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So far Paul Natinsky has created 299 blog entries.

Insurance Panel Abruptly Takes Up Provider Reimbursement Bill

House Insurance Committee Chair Daire Rendon (R-Lake City) began the process of passing legislation that penalizes auto insurers that are not fully compensating the providers of those taking care of people catastrophically injured in car accidents.

Although it wasn’t on the agenda, Rendon took up Rep. Ryan Berman’s (R-Commerce Twp.) HB 5870, which hits insurers acting in bad faith that don’t pay the bill sent to them by providers three times the amount of the overdue payment plus attorney costs.

She then took testimony from health care providers who claimed they hadn’t been compensated under the law for, in some cases, 10 months. They claimed they are having to take money out [Read More]

Insurance Panel Abruptly Takes Up Provider Reimbursement Bill2022-05-27T16:54:14-04:00

Why So Slow? Legislators Take on Insurers’ Delays in Approving Prescribed Treatments

By MICHELLE ANDREWS
Andrew Bade, who was diagnosed with Type 1 diabetes nearly two decades ago, is accustomed to all the medical gear he needs to keep his blood sugar under control. His insulin pump contains a disposable insulin cartridge, and a plastic tubing system with an adhesive patch keeps in place the cannula that delivers insulin under his skin. He wears a continuous glucose monitor on his arm.

Bade, 24, has used the same equipment for years, but every three months when he needs new supplies, his health insurance plan requires him to go through an approval process called prior authorization.

Getting that approval can take as many as three weeks, and [Read More]

Why So Slow? Legislators Take on Insurers’ Delays in Approving Prescribed Treatments2022-05-27T16:51:29-04:00

ON POINT WITH POs: Don’t Get Trained…Learn!

By EWA MATUSZEWSKI
While I may occasionally substitute the word training for learning, my strong preference when bringing professionals together to gain new insights is to focus on the learning that is taking place. Training too often connotes the visual of people gathered in a classroom being told from an “expert” how to tackle a particular issue or topic, while learning takes on a more comprehensive approach and includes sharing experiences among those assembled.

I broach this matter today because late last month, our organization sponsored a conference on Health Information Exchange (HIE) presented by Practice Transformation Institute and supported through a grant from BCBSM. A mainly in-person event, I attended virtually [Read More]

ON POINT WITH POs: Don’t Get Trained…Learn!2022-05-27T16:48:22-04:00

COMPLIANCE CORNER: The Provider Relief Fund Saga Continues

By STEPHEN SHAVER
Wachler & Associates, PC

The week of May 9, healthcare providers began to find out if their requests to file late reports under the Provider Relief Fund were granted. Providers whose requests were granted will have 10 days to file the required reports, while providers whose requests were denied can likely expect a repayment demand. These decisions are the latest chapter in the saga of the ever-shifting reporting requirements under the PRF.

Although initially intended to keep the nation’s healthcare providers afloat during the early days of the COVID-19 pandemic, the PRF has since descended into a bureaucratic labyrinth of compliance traps ready to snare the unsuspecting provider. The [Read More]

COMPLIANCE CORNER: The Provider Relief Fund Saga Continues2022-05-27T16:58:03-04:00

LEGAL LEANINGS: Continued IRS Attack On ‘Zero Out’ Of Profits

By RALPH Z. LEVY JR.
A prior article in this publication (IRS Attack on Zeroed Out Taxable Income in Recent Tax Court Cases) discussed the lessons that physician and other incorporated medical practice groups could learn from taxpayer losses in two then recent Tax Court cases in use of the “zero out” technique in the payment of compensation to the group’s owners. Under this approach, the practice group typically compensates its physician-owners or other licensed professional shareholders by payment of a portion of the anticipated pre-tax operating profits as compensation (salary) in regular increments during the tax year and then it will distribute the bulk of its profits in bonuses [Read More]

LEGAL LEANINGS: Continued IRS Attack On ‘Zero Out’ Of Profits2022-05-27T15:59:35-04:00

LANSING LINES

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

40% Of Health Clinics Saying No To Opioids

Doctors in Michigan are writing fewer opioid prescriptions, but the state’s death rate continues to climb. Also, more than 40% of the health care clinics have a sign on their doors: We do not prescribe opioids.

Those are two of the major takeaways from a three-hour presentation at the Spring Scientific Convention sponsored by the Michigan Osteopathic Association earlier this month.

A trio of physicians told the members that many doctors are “afraid” of being prosecuted by the state for alleged overuse of the addictive painkillers. To avoid any such action, [Read More]

LANSING LINES2022-05-27T15:29:54-04:00

Senate OKs Easier Merges Between Independent Hospitals And Large Health Systems

Without opposition, the Senate greenlighted legislation designed to “streamline the process” allowing smaller-sized independent hospitals to partner with larger health systems, removing “redundant” barriers created by a 1945 act.

The principal stakeholder behind SB 944 was the North Ottawa Community Health System (NOCHS), which operates an 81-bed hospital in Grand Haven and—near the end of March—entered a non-binding letter of intent to discuss the feasibility of joining Trinity Health, according to a report from the Grand Haven Tribune.

In 1996, the six local municipalities formerly responsible for the NOCHS voted to transition it from the statute of an authority over to a 501(c)(3) organization.

SB 944 aims to eliminate the need for a [Read More]

Senate OKs Easier Merges Between Independent Hospitals And Large Health Systems2022-04-27T12:56:32-04:00

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
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