Tuesday, October 7, 2014

Hospitals Beware—2013 MVA Emergency Room Claims Are Likely Being Underpaid

Written by: Thomas LaGreca, Client Liaison for Callagy Law

New regulations for motor vehicle accident (MVA) claims, also known as Personal Injury Protection (PIP) claims, went into effect January 4, 2013.  These regulations created for the first time a hospital fee schedule, the Hospital Outpatient Surgery Fee Schedule (HOSF).  This fee schedule addresses specifically outpatient surgeries conducted at New Jersey hospitals.  It does not govern charges associated with inpatient services; and emergency room (ER) surgical services were specifically exempted from application of the fee schedule.  Both inpatient and ER services are to be paid by PIP insurance carriers at the usual and customary rates (UCR) of the hospital.  Not surprisingly, PIP carriers in the context of ER services have been attempting to pay less than a hospital’s UCR through a variety of ways.

  1. The ER Modifier. The new regulations refer to use of an “ER” modifier to indicate that the hospital services were rendered as part of hospital emergency room treatment.  It is best to use the ER modifier, as called for in the regulations, so as to deny PIP carriers the ability to argue against the applicability of UCR.  However, it is our position that use of the modifier is not a prerequisite to being paid at the hospital’s UCR.  The provision calling for use of the modifier, we contend, refers only to outpatient surgery services conducted pursuant to ER treatment.  Also, we contend, the bill (UB) itself, including the words “Emergency Room” appearing next to the ER evaluation code 9928X, is quite clear in these circumstances that the services are ER services. In our view, use of the modifier is aimed at informing the carrier as to the nature of the services, and the UB achieves that with or without the modifier.


  1. Multiple Modality Reduction (MMR) Formula Applied to Radiology. Carriers have attempted to apply MMR to ER radiology.  MMR is the formula applied to surgeries whereby the first surgical procedure is paid at 100%, and any additional procedures performed on the same day are paid at 50%.  Carriers have tried to apply this to ER radiology.  We have been aggressively opposing this practice and continue to do so.


  1. Applying the Physician Fee Schedule to ER Radiology. Carriers have also been trying to apply the physicians’ fee schedule rates to ER radiological services.  This would result in the hospital often being paid even less than the hospital outpatient surgery fee schedule rate.  There is scant support for this practice on the part of carriers, but that has not deterred them.  We have also been aggressively opposing this practice.

If you are a New Jersey hospital, there is little doubt that your facility is experiencing the above underpayments.  As a general proposition, you should be reimbursed at your billed charges for the ER services you render to patients suffering as a result of a motor vehicle accident.  Assuming your charges are your usual and customary rates, and they are reasonable for the geographic area in which your facility is located, PIP carriers should be paying you at your billed charges for ER services.  Anything short of this is likely to be a claim that should be arbitrated.

