Joseph S. Eastern, MD

Have you ever run across a negative or even malicious comment about you or your practice on the web, in full view of the world? You’re certainly not alone.

Chances are it was on one of those doctor rating sites, whose supposedly "objective" evaluations are anything but fair or accurate. One curmudgeon, angry about something that usually has nothing to do with your clinical skills, can use his First Amendment–protected right to trash you unfairly, as thousands of satisfied patients remain silent.

What to do? You could hire one of the many companies in the rapidly burgeoning field of online reputation management, but that can cost hundreds to thousands of dollars per month for monitoring and intervention, and there are no guarantees of success.

A better solution is to generate your own search results – positive ones – that will overwhelm any negative comments that search engines might find. Start with the social networking sites. However you feel about networking, there’s no getting around the fact that personal pages on Facebook, LinkedIn, and Twitter rank very high on major search engines. (Some consultants say a favorable LinkedIn profile is particularly helpful because of that site’s reputation as a "professional" network.) Your community activities, charitable work, interesting hobbies – anything that casts you in a favorable light – need to be mentioned prominently in your network profiles.

You can also use Google’s profiling tool (google.com/profiles) to create a sterling bio, complete with links to URLs, photos, and anything else that shows you in the best possible light. And your Google profile will be at or near the top of any Google search.

Wikipedia articles go to the top of most searches, so if you’re notable enough to merit mention in one – or to have one of your own – see that it is updated regularly. You can’t do that yourself, however; Wikipedia’s conflict-of-interest rules forbid writing or editing content about yourself. Someone with a "neutral point of view" will have to do it.

If you don’t yet have a website, now would be a good time. As I’ve discussed many times, a professionally-designed site will be far more attractive and polished than anything you could build yourself. Furthermore, an experienced designer will employ "search engine optimization" (SEO), meaning that content will be created in a way that is readily visible to search engine users.

Leave design and SEO to the pros, but don’t delegate the content itself. As captain of the ship, you are responsible for all the facts and opinions on your site. And remember that once it’s online, it’s online forever. Consider the ramifications of anything you post on any site (yours or others) before hitting the "send" button. "The most damaging item about you," one consultant told me, "could well be something you posted yourself." Just ask any of several prominent politicians who have sabotaged their careers online.

That said; don’t be shy about creating content. Make your (noncontroversial) opinions known on Facebook and Twitter. If social networks are not your thing, add a blog to your website and write about what you know, and what interests you. If you have expertise in a particular field, write about that.

Incidentally, if the URL for your website is not your name, you should also register your name as a separate domain name, if only to be sure that a trickster – or someone with the same name and a bad reputation – doesn’t get it.

Set up an RSS news feed for yourself so you’ll know immediately anytime your name pops up in news or gossip sites, or on blogs. If something untrue is posted about you, take action. Reputable news sites and blogs have their own reputations to protect, and so can usually be persuaded to correct anything that is demonstrably false. Try to get the error removed entirely, or corrected within the original article. An erratum on the last page of the next edition will be ignored, and will leave the false information online, intact.

Unfair comments on doctor rating sites are unlikely to be removed unless they are blatantly libelous, but there is nothing wrong with encouraging happy patients to write favorable reviews. Turnabout is fair play.

Dr. Eastern practices dermatology and dermatologic surgery in Belleville, N.J. He holds teaching positions at several hospitals and has delivered more than 500 academic speaking presentations. He is the author of numerous articles and textbook chapters, and is a long-time monthly columnist for Skin & Allergy News.

Have you ever run across a negative or even malicious comment about you or your practice on the web, in full view of the world? You’re certainly not alone.

Chances are it was on one of those doctor rating sites, whose supposedly "objective" evaluations are anything but fair or accurate. One curmudgeon, angry about something that usually has nothing to do with your clinical skills, can use his First Amendment–protected right to trash you unfairly, as thousands of satisfied patients remain silent.

What to do? You could hire one of the many companies in the rapidly burgeoning field of online reputation management, but that can cost hundreds to thousands of dollars per month for monitoring and intervention, and there are no guarantees of success.

A better solution is to generate your own search results – positive ones – that will overwhelm any negative comments that search engines might find. Start with the social networking sites. However you feel about networking, there’s no getting around the fact that personal pages on Facebook, LinkedIn, and Twitter rank very high on major search engines. (Some consultants say a favorable LinkedIn profile is particularly helpful because of that site’s reputation as a "professional" network.) Your community activities, charitable work, interesting hobbies – anything that casts you in a favorable light – need to be mentioned prominently in your network profiles.

You can also use Google’s profiling tool (google.com/profiles) to create a sterling bio, complete with links to URLs, photos, and anything else that shows you in the best possible light. And your Google profile will be at or near the top of any Google search.

Wikipedia articles go to the top of most searches, so if you’re notable enough to merit mention in one – or to have one of your own – see that it is updated regularly. You can’t do that yourself, however; Wikipedia’s conflict-of-interest rules forbid writing or editing content about yourself. Someone with a "neutral point of view" will have to do it.

If you don’t yet have a website, now would be a good time. As I’ve discussed many times, a professionally-designed site will be far more attractive and polished than anything you could build yourself. Furthermore, an experienced designer will employ "search engine optimization" (SEO), meaning that content will be created in a way that is readily visible to search engine users.

Leave design and SEO to the pros, but don’t delegate the content itself. As captain of the ship, you are responsible for all the facts and opinions on your site. And remember that once it’s online, it’s online forever. Consider the ramifications of anything you post on any site (yours or others) before hitting the "send" button. "The most damaging item about you," one consultant told me, "could well be something you posted yourself." Just ask any of several prominent politicians who have sabotaged their careers online.

That said; don’t be shy about creating content. Make your (noncontroversial) opinions known on Facebook and Twitter. If social networks are not your thing, add a blog to your website and write about what you know, and what interests you. If you have expertise in a particular field, write about that.

Incidentally, if the URL for your website is not your name, you should also register your name as a separate domain name, if only to be sure that a trickster – or someone with the same name and a bad reputation – doesn’t get it.

Set up an RSS news feed for yourself so you’ll know immediately anytime your name pops up in news or gossip sites, or on blogs. If something untrue is posted about you, take action. Reputable news sites and blogs have their own reputations to protect, and so can usually be persuaded to correct anything that is demonstrably false. Try to get the error removed entirely, or corrected within the original article. An erratum on the last page of the next edition will be ignored, and will leave the false information online, intact.

Unfair comments on doctor rating sites are unlikely to be removed unless they are blatantly libelous, but there is nothing wrong with encouraging happy patients to write favorable reviews. Turnabout is fair play.

Dr. Eastern practices dermatology and dermatologic surgery in Belleville, N.J. He holds teaching positions at several hospitals and has delivered more than 500 academic speaking presentations. He is the author of numerous articles and textbook chapters, and is a long-time monthly columnist for Skin & Allergy News.

