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The Scrutiny Over Insurer Practices in Michigan’s PIP System: Attendant Care Reimbursement Challenges

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 […]

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Exploring the Key Elements of a Neurological Cognitive Day Rehabilitation Program: A Lifelong Resource for Recovery

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

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Proactive Clinical Justification for Personal Injury Protection (PIP) Benefits in Michigan: An Article for Providers

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

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Medical and Rehabilitation Providers Benefit from External Auditors

Medical providers can benefit from using an outside claims auditor to review their claims and billing processes. It is something in which we specialized along with one of our affiliate organizations. An outside claims auditor is an independent third-party professional who specializes in reviewing medical claims for accuracy, completeness, and compliance with regulations. Here are

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THE MEDICAL NECESSITY OF PROFESSIONAL REHABILITATION

Far too often a nurse reviewer will decide simply from looking at the duration of a clinical or rehabilitative service that it should be discontinued.  What science these decisions are based upon is not always shared when insurance companies or government departments make them.  However, there are several important factors which are often ignored.  Further,

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In Michigan PIP System Know Utilization Documentation Rules

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

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