WE’RE SO MUCH MORE…
Customers Have FREE ACCESS to Extensive Resources:
REPORT A CLAIM
24/7 CLAIM HOTLINE
To report a claim or lawsuit, contact your claim representative by phone or submit pertinent information, lien letter, or petition by mail, fax or email to:
Mail: P.O. Box 1498, Jefferson City, MO 65102
Email: firstname.lastname@example.org or one of the HSG Claim Management Team members directly.
Step by Step Claim Management
- Notice of claim or lawsuit received by phone, email or fax
- Communication with insured client regarding details involved in the claim
- Assignment to Investigator or Defense Counsel
- Claim: Assigned to Investigator to analyze records
- Lawsuit: Assigned to defense counsel to defend case and work through legal process with the insured. As the case progresses, claim representative and defense counsel will discuss findings and strategy with the insured. With the insured client’s agreement, we will either attempt settlement or continue to defend the case through trial.
- Settlement or continued defense through trial and appeal
- Close claim
ASSISTANCE WITH LEGAL MATTERS / LEGAL CONSULTATION
Our claim managers are available 24/7 to address your claim concerns or questions.
During normal business hours (8a-4:30p), simply call our home office and request our Claim Management staff. After normal hours, call our regular telephone number and our automated telephone system will provide instructions on how to activate the Claims Urgent Response System. Callers will be asked to provide a brief description of the event, their name and telephone number. A member of our Claims Management staff will return your call as soon as possible.
DEDICATED INDIVIDUALIZED SERVICE
Our attorneys are available to consult with insureds concerning legal matters, even if a formal claim has not been made. Such matters may include advice on HIPAA compliance, responding to complaints or requests by patients or family members, and other legal matters.
Our claim representatives can assist our insureds in responding to subpoenas and other requests for the production of medical records or other documents. When appropriate, we will retain outside counsel as well to represent the insured’s interests.
When an insured client or any of its employees are subpoenaed or requested to give a deposition regarding medical care (even if a formal claim has not been presented), we will assign an attorney to represent and defend the individual at the deposition. Our claim representative may also attend the deposition.
When a licensing board or other governmental agency requires an insured client or any of its employees to provide records, create a written summary, or appear in front of the board or agency, our claim representatives will assist throughout the process and will retain an attorney to represent the insured.
HSG strives to provide individualized claim service for our insured clients. We provide each insured with the dedicated service of one claim representative. That claim representative will handle all claims that may arise.
The HSG Claim Management Team has frequent face-to-face interaction with the HSG Risk Management Staff. This communication allows us to address issues facing you to improve patient care, minimize recurrent problems, and decrease the frequency and severity of claims.
KNOWLEDGEABLE, EXPERIENCED PARTNERS
The HSG Claim Management Team partners with independent investigators and defense attorneys on claims and lawsuits. These investigators and attorneys are knowledgeable and experienced because they specialize in healthcare-related claims and litigation. Moreover, each has experience in the geographic area where the claim is pending. This engagement provides a familiarity with the judges, types of juries and local environment. HSG has had a long-standing relationship with these preferred partners because they provide priority service to our insured clients and have shown consistently successful results.
MONTHLY LOSS REPORT
A monthly claim summary documenting each claim, status of each claim and current reserve is provided.
PERSONALIZED CLAIM REVIEW
In addition to periodic claim reviews, our Claim Management Team
is available to speak about pending matters at any time. Moreover, at the appropriate time, we will discuss each claim with you to determine if we should attempt to settle the claim or if the claim should be pursued through trial.
We review pending claims periodically with insured clients to address the status of the claim and the future course of action. In addition, the claim representative, when appropriate, will meet with each insured client annually. We will discuss the status of each claim, the issues that have arisen, potential defense strategies, and the plans for future handling.