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Monday, October 6, 2014

There Was A Time When I Thought Business Success Was About Working the Hardest

Friends,
There was a time when I thought business success was about working the hardest.
I was wrong.
Hard work is important, but not more important than mastering influencing skills and working smartest.
With the knowledge I've acquired over the past 30 years, I've been blessed to build four successful companies from start up.
The back bone of all of it has been learning to master communication dynamics with other human beings.
Contrary to popular belief, communication, sales and education are all one and the same.
This is so misunderstood by people, and this mistake is a critical limiting factor on why people are not more powerful influencers.
Education, sales and communication all are a process of having a point of view or desire that you are communicating to another human being that you want to accept your point of view and take action on it.
Don't believe me?
You are doing precisely that if you are:
  1. Selling pens;
  2. Teaching math;
  3. Asking someone out on a date;
  4. Telling someone you love them;
  5. Meeting a potential strategic partner and/or referral source; 6. Talking to a teen about not smoking or using drugs;
  6. Coaching a sports team;
  7. Encouraging a friend to believe in him or herself;
  8. Working with two people involved in a conflict: and;
  9. Sharing a sermon in Church.
The list goes on forever.
What we will be doing on October 30, 2014, for the first time ever at the Callagy Business Mastery Club, is presenting you with all four steps, in detail, with our special way of making sure you remember and be able to use these four steps, with integrity, to make your business and life, far more effective in terms of meeting your next level of goals and outcomes.
I currently have a 120 person law firm that I am privileged to own and manage.
I used these skills to build it, run it and grow it.
I had a forty person law firm when I was thirty years old that I built.
I've never heard of another 30 year old ever building a forty person law firm from scratch.
I did it through using this process.
Please, for your benefit, come and accept this gift.
We are selling NOTHING.
So, why do I do this?
  1. I love to give:
  2. It makes me sharper and more accountable to my own beliefs:
  3. I get to train my own team at the same time:
  4. We all, collectively, get to meet more new and great people: and 5. I get to have fun with my best friend, Ben Burton, another super successful entrepreneur, who is my co-host.
I've never had anyone attend and say they've seen anything like it.
I've also never had anyone tell me it wasn't a massively valuable use of their time.
People have told me I'm foolish for giving this away.
We all have gifts. This communication process may be my greatest gift.
People tell me all the time they think:
  1. I am clairvoyant (I am not):
  2. I can read minds (I cannot, at least not in the way they are thinking):
  3. I can convince anyone to do anything (I cannot unless it is good for them!):
  4. I have a better program than anything they've ever seen or heard of:
  5. People are crazy for not attending CBMC.
I challenge you to attend on October 30, 2014 AND to bring 3 guests.
Put it on your calendar now, please, and invite your guest immediately.
Do not procrastinate.  You will lose this incredible opportunity in the busy day you have.
Take action now!!!!!!!!!!!!!
See you on October 30th at our offices 650 From Road, Paramus, New Jersey.
Don’t forget to reserve your space online here.
In your service,

Original Article:

http://callagylaw.com/time-thought-business-success-working-hardest/

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Friday, October 3, 2014

Lessons for Life

Lessons for Life

Written by Sean Callagy of Callagy Law


A scary man, brotherhood, and lessons for life...


It was a hot day in August, 1984.


Emerson High School's varsity football team, the mighty Cavos, had just won a state champion the prior fall.


As "8th graders", my now freshman football teammates and I, watched as the Cavos defeated the now legendary Coach Greg Toal of Don Bosco, as he coached Saddle Brook on a cold day in December.


The seniors on that team were our larger than life heroes that walked our same hall ways at Emerson High.


Now, we were standing on their field.


There was a problem though.


We were supposed to stink.


That's what all the older kids told us.


We were too small and just not good.


The golden era of Emerson football would die in our hands.


We were all pretty nervous that first day. We had heard that the freshman football coaches, Dennis Slezak and Bob Carcich, were very tough, if not insane.


Coach Carcich went on to become a legendary Bergen County head baseball coach at Emerson.


This story, though, is about his crazy partner in crime, maybe literally, Coach Dennis Slezak.


Immediately, I was never more frightened of anyone than I was of Coach Slezak. He was a large man, probably 6'1, 220 pounds, and he had a ferocious intensity the poured out of every part of him.


He yelled, screamed, told you what you were doing wrong, and he told us "once you cross the white lines, you have no friends who are lined up against you."


And, he meant it.


He wanted us to punish and terrorize our opponents. He wanted us to physically beat them, which for now at practice, was each other, into submission.


Walking into practice, I thought I was pretty tough kid and a good athlete.


Taking the two mile walk home from practice, I felt like I had stepped into a frightening world in which I didn't belong.


That night, I told my parents I wanted to quit football. I told them that Coach Slezak was mean and crazy and that I never wanted to play for him.


My mom and dad told me it was okay to quit. My step father convinced me to go back and give it a little time.


I am only slightly exaggerating when I say that practices were something out of what you might expect for the youth of Sparta in the movie 300.


The physical violence was incredible. We hit, and hit and hit and hit and then, we hit more.


Coach Slezak demanded more ferocity, more aggression, more pride, more intensity, and then, even more and more and more.


When Coach Slezak didn't get it, he would borrow a helmet and you would have to go up against him.


He had no pads, we were fully suited up, but it was something out of a nightmare to have to go up against him.


He challenged us. He belittled us. He screamed at us, and he broke us down completely for weeks.


Somehow though, I, and my brothers in this process, kept coming back for more.


Somehow, we liked it.


In the early stages, we didn't like Coach Slezak though. He seemed like a very unnecessary evil in this process to many of us.


