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So far Paul Natinsky has created 352 blog entries.

The End of the COVID Emergency Could Mean a Huge Loss of Health Insurance

By ELISABETH ROSENTHAL
Now, as the pandemic’s acute phase seemingly draws to an end, millions of low-income and middle-income Americans are at risk of losing health insurance. The United States might see one of the steepest increases in the country’s uninsured rate in years.

When the federal COVID-19 public health emergency ends — as it is currently scheduled to on April 15, though it is likely to be extended — so will many of its associated insurance protections. That includes a rule forbidding states to kick anyone off Medicaid while COVID-19 raged, which came along with a 6.2-percentage-point boost in federal Medicaid funding to keep these most vulnerable patients insured.

Before the pandemic, [Read More]

The End of the COVID Emergency Could Mean a Huge Loss of Health Insurance2022-04-27T12:51:22-04:00

ON POINT WITH POs: Make Diversity, Equity And Inclusion More Inclusive

By EWA MATUSZEWSKI
One of my most interesting, recurring roles as a healthcare CEO is to lead physicians, APPs, care teams and executives in a webinar series on implicit/unconscious bias under the umbrella focus of diversity, equity and inclusion. I initially developed an implicit/unconscious bias learning activity for Practice Transformation Institute and the Michigan Osteopathic Association and was recently asked by Blue Cross Blue Shield of Michigan to expand the curriculum. I am grateful for the opportunity to engage in meaningful dialogue on a subject I am passionate about.

One of my main goals in this series is to expand considerations of DEI and implicit/unconscious bias beyond race, gender and sexual orientation [Read More]

ON POINT WITH POs: Make Diversity, Equity And Inclusion More Inclusive2022-04-27T12:48:20-04:00

COMPLIANCE CORNER: CMS’ Supplemental Medical Review Contractor Targets Vulnerabilities with Nationwide Medical Reviews

By JENNIFER COLAGIOVANNI, ESQ.
Wachler & Associates, P.C.

Meet one of the Centers for Medicare and Medicaid Services (CMS) newest contractors. CMS contracts with a Supplemental Review Contractor (SMRC) to help lower improper payment rates through audit and medical review activities. Noridian Healthcare Solutions, which is also a Medicare Administrative Contractor (MAC), was selected as the SMRC in 2018.

The SMRC conducts nationwide medical reviews for compliance with coverage, coding, payment, and billing requirements based on CMS-directed topic selections and timeframes. CMS assigns the focus project to the SMRC via a formal notification process. Review topics focus on issues identified through national claims data analysis from the Comprehensive Error Rate Testing (CERT) program, [Read More]

COMPLIANCE CORNER: CMS’ Supplemental Medical Review Contractor Targets Vulnerabilities with Nationwide Medical Reviews2022-04-27T12:43:49-04:00

LEGAL LEANINGS: Taking Care of Patients, and Taking Care of Yourselves

A brief look into the Good Faith Estimate rules of the No Surprises Act, the National Crisis Hotline, and the New Act Promoting Mental Health among Health Care Professionals

By ERICA A. ERMAN

No Surprises Act: Behavioral Health Considerations Regarding the Good Faith Estimate Provisions

With the passage of the No Surprises Act, effective January 1, 2022, providers and facilities are now required to provide Good Faith Estimates to uninsured and self-pay individuals detailing the cost of the primary service or item needed and the cost of services or items that are customarily provided in conjunction with that primary item or service. This is relevant across the entire health care sphere, but is [Read More]

LEGAL LEANINGS: Taking Care of Patients, and Taking Care of Yourselves2022-04-27T12:38:54-04:00

LANSING LINES

At-Home Care Provider Believes $400 Insurance Refund Was Inflated

Lansing Lines is presented in cooperation with MIRS, a Lansing-based news and information service.

An at-home care provider for catastrophic car accident survivors is accusing the governor of “inflating and expediting” the $400 per-vehicle refunds, claiming it was inappropriately calculated as “a political favor.”

Based on his calculations, Bob Mlynarek, the co-owner of 1st Call Home Healthcare, said the Michigan Catastrophic Claims Association (MCCA) should have limited the reimbursement to $78 per driver in order to stay in line with the state law that lays out the calculations under which a refund is triggered.

