosecutor's Office of Ukraine and the website of court decisions regarding criminal cases against medical practitioners. RESULTS: Review: Approximately 600 cases of alleged medical malpractice cases are registered annually in Ukraine. Only less than one percent of them are brought to the court. The guilt of medical practitioners was proven in majority (80,8%) of court decisions. Acquittals of defendants were pronounced in 5,9% of court verdicts. Obstetrics and gynecology, surgery, internal medicine and anesthesiology are in the top of high-risk medical specialties. CONCLUSION: Conclusions: Majority of medical malpractice litigations are sued in Ukraine baselessly. In cases of medical negligence majority of defendants are acquitted as usual.

Despejando las sospechas: informes médicos en los tribunales de justicia de la comarca de la Ribera del Júcar (ss. XVI y XVII) / Clearing suspicions: medical reports in law courts of the Ribera del Júcar region (XVI and XVII centuries)

El presente estudio analiza la presencia de los practicantes de la medicina en los tribunales de justicia de una comarca rural valenciana conocida como la Ribera del Júcar, durante los siglos XVI y XVII. Las fuentes utilizadas se refieren fundamentalmente a la villa real más importante de la región, Alzira, y a otro lugar de señorío de pequeñas dimensiones, Albalat, que conservan un importante volumen de procesos judiciales. Se analizan los procedimientos periciales y sus protagonistas, particularmente el informe relacionado con las heridas (dessospitació), ya fueran de arma blanca o de arma de fuego, y su pronóstico, estableciendouna comparación con la literatura médica desarrollada para tal fin

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Medical Malpractice Damage Caps and Provider Reimbursement.

A common state legislative maneuver to combat rising healthcare costs is to reform the tort system by implementing caps on noneconomic damages awardable in medical malpractice cases. Using the implementation of caps in several states and large database of private insurance claims, I estimate the effect of damage caps on the amount providers charge to insurance companies as well as the amount that insurance companies reimburse providers for medical services. The amount providers charge insurers is unresponsive to tort reform, but the amount that insurers reimburse providers decreases for some procedures. Copyright © 2015 John Wiley & Sons, Ltd.