24/7 ADVERSE OUTCOME HOTLINE
CMEs FOR PHYSICIANS
As a companion to our consultative services, our staff provides 24/7 access to risk management assistance and advice in the event of an adverse outcome. During emergent events, physicians, risk managers and hospital administration are able to contact a Risk Management Consultant.
During normal business hours (8a-4:30p), simply call our home office and request our Risk Management staff.
After normal business hours, call our regular telephone number and our automated telephone system will provide instructions on how to activate the 24/7 Adverse Outcome Hotline. Callers will then be asked to provide a brief description of the event, their name, and telephone number. HSG Risk Management staff will return the call as soon as possible.
|To activate the 24/7 Adverse Outcome Hotline:
CEUs FOR NURSES
We partner with ELM Exchange to provide online educational courses. These courses are designed to provide Physicians/Surgeons and Allied Healthcare Professionals a convenient opportunity to improve risk management and patient safety practices, while earning continuing education credit. In addition, insured physicians, surgeons and allied health care professionals who successfully complete these ELM Exchange online educational courses may qualify for a 1% Risk Management premium credit discount for each course completed, up to 5%.
CONCEPTS: GUIDING PRINCIPLES FOR CLINICAL RISK MANAGEMENT©
We partner with ELM Exchange to provide online educational courses. These courses are designed to provide Registered Nurses a convenient opportunity to improve risk management and patient safety practices, while earning continuing education credit.
This manual serves as a desk reference when risk management and patient safety topics and questions arise in the physician clinic setting.
Each section provides information and additional resources about the topic, along with relevant sample policies.
Content available includes:
Facility and Environment: Cleaning and Safety
Healthcare Provider Practice
Communication and Follow-up
Emergency Protocols & Fire Safety
Regulations and Standards
The manual also serves as an excellent employee orientation manual and training resource. It includes a Clinic Self-Survey that is helpful in identifying potential liability risks, particularly in clinic-type settings. After completion of the Clinic Self-Survey, it will be reviewed and specific recommendations and action plans will be developed to help you address opportunities for improvement. In addition, a report comparing your organization to other survey respondents will also be produced.
Copyright © 2010 Healthcare Services Group. The materials contained in CONCEPTS are proprietary and may not be distributed or reproduced without the express consent of HSG. MLA insureds have permission to reproduce and use information contained in this manual within their facilities.
HEALS (HEALTHCARE EVENT ASSISTANCE & LENDING SUPPORT) PROGRAM
Our Risk Management & Patient Safety staff provides 24/7 risk management consultative services covering a broad spectrum of risk-related issues, including but not limited to, questions related to medical records and confidentiality, adverse outcome disclosure, patient communication and follow-up, patient relations, patient safety, medical-legal issues, regulations and standards, policies and procedures and general office risk management practices.
|To contact Risk Management & Patient Safety Staff:
|(Please call the Hotline outside of normal business hours.)
HIPAA PRIVACY AND SECURITY RULE AUDIT TOOL (SRAT)
Unfortunately, in medicine things do not always go as planned. During treatment, patients may experience complications and subsequently suffer harm or patients perceive that the provider did something wrong, resulting in a complaint investigation or lawsuit being filed. In many cases, the healthcare provider experiences anxiety and distress after one of these events.
HEALS provides education and support to insured healthcare providers after they experience a bad patient outcome, during a complaint investigation and during malpractice litigation. The program focuses on the healthcare providers’ thoughts, concerns and questions about the events unfolding around them. HEALS is an information sharing program with its primary objective being to help providers return to peak performance as quickly as possible.
HSG’s Claim Department and the Risk Management & Patient Safety (RM&PS) Department work closely together to deliver the HEALS program to insured clients. HEALS is part of HSG’s claims services. HEALS is managed and controlled by the Claim Department as part of the claims process but delivered by HSG’s RM&PS Department. Since it is a part of the claims management process, the information discussed is privileged just like other claims related information.
For more information: Risk Management & Patient Safety Newsletter, Spring 2014, Volume 11, No. 2 newsletter & HEALS brochure.