He was a scary, disconnected tyrant, who seemed to enjoy torturing us.


Then, one day, after practice, we were in the locker room. Coach Slezak walked in. We all did what we normally did and avoided eye contact with him.


Then, Coach Slezak stopped, and he offered us pretzels.


I will never forget that moment. It was the first act of kindness, or even mild softness or caring that I could perceive in him, and It was directed towards us.


He then talked to us like a normal human being for a couple of minutes.


Somehow, it clicked, he cared about us.


The next day at practice was as ferocious as ever. Our relationship with him though, began to change.


He showed more of these moments of caring.


He was still scary, but I remember feeling that I trusted him and that he should be followed.


Our first football scrimmage was against Park Ridge, a local rival that had moved out of our league.


Thirty minutes after the scrimmage began, it was over.


Park Ridge was considerably bigger than us, but in a half hour, we had hurt and knocked out so many of their players that the scrimmage was called off by their coach.


I do not recall them having one play for positive yardage against our defense.


The insanity never let up in practice.


We would line up twenty yards apart from one another, one person with the ball and the other on defense. Coach Slezak would be screaming at both players and challenging them to win the battle of score or don't score by crossing the cone at full speed.


The collisions were epic. Kids got hurt. A concussion, broken bones, and certainly tons of bruising were the results, but we loved it.


In our first game, we sprinted into the locker room at half time up 20-0. We thought we, a bunch of crazy fourteen year olds, thought we were world conquerors.


Coach Slezak stormed into the locker room and ripped us for all the things we were doing wrong.


We were stunned.


BUT, he had us all completely bought in to him, and more importantly, to each other and ourselves.


After that first game, we had a day off. I decided to go out with friends and ride a go-kart.


Not surprisingly, I crashed into a brick wall and broke my knee cap. My freshman football season was over.


I was beyond devastated.


The next day I went to our second game, on crutches. Coach Slezak was so angry at me, he was cursing and screaming about me to the other players and wouldn't even speak to or look at me.


Why? He was angry, because I was stupid and hurt myself and the team.


We won that game 55-0.


Things rolled pretty well from there for Coach Selzak's young Cavos.


Our last game of that season would be against Emerson's ferocious arch rival, the hated Cresskill Cougars.


As the weeks passed, Cresskill destroyed everyone. They were enormous.  Their starting running back was two hundred pound


Their smallest starter was bigger than our largest starters.


With some help which is a different story for another day, Coach Slezak put in an entirely new defense to stop Cresskill and their beast of a running back.


BUT, how do you stop a two hundred pound kid, when we had a starting corner back who was 95 pounds?


What happens when they run around that end?


Coach Slezak had us past asking such "realistic" questions.


The physics of this problem never even entered our minds.


As the weeks passed and what was to be a league championship game with Cresskill approached, I shocked the doctors with the fact that my knee had healed and five days before the game I was allowed to start physical therapy.


I told Coach Slezak I wanted in.


Well, actually, I politely asked him.


He looked at me and said,  "Suit up for practice and we'll see."


I had not had a day of physical therapy and had not run for two months, and I didn't care.


I was going to play in this game.


We, the tiny Cavos that were supposed to be nothing, were following in the foot steps of the State Champs of 1984.


This was going to be the greatest day of all of our lives, I was going to play.


I didn't know that we had no chance to win. None of us did.


The Cresskill freshman team of 1984 had been undefeated in every football game they ever played. They had been playing since 3rd grade. So, they were working on their 7th consecutive undefeated season as a team.


We didn't have youth football in Emerson. That's what Coach Slezak inherited.


Cresskill was 50 something and "0" coming into freshman year, and we had never played an organized football game.


They had a two hundred pound running back. We had a 95 pound corner back to go with our 125-145 pound line backers.


As I stepped onto the practice field, I was thrilled. It was freezing, but the energy was electric, and no one noticed or cared about the cold.


As soon as warm ups were over, Coach Slezak called me out to line up in a full speed tackling drill.


I was a little in shock, but I shouldn't have been.


This was Coach Slezak.


He gave me three chances.


I was ready to crush the guy lined up against me.


"I have no friends once we cross the white lines!", I was screaming in my head.


