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Detroit, MI – In medical environments, billing accuracy is paramount—not only for ethical and financial reasons but also for legal compliance. When medical billing does not accurately reflect the services provided, responsibility can fall on multiple parties, including medical billers, healthcare providers, and even facility administrators. However, the legal implications can be severe, particularly under […]

Insurers in the Michigan Personal Injury Protection (PIP) system frequently use specific denial codes to reject or reduce payments for medical services, attendant care, rehabilitation, and other benefits. Below is an overview of commonly used denial codes and their meanings: Understanding these denial codes is crucial for providers and case managers to challenge inappropriate denials,

The Michigan Personal Injury Protection (PIP) system has long served as a lifeline for individuals catastrophically injured in auto accidents, offering comprehensive coverage for medical expenses, rehabilitation, and long-term care. However, care providers are increasingly scrutinizing insurers who refuse to pay for Attendant Care or significantly reduce reimbursement rates, often citing the Fair Health Charge

Neurological Cognitive Day Rehabilitation Programs are critical tools in the continuum of care for individuals recovering from traumatic brain injuries (TBI), strokes, or other neurological conditions. These programs go beyond traditional therapy, functioning as lifelong resources for enhancing brain function and analyzing cognitive progress under the right circumstances. By combining therapeutic activities with structured cognitive

In Michigan, providers of care who rely on Personal Injury Protection (PIP) benefits for reimbursement must understand the critical importance of proactively justifying their services. This necessity extends to various care services, including cognitive rehabilitation, vocational programs, and attendant care within licensed adult foster care settings. The process of documentation and clinical justification is not

One process that can be used when providers feel an insurer has acted unethically or has ignored market realities in pricing services is the Utilization process.  This is available via the Michigan Department of Insurance and Financial Services.  Its availability does not mean that litigation and negotiation cannot continue to be utilized. It is a