Have you ever run across a negative or even malicious comment about you or your practice on the web, in full view of the world? You’re certainly not alone.

Chances are it was on one of those doctor rating sites, whose supposedly "objective" evaluations are anything but fair or accurate. One curmudgeon, angry about something that usually has nothing to do with your clinical skills, can use his First Amendment–protected right to trash you unfairly, as thousands of satisfied patients remain silent.

What to do? You could hire one of the many companies in the rapidly burgeoning field of online reputation management, but that can cost hundreds to thousands of dollars per month for monitoring and intervention, and there are no guarantees of success.

A better solution is to generate your own search results – positive ones – that will overwhelm any negative comments that search engines might find. Start with the social networking sites. However you feel about networking, there’s no getting around the fact that personal pages on Facebook, LinkedIn, and Twitter rank very high on major search engines. (Some consultants say a favorable LinkedIn profile is particularly helpful because of that site’s reputation as a "professional" network.) Your community activities, charitable work, interesting hobbies – anything that casts you in a favorable light – need to be mentioned prominently in your network profiles.

You can also use Google’s profiling tool (google.com/profiles) to create a sterling bio, complete with links to URLs, photos, and anything else that shows you in the best possible light. And your Google profile will be at or near the top of any Google search.

Wikipedia articles go to the top of most searches, so if you’re notable enough to merit mention in one – or to have one of your own – see that it is updated regularly. You can’t do that yourself, however; Wikipedia’s conflict-of-interest rules forbid writing or editing content about yourself. Someone with a "neutral point of view" will have to do it.

If you don’t yet have a website, now would be a good time. As I’ve discussed many times, a professionally-designed site will be far more attractive and polished than anything you could build yourself. Furthermore, an experienced designer will employ "search engine optimization" (SEO), meaning that content will be created in a way that is readily visible to search engine users.

Leave design and SEO to the pros, but don’t delegate the content itself. As captain of the ship, you are responsible for all the facts and opinions on your site. And remember that once it’s online, it’s online forever. Consider the ramifications of anything you post on any site (yours or others) before hitting the "send" button. "The most damaging item about you," one consultant told me, "could well be something you posted yourself." Just ask any of several prominent politicians who have sabotaged their careers online.

That said; don’t be shy about creating content. Make your (noncontroversial) opinions known on Facebook and Twitter. If social networks are not your thing, add a blog to your website and write about what you know, and what interests you. If you have expertise in a particular field, write about that.

Incidentally, if the URL for your website is not your name, you should also register your name as a separate domain name, if only to be sure that a trickster – or someone with the same name and a bad reputation – doesn’t get it.

Set up an RSS news feed for yourself so you’ll know immediately anytime your name pops up in news or gossip sites, or on blogs. If something untrue is posted about you, take action. Reputable news sites and blogs have their own reputations to protect, and so can usually be persuaded to correct anything that is demonstrably false. Try to get the error removed entirely, or corrected within the original article. An erratum on the last page of the next edition will be ignored, and will leave the false information online, intact.

Unfair comments on doctor rating sites are unlikely to be removed unless they are blatantly libelous, but there is nothing wrong with encouraging happy patients to write favorable reviews. Turnabout is fair play.

Dr. Eastern practices dermatology and dermatologic surgery in Belleville, N.J. He holds teaching positions at several hospitals and has delivered more than 500 academic speaking presentations. He is the author of numerous articles and textbook chapters, and is a long-time monthly columnist for Skin & Allergy News.

The current discussion of the transition to ICD-10 and other health insurance reforms has overshadowed the broader issue of dealing with other types of insurance claims. We buy casualty and liability insurance hoping we will never need it; but when we do, it’s important to get it right, and your extensive experience in coping with health insurance claims can be put to good use in such situations.

Prompt filing is just as important with a casualty or liability claim as it is with a health claim. All insurance policies have a filing deadline, which varies with different policies and states. But just because you file promptly does not mean you have to settle on a payment right away.

Most insurers want a quick resolution as much as you do, but if you allow yourself to be rushed, you could end up with a smaller settlement than you deserve.

If you’re a regular reader of this column, you’re familiar with my first rule of dealing with health insurers: Everything is negotiable. And it’s no different with casualty insurers. Regardless of what adjusters tell you, the initial amount offered is never engraved in stone.

Adjusters are evaluated on the basis of how much money they "save" on claims; so their initial number will usually be low – often too low.

Just as with health insurance claims, there are multiple "gray areas" in casualty policies that can be negotiated. In the case of a burglary or storm or fire damage in your office, for example, reasonable expenses will vary considerably for repair of damaged medical equipment and replacement of equipment that was destroyed, or for rental of alternate office space while a damaged office is being repaired.

Other negotiable costs are moving expenses, storage of damaged and undamaged equipment, and depreciation on specific items. And as we all know from our health insurance experience, injuries are particularly fertile areas for negotiation.

Another adjuster’s trick, which you may have already encountered with a damaged car, is to steer you to certain repair shops and contractors that give the insurer prenegotiated prices for their work, but may offer inferior parts and service. Most policies do not require that you accept the insurer’s choice of contractors. Insist on having work done by people you know and trust. Almost always, you are entitled to the same kind and quality of materials you had before the disaster.

Do your own research on the value of lost and damaged items; the more documentation you have, the less likely an adjuster is to question your claim. Just as with health insurance coding, preparation pays off.

Document your losses very specifically. Adjusters often attempt to group material losses nonselectively, just as health insurers sometimes attempt to "bundle" your services. For example, if a certain cabinet contained medical supplies, try to be very specific about the supplies it contained. That way, you can assign value to individual items, rather than allowing the insurance company to estimate a lump sum.

After the trauma of a burglary, fire, or flood, you may overlook some damage. As many victims of hurricanes and other natural disasters have learned, damage that is not immediately apparent can add up to a significant amount of money later. Another thing your insurer may not tell you is even after you arrive at a settlement, you can still file another claim if you discover additional losses.

It is usually not wise to rely solely on your insurance agent in such situations, because an agent’s loyalty resides primarily with the insurance company, not the claimant. Retaining a lawyer is often a good idea, if only to review paperwork and help you value your losses. It will cost comparatively little, and is usually money well spent. In addition, you will probably need a lawyer for representation if you have a large or complicated case, and certainly if you suspect that the insurance company is not dealing with you fairly.

A less expensive alternative to a lawyer may be a public insurance adjuster. Public adjusters are professionals who work for policyholders, not insurers. They inspect the loss site, analyze the damages, assemble claim support data, review your coverage, determine replacement costs, and strive to maximize your settlement in the same way the insurer’s adjuster will try to minimize it. You can find more information and a list of public adjusters in your area on the website of the National Association of Public Insurance Adjusters.