SRAT is designed to help our clients achieve HIPAA compliance, as well as prepare for potential HIPAA audits. The SRAT can be used to check existing HIPAA compliance programs, create a Security Rule Compliance plan and/or be used as a tool with business associates to ensure their compliance with HIPAA.
The SRAT breaks down each audit protocol into subparts and consolidates the guidance and requirements into self-contained units that guide the users to the required policies and procedures. SRAT starts with the required Risk Assessment and ends with Breach Protocol requirement.
Content available includes:
HIPAA Compliance Program Overview
HIPAA Audit Preparation Security Rule Audit Tool
Basics of Analysis and Risk Management for HIPAA Security and Privacy Rules
Administrative Safeguards Risk Assessment
Physical Safeguards Risk Assessment
Technical Safeguards Risk Assessment
Privacy Rule & Breach Risk Assessment
References and Resources
SRAT Audit Protocol Phase I
SRAT Audit Protocol Phase II
ONLINE EDUCATION (ELM EXCHANGE)
Our media library provides access to important healthcare, risk management and patient safety education and information. The materials can be borrowed, at no cost, as part of your staffs’ continuing education and training.
2016 Media Catalog
ON-SITE RISK ASSESSMENTS AND SELF-ASSESSMENT EVALUATIONS
We partner with ELM Exchange to provide online educational courses. These courses are designed to provide Physicians/Surgeons, Allied Healthcare Professionals and Registered Nurses a convenient opportunity to improve risk management and patient safety practices, while earning continuing education credit. In addition, insured physicians, surgeons and allied health care professionals who successfully complete these ELM Exchange online educational courses may qualify for a 1% Risk Management premium credit discount for each course completed, up to 5%.
PREMIUM DISCOUNT PROGRAM
Annual on-site risk assessments are provided to assess risk management and patient safety issues facility-wide. The assessment focuses on one to two specific departments and includes environmental assessment tours. Patient safety issues identified will be included in a consultation visit report, as well as on a user-friendly Recommendations Tracking Tool to be used by the facility for follow-up work. Often, resources are provided to meet the recommendations requirements. During these on-site assessment visits, education programs can be provided to meet your specific needs.
RISK MANAGEMENT DISCUSSION FORUM
We believe that our insured clients who apply solid risk management practices should see their efforts reflected in their premium. Participation is strictly voluntary in program; however, it can result in a discounted premium of up to 7.5% on your professional liability insurance renewal.
MHP & MLA Clients
The first part of the program focuses on education. There are two ways to earn the education premium discount — up to 5% per year. Eligible insured Physicians/Surgeons or Allied Healthcare professionals can attend a one-hour, on-site risk management program, provided by a MLA consultant, for 3% premium discount or successfully complete our online educational courses for 1% premium discount for each completed course. These options can be combined to earn a total of 5% education premium discount per year.
MLA Clients Only
The second part of the program focuses on self-survey and office practice assessment and provides a 2.5% premium discount for two years upon premium renewal. Our Clinic Self-Survey is designed to assist in identifying and correcting risk management concerns in your office practice. In addition to the premium discount you will earn for reviewing and completing this Clinic Self-Survey, it will be reviewed and specific recommendations and action plans will be developed to help you address opportunities for improvement. A report comparing your organization to other survey respondents will also be provided.
Our quarterly SOLUTIONS newsletter is designed to provide our members with valuable information about risk management, patient safety, legal issues, coverage, benefits, ways to save on premiums and other costs, as well as ways to take advantage of all the products and services we offer. In each newsletter, look for updates and SOLUTIONS from Underwriting, Claims and Legal Services, Risk Management and Patient Safety, Marketing and Communications, ProCon, HSG Charitable Foundation, and the HSG Employee Benefits Consortium.
We offer periodic webinars covering an array of risk management and patient safety topics. Each webinar is a 45-minute presentation followed by “Q&A” and discussion. For those unable to attend the live webinar sessions, the sessions are recorded and available for later viewing by request.
