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Tuesday, May 22, 2012

ICD-10 Is Coming

CMS will initiate enforcement action after June 30, 2012 to enforce compliance to ICD-10 coding.


1.  The compliance date for upgrading to Version 5010 standards for electronic health transactions was January 1, 2012; CMS enforcement discretion is in place until June 30, 2012.
2.  The transition to ICD-10 for medical diagnosis and inpatient procedure coding is coming.

CMS utilizes ICD data for Medicare Secondar Payer Act (MSP) enforcement.


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Monday, May 21, 2012

Too Big To Fail?

Seal of Missouri.
Seal of Missouri. (Photo credit: Wikipedia)
Is the  Missouri Second Injury Fund too big to fail? It appears not. Stagnation and indecision has really become a phase-out of the program and that wind-down process was initiated 7 years ago.


Read more: No changes made for Missouri injured worker fund
Southeast Missourian
In addition, more than 31000 cases are pending against the Second Injury Fund. The fund is financed through a surcharge that employers pay on their workers' compensation insurance. That charge was capped at 3 percent under a 2005 workers' compensation ...

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Saturday, May 19, 2012

Fracking: Vermont Become The First State to Outlaw



Vermont Governor Peter Shumlin signed into law on Thursday a bill [H 464 materials] outlawing hydraulic fracturing, or fracking, making Vermont the first US state to ban the controversial technique used to extract natural gas from the ground.


Click here to read more from The Jurist

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Thursday, May 17, 2012

CMS Waiver Denied Where Medical Negligence Alleged

Alleged negligent medical care does give rise to a waiver o Medicare Secondary Recovery of a Conditional Payment.
Salveson v. Sebelius, 2012 WL 1665424, D.S.D.,2012., May 11, 2012
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Friday, May 11, 2012

OSHA Proposes Fines for NJ Uniform & Laundry Company

The U.S. Department of Labor has cited Wilmington, Mass.-based UniFirst Corp., a uniform and laundry service, for seven serious safety and health violations, including some involving bloodborne pathogen and lead exposure hazards, at its West Caldwell facility. A complaint alleging hazards prompted OSHA's inspection. Proposed penalties total $186,000.

"The violations at this facility compromise the safety and health of UniFirst's workers," said Kris Hoffman, director of OSHA's Parsippany Area Office, which conducted the inspection. "It is vital that the company take appropriate steps to eliminate all identified hazards."

Three willful violations involve a failure to conduct proper training and provide hepatitis B vaccinations, as well as to have engineering and work practice controls in place to eliminate or minimize exposure to bloodborne pathogens. A willful violation is one committed with intentional knowing or voluntary disregard for the law's requirements, or with plain indifference to worker safety and health. The citations carry $165,000 in penalties.

Four serious violations involve a locked emergency door, a lack of training on fire extinguisher use, lead-contaminated surfaces, inadequate training on OSHA's lead standard and not providing gloves to workers exposed to potentially contaminated clothing. A serious violation occurs when there is substantial probability that death or serious physical harm could result from a hazard about which the employer knew or should have known. The citations carry $21,000 in penalties.

"A first step toward a safer, healthier workplace is to develop and implement an illness and injury prevention program in which management and workers proactively identify and eliminate hazardous conditions," said Robert Kulick, OSHA's regional director in New York.

The citations can be viewed at http://www.osha.gov/ooc/citations/UnifirstCorporation_315956458_04_12.pdf*.

UniFirst Corp., which employs 35 workers at the West Caldwell facility, has 15 business days from receipt of the citations to comply, request an informal conference with the OSHA area director, or contest the citations and proposed penalties before the independent Occupational Safety and Health Review Commission.

To ask questions, obtain compliance assistance, file a complaint, or report workplace hospitalizations, fatalities or situations posing imminent danger to workers, the public should call OSHA's toll-free hotline at 800-321-OSHA (6742) or the agency's Parsippany office at 973-263-1003.

Under the Occupational Safety and Health Act of 1970, OSHA's role is to promote safe and healthful working conditions for America's working men and women by setting and enforcing standards, and providing training, outreach and education. For more information, visit http://www.osha.gov.
For over 3 decades the Law Offices of Jon L. Gelman 1.973.696.7900 jon@gelmans.com have been representing injured workers and their families who have suffered work related accident and injuries.

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OSHA Fines NJ Employer For Unsafe Conditions


US Labor Department's OSHA cites Wisconsin-based food and beverage
manufacturer for repeat safety hazards at Flemington, NJ, facility

The U.S. Department of Labor's Occupational Safety and Health Administration has cited Kerry Ingredients & Flavours Inc., headquartered in Beloit, Wis., for three repeat violations at its Flemington facility. Proposed penalties total $50,000 following an inspection conducted under OSHA's Site-Specific Targeting Program for industries with high injury and illness rates.