Dr. Eastern practices dermatology and dermatologic surgery in Belleville, N.J. He holds teaching positions at several hospitals and has delivered more than 500 academic speaking presentations. He is the author of numerous articles and textbook chapters, and is a long-time monthly columnist for Skin & Allergy News.

The current discussion of the transition to ICD-10 and other health insurance reforms has overshadowed the broader issue of dealing with other types of insurance claims. We buy casualty and liability insurance hoping we will never need it; but when we do, it’s important to get it right, and your extensive experience in coping with health insurance claims can be put to good use in such situations.

Prompt filing is just as important with a casualty or liability claim as it is with a health claim. All insurance policies have a filing deadline, which varies with different policies and states. But just because you file promptly does not mean you have to settle on a payment right away.

Most insurers want a quick resolution as much as you do, but if you allow yourself to be rushed, you could end up with a smaller settlement than you deserve.

If you’re a regular reader of this column, you’re familiar with my first rule of dealing with health insurers: Everything is negotiable. And it’s no different with casualty insurers. Regardless of what adjusters tell you, the initial amount offered is never engraved in stone.

Adjusters are evaluated on the basis of how much money they "save" on claims; so their initial number will usually be low – often too low.

Just as with health insurance claims, there are multiple "gray areas" in casualty policies that can be negotiated. In the case of a burglary or storm or fire damage in your office, for example, reasonable expenses will vary considerably for repair of damaged medical equipment and replacement of equipment that was destroyed, or for rental of alternate office space while a damaged office is being repaired.

Other negotiable costs are moving expenses, storage of damaged and undamaged equipment, and depreciation on specific items. And as we all know from our health insurance experience, injuries are particularly fertile areas for negotiation.

Another adjuster’s trick, which you may have already encountered with a damaged car, is to steer you to certain repair shops and contractors that give the insurer prenegotiated prices for their work, but may offer inferior parts and service. Most policies do not require that you accept the insurer’s choice of contractors. Insist on having work done by people you know and trust. Almost always, you are entitled to the same kind and quality of materials you had before the disaster.

Do your own research on the value of lost and damaged items; the more documentation you have, the less likely an adjuster is to question your claim. Just as with health insurance coding, preparation pays off.

Document your losses very specifically. Adjusters often attempt to group material losses nonselectively, just as health insurers sometimes attempt to "bundle" your services. For example, if a certain cabinet contained medical supplies, try to be very specific about the supplies it contained. That way, you can assign value to individual items, rather than allowing the insurance company to estimate a lump sum.

After the trauma of a burglary, fire, or flood, you may overlook some damage. As many victims of hurricanes and other natural disasters have learned, damage that is not immediately apparent can add up to a significant amount of money later. Another thing your insurer may not tell you is even after you arrive at a settlement, you can still file another claim if you discover additional losses.

It is usually not wise to rely solely on your insurance agent in such situations, because an agent’s loyalty resides primarily with the insurance company, not the claimant. Retaining a lawyer is often a good idea, if only to review paperwork and help you value your losses. It will cost comparatively little, and is usually money well spent. In addition, you will probably need a lawyer for representation if you have a large or complicated case, and certainly if you suspect that the insurance company is not dealing with you fairly.

A less expensive alternative to a lawyer may be a public insurance adjuster. Public adjusters are professionals who work for policyholders, not insurers. They inspect the loss site, analyze the damages, assemble claim support data, review your coverage, determine replacement costs, and strive to maximize your settlement in the same way the insurer’s adjuster will try to minimize it. You can find more information and a list of public adjusters in your area on the website of the National Association of Public Insurance Adjusters.

Dr. Eastern practices dermatology and dermatologic surgery in Belleville, N.J. He holds teaching positions at several hospitals and has delivered more than 500 academic speaking presentations. He is the author of numerous articles and textbook chapters, and is a long-time monthly columnist for Skin & Allergy News.

The current discussion of the transition to ICD-10 and other health insurance reforms has overshadowed the broader issue of dealing with other types of insurance claims. We buy casualty and liability insurance hoping we will never need it; but when we do, it’s important to get it right, and your extensive experience in coping with health insurance claims can be put to good use in such situations.

Prompt filing is just as important with a casualty or liability claim as it is with a health claim. All insurance policies have a filing deadline, which varies with different policies and states. But just because you file promptly does not mean you have to settle on a payment right away.

Most insurers want a quick resolution as much as you do, but if you allow yourself to be rushed, you could end up with a smaller settlement than you deserve.

If you’re a regular reader of this column, you’re familiar with my first rule of dealing with health insurers: Everything is negotiable. And it’s no different with casualty insurers. Regardless of what adjusters tell you, the initial amount offered is never engraved in stone.

Adjusters are evaluated on the basis of how much money they "save" on claims; so their initial number will usually be low – often too low.

Just as with health insurance claims, there are multiple "gray areas" in casualty policies that can be negotiated. In the case of a burglary or storm or fire damage in your office, for example, reasonable expenses will vary considerably for repair of damaged medical equipment and replacement of equipment that was destroyed, or for rental of alternate office space while a damaged office is being repaired.

Other negotiable costs are moving expenses, storage of damaged and undamaged equipment, and depreciation on specific items. And as we all know from our health insurance experience, injuries are particularly fertile areas for negotiation.

Another adjuster’s trick, which you may have already encountered with a damaged car, is to steer you to certain repair shops and contractors that give the insurer prenegotiated prices for their work, but may offer inferior parts and service. Most policies do not require that you accept the insurer’s choice of contractors. Insist on having work done by people you know and trust. Almost always, you are entitled to the same kind and quality of materials you had before the disaster.

Do your own research on the value of lost and damaged items; the more documentation you have, the less likely an adjuster is to question your claim. Just as with health insurance coding, preparation pays off.

Document your losses very specifically. Adjusters often attempt to group material losses nonselectively, just as health insurers sometimes attempt to "bundle" your services. For example, if a certain cabinet contained medical supplies, try to be very specific about the supplies it contained. That way, you can assign value to individual items, rather than allowing the insurance company to estimate a lump sum.

After the trauma of a burglary, fire, or flood, you may overlook some damage. As many victims of hurricanes and other natural disasters have learned, damage that is not immediately apparent can add up to a significant amount of money later. Another thing your insurer may not tell you is even after you arrive at a settlement, you can still file another claim if you discover additional losses.

It is usually not wise to rely solely on your insurance agent in such situations, because an agent’s loyalty resides primarily with the insurance company, not the claimant. Retaining a lawyer is often a good idea, if only to review paperwork and help you value your losses. It will cost comparatively little, and is usually money well spent. In addition, you will probably need a lawyer for representation if you have a large or complicated case, and certainly if you suspect that the insurance company is not dealing with you fairly.

