By EWA MATUSZEWSKI
CEO MedNetOne Health Solutions

For years, there’s been a concerted effort by insurance companies to halt the number of unnecessary visits to the Emergency Department. (Note – it is no longer a room.) This was a wise move designed to contain overall health care costs and excessive—and often unmerited—testing. While numbers are still too high, there’s been a decrease in the number of visits over the past several years.

That’s good news, the education on not using the ED like a physician’s office is working! Yet the shift from the ED to urgent care clinics or primary care physicians, where patients’ nonemergent needs are best met, resulted in reduced fees [Read More]

By SARAH HILLEGONDS
Wachler & Associates, P.C.

In today’s mobile society, it is important that physicians are reminded of the requirement to maintain current, accurate mailing information with the appropriate state and federal agencies for licensing and Medicare and/or Medicaid billing purposes. There are significant potential consequences if a physician has an inaccurate address on file, fails to regularly check the mailbox connected to the address on file, or does not timely report a change in mailing address or practice location.

For state licensing, under the Michigan Public Health Code, Act 368 of 1978, physicians have a duty to notify the Michigan Department of Licensing and Regulatory Affairs (“LARA”) of a change in [Read More]

By PETER LEVINE, MPH

Recently, it was reported on CNN that a county in Great Britain has announced a controversial policy to “support patients whose health is at risk from smoking or being very overweight.” The plan for the local clinical commissioning group is to “delay access to routine or non-urgent surgery under the National Health Service until patients improve their health.” Criteria have been established for the time limits and percentage of weight loss required for those with a BMI of over 30 and over 40. For smokers to have elective surgeries would require a patient to go eight weeks or more without a cigarette. They would have to take [Read More]

By ALLAN DOBZYNIAK, MD

The practice of medicine was not a political exercise for centuries. Now it seems more political and proscribed than thoughtful, deliberative or even analytical. The educated experienced physician exercising judgment and guidance for a unique individual, his or her patient, has been increasingly replaced by rules, regulations, mandates, laws, schemes and perverse incentives. These have been mostly at the hands of non-professional administrators and bureaucrats. That medical professionals have been cajoled into participating in this evolution acknowledges physicians acceptance of such questionable transitions in rendering care.

Politics, laws, and the burgeoning onerous administrative state are not intrinsic to the medical profession. How this occurred, has been allowed to [Read More]

By PETER DOMAS
Dickinson Wright

Over the past decade, the health care industry has been accustomed to being center stage in political debates, but while medical providers and facilities did not have a prominent role in the latest political drama, the far-reaching effects of the Tax Cuts and Jobs Act of 2017, will impact almost everyone delivering health care goods and services. In addition to the reduction of personal tax rates, the following provisions will likely be most applicable to health care providers:

1. Reduced Business Tax Rates

The tax rate for businesses taxed as corporations was reduced from 35 percent to 21 percent, and entities taxed as a partnership, S corporation, or sole [Read More]

By KEVIN R. MISEREZ, ESQ.
Wachler & Associates, P.C.

The Department of Health and Human Services recently unveiled the next two steps in its ongoing efforts to reduce the significant volume of claims pending at the Administrative Law Judge (ALJ) level of the Medicare appeals process, each of which involve additional settlement options for providers to resolve their pending claim appeals.

The first new settlement option was announced by the Centers for Medicare & Medicaid Services (CMS), which CMS refers to as the “low volume appeals settlement option (LVA).” As the name suggests, the LVA will be limited to provider appellants with a low volume of claims pending at the ALJ [Read More]

By JESSICA RUSSELL & PAHL ZINN

It is not uncommon for a physician organization to act as an intermediary between its physician participants and third-party payers to facilitate the negotiation and acceptance of reimbursement rates and other payer contract terms.

However, when facilitation becomes negotiation and a PO accepts contracts with third-party payers on behalf of physician participants, also known as “single-signature contracting,” a PO may be unintentionally engaging in illegal “price-fixing” in violation of antitrust law.

Under Section 1 of the Sherman Act, it is illegal to engage in horizontal price fixing arrangements. This includes circumstances where PO physician participants, who are otherwise competitors in the market, collectively agree or [Read More]

The Department of Health and Human Services would be barred from crafting future immunization-related rules, meaning any age- or dose-related updates would need legislative approval, under a pair of bills debated in committee Nov. 30.

HB 5162 and HB 5163 comes as parents with objections to child immunization told the House Oversight Committee how state and local health officials have been “overly zealous” in pursuing a pro-vaccination agenda by belittling those seeking a state exemption.

Joel Dorfman, of Michigan for Vaccine Choice, said DHHS has used the administrative rules process to “eviscerate” a state law that is neutral on child immunizations by treating citizens who don’t want to give their kids shots [Read More]