On the first play, I got crushed.


On the second play I got crushed.


On the third play I got crushed.


I had missed two months of warrior training and my leg had atrophied.


My strength, speed and explosiveness were not there. Not at all.


Coach Slezak just looked at me and said, "No."


I looked at him and saw such love, sadness and compassion for a second, then he was back to getting "us" ready for a war with Cresskill.


I cried as I walked alone back to the locker room. In the locker room, I sobbed, not believing I was going to miss this.


On a freezing Saturday morning in late November, 1984, "we" destroyed Cresskill. They never crossed our side of the 50 yard line.


Our 95 pound corner back, "stuck" their giant running back twice and made him fumble.


Overall, our ferocious swarming defense forced Cresskill to fumble five times.


We were everywhere, and they had no answers.


If you watched any one play in that game, you would know who wanted it more.


I watched all of this back on crutches, screaming and urging on my newly formed family that Coach Slezak had built.


No feeling I had ever had up to that point in my life matched the feeling of beating Cresskill that day.


AND, I wasn't even playing.


Yesterday, two months shy of thirty years after that fateful Saturday that brought us, and more importantly Emerson, the Freshman league championship, I got a text that Coach Slezak and his wife, who was also a wonderful woman and our high school class advisor, were moving to South Carolina.


My Emerson brother Tom, one of our freshman captains, had put together an impromptu dinner at a local bar and grill.


I was exhausted from a crazy week between work and my kids' practices and games, plus it was back to school night.


BUT, there was no way I would miss seeing the guys and Coach Slezak.


I owed this man so much.


Ten of us were able to make it.


Whenever we are together, it always feels like the best of family, plus something else.


When we gather, we know we did something amazing, unique and special together.


And, we know we did it with great sacrifice and complete commitment of and to ourselves and one another.


That is something very rare and very special.


We had very successful high school sports careers at Emerson and continued the proud legacy we were supposed to drop.


We left Emerson as champions senior year after Coach Slezak was gone, having been asked to leave the year after our Cresskill victory because a parent complained about him yelling at practice, Coach Slezak told the parent where to go.


Everyone always thinks they were the end of an era and that it all changed after them. That's a part of getting older.


I do think though we were truly the end of an era at Emerson and that everything did change after us and Coach Slezak and his mentality.


Parents became more protective. Coaches lost power. Safety became a bigger concern.


In certain situations, and maybe overall, that was great and necessary.


Sports coaches were often abusive and dangerous for the sake of just being those things.


What was lost in the process though, were the Coach Slezak's of the world.


He could never exist today. We joked that today, he would be put in jail for what he did to us.


Maybe though, that's a little bit of what is wrong with the world today.


He cared, and he loved us. In today's world of me first, that is not easy to find in coaches anymore.


Often, coaches are all about what can you do for me, Coach Slezak was about doing for, and giving to, us.


I only played football for five weeks of my life for Coach Slezak.


I have been blessed to have achieved a lot in my sports and professional career.


I have been blessed to have many great and critical mentors in my life that helped me get there.


Coach Slezak was one of the indispensable ones.


I truly believe I would not have achieved much of what I have achieved in my life without him.


When I've wanted to quit, but haven't, I've often thought about that first day of football freshman year and how scared I was.


I often think of what would have happened to my life if I did run away that first day.


I know the people there last night, my Emerson family of brothers, and many of those who couldn't make it last night, feel exactly the same way.


Tom bought Coach Slezak a football last night, and we all signed it and gave it to him.


He told us he has our freshmen team picture in his "man cave" at home.


On my space on the football, I wrote:


Coach, you changed all of our lives for the better. I tell everyone about you and how you made us a family and men. We love you and thank you with all our hearts.


Coach Slezak told us he loved us and you knew he meant it. He is a man's man, and a true man's man can tell other men he loves them.


Coach taught us how to compete, find the greatness inside of us, be an unstoppable team, deal with adversity, make our way in the world, and believe when all things look impossible.


It's hard to think of much greater value you can bring to the lives of fourteen year old boys trying to become young men.


Last night, I told Coach I love my life, but I would give a lot to do that year again, injury, heart break and all.


I was very emotional as I drove home.


