BOM Toolkit

Provided by ProAssurance, Part of The Doctors Company

Physicians should be cautious about using artificial intelligence or conducting independent online research after an adverse event or when litigation may be anticipated.

A recent federal court decision found that materials independently created using an AI platform were not protected by attorney-client privilege or the work product doctrine simply because they related to anticipated litigation or were later shared with an attorney. The same concern may apply to independent literature searches, online medical research, and AI-generated analysis conducted without counsel's direction.

Read the full article from ProAssurance, Part of The Doctors Company, for additional guidance on AI use, privilege, and healthcare litigation risk.

Delayed diagnoses are a significant source of medical liability. In a review of 6,544 general medicine malpractice cases closed between 2014 and 2023, diagnostic failure was the primary allegation in 46% of cases, with missed or delayed cancer diagnoses cited most frequently. Common contributing factors included missed warning signs, inadequate follow-up, communication gaps, and insufficient documentation.

A case highlighted in the article shows how risk can build over time. A patient with persistent hoarseness, difficulty swallowing, weight loss, and abnormal findings was initially treated for reflux. Months later, she was diagnosed with Stage III laryngeal cancer. Reviewers identified diagnostic anchoring, underappreciated test findings, limited documentation, and follow-up gaps as contributing factors.

What Practices Should Review

• Diagnostic bias: Reassess persistent or worsening symptoms and ask whether the original diagnosis still fits.

• Documentation: Record differential diagnoses, clinical reasoning, follow-up instructions, and why additional testing is or is not being pursued.

• Referral tracking:…

The updated state file makes an NPI-by-NPI check timely for practices that order, refer or prescribe for Medi-Cal patients.

What changed: California's public provider-enrollment dataset was updated September 7 with records through August 31. CMA says phased enforcement could begin as early as February 2027 and enrollment can take up to 90 days.

Who it affects: Especially solo, small and independent practices whose physicians prescribe or refer for Medi-Cal members. Enrollment with a managed care plan or Medicare alone does not satisfy the individual Type 1 NPI requirement.

Your move: Ask practice managers to run each prescriber's Type 1 NPI against the refreshed roster and start PAVE enrollment for any gap.

DHCS enrolled-provider dataset  ·  CMA enrollment guidance

California approved a progressive enforcement framework for organizations that exceed health-care spending targets, with financial penalties possible only after several corrective steps.

What changed: On August 26, the Office of Health Care Affordability board adopted a penalty range of 0% to 125% of the amount by which an entity's spending exceeded its target, after permitted adjustments. It also approved procedural penalties of up to $10,000 per day for repeated failures involving performance-improvement plans or required information, and one-time penalties up to $500,000 for repeated failure to implement a plan or knowing falsification.

Who it affects: Physician organizations with fewer than 25 physicians are generally exempt unless identified as high-cost outliers. The statewide spending-growth target is 3.5% for 2026, falling to 3% by 2029.

What to watch: Enforcement is staged through technical assistance, possible public testimony and a performance-improvement plan of up to three years. OHCA says the earliest spending-target penalty…

As fall approaches, physicians and care teams will need to navigate updated immunization guidance, changes affecting Medi-Cal coverage, and emerging public health concerns.

On September 23, the Los Angeles County Department of Public Health will host a live CME session covering several issues that could directly affect patient care and practice operations this season.

Topics include:

• Updated COVID-19, influenza, and RSV immunization recommendations for the coming respiratory viral season

• Changes to Medi-Cal and efforts to help preserve patient coverage across Los Angeles County

• A clinical review of Cyclospora and current food and water safety considerations

In CAP's latest edition of Physician Today, you’ll find expert insights into the changing medical malpractice landscape, along with practical guidance for strengthening informed consent processes, streamlining payer credentialing, cutting supply costs, managing online patient portals, and much more.

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This issue covers:

• Key developments impacting the medical malpractice landscape

• Strategies to strengthen informed consent processes and documentation

• Streamlining your payer credentialing approach

What happens when a healthcare facility questions whether a service dog is truly a service animal? This Case of the Month shows why the answer is not as simple as it seems and provides guidance about what physician practices can, and cannot, do when a patient arrives with a service dog.

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Interested in reading more case studies? Request your free copy of From Exam Room to Courtroom,…

Noridian has released its latest quarterly provider update, highlighting several important Medicare billing, compliance, and educational resources for physician practices. We’ve summarized the most relevant updates below. The complete Noridian newsletter is available at the bottom of this page.

Key Updates

Medicare Secondary Payer (MSP) Form Now Available in the Noridian Medicare Portal

As of June 19, 2026, providers can now submit the Part B Medicare Secondary Payer (MSP) Correspondence Formdirectly through the Noridian Medicare Portal (NMP) instead of mailing it. Supporting documentation can also be uploaded electronically, streamlining requests related to previously processed claims.

This submission option is intended for requests involving:

• Claims unrelated to No-Fault, Workers’ Compensation, Liability, or Medicare Set-Aside cases

Noridian has released its latest quarterly provider update, highlighting several important Medicare billing, compliance, and educational resources for physician practices. We’ve summarized the most relevant updates below. The complete Noridian newsletter is available at the bottom of this page.

Key Updates

Medicare Secondary Payer (MSP) Form Now Available in the Noridian Medicare Portal

As of June 19, 2026, providers can now submit the Part B Medicare Secondary Payer (MSP) Correspondence Formdirectly through the Noridian Medicare Portal (NMP) instead of mailing it. Supporting documentation can also be uploaded electronically, streamlining requests related to previously processed claims.

This submission option is intended for requests involving:

• Claims unrelated to No-Fault, Workers’ Compensation, Liability, or Medicare Set-Aside cases

The annually updated Human Resources Manual for Medical Practices, offered for free by the Cooperative of American Physicians (CAP), is now available to download. This essential resource, which can cost you thousands elsewhere, addresses California's complex employment laws and provides policies that help prevent lawsuits and set clear workplace expectations.

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The Human Resources Manual for Medical Practices, available in a customizable Word format, includes separate handbooks for employees and managers.

It’s crucial to use the latest version of this HR manual as laws change frequently.

This program will equip you and your staff with critical knowledge to understand each component of the process, tackle common pitfalls, and maximize reimbursements. Take advantage of this valuable learning opportunity to help navigate this complex but essential aspect of your practice.

This webinar will walk you through the life cycle of a provider complaint, including when and how to file through DMHC’s provider complaint portal. This webinar will also cover what constitutes an unfair payment pattern and the importance of utilizing the provider complaint portal to file complaints. Additionally, we will discuss when an Independent Medical Review (IMR) may be the appropriate course of action for medical necessity denials and how to determine which regulator to file a complaint with.

A timely policy briefing featuring experts from the federal and state levels as we explore the evolving healthcare policy landscape in 2025. This session will offer critical insights into how national and California-specific legislation is shaping practice operations, reimbursement, and care delivery.

📞(800) 786-4262 | Direct Access to Legal Guidance for Your Practice | Operating a medical practice comes with complex legal challenges. The CMA Legal Information Line connects physicians with trusted information about laws and regulations that impact the business of medicine—from employment policies to compliance and contracting. >>>

The CMA Health Law Library supports the business of medicine by helping physicians and their staff understand and navigate the legal landscape that affects their practice operations, contracts, and professional risk. Whether you’re reviewing a payer agreement or managing a peer review process, this is your go-to legal resource. >>>