A bi-weekly newsletter from your physician organization
Friday, November 6, 2020
Free/discount prescriptions available to Michigan residents
Prescription drugs can be life-saving for patients. However, many patients may struggle to pay for these medications. Michigan Department of Health and Human Services offers the MiRx (My Prescription) card, a prescription drug discount program for Michigan residents who do not have prescription drug coverage.

There is no cost to enroll in the program. Participants provide the card to pharmacists who charge the MiRx discounted price. The discount is good on any prescribed medicine in stock at the pharmacy (over-the-counter drugs are not covered even when prescribed by a doctor). Savings average 5-25 percent.

Participating pharmacies are listed on the Department of Community Health web site (www.michigan.gov/mdch).

To be eligible to participate in the MiRx Card program:
  • Be a Michigan resident
  • There is no age limit to participate in the MiRx Card program. Make sure all eligible members of a family or household are included on the enrollment form. Each eligible applicant will receive their own MiRx card within two weeks of application submission, along with a list of participating pharmacies in their area.
  • Have no other prescription drug coverage
  • Have an income level at or below the state’s median income level

Click here for more information and participating pharmacy list. View the brochure and application form to share with patients. If you have questions, call the MiRx Enrollment hotline at 1-866-755-6479.
Health Insurance Marketplace enrollment period open
report from the National Center for Coverage Innovation found that Michigan experienced a 46 percent increase uninsured adults from February to May 2020. Lack of insurance can lead to skipped health appointments and screenings. There are some options for individual health insurance coverage.

The Health Insurance Marketplace open enrollment period begins Sunday, Nov. 1 - Tuesday, Dec. 15, 2020. Nearly 260,000 Michiganders got coverage for 2020 through the Health Insurance Marketplace, with an estimated 80 percent qualifying for free or reduced cost coverage through federal tax subsidies. Depending on income and their situation, consumers may qualify for no- or low-cost coverage for adults and children.

Here is some helpful information related to insurance coverage:  

  • Visit healthcare.gov to enroll in the Marketplace. The deadline is Dec. 15, 2020. Coverage begins January 1, 2021. Once the Dec. 15 deadline passes, individuals can't enroll for 2021 benefits unless they qualify for a special enrollment period.
  • Depending on income and other factors, coverage is available through Medicaid, Healthy Michigan Plan, and Michigan.gov/MIBridges. Information is also available by calling the Michigan 211 COVID-19 Resource Navigation line at 844-587-2485.  
  • Seniors who have lost employer-provided health insurance during the pandemic may also be able to sign up for Medicare during a special enrollment period. For more information about signing up for Medicare or eligibility for a special enrollment period, seniors may visit Medicare.gov or call the Michigan Medicare Medicaid Assistance Program at 1-800-803-7174. 
  • For assistance with private insurance, consumers should visit the Health Insurance Marketplace at www.healthcare.gov or call the Marketplace Call Center at 800-318-2596.
Tips for auditing your practice to avoid fines
Compliance is an instrumental part of healthcare, yet all too often, it gets relegated to a forgotten binder on a shelf. Making sure your records are accurate is a vital part of compliance. While most physicians strive for accuracy in their billing and coding, it is always important to conduct both internal and external audits to ensure compliance and avoid hefty fines. Failure to plan and prepare for an audit can lead to disastrous fines and penalties.

Audits should be done regularly, but no less than once per year. There are both internal and external audits. External audits should be completed by a healthcare attorney to ensure that the results are protected by attorney-client privilege.

To begin, start by evaluating your last audit results. Look at the type of audit that was performed, the findings, and mitigating actions that were taken. If it has been awhile or any areas of concern were not remedied, it might be beneficial to do an external audit. When an external audit is performed, the auditor should start by interviewing staff to help focus in on potential issues.

Your audit should always include a sufficient sample of:
  • Each practice location (office, clinic, hospital, etc.),
  • Every physician, and of
  • All payors

When an issue is identified, stop the audit. Get the training your office needs and resume the audit after implementing changes. This way, you are able to make your training effective. Your audit should have the goal of improving records, processes and information flow - not just identifying issues. Comprehensive compliance training is an essential part of all audits.

Audits are essential to catch underbilling, overbilling, up-coding, template issues, and areas of concern. Once you’ve completed your audit, make sure to regularly monitor your records.    

Source: Rickard & Associates is one of TPA's Affiliate Partners. Combining their team's hands-on business experience with legal knowledge, Rickard & Associates offers an array of services including, HIPAA readiness, compliance education and review, audits, employee relations, healthcare business transactions and more. TPA members will receive premium services at a preferred rate.
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