"Not using proper safeguards leaves workers at risk of serious injury," said Patricia Jones, director of OSHA's Avenel Area Office. "Employers have a legal responsibility to ensure a safe and healthful workplace."

The violations involve amputation and laceration hazards due to a lack of lockout procedures for the energy sources of specific equipment, and the improper adjustment of bench rests and guards on a bench grinder. Similar violations were cited at the company's Chicago facility in May and October 2008. A repeat violation exists when an employer previously has been cited for the same or a similar violation of a standard, regulation, rule or order at any other facility in federal enforcement states within the last five years.

"Employers can take proactive steps alongside workers to identify and eliminate hazardous conditions by establishing an injury and illness prevention program," said Robert Kulick, OSHA's regional administrator in New York.

Kerry Ingredients & Flavours Inc. manufactures cereal, soft drinks and seasonings, and employs 45 workers at the Flemington site. The company has 15 business days from receipt of the citations to comply, ask for an informal conference with OSHA's area director or contest the citations and proposed penalties before the independent Occupational Safety and Health Review Commission.

To ask questions, obtain compliance assistance, file a complaint, or report workplace hospitalizations, fatalities or situations posing imminent danger to workers, the public should call OSHA's toll-free hotline at 800-321-OSHA (6742) or the agency's Avenel office at 732-750-3270.

Under the Occupational Safety and Health Act of 1970, employers are responsible for providing safe and healthful workplaces for their employees. OSHA's role is to ensure these conditions for America's working men and women by setting and enforcing standards, and providing training, education and assistance. For more information, visit http://www.osha.gov.
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    Law to Ban Medical Expense Claims Proposed

    Legislation (A-2652) [introduced May 10, 2012] has been proposed in NJ that would ban charging workers’ compensation claimants for medical expenses and gives the Division of Workers’ Compensation sole jurisdiction over work-related medical claims. The law would be a positive initiative for all parties as it will subject medical provider claims to an exclusive remedy and consolidate the claims before a single administrative agency for resolution.


    The legislation will be the subject of consideration by the NJ Assembly Labor Committee on Monday, May 14, 2012.


    Click here to read: Clearing the Workers' Compensation Benefit Highway of Medical Expense Land Mines

    By John H. Geaney and Jon L. Gelman
    "Medical expenses in contested workers’ compensation cases are now a significant and troublesome issue resulting in uncertainty, delay and potential future liability. Th recent NJ Supreme Court decision, University of Mass. Memorial Hospital v. Christodoulou, 180 N.J. 334 (2004) has left the question of how to adjudicate medical benefits that were conditionally paid or paid in error. Presently there is no exclusively defined procedure to determine the allocation, apportionment of primary responsibility for unauthorized medical expenses and reimbursement."


    Statement of the Bill

    "This bill prohibits the charging of workers’ compensation 
    claimants for medical expenses that have been authorized by the 
    employer or its carrier or its third party administrator, that have 
    been paid by the employer, its carrier or third party administrator 
    pursuant to pursuant to the workers’ compensation law, or which 
    been determined by the Division of Workers’ Compensation to 
    be the responsibility of the employer, its carrier or third party 
    administrator.  The bill gives the division sole jurisdiction over 
    disputed work-related medical claims, and directs the division to 
    provide procedures to resolve those disputes, including procedural 
    requirements for medical providers or any other party to the 
    dispute.  Finally, the bill provides that the treatment of an injured 

    worker or the payment of workers’ compensation to an injured 

    worker or dependent of an injured or deceased worker shall not be 
    delayed because of a claim by a medical provider. "


    Further Reference:
    NJ Task Force Report on Medical Provider Claims
    "During our meetings, it came to the attention of the Task Force that “balance billing” is a 
    problem. This is the practice wherein authorized medical providers accept fees paid by the
    carrier and then issue a bill to the petitioner for any remaining balance. In an effort to eradicate
    this practice, the Task Force recommends an amendment to N.J.S.A. 34:15-15. Section 15 of the
    Act requires that employers furnish and pay for physicians, surgeons and hospital services for the
    injured worker. Having reviewed the statute and the case law, the Task Force believes that there
    is a need to clarify that balance billing in the workers’ compensation setting is inappropriate.

    Accordingly, the Task Force recommends the following amendment to N.J.S.A. 34:15-15 which
    we would propose would appear as a paragraph between the final two paragraphs of that section.

    This additional language would read as follows:
    “Fees for treatments that have been authorized by the employer or
    its carrier or its third party administrator, or which have been
    determined by the court to be the responsibility of the employer, its
    carrier or third party administrator, shall not be charged against or
    collectible from the injured worker. Sole jurisdiction for any
    disputed medical charge arising from a workers’ compensation
    claim shall be vested in the Division of Workers’ Compensation.”

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