“You tell me in the insurance code or the MCCA Plan [Read More]

LANSING LINES2022-04-27T12:33:21-04:00

Shirkey Says It’s Time To End COVID Testing ‘Obsession’

As barrels of at-home COVID-19 tests wait to be picked through and new daily COVID-19 case numbers continue to decline, Michigan’s Senate Republican Leader is calling on the state to “back off on our obsession on testing.”

“. . . Especially since Omicron remains the dominant strain,” said Senate Majority Leader Mike Shirkey (R-Clarklake). “Too many false positives. And negative tests often cause people (with symptoms) to unintentionally spread other viruses like the flu. If you’re sick, stay home.”

Michigan’s Department of Health and Human Services reported 1,656 new cases of the virus since the report on March 4, as well as 16 deaths due to the virus.

A seven-day positive rate of [Read More]

Shirkey Says It’s Time To End COVID Testing ‘Obsession’2022-03-28T15:19:10-04:00

COVID’s ‘Silver Lining’: Research And Breakthroughs

By LIZ SZABO
The billions of dollars invested in COVID vaccines and COVID-19 research so far are expected to yield medical and scientific dividends for decades, helping doctors battle influenza, cancer, cystic fibrosis, and far more diseases.

“This is just the start,” said Dr. Judith James, vice president of clinical affairs for the Oklahoma Medical Research Foundation. “We won’t see these dividends in their full glory for years.”

Building on the success of mRNA vaccines for COVID, scientists hope to create mRNA-based vaccines against a host of pathogens, including influenza, Zika, rabies, HIV, and respiratory syncytial virus, or RSV, which hospitalizes 3 million children under age 5 each year worldwide.

Researchers see promise in [Read More]

COVID’s ‘Silver Lining’: Research And Breakthroughs2022-03-28T15:16:49-04:00

ON POINT WITH POs: Behavioral Health Crisis Puts Spotlight on Value of Social Worker Role

By EWA MATUSZEWSKI

I’ve been writing this column for years now and have given appropriate kudos to a variety of disciplines within the healthcare realm. But I’m not sure I’ve explicitly called out social workers for the tremendous value the profession brings to healthcare, specifically as it relates to the behavioral health component of primary care.

I’ve been a personal supporter and advocate of social workers as far back as 20 years ago, when the Medical Network One CMO’s primary care practice used their services to help coordinate community resources for patients with needs beyond traditional medical care. Our physicians organization also included social workers in our Community Care Travel Teams (CCTT) [Read More]

ON POINT WITH POs: Behavioral Health Crisis Puts Spotlight on Value of Social Worker Role2022-03-28T15:11:48-04:00

COMPLIANCE CORNER: Michigan Ramps Up Efforts To Recruit And Retain Providers During COVID-19

By JESSE A. MARKOS, Esq.
Wachler & Associates, P.C

The outbreak and continuation of the COVID-19 pandemic has stretched the staffing resources of Michigan’s health care system to unprecedented levels. Adding to the demand for already scarce health care providers, hospitals have scrambled to find additional frontline workers like emergency medicine physicians and nurses. During this period of mounting workforce shortage, Michigan has taken significant steps to enhance efforts to recruit and retain health care providers.

For example, on Feb. 16, 2022, Gov. Gretchen Whitmer signed a new law approving $1.2 billion in federal aid money for COVID-19 relief efforts. Importantly, $300 million of that federal aid has been earmarked to address the [Read More]

COMPLIANCE CORNER: Michigan Ramps Up Efforts To Recruit And Retain Providers During COVID-192022-03-28T15:06:24-04:00

LEGAL LEANINGS: How Application Programming Interfaces Apply to Healthcare Entities

By EMMA TRIVAX, Esq.

ONC Final Rule

Information blocking

On May 1, 2020, the Federal Department of Health and Human Services (“HHS”), Office of the National Coordinator for Health Information Technology (“ONC”) released a Final Rule (the “ONC Final Rule”), which implements the information blocking provision of the 21st Century Cures Act, enacted in 2016. The information blocking provision applies to health care providers, health IT (“HIT”) developers, and health information exchanges/networks (“HIEs”).

“Information blocking”, in this context, refers to actions that discourage or interfere with the interoperability of electronic health information (“EHI”) except when necessary to comply with laws, such as HIPAA. An example of a common instance of information blocking is when [Read More]

LEGAL LEANINGS: How Application Programming Interfaces Apply to Healthcare Entities2022-03-28T14:57:00-04:00
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