A less expensive alternative to a lawyer may be a public insurance adjuster. Public adjusters are professionals who work for policyholders, not insurers. They inspect the loss site, analyze the damages, assemble claim support data, review your coverage, determine replacement costs, and strive to maximize your settlement in the same way the insurer’s adjuster will try to minimize it. You can find more information and a list of public adjusters in your area on the website of the National Association of Public Insurance Adjusters.

Dr. Eastern practices dermatology and dermatologic surgery in Belleville, N.J. He holds teaching positions at several hospitals and has delivered more than 500 academic speaking presentations. He is the author of numerous articles and textbook chapters, and is a long-time monthly columnist for Skin & Allergy News.

If you have been paying attention at all, you are aware that the International Classification of Diseases, 10th Revision (ICD-10) will be implemented later this year. So why – if you’re like most of the physicians I’ve talked with recently – have you done little or nothing about it? Since the launch is more than 6 months away, why am I telling you (and I am) that this is a very bad idea?

Because there is much to do before the deadline arrives. On Sept. 30, you will be using ICD-9 codes, and the next day you will have to begin using ICD-10. There is no transition period; all ICD-9–coded claims will be rejected from Oct. 1 forward, and no ICD-10 codes can be used before that date. Failure to prepare will be an unmitigated disaster for your practice’s cash flow.

The Centers for Medicare & Medicaid Services has already rejected a request from medical organizations for another 1-year delay (in addition to the one granted last year), so further extensions are highly unlikely. So you’ll need to be ready if you expect to be paid come October.

First, you will need to decide which parts of your coding and billing systems, and electronic health record (EHR, if you have one) need to be upgraded, how you will do it, and what it will cost. Then, you must get familiar with the new system.

Coders and billers will need the most training on the new methodology, but physicians and other providers also must learn how the new codes are different from the old ones. In general, the biggest differences are in level of documentation and specificity, but there are many brand-new codes as well.

I suggest that you start by identifying your 20 or 30 most-used diagnosis codes and then study in detail the differences between the ICD-9 and ICD-10 versions of them. Once you have mastered those, you can go on to other, less-used codes. Take as much time as you need to do this; remember, everything changes abruptly on Oct. 1, and you will have to get it right the first time.

Be sure to cross-train your coders and other staff members. If a crucial employee quits in the middle of September, you don’t want to have to start from square one. Also, ask your employees to plan their vacations well in advance – and not during the last 3 months of the year. This will not be a good time for the office to run short staffed.

Next, I suggest that you contact all of your third-party payers, billing services, and clearinghouses. Start with the payers responsible for the majority of your claims. Be aggressive; ask them how, exactly, they are preparing for the changeover, and stay in continuous contact with them. Unfortunately, many of these organizations are as behind as most medical practices in their preparations.

Many payers and clearinghouses (including CMS) will be staging "test runs," during which you will be able to submit "practice claims" using the new system. Payers will determine whether your ICD-10 code is in the right place and in the right format, whether the code you’ve used is appropriate, and whether the claim would have been accepted, rejected, or held pending additional information. You will have to do this for each payer, because each will have different coding policies; those policies have not yet been released, and in some cases, have not even been developed.

The CMS will run its first testing opportunity in March; you can register for it, or for future tests, through your local Medicare Administrative Contractor (MAC) website.

You can use these testing opportunities to test your internal system as well, ensuring that everything works smoothly from the time you code a claim until payment is received. Select commonly used ICD-9 claims and practice coding them in ICD-10. The American Academy of Dermatology offers a nice ICD-9/ICD-10 "crosswalk," along with other training aids, at its website.

Even the best laid plans can go awry, so it would be prudent to put aside a cash reserve, or secure a line of credit, to cover expenses during the first few months of the transition, in case the payment machinery falters and large numbers of claims go unpaid. For the same reason, consider postponing major capital investments from mid-year until early 2015.

You may have heard that ICD-10 is only a transition system; that ICD-11 will be following closely on its heels, only a year or 2 later. Many of the experts that I’ve spoken with feel that this highly unlikely, and I agree. So don’t feel that you are wasting your time adjusting to ICD-10; in all probability, we will be using it a lot longer than CMS is expecting.

Dr. Eastern practices dermatology and dermatologic surgery in Belleville, N.J. He is the author of numerous articles and textbook chapters, and is a long-time monthly columnist for Skin & Allergy News.

If you have been paying attention at all, you are aware that the International Classification of Diseases, 10th Revision (ICD-10) will be implemented later this year. So why – if you’re like most of the physicians I’ve talked with recently – have you done little or nothing about it? Since the launch is more than 6 months away, why am I telling you (and I am) that this is a very bad idea?

Because there is much to do before the deadline arrives. On Sept. 30, you will be using ICD-9 codes, and the next day you will have to begin using ICD-10. There is no transition period; all ICD-9–coded claims will be rejected from Oct. 1 forward, and no ICD-10 codes can be used before that date. Failure to prepare will be an unmitigated disaster for your practice’s cash flow.

The Centers for Medicare & Medicaid Services has already rejected a request from medical organizations for another 1-year delay (in addition to the one granted last year), so further extensions are highly unlikely. So you’ll need to be ready if you expect to be paid come October.

First, you will need to decide which parts of your coding and billing systems, and electronic health record (EHR, if you have one) need to be upgraded, how you will do it, and what it will cost. Then, you must get familiar with the new system.

Coders and billers will need the most training on the new methodology, but physicians and other providers also must learn how the new codes are different from the old ones. In general, the biggest differences are in level of documentation and specificity, but there are many brand-new codes as well.

I suggest that you start by identifying your 20 or 30 most-used diagnosis codes and then study in detail the differences between the ICD-9 and ICD-10 versions of them. Once you have mastered those, you can go on to other, less-used codes. Take as much time as you need to do this; remember, everything changes abruptly on Oct. 1, and you will have to get it right the first time.

Be sure to cross-train your coders and other staff members. If a crucial employee quits in the middle of September, you don’t want to have to start from square one. Also, ask your employees to plan their vacations well in advance – and not during the last 3 months of the year. This will not be a good time for the office to run short staffed.

Next, I suggest that you contact all of your third-party payers, billing services, and clearinghouses. Start with the payers responsible for the majority of your claims. Be aggressive; ask them how, exactly, they are preparing for the changeover, and stay in continuous contact with them. Unfortunately, many of these organizations are as behind as most medical practices in their preparations.

Many payers and clearinghouses (including CMS) will be staging "test runs," during which you will be able to submit "practice claims" using the new system. Payers will determine whether your ICD-10 code is in the right place and in the right format, whether the code you’ve used is appropriate, and whether the claim would have been accepted, rejected, or held pending additional information. You will have to do this for each payer, because each will have different coding policies; those policies have not yet been released, and in some cases, have not even been developed.