2016 Webinar Catalog
Additional Customer Benefits
DIVIDENDS AND PROFIT SHARING
BREECH RESPONSE INSURANCE
Healthcare Services Group (HSG) Family of Companies believes in giving back to its members and policyholders. The Companies employ highly efficient operating practices, keeping the expense ratio well below the national average, providing additional revenue to the bottom line, and allowing us to sustain increasing dividends and profit sharing to policyholders. 2016 Dividend and Profit Sharing Press Release
In 2016, HSG announced a record-setting $14.9 million in dividends and profit sharing by its companies, Missouri Hospital Plan and Medical Liability Alliance, the largest writers of medical professional liability insurance in Missouri. This is not only the largest combined return in company history, but also the biggest year-over-year increase since 2008.
MHP DIVIDEND FACTS
Fact 1: Eligibility: Members are eligible to receive dividends after one year upon renewal
Fact 2: 2016 Return: $13.1M was returned
Fact 3: Dividend Sharing Ratio: MHP’s 60% dividend ratio is more than 20 times that of industry peers
Fact 4: Over the past five years, payouts have increased by 23%
Fact 5: Rate History: Insurance policy rates have been maintained or decreased every year since 2004
HSG CHARITABLE FOUNDATION
The advent of electronic medical records, in conjunction with mandates stemming from data-information breeches, has fueled the need for Cyber Liability Insurance. Cyber Liability-related claims are for the most part excluded by the traditional insurance coverage purchased by hospitals and medical providers. Most notably, but not exclusively, cyber policies cover a business’ liability for a data breach in which the firm’s customers’ personal information, such as Social Security or personal healthcare information, is exposed or stolen by a hacker or other criminal who has gained access to such data.
ProCon has developed a Cyber Liability program specifically designed for hospitals and leveraged the buying power of the group, resulting in broad coverage with an extremely competitive pricing model. The policies cover a variety of expenses associated with data breaches, including: notification costs, credit monitoring, costs to defend claims by state regulators, fines and penalties, and loss resulting from identity theft.
HOSPITAL ASSOCIATION TRUST (HAT)
The Healthcare Services Group Charitable Foundation provides financial support of students pursuing medical, nursing or other healthcare related degrees or certificate programs. The scholarship/tuition reimbursement program facilitates the attraction and retention of healthcare professionals in Missouri. This program is designed to match scholarships or tuition reimbursements awarded by hospitals that are insured by Missouri Hospital Plan. The 2016 match per eligible hospital is $3,000.
For more information visit the HSGCF page.
HSG EMPLOYEE BENEFITS CONSORTIUM (HSGEBC)
The Hospital Association Trust (HAT) is a multiple employer trust arrangement, incorporated by hospitals for hospitals, formed to address the lack of availability of reasonably priced Workers’ Compensation insurance.
HAT combines most of the benefits of self-insurance with the protection of guaranteed cost programs. Its group trust arrangement gives it the ability to control price, based on its own experience combined with improved safety and claim management efforts. The board consists of participants that have a vested interested in reducing injuries and claim costs. Like other HSG companies, the Trust has been very profitable for many years and has returned substantial dividends to its members.
ProCon is the exclusive agent for HAT and can also access commercial markets to provide coverage for smaller hospitals on a guaranteed cost basis and self-insurance programs.
Through its group purchasing strength, HSGEBC provides affordable insurance coverage and flexible benefit programs for member hospitals. Available programs include group health, life, dental, disability, voluntary benefits and retirement plan products and services.
Members have realized substantial savings and employee benefit plan improvements as members of this group.
Contact Information? Or for more information HSGEBC Link?
Include emails and website info like on dropdown menu.
For information on retirement plans call Josh Selzer at 800-683-3440.
For information on all other benefit plan products call Randy Lueckenotte at 800-869-5994.