I thought that the world would be a much greater place if everyone had a Coach Slezak when they were fourteen and parents who would let them have a Coach Slezak.


A lot of coaches can act tough and act like they cared. Coach Slezak was tough and he cared like there was no tomorrow.


Coach Slezak was, and is, the real deal.


As we talked last night, we all noted how much the world has changed and that none of us from our team had a child playing football.


Coach Slezak thought that was probably a good thing because football is so dangerous.


Maybe, but I'm not so sure.


Thank you Coach Slezak.


Original Article:                                                                                                              www.callagylaw.com/lessons-life/                                                                                                                                                   
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http://callagylaw.com/leader/

You Remind Me Of Superman: Be A Leader, Not A Boss

You Remind Me Of Superman: Be A Leader, Not A Boss



“Would you rather be loved or feared?”  Michael Scott, Regional Manager of the Scranton Branch of the Paper Company Dunder Mifflin, Inc., answered that age old question.  His answer: “Easy, both. I want people to be afraid of how much they love me.”  Perfect.
Though Michael Scott is a fictional character played by actor Steve Carell on NBC’s The Office, the question he answered is a very real question that has dogged supervisors, managers and executives throughout the world.  Everyone has their own opinions and, like most things in life, there is no exact perfect answer (except Michael Scott’s answer of course).    
While there is no answer to the fear or love question, there are certain qualities that make you the kind of person people want to work with.  These are some of the qualities that make you a leader of people, and not just a boss:   

1.                        Integrity.  Since 2010, Superhero movies have grossed over $3.6 billion dollars.   Why is that?  Maybe people just want to see Superman explode things with his eyes.  My theory is that people are drawn to heroes, and it is not just the cool superpowers.  People want to see the good guy win and the bad guy lose (but not before the epic struggle where things get destroyed).  Heck, maybe deep down inside, people probably can relate to the hero and see themselves as a hero.  Each and every hero, whether it be Superman, Batman, Ironman, Spiderman and even the Hulk, have at least one quality in common: integrity.  They are innately honest and do the right thing.  If you establish yourself as a person of integrity and live by that ideal, those that work with you or for you will follow suit.  This is especially true if you work in a field that is filled with “moral ambiguity” and gray areas.  If you maintain the highest standard of truth and honesty, you will position yourself as a moral compass for those trying to navigate their way through those gray areas. 
2.                        Communication.  Who likes it when their friends, family or significant other acts sarcastic or in a passive-aggressive manner towards them?  I certainly do not.  If I do something wrong, tell me and I will fix it.  How about when you do something right?  Don’t you want someone to say “great job!”?  I certainly do.  Communicating with the members of your team is just as important as maintaining your integrity.  That means telling them the good and the bad.  Some managers are great at telling you when you mess up (and everyone messes up), but never tell you what a great job you are doing when you are doing a great job.   It is important that you speak frankly and honestly with your team and let them know what they are doing well and what they are not doing well.  What’s more, as people we sometimes forget that those that are close to us cannot read out minds.  We have to set our expectations and communicate them clearly so everyone is on the same page.  Whenever I meet with a new hire or team mate, I tell them upfront that I am excited to be working with them and I communicate what is expected of them.  That way, you will never have to hear those dreaded words, “but I didn’t know you wanted me to do that.”
3.                        Confidence.  In the same way our canine companions can sense fear, human beings can sense confidence.  Confident people carry themselves differently than those who lack confidence.  The differences are staggering.  Confident people stand taller, are more calm under pressure, speak loudly and more clearly, and they take up more space than their counter-parts that lack confidence.   Your team takes their cues from you.  If you are calm and confident, they will feel calm and confident.  Confident people inspire those around them and fill them with certainty and conviction.  Ask yourself, would you rather follow a leader who speaks decisively about the course of action the team will take, or a person who is unsure and shrugs his shoulders when it comes time to make decisions?  The answer is clear. 
4.                        Judgment.  I do not mean gossiping about Jack’s terrible haircut.  I am referring to the ability to make informed and considered decisions, become committed to those decisions and, most importantly, execute and implement those decisions.  Decisions are the first step in taking action.  You cannot just want to take action, you have to decide on your course of action and then take steps in furtherance of that decision.  When faced with more than one path, you have to decide which path you will take quickly and with certainty.  Being able to make informed and well-reasoned decisions is what separates leaders from bosses.  You cannot be paralyzed by fear of making mistakes.  I never fully grasped the saying “no one is perfect” before I started making real decisions in my life.  Everyone makes mistakes and no decision is 100% correct and 100% perfectly implemented.  There is always room for improvement, even if that improvement is just a better execution on your decisions.  The only way to develop better judgment is to get out there and start making some decisions, implementing those decisions and revisiting those decisions to see if they were successful or not. 
5.                        Sense of Humor.  Did you hear that one about the guy that walked into the bar?  Let’s be serious for a second…  Okay that’s long enough.  The workplace is filled with ups and downs.  Missed opportunities and obstacles are intermingled with rewards for opportunities seized and successes.  A keen sense of humor will smooth out those curves and make the struggles in the workplace more bearable.  Happy people are productive people.
In closing, whether you are a team of one or manage a team of hundreds of people, these qualities will make you a more effective leader, inspire those around you and make you the kind of person that people want to follow.  So be honest, communicate your expectations, be confident, be decisive, and, most importantly, don’t take life too seriously, you’ll never get out alive!