The CMS will run its first testing opportunity in March; you can register for it, or for future tests, through your local Medicare Administrative Contractor (MAC) website.

You can use these testing opportunities to test your internal system as well, ensuring that everything works smoothly from the time you code a claim until payment is received. Select commonly used ICD-9 claims and practice coding them in ICD-10. The American Academy of Dermatology offers a nice ICD-9/ICD-10 "crosswalk," along with other training aids, at its website.

Even the best laid plans can go awry, so it would be prudent to put aside a cash reserve, or secure a line of credit, to cover expenses during the first few months of the transition, in case the payment machinery falters and large numbers of claims go unpaid. For the same reason, consider postponing major capital investments from mid-year until early 2015.

You may have heard that ICD-10 is only a transition system; that ICD-11 will be following closely on its heels, only a year or 2 later. Many of the experts that I’ve spoken with feel that this highly unlikely, and I agree. So don’t feel that you are wasting your time adjusting to ICD-10; in all probability, we will be using it a lot longer than CMS is expecting.

Dr. Eastern practices dermatology and dermatologic surgery in Belleville, N.J. He is the author of numerous articles and textbook chapters, and is a long-time monthly columnist for Skin & Allergy News.

If you have been paying attention at all, you are aware that the International Classification of Diseases, 10th Revision (ICD-10) will be implemented later this year. So why – if you’re like most of the physicians I’ve talked with recently – have you done little or nothing about it? Since the launch is more than 6 months away, why am I telling you (and I am) that this is a very bad idea?

Because there is much to do before the deadline arrives. On Sept. 30, you will be using ICD-9 codes, and the next day you will have to begin using ICD-10. There is no transition period; all ICD-9–coded claims will be rejected from Oct. 1 forward, and no ICD-10 codes can be used before that date. Failure to prepare will be an unmitigated disaster for your practice’s cash flow.

The Centers for Medicare & Medicaid Services has already rejected a request from medical organizations for another 1-year delay (in addition to the one granted last year), so further extensions are highly unlikely. So you’ll need to be ready if you expect to be paid come October.

First, you will need to decide which parts of your coding and billing systems, and electronic health record (EHR, if you have one) need to be upgraded, how you will do it, and what it will cost. Then, you must get familiar with the new system.

Coders and billers will need the most training on the new methodology, but physicians and other providers also must learn how the new codes are different from the old ones. In general, the biggest differences are in level of documentation and specificity, but there are many brand-new codes as well.

I suggest that you start by identifying your 20 or 30 most-used diagnosis codes and then study in detail the differences between the ICD-9 and ICD-10 versions of them. Once you have mastered those, you can go on to other, less-used codes. Take as much time as you need to do this; remember, everything changes abruptly on Oct. 1, and you will have to get it right the first time.

Be sure to cross-train your coders and other staff members. If a crucial employee quits in the middle of September, you don’t want to have to start from square one. Also, ask your employees to plan their vacations well in advance – and not during the last 3 months of the year. This will not be a good time for the office to run short staffed.

Next, I suggest that you contact all of your third-party payers, billing services, and clearinghouses. Start with the payers responsible for the majority of your claims. Be aggressive; ask them how, exactly, they are preparing for the changeover, and stay in continuous contact with them. Unfortunately, many of these organizations are as behind as most medical practices in their preparations.

Many payers and clearinghouses (including CMS) will be staging "test runs," during which you will be able to submit "practice claims" using the new system. Payers will determine whether your ICD-10 code is in the right place and in the right format, whether the code you’ve used is appropriate, and whether the claim would have been accepted, rejected, or held pending additional information. You will have to do this for each payer, because each will have different coding policies; those policies have not yet been released, and in some cases, have not even been developed.

The CMS will run its first testing opportunity in March; you can register for it, or for future tests, through your local Medicare Administrative Contractor (MAC) website.

You can use these testing opportunities to test your internal system as well, ensuring that everything works smoothly from the time you code a claim until payment is received. Select commonly used ICD-9 claims and practice coding them in ICD-10. The American Academy of Dermatology offers a nice ICD-9/ICD-10 "crosswalk," along with other training aids, at its website.

Even the best laid plans can go awry, so it would be prudent to put aside a cash reserve, or secure a line of credit, to cover expenses during the first few months of the transition, in case the payment machinery falters and large numbers of claims go unpaid. For the same reason, consider postponing major capital investments from mid-year until early 2015.

You may have heard that ICD-10 is only a transition system; that ICD-11 will be following closely on its heels, only a year or 2 later. Many of the experts that I’ve spoken with feel that this highly unlikely, and I agree. So don’t feel that you are wasting your time adjusting to ICD-10; in all probability, we will be using it a lot longer than CMS is expecting.

Dr. Eastern practices dermatology and dermatologic surgery in Belleville, N.J. He is the author of numerous articles and textbook chapters, and is a long-time monthly columnist for Skin & Allergy News.

Insurance – so goes the hoary cliché – is the one product you buy hoping never to use. While no one enjoys foreseeing unforeseeable calamities, regular meetings with your insurance broker are important. Overinsuring is a waste of money, but underinsuring can prove even more costly, should the unforeseeable happen.

Malpractice premiums continue to rise. If yours are getting out of hand, ask your broker about alternatives.

"Occurrence" policies remain the coverage of choice where they are available and affordable, but they are becoming an endangered species as fewer insurers are willing to write them. "Claims-made" policies are usually cheaper, and provide the same coverage as long as you remain in practice. You will need "tail" coverage against belated claims after you retire, but many companies provide free tail coverage after you’ve been insured for a minimum period (usually 5 years).

Other alternatives are gaining popularity as the demand for more reasonably priced insurance increases. The most common, known as reciprocal exchanges, are very similar to traditional insurers, but differ in certain aspects of funding and operations. For example, most exchanges require policyholders to make capital contributions in addition to payment of premiums, at least in their early stages. You get your investment back, with interest, when (if) the exchange becomes solvent.

Another option, called a captive, is an insurance company formed by several noninsurance entities (such as medical practices) to write their own insurance policies. All participants are shareholders, and all premiums (less administrative expenses) go toward building the security of the captive. Most captives purchase reinsurance to protect against catastrophic losses. If all goes well, individual owners sell their shares at retirement for a nice profit, which has grown tax free in the interim.

Risk Retention Groups (RRGs) are a combination of exchanges and captives, in that capital investments are usually required, and the owners are the insureds themselves; but all responsibility for management and adequate funding falls on the insureds’ shoulders, and reinsurance is rarely an option. Most medical malpractice RRGs are licensed in Vermont or South Carolina, because of favorable laws in those states, but they can be based in any state that allows them.

