What Every Orthopaedic Practice Should Know About Denials from Insurers & Health Plans

NYSSOS hosted an informational webinar on November 15th with the New York State Department of Financial Services (DFS), the state’s top watchdog concerning insurance and financial matters, and leadership from its Consumer Assistance Unit (CAU). 

The webinar provided members with guidance on the agency’s ability to respond to complaints from patients and physicians including those related to prior authorization and utilization review. In addition the presenters summarized what is permissible under NYS law and regulation regarding Prior Authorizations/Utilization Review/Clawbacks; and showed members how to navigate and execute a DFS complaint.

If you missed the webinar you can view it at your convenience.

  • You may view a recording of the presentation
  • A copy of the slides can be found here.
  • A copy of how to navigate the complaint process can be found here.

Is Private Equity right for you?

originally presented on February 2, 2022.
> Watch on Demand 

The purpose of this program is to provide you with an overview of private equity deals, what you need to consider, what questions you should ask, and how you can better assess whether this is a right move for you and your practice.  

Topics to be discussed: 
  • What is "Private Equity"
  • Is there a Good Match?
  • The Transaction
  • Evaluating the Risks and Benefits


Barry B. Cepelewicz, M.D., Esq.
Partner / Director

Kimberly Kempton-Serra, Esq.

Healthcare Law Review

originally presented on June 24, 2021.
> Watch on Demand 

New York will end the state disaster emergency declared on March 7, 2020 to fight COVID-19. Given New York's dramatic progress against COVID-19, the state of emergency will expire after Thursday, June 24.

So what does this mean for you, your practice and your patients?

During this 60-minute complimentary webinar sponsored by MLMIC Insurance Company, an attorney from Fager Amsler Keller & Schoppmann, LLP will provide an overview of the recent legislative, regulatory and case law developments that impact the provision of healthcare.

A focus on reopening orthopaedics amid covid-19

originally presented on June 2, 2020.
> Watch on Demand 

On behalf of the NYS Society of Orthopaedic Surgeons, we are pleased to offer members the following presentation provided by MLMIC.

 After listening to this program, viewers will be able to:

- Understand regulatory requirements associated with COVID-19.
- Recognize resources necessary to reopen.
- Develop infection control measures for protecting patients and staff.
- Create new workflows and prioritize patient backlog.
- Identify areas of need in anticipation for a future surge.


originally presented on February 27, 2019> Watch on Demand  | Copy of the Presentation

Ms. Silverman provided attendees with an overview of the payment structures that comprise value based payment (VPB) arrangements and how orthopedic surgeons fit into the various paradigms.  Additionally, she discussed alternate health care delivery models like accountable care organizations and independent practice associations (IPAs) and answered the following questions:  

  • What does it means for an orthopedic surgeon to participate in a clinically integrated network. 
  • How might an orthopedic surgeon evaluate joining one network over another?
  • In today’s environment of mergers and consolidations, can an orthopedic surgeon remain financially viable without joining a network or participating in managed care at all?  

Debra A. Silverman represents hospital systems, teaching and community hospitals, faculty practice plans and physician group practices, with an emphasis on managed care contracting, health care delivery networks, accountable care organizations, clinical integration, physician arrangements, antitrust and regulatory matters.

Your Employment Agreement: How To Be Best Protected

originally presented on March 27, 2019. > Watch on Demand |Copy of the Presentation

Barry B. Cepelewicz, M.D., Esq. provided attendees with guidance on how to review and construct a  comprehensive employment agreement that will protect both the employer and employee.  Key provisions he focused on:
•    Compensation Models
•    Termination Provisions
•    Restrictive Covenants
•    Professional Liability Insurance
•    Indemnification
•    Duties and Obligations
•    Benefits
•    Post-Termination Rights
•    Dispute Resolution
•    Outside Activities
Barry B. Cepelewicz holds dual degrees in law and medicine, providing a unique perspective to clients on health care related matters.  For nearly three decades, he has represented health care related entities in transactional, regulatory, and litigation matters, including creating large single and multi-specialty group practices and other joint ventures, and successfully defending health care professionals in State, Federal and other investigations. 

Reducing Nerve injuries in joint replacements

originally presented on December 5, 2019 > Watch on Demand

Working together, NYSSOS and MLMIC designed a multi-modal, statewide educational opportunity to help identify risks for nerve injuries in hip/knee joint replacement surgical cases in the office, surgical and postoperative settings.

Those involved in the patient care team are invited to attend as well (ie physician assistants,  anesthesiologists, nurses, risk Managers, orthopaedic practice managers.) No charge to attend.  He/she does not have to be a NYSSOS member or MLMIC insured.

Learn strategies:

  • For documentation of the pre-operative, operative, post-operative phases to mitigate risk.

  • To limit allegations of a lack of informed consent.

  • On how to disclose unanticipated outcomes.

  • Facilitate prompt and equitable post-operative follow-up care for suspected nerve injuries to improve patient outcomes from such events.

  • On how to handle patient noncompliance.

  • To enhance communication between physicians, patients, staff and facilities.
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