Original Article

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Confessions of a Skeptic at Callagy Business Mastery Club

Confessions of a Skeptic at Callagy Business Mastery Club
Written By:
Dan Fredenberg – Callagy Law

I am a trial attorney.  In its simplest form, jury trials are nothing more than a story contest.  The winner of the contest is the attorney who puts on the most compelling and truthfulstory on behalf of their client.  In this sense, a trial attorney serves in the role of a producer, director, and lead actor in the story.  Because the story is played out on the stage of a live courtroom, the most successful trial attorneys keep watchful eyes on their adversary, constantly looking for any weaknesses, holes or better yet, lies, in the story being presented by the other side.  In other words, trial attorneys are professional skeptics. 

During my career as a trial attorney representing Fortune 500 companies in multi-million dollar jury trials, I have traveled throughout the US and had the opportunity to speak to jurors after the trial (fortunately on the winning side) and learned that one common thread emerges:  a true story is easy to tell.  A true story doesn’t leave you guessing or leave you with unanswered questions.  In our everyday life, we are all jurors in a sense.  We have all seen the ads for $1.00 iPads or get rich quick systems on infomercials and without exception we ask the question:  what’s the hook?

I recently joined Callagy Law as a partner in its Arizona office, and in spite my alignment with the firm, I entered the most recent Callagy Business Mastery Club as a professional skeptic.  But as I entered the room, I quickly noticed there was nothing for sale.  No books.  No sales systems.  Nothing but a room full of business owners and professionals. 

As the evening began, Sean Callagy began by challenging the members to shift their mindset from why, to why not?  Why not use one evening a month to work on your personal and business growth?  Being a trial attorney, I was certain that I could come up with a witty response, but I drew a blank.  Other members tried to come up with better uses of their time, but each of them failed.  Resoundingly.

As I scanned the room, I noticed other would-be skeptics becoming more receptive to the concepts that Sean Callagy was introducing.  The focus on this particular evening was communicating your unique business identity to your audience.  The idea of communicating your business to another person sounds incredibly easy, almost like an afterthought.  Until you actually try it. 

Sean Callagy invited members-career salespeople and experienced business owners to try out their story in front of the audience.  After each member would share their story, they would be rated on a scale of 1 to 10.  The results after their first attempt were mostly the same.  5 to 7, with an occasional 8.  But then an interesting transformation happened.  Sean Callagy introduced the idea of communicating your unique business identity through a true story about yourself and why you are excited to share your story.  Tell a story that incorporates all of the characteristics of a hero:  courage, passion, integrity, empathy, strength, energy, relentless persistence.  As we broke out into groups of three, each of us practicing our unique business story on one another, the skeptics were gone.  Instead, we were collaborating with new friends and contacts, listening and helping each other with positive feedback on the ways we can improve our story.  The improvements made by the members were drastic.  8 was the new floor.

Once a skeptic, now I tell my friends and clients they would be crazy not to come to the Callagy Business Mastery Club.

Original Post:
http://callagylaw.com/callagy-business-mastery-club/

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