Exchanges, captives, and RRGs all carry risk: A few large claims can eat up all the profits, and may even put you in a financial hole. But of course, traditional malpractice policies offer zero profit opportunity.

If your financial situation has changed since your last insurance review, your life insurance needs have probably changed, too. As your retirement savings accumulate, less insurance is necessary. And if you own any expensive whole life policies, you can probably convert them to much cheaper term insurance.

Disability insurance is not something to skimp on, but if you are approaching retirement age, you may be able to decrease your coverage, or even eliminate it entirely, if your retirement plan is far enough along.

Liability insurance is likewise no place to pinch pennies, but you might be able to add an umbrella policy providing comprehensive catastrophic coverage, which may allow you to decrease your regular coverage, or raise your deductible limits.

One additional policy to consider is Employment Practices Liability Insurance, which protects you from lawsuits brought by militant or disgruntled employees. More on that next month.

Health insurance premiums continue to soar; Obamacare might offer a favorable alternative for your office policy. Open enrollment began Oct. 1, with coverage scheduled to begin Jan. 1, 2014. If you are considering such an option, go to the Center for Consumer Information and Insurance Oversight and pick a plan for your employees to enroll in.

Workers’ compensation insurance is mandatory in most states, and heavily regulated, so there is little room for cutting expenses. However, some states do not require you, as the employer, to cover yourself, and eliminating that coverage could save you a substantial amount. This is only worth considering, of course, if you have adequate health and disability policies in place.

If you’re over 50 years old, look into long-term care insurance as well. It’s relatively inexpensive if you buy it while you’re still healthy, and it could save you and your heirs a load of money on the other end. If you have shouldered the expense of a chronically ill parent or grandparent, you know what I’m talking about.

Dr. Eastern practices dermatology and dermatologic surgery in Belleville, N.J., and has been a long-time monthly columnist for Skin & Allergy News.

Insurance – so goes the hoary cliché – is the one product you buy hoping never to use. While no one enjoys foreseeing unforeseeable calamities, regular meetings with your insurance broker are important. Overinsuring is a waste of money, but underinsuring can prove even more costly, should the unforeseeable happen.

Malpractice premiums continue to rise. If yours are getting out of hand, ask your broker about alternatives.

"Occurrence" policies remain the coverage of choice where they are available and affordable, but they are becoming an endangered species as fewer insurers are willing to write them. "Claims-made" policies are usually cheaper, and provide the same coverage as long as you remain in practice. You will need "tail" coverage against belated claims after you retire, but many companies provide free tail coverage after you’ve been insured for a minimum period (usually 5 years).

Other alternatives are gaining popularity as the demand for more reasonably priced insurance increases. The most common, known as reciprocal exchanges, are very similar to traditional insurers, but differ in certain aspects of funding and operations. For example, most exchanges require policyholders to make capital contributions in addition to payment of premiums, at least in their early stages. You get your investment back, with interest, when (if) the exchange becomes solvent.

Another option, called a captive, is an insurance company formed by several noninsurance entities (such as medical practices) to write their own insurance policies. All participants are shareholders, and all premiums (less administrative expenses) go toward building the security of the captive. Most captives purchase reinsurance to protect against catastrophic losses. If all goes well, individual owners sell their shares at retirement for a nice profit, which has grown tax free in the interim.

Risk Retention Groups (RRGs) are a combination of exchanges and captives, in that capital investments are usually required, and the owners are the insureds themselves; but all responsibility for management and adequate funding falls on the insureds’ shoulders, and reinsurance is rarely an option. Most medical malpractice RRGs are licensed in Vermont or South Carolina, because of favorable laws in those states, but they can be based in any state that allows them.

Exchanges, captives, and RRGs all carry risk: A few large claims can eat up all the profits, and may even put you in a financial hole. But of course, traditional malpractice policies offer zero profit opportunity.

If your financial situation has changed since your last insurance review, your life insurance needs have probably changed, too. As your retirement savings accumulate, less insurance is necessary. And if you own any expensive whole life policies, you can probably convert them to much cheaper term insurance.

Disability insurance is not something to skimp on, but if you are approaching retirement age, you may be able to decrease your coverage, or even eliminate it entirely, if your retirement plan is far enough along.

Liability insurance is likewise no place to pinch pennies, but you might be able to add an umbrella policy providing comprehensive catastrophic coverage, which may allow you to decrease your regular coverage, or raise your deductible limits.

One additional policy to consider is Employment Practices Liability Insurance, which protects you from lawsuits brought by militant or disgruntled employees. More on that next month.

Health insurance premiums continue to soar; Obamacare might offer a favorable alternative for your office policy. Open enrollment began Oct. 1, with coverage scheduled to begin Jan. 1, 2014. If you are considering such an option, go to the Center for Consumer Information and Insurance Oversight and pick a plan for your employees to enroll in.

Workers’ compensation insurance is mandatory in most states, and heavily regulated, so there is little room for cutting expenses. However, some states do not require you, as the employer, to cover yourself, and eliminating that coverage could save you a substantial amount. This is only worth considering, of course, if you have adequate health and disability policies in place.

If you’re over 50 years old, look into long-term care insurance as well. It’s relatively inexpensive if you buy it while you’re still healthy, and it could save you and your heirs a load of money on the other end. If you have shouldered the expense of a chronically ill parent or grandparent, you know what I’m talking about.

Dr. Eastern practices dermatology and dermatologic surgery in Belleville, N.J., and has been a long-time monthly columnist for Skin & Allergy News.

Insurance – so goes the hoary cliché – is the one product you buy hoping never to use. While no one enjoys foreseeing unforeseeable calamities, regular meetings with your insurance broker are important. Overinsuring is a waste of money, but underinsuring can prove even more costly, should the unforeseeable happen.

Malpractice premiums continue to rise. If yours are getting out of hand, ask your broker about alternatives.

"Occurrence" policies remain the coverage of choice where they are available and affordable, but they are becoming an endangered species as fewer insurers are willing to write them. "Claims-made" policies are usually cheaper, and provide the same coverage as long as you remain in practice. You will need "tail" coverage against belated claims after you retire, but many companies provide free tail coverage after you’ve been insured for a minimum period (usually 5 years).

Other alternatives are gaining popularity as the demand for more reasonably priced insurance increases. The most common, known as reciprocal exchanges, are very similar to traditional insurers, but differ in certain aspects of funding and operations. For example, most exchanges require policyholders to make capital contributions in addition to payment of premiums, at least in their early stages. You get your investment back, with interest, when (if) the exchange becomes solvent.

Another option, called a captive, is an insurance company formed by several noninsurance entities (such as medical practices) to write their own insurance policies. All participants are shareholders, and all premiums (less administrative expenses) go toward building the security of the captive. Most captives purchase reinsurance to protect against catastrophic losses. If all goes well, individual owners sell their shares at retirement for a nice profit, which has grown tax free in the interim.

