Physician Audit Consultation
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Physician Audit Consultation

Health Law Services

Given the increased frequency with which governmental and private health plans audit physicians for overpayments, physicians need access to knowledgeable legal counsel and consultants with expertise in coding, reimbursement and documentation issues more than ever. In response to physicians' growing need, the Michigan State Medical Society has developed the Physician Audit Consultation Service.

Who is Eligible

Physician Audit Consultation is available to all Michigan State Medical Society members who seek a legal consultation relative to overpayment audits by governmental or private health plans. Physicians will receive legal services directly from Kerr Russell, legal counsel to the Michigan State Medical Society. The program accommodates physicians seeking advice on the legal aspects of audits -- and preventative counseling -- before audits occur, as well as physicians undergoing an audit.

Audit Consultation Attorney

Kerr Russell has an extensive health care law practice spanning the last 50 years. The firm has the expertise necessary to advise physicians on all legal aspects of overpayments audits, ranging from preventive counseling to defending a payor's overpayment demand. The firm's services include educating physicians on their legal rights and responsibilities, review of an audit’s procedural rules, assessment of the audit results and the overpayment demand, and representation of physicians in negotiations with payors or challenging the overpayment demand in administrative proceedings or litigation. The firm stresses a team approach in order to advise physicians in a cost efficient manner.

Review Services Available

For a fixed fee, physicians now have direct access to the following services:

  • Initial legal consultation (including preliminary legal assessment and recommendations).
  • Initial legal consultation and preliminary assessment by a consultant with expertise in coding, reimbursement and documentation issues.

Any fixed fees do not include reimbursable expenses, which will be billed separately. When obtaining services, physicians should be prepared to submit copies of relevant documents, including the health plan's provider agreement (including procedure manual and relevant policies), the audit results and overpayment demand, and representative samples of the underlying billings and clinical documentation. Fixed fees are payable when services are requested.

Contact MSMS or Kerr Russell for the current fee schedule.

All requests for services are subject to acceptance by Kerr Russell. All services would be provided pursuant to a written engagement letter confirming and requiring pre-payment of the applicable fixed fee(s).

Additional Legal and Consultation Services

Legal and consultation services which are not included among the review services listed above will be provided on an hourly rate basis. Services in this category may include, but are not limited to, communications and direct participation in negotiations with health plans, attendance at meetings, drafting documents, and representation of physicians in litigation or administrative proceedings. Actual charges will vary depending on the attorney and consultation furnishing services.

How to Enroll

The provision of legal and consulting services will be managed directly by Kerr Russell. The Michigan State Medical Society has no responsibility for the provision of the legal and consultation services offered under the program. However, physician satisfaction will be continuously monitored by the Michigan State Medical Society. To obtain services, please complete the form below:

Request more information:

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AMA
As part of CCB, and having become known in the HOD as a trusted and respected parliamentarian and advisor, he has been actively sought out by sections and delegations for his expertise and counsel, to ensure their concerns are met and can be adopted by the House. His commitment to open, fair and unbiased discussion and debate empowers colleagues wherever he leads, including in our House of Delegates.

ACEP
In addition to his commitments to MSMS, the AMA and CCB, Pino participates in the American College of Emergency Physicians (ACEP) Section Council. This allows him to stay informed about the latest issues facing their specialty and the broader medical landscape across the country. The council comprises representatives from all over the US, who bring unique perspectives and experiences to the table, and gain a better understanding of the challenges and opportunities facing emergency medicine in different regions, and work collaboratively to develop solutions and best practices. This also allows him to build relationships across the country, which are key to getting the House to “yes.”

MSMS
Dr. Colone has been an active member of the AMA since his first year of medical school. He served as Chair of the Medical Student Section, Resident and Fellows Section, and the Young Physician Section of the Michigan State Medical Society, as well as representing each of those sections as delegate from MSMS to the AMA. He has served on the Michigan Delegation to the AMA for almost 30 years, and on the MSMS Board of Directors for 11 years during that time. He is also a recipient of the AMA Foundation Leadership Award.

In addition to influencing the national debate, Dr. Colone served as president of his county and state medical societies during times of crisis. He led his county medical society during the Flint water crisis and MSMS during the COVID pandemic from 2021-2022, standing up to outside efforts by lay persons and legislators and standing by science for the safety and betterment of the public. During his presidency he led a coalition of 50 patient and health care organizations to achieve comprehensive prior authorization reform removing barriers and improving the health of all Michiganders.

President of MSMS: Pino took the helm of MSMS as President during a tumultuous time. The COVID pandemic was entering its second year. Effective and, more importantly, ineffective treatments, were becoming better known, better understood, as physicians were learning every day how to best save lives. He stood by science and resisted pressures and endorsed science based treatments based on what we’d learned, over unproven, and even dangerous, treatments.

Health Can’t Wait Initiative: Pino advanced the Health Can’t Wait Initiative as President of MSMS, a coalition of over 50 health-focused groups that saw the successful passage of comprehensive prior authorization reform into law.

Read more about the coalition here

Organizations involved in the coalition 

PA Reform Signed into Law

“Today is a wonderful day for Michigan patients who can now rest easy knowing insurance company prior authorization practices will no longer prove to be an impassable roadblock between them and the timely care and treatment they too often desperately need," said MSMS President Pino Colone, MD. “Speaking on behalf of providers, patient advocacy groups and patients across the state, I want to thank Governor Whitmer and Michigan’s lawmakers for recognizing the need for reform in this area and then working to craft and enact legislation that delivers. In signing SB 247, Governor Whitmer has ushered in a new era where transparency, clinical validity and fairness to patients will all be factored into the prior authorization process, protecting Michigan patients from costly and dangerous delays in access to health care. Officially signing this bill into law is a tremendous—and much needed—win for countless Michigan patients and the providers who serve them.”

Scope of Practice: He has testified on scope of practice helping legislators understand that nonphysician practitioners (NPPs) do not have the training or education to safely care for our families, and that medical school matters. (include the graphic from the article) and link the article: https://www.mha.org/newsroom/tag/pino-colone/

Pino spent six years as chair of the MSMS Task Force on Opioid Stewardship, advocating for naloxone to be available to residents of Michigan without a prescription, collaborating with colleagues and state officials, and disseminating timely and accurate information to MSMS members. In this role, he was pivotal in shaping MSMS’s strategic plan to reduce opioid-related overdose, eliminate stigma, and support harm reduction efforts by fighting to make naloxone available over the counter.

He was also a member of the MSMS Executive Task Force on Health Care Disparities. 

Genesee County Medical Society
Pino was also president of the GCMS during the water crisis of its largest city, Flint. He led efforts by the Society to disseminate accurate information about lead in drinking water and its effects on health. With the city and state in the national spotlight, Pino stood firm against pressure from government officials to endorse what would later prove to be flawed information, putting the expertise of his physician colleagues and the safety of local residents first.
Read more about Pino’s service as county medical society president below: 

§  November 2020 GCMS Bulletin 

§  December 2020 GCMS Bulletin

§  January 2020 GCMS Bulletin

§  February 2020 GCMS Bulletin

§  March 2020 GCMS Bulletin 

§  April 2020 GCMS Bulletin

§  May 2020 GCMS Bulletin

§  June 2020 GCMS Bulletin

§  July 2020 GCMS Bulletin

§  August 2020 GCMS Bulletin

§  September 2020 GCMS Bulletin

§  October 2020 GCMS Bulletin

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§  Twindemic – 2021-2022

§  COVID-19 vaccination