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By Electronic Medical Services and Direct Care Training & Resource Center, Inc. A recent Michigan court ruling and guidance from the Department of Insurance and Financial Services (DIFS) underscore a critical point for post-acute care providers: reasonableness is not merely about what you charge—it also encompasses what you do, how you do it, and whether […]

By Bruce W. McCollum, Long-Term Care Project Developer In the care industry—especially in complex, high-stakes sectors like workers’ compensation and Michigan’s Personal Injury Protection (PIP) system—providers must walk a fine line. On one side lies the need for fiscal responsibility: collecting what is owed, maintaining cash flow, and securing rate agreements that reflect the true

In Michigan’s Personal Injury Protection (PIP) system, insurers have increasingly adopted tactics to delay or avoid rightful reimbursement for essential services. One of these tactics includes requiring an injured party’s health insurance to first issue a denial before the PIP insurer will consider payment. However, this demand often disregards the reality that certain services—such as

By Direct Care Training & Resource Center, Inc. & Electronic Medical Services, LLC Providers delivering care in Michigan’s Personal Injury Protection (PIP) system must be aware of an often-overlooked financial adjustment that can impact reimbursement for attendant care services. When a foster care resident receiving 24-hour attendant care also participates in outpatient therapy sessions, insurers

In healthcare settings, the integrity of nursing documentation is critical to ensuring patient safety, regulatory compliance, and legal protection. Nursing notes, medication records, and care plans serve as official medical records that directly impact patient care decisions, reimbursement, and potential legal liability. When a non-nurse—someone without a nursing license—modifies, edits, or refines nurse-prepared documentation, serious

Aquatic therapy is an essential rehabilitative service for individuals recovering from catastrophic injuries, including those covered under Michigan’s Personal Injury Protection (PIP) No-Fault Insurance system. However, proper CPT Code usage and provider qualifications are critical to ensuring compliance with MCL 500.3157, which governs the legitimacy of reimbursable medical expenses. CPT Codes and Licensed Providers When

Medical billing is a complex process that requires a thorough understanding of Current Procedural Terminology (CPT) codes to ensure compliance with federal regulations and ethical billing practices. These codes are not just numerical representations of services—they come with specific definitions that outline the obligations for how services must be executed, including requirements regarding licensed professionals

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