Risk Retention Groups (RRGs) are a combination of exchanges and captives, in that capital investments are usually required, and the owners are the insureds themselves; but all responsibility for management and adequate funding falls on the insureds’ shoulders, and reinsurance is rarely an option. Most medical malpractice RRGs are licensed in Vermont or South Carolina, because of favorable laws in those states, but they can be based in any state that allows them.

Exchanges, captives, and RRGs all carry risk: A few large claims can eat up all the profits, and may even put you in a financial hole. But of course, traditional malpractice policies offer zero profit opportunity.

If your financial situation has changed since your last insurance review, your life insurance needs have probably changed, too. As your retirement savings accumulate, less insurance is necessary. And if you own any expensive whole life policies, you can probably convert them to much cheaper term insurance.

Disability insurance is not something to skimp on, but if you are approaching retirement age, you may be able to decrease your coverage, or even eliminate it entirely, if your retirement plan is far enough along.

Liability insurance is likewise no place to pinch pennies, but you might be able to add an umbrella policy providing comprehensive catastrophic coverage, which may allow you to decrease your regular coverage, or raise your deductible limits.

One additional policy to consider is Employment Practices Liability Insurance, which protects you from lawsuits brought by militant or disgruntled employees. More on that next month.

Health insurance premiums continue to soar; Obamacare might offer a favorable alternative for your office policy. Open enrollment began Oct. 1, with coverage scheduled to begin Jan. 1, 2014. If you are considering such an option, go to the Center for Consumer Information and Insurance Oversight and pick a plan for your employees to enroll in.

Workers’ compensation insurance is mandatory in most states, and heavily regulated, so there is little room for cutting expenses. However, some states do not require you, as the employer, to cover yourself, and eliminating that coverage could save you a substantial amount. This is only worth considering, of course, if you have adequate health and disability policies in place.

If you’re over 50 years old, look into long-term care insurance as well. It’s relatively inexpensive if you buy it while you’re still healthy, and it could save you and your heirs a load of money on the other end. If you have shouldered the expense of a chronically ill parent or grandparent, you know what I’m talking about.

Dr. Eastern practices dermatology and dermatologic surgery in Belleville, N.J., and has been a long-time monthly columnist for Skin & Allergy News.

No matter how complete your insurance portfolio, there is one policy – one you probably have never heard of – that you should definitely consider adding to it.

A few years ago I spoke with a California dermatologist who experienced every employer’s nightmare: He fired an incompetent employee, who promptly sued him for wrongful termination and accused him of sexual harassment to boot. The charges were completely false, of course, and the employee’s transgressions were well documented, but defending the lawsuit, successfully or not, would have been expensive, so his lawyer persuaded him to settle it for a significant sum of money.

Disasters like that are becoming more common. Plaintiffs’ attorneys know all too well that most small businesses, including medical practices, are not insured against employees’ legal actions, and usually cannot afford to defend these cases in court.

Fortunately, there is a relatively inexpensive way to protect yourself: Employee Practices Liability Insurance (EPLI) provides protection against many kinds of employee lawsuits not covered by conventional liability insurance. These include wrongful termination, sexual harassment, discrimination, breach of employment contract, negligent hiring or evaluation, failure to promote, wrongful discipline, mismanagement of benefits, and the ever-popular "emotional distress."

EPLI would have covered the California dermatologist, had he carried it, against his employee’s charges. In fact, there is a better than even chance that the plaintiff’s attorney would have dropped the lawsuit entirely once informed that it would be aggressively defended.

Some liability carriers are beginning to cover some employee-related issues in "umbrella" policies, so check your current insurance coverage first. Then, as with all insurance, shop around for the best price, and carefully read the policies on your short list. All EPLI policies cover claims against your practice and its owners and employees, but some cover only claims against full-time employees. Try to obtain the broadest coverage possible so that part-time, temporary, and seasonal employees, and if possible even applicants for employment and former employees, are covered.

You should also look for the most comprehensive policy in terms of coverage. Almost every EPLI policy covers the allegations mentioned above, but some offer a more comprehensive list of covered acts, such as invasion of privacy and defamation of character.

Also be aware of precisely what each policy does not cover. Most contain exclusions for punitive damages and court-imposed fines, as well as for criminal acts, fraud, and other clearly illegal conduct. For example, if it can be proved that you fired an employee because he or she refused to falsify insurance claims, any resulting civil suit against you will not be covered by any type of insurance.

Depending on where you practice, it may be necessary to ask an employment attorney to evaluate your individual EPLI needs. An underwriter cannot anticipate every eventuality for you, particularly if he or she does not live in your area and is not familiar with employment conditions in your community.

Try to get a clause added that permits you to choose your own defense attorney. Better still, pick a specific attorney or firm that you trust, and have that counsel named in an endorsement to the policy. Otherwise, the insurance carrier will select an attorney from its own panel who may not consider your interests a higher priority than those of the insurer itself.

If you must accept the insurer’s choice of counsel, you should find out whether that attorney is experienced in employment law, which is a very specialized area. And just as with your malpractice policy, you will want to maintain as much control as possible over the settlement of claims. Ideally, no claim should be settled without your express permission.

As with any insurance policy you buy, be sure to choose an established carrier with ample experience in the field and solid financial strength. A low premium is no bargain if the carrier is new to EPLI, goes broke, or decides to cease covering employee practices liability.

Above all, as with any insurance policy, make sure that you can live with the claims definition and exclusions in the policy you choose, and seek advice if you are unsure what your specific needs are, before you sign on the dotted line.

Dr. Eastern practices dermatology and dermatologic surgery in Belleville, N.J. He is a clinical associate professor of dermatology at Seton Hall University School of Graduate Medical Education in South Orange, N.J. Dr. Eastern is a two-time past president of the Dermatological Society of New Jersey, and currently serves on its executive board. He holds teaching positions at several hospitals and has delivered more than 500 academic speaking presentations. He is the author of numerous articles and textbook chapters, and is a long-time monthly columnist for Skin & Allergy News.

No matter how complete your insurance portfolio, there is one policy – one you probably have never heard of – that you should definitely consider adding to it.

A few years ago I spoke with a California dermatologist who experienced every employer’s nightmare: He fired an incompetent employee, who promptly sued him for wrongful termination and accused him of sexual harassment to boot. The charges were completely false, of course, and the employee’s transgressions were well documented, but defending the lawsuit, successfully or not, would have been expensive, so his lawyer persuaded him to settle it for a significant sum of money.

Disasters like that are becoming more common. Plaintiffs’ attorneys know all too well that most small businesses, including medical practices, are not insured against employees’ legal actions, and usually cannot afford to defend these cases in court.

