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• Makedeterminationsregardingtheappropriateness of treatment, training, products, services, and accommodations based on medically accepted standards.
• IssuedeterminationsundertheFinalRules,as discussed above.
Insurers must submit information regarding its utilization review program to the Department annually for review and certification or re-certification. The Department may revoke an insurer’s certification if it fails to comply with any of the Final Rules. Insurers must also submit a report to the Department by March 31 of each year regarding its utilization review data and activities as instructed by the Department. The annual reports are subject to disclosure under the Freedom
of Information Act, MCL §§15.231-15.246. Providers should look for insurers to publish their utilization review programs.
Record Retention
The Final Rules would require insurers, the MCCA and providers to retain copies of all requests, explanations, and determinations issued under the Final Rules for at least two years after the date of the request, explana- tion, or written notice, and must submit them to the Department upon request.
Conclusion
The Final Rules, if made effective in their current form, could significantly impact health care providers, and particularly providers who regularly provide treatment, products, services or accommodations to individuals injured in auto accidents. Health care providers may become increasingly burdened with the task of respond- ing to multiple requests for written explanations for treatment and services, as well as supporting documen- tation to substantiate a bill or claim, particularly if insurers begin submitted requests for written explana- tions on a routine basis. In addition, if a health care provider’s ability to dispute an insurer’s adverse deter- mination of a bill for treatment or services rendered to an individual injured in an auto accident is limited to an administrative appeal to the Department as an exclusive remedy, this could further place an administrative burden on health care providers to ensure that an appeal of an adverse determination does not become time-barred due to the short time (90 days) provided to appeal a determination to the Department.
    JOIN THE
 The Medical/Legal Committee, held in conjunction with the Oakland County Bar Association, is composed of physicians and attorneys who deal with inter-professional relationships and matters of concern to both professional groups.
UPCOMING MEETINGS FOR THE MEDICAL/LEGAL COMMITTEE
Thursday, October 1st Thursday, November 5th
Both are at 7:45 a.m. These are virtual Zoom meetings. If you would like to attend, please email Cindy Dady at cdady@ocms-mi.org to receive the link.
Hope to see you there!
MEDICAL/LEGAL
COMMITTEE
 SEPTEMBER/OCTOBER 2020 | WWW.OCMS-MI.ORG
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 Congratulations to Patrick Haddad from Kerr Russell for being named to the 2021 The Best Lawyers in America® and Kathleen Westfall from Kerr Russell being named to the 2021 Best Lawyers: Ones To Watch.
















































































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