Fortunately, there is a relatively inexpensive way to protect yourself: Employee Practices Liability Insurance (EPLI) provides protection against many kinds of employee lawsuits not covered by conventional liability insurance. These include wrongful termination, sexual harassment, discrimination, breach of employment contract, negligent hiring or evaluation, failure to promote, wrongful discipline, mismanagement of benefits, and the ever-popular "emotional distress."

EPLI would have covered the California dermatologist, had he carried it, against his employee’s charges. In fact, there is a better than even chance that the plaintiff’s attorney would have dropped the lawsuit entirely once informed that it would be aggressively defended.

Some liability carriers are beginning to cover some employee-related issues in "umbrella" policies, so check your current insurance coverage first. Then, as with all insurance, shop around for the best price, and carefully read the policies on your short list. All EPLI policies cover claims against your practice and its owners and employees, but some cover only claims against full-time employees. Try to obtain the broadest coverage possible so that part-time, temporary, and seasonal employees, and if possible even applicants for employment and former employees, are covered.

You should also look for the most comprehensive policy in terms of coverage. Almost every EPLI policy covers the allegations mentioned above, but some offer a more comprehensive list of covered acts, such as invasion of privacy and defamation of character.

Also be aware of precisely what each policy does not cover. Most contain exclusions for punitive damages and court-imposed fines, as well as for criminal acts, fraud, and other clearly illegal conduct. For example, if it can be proved that you fired an employee because he or she refused to falsify insurance claims, any resulting civil suit against you will not be covered by any type of insurance.

Depending on where you practice, it may be necessary to ask an employment attorney to evaluate your individual EPLI needs. An underwriter cannot anticipate every eventuality for you, particularly if he or she does not live in your area and is not familiar with employment conditions in your community.

Try to get a clause added that permits you to choose your own defense attorney. Better still, pick a specific attorney or firm that you trust, and have that counsel named in an endorsement to the policy. Otherwise, the insurance carrier will select an attorney from its own panel who may not consider your interests a higher priority than those of the insurer itself.

If you must accept the insurer’s choice of counsel, you should find out whether that attorney is experienced in employment law, which is a very specialized area. And just as with your malpractice policy, you will want to maintain as much control as possible over the settlement of claims. Ideally, no claim should be settled without your express permission.

As with any insurance policy you buy, be sure to choose an established carrier with ample experience in the field and solid financial strength. A low premium is no bargain if the carrier is new to EPLI, goes broke, or decides to cease covering employee practices liability.

Above all, as with any insurance policy, make sure that you can live with the claims definition and exclusions in the policy you choose, and seek advice if you are unsure what your specific needs are, before you sign on the dotted line.

Dr. Eastern practices dermatology and dermatologic surgery in Belleville, N.J. He is a clinical associate professor of dermatology at Seton Hall University School of Graduate Medical Education in South Orange, N.J. Dr. Eastern is a two-time past president of the Dermatological Society of New Jersey, and currently serves on its executive board. He holds teaching positions at several hospitals and has delivered more than 500 academic speaking presentations. He is the author of numerous articles and textbook chapters, and is a long-time monthly columnist for Skin & Allergy News.

No matter how complete your insurance portfolio, there is one policy – one you probably have never heard of – that you should definitely consider adding to it.

A few years ago I spoke with a California dermatologist who experienced every employer’s nightmare: He fired an incompetent employee, who promptly sued him for wrongful termination and accused him of sexual harassment to boot. The charges were completely false, of course, and the employee’s transgressions were well documented, but defending the lawsuit, successfully or not, would have been expensive, so his lawyer persuaded him to settle it for a significant sum of money.

Disasters like that are becoming more common. Plaintiffs’ attorneys know all too well that most small businesses, including medical practices, are not insured against employees’ legal actions, and usually cannot afford to defend these cases in court.

Fortunately, there is a relatively inexpensive way to protect yourself: Employee Practices Liability Insurance (EPLI) provides protection against many kinds of employee lawsuits not covered by conventional liability insurance. These include wrongful termination, sexual harassment, discrimination, breach of employment contract, negligent hiring or evaluation, failure to promote, wrongful discipline, mismanagement of benefits, and the ever-popular "emotional distress."

EPLI would have covered the California dermatologist, had he carried it, against his employee’s charges. In fact, there is a better than even chance that the plaintiff’s attorney would have dropped the lawsuit entirely once informed that it would be aggressively defended.

Some liability carriers are beginning to cover some employee-related issues in "umbrella" policies, so check your current insurance coverage first. Then, as with all insurance, shop around for the best price, and carefully read the policies on your short list. All EPLI policies cover claims against your practice and its owners and employees, but some cover only claims against full-time employees. Try to obtain the broadest coverage possible so that part-time, temporary, and seasonal employees, and if possible even applicants for employment and former employees, are covered.

You should also look for the most comprehensive policy in terms of coverage. Almost every EPLI policy covers the allegations mentioned above, but some offer a more comprehensive list of covered acts, such as invasion of privacy and defamation of character.

Also be aware of precisely what each policy does not cover. Most contain exclusions for punitive damages and court-imposed fines, as well as for criminal acts, fraud, and other clearly illegal conduct. For example, if it can be proved that you fired an employee because he or she refused to falsify insurance claims, any resulting civil suit against you will not be covered by any type of insurance.

Depending on where you practice, it may be necessary to ask an employment attorney to evaluate your individual EPLI needs. An underwriter cannot anticipate every eventuality for you, particularly if he or she does not live in your area and is not familiar with employment conditions in your community.

Try to get a clause added that permits you to choose your own defense attorney. Better still, pick a specific attorney or firm that you trust, and have that counsel named in an endorsement to the policy. Otherwise, the insurance carrier will select an attorney from its own panel who may not consider your interests a higher priority than those of the insurer itself.

If you must accept the insurer’s choice of counsel, you should find out whether that attorney is experienced in employment law, which is a very specialized area. And just as with your malpractice policy, you will want to maintain as much control as possible over the settlement of claims. Ideally, no claim should be settled without your express permission.

As with any insurance policy you buy, be sure to choose an established carrier with ample experience in the field and solid financial strength. A low premium is no bargain if the carrier is new to EPLI, goes broke, or decides to cease covering employee practices liability.

Above all, as with any insurance policy, make sure that you can live with the claims definition and exclusions in the policy you choose, and seek advice if you are unsure what your specific needs are, before you sign on the dotted line.

Dr. Eastern practices dermatology and dermatologic surgery in Belleville, N.J. He is a clinical associate professor of dermatology at Seton Hall University School of Graduate Medical Education in South Orange, N.J. Dr. Eastern is a two-time past president of the Dermatological Society of New Jersey, and currently serves on its executive board. He holds teaching positions at several hospitals and has delivered more than 500 academic speaking presentations. He is the author of numerous articles and textbook chapters, and is a long-time monthly columnist for Skin & Allergy News.