If You Don’t, Who Will?


TPPA Coverage

Posted by on Dec 19, 2014 in Health | 0 comments

The Texas Prompt Pay Act (TPPA) is specific to insurance companies that are styled as Health Managed Organizations (HMOs) and Preferred Provider Organizations (PPO). This means that insurance carriers other than HMOs and PPOs are not covered by the provisions of the TPPA except in very few instances. According to the website of the prompt pay law firm Williams Kherkher, this means it does not apply to claims against Medicare and Medicaid, although the forms used for TPPA clean claim compliance is supplied by the Centers for Medicare and Medicaid Services (Forms CMS-1500 for physicians and UB-04 for hospitals).

It does not mean that these excluded carriers are not addressed in the legislation when it comes to prompt pay issues. It just means that they are not addressed in the provisions of the TPPA.

For example, if you are a dentist contracted by HMO A to provide certain services at a specified rate for a group of employees, you will bill HMO A for whatever services you have rendered using Form CMS-1500 (filling it up completely and according to TPPA regulations). If HMO A fails to pay for the claims within 45 days for a mailed claim, or 30 days for an electronically submitted claim, then HMO A is possibly in violation of TPPA regulations, and you can consult with a prompt pay lawyer for guidance on what you should do. On the other hand, if you rendered dental services to Medicare patients and you are being paid late, you cannot rightly cite the TPPA to claim protection or impose sanctions.

The TPPA is a highly specific subsection of laws enforced by the Texas Department of Insurance which is also embodied in the Texas Administrative Code. For a detailed explanation of the TPPA in preparation for filing a claim, it would be advisable to consult with a prompt pay lawyer to make sure that the TPPA applies to a particular case.

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Court Denies J&J Division’s Motion to Xarelto Lawsuit

Posted by on Sep 30, 2014 in Health | 1 comment

The first lawsuit filed against a division of Johnson & Johnson (J&J) Janssen Ortho LLC for anti-coagulant drug Xarelto was shifted back from federal court to state court contrary to the motion of the drug distributor to keep the case in federal jurisdiction. The case was filed by Kentucky resident Virginia Stuntebeck who claimed that using the drug for her atrial fibrillation, for which the drug is primarily designed for, resulted in serious injuries. While this was the first case, it is anticipated that many more will be following.

Janssen’s motion was based on the fact that because its co-defendant Bayer Corp has yet to be served with the complaint, it was practical for the out-of-state distributor to want the case brought to federal court instead of in the state of Pennsylvania, where Bayer is located. Others believe that this move was an attempt to avoid being tried in Pennsylvania, where a recent Supreme Court decision (Lance vs Wyeth) upheld that a drug manufacturer can be held responsible for any injuries resulting from distributing a product that was too dangerous to be in the market in the first place.

This is the main contention of Stuntebeck, that Janssen and associated companies should not have sold Xarelto in the first place because they knew or should have known about the risks involved in using the product, which according to the website of Williams Kherkher specifically involves unstoppable bleeding. This constituted an act of negligence, for which the plaintiff is suing them for damages to compensate for her medical expenses and accompanying pain and suffering.

This recent decision by the Pennsylvania Supreme Court is the first to raise the bar regarding the duty of care of pharmaceutical companies. In previous cases, as long as the drug company provided adequate warning regarding the risks involved in using a product, they may be able to avoid a claim of negligence. With the Pennsylvania decision, drug companies that push through with marketing a product that they knew presented excessive harm to patients can be held liable for any resulting injuries even if they warned them about it.

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Choosing the Best Water System

Posted by on Sep 3, 2014 in Health | 2 comments

The water that flows through our pipes may not be as pure and pristine as we would like it to be. Even if it looks fine, eyeballing water will not guarantee that there are no microscopic demons in there just waiting to take over our body. It is highly unlikely, but still, better to be safe than sorry when it comes to our health, right? The solution is to filter it, but how to choose the best system?

There are many filtration methods available out there to fit all budgets, and each has its set of pros and cons. Here are some tips on how to narrow down your choices.

Have Your Water Tested

Until you know what your problem is, you won’t know what filtration system you need. Depending on the extent of the problem, the system you choose could be overkill or inadequate. Most water filter system companies offer free water testing which will help you decide what kind of filter you need. You could also get the same test done by a state-certified laboratory for a small fee.

Find out What Filters You Will Need

Once you get back the results of your test, you will be able to ask the right questions. What system works best for water with heavy metals such as copper, lead, and mercury? Activated carbon. Perchlorates, parasites, and pesticides? Reverse osmosis. Arsenic? Distillation. And so on. If you want a complete list of contaminants and the filter you need to address the problem, you can obtain it from NSF International. It would be worth it to note that the Environmental Working Group considers reverse osmosis as the most effective water filtration and softening system although activated carbon is less expensive.

When choosing a water filter system, keep in mind that while the best system may cost more, they ultimately save you money by being more efficient and keeping you safe and healthy. In the end, the decision boils down to what is more important to you.

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Spastic Types of Cerebral Palsy

Posted by on Aug 12, 2014 in Health | 1 comment

Cerebral palsy (CP) is one of the most common developmental disorders that usually develop in children. This can be due to genetic predisposition, birth injury, maternal disease, head injuries, or infections affecting the brain. CP is a complex condition that varies from patient to patient and it is a life-long condition; it cannot be cured, but it can be managed. The types of cerebral palsy are spastic, athetoid, and ataxic, but the one that most commonly occurs is spastic CP which affects at least 70% of all CP cases.

People with spastic CP, which is also called bilateral spasticity, experience muscle tightness (hypertonic) in certain groups of muscles in excess of what an individual with normal muscle development will experience. The muscles are always contracting, which can eventually lead to abnormal postures and movement. This is thought to be due to a lesion in the upper motor neurons of the brain, and perhaps the motor cortex. CP is classified as neuromuscular mobility impairment, although some experience co-morbid language and cognitive impairment.

There are different types of spastic CP:

  • Spastic Hemiplegia – one-sided; may manifest as a limp but otherwise does not significantly affect mobility
  • Spastic Diplegia – affecting the legs only; affects up to 80% of all spastic CP cases; may manifest as a scissor-like gait; severe cases may require assistive devices for mobility, such as walkers; many also present with strabismus
  • Spastic Monoplegia – affects only one limb
  • Spastic Triplegia – affects 3 limbs
  • Spastic Quadriplegia – affects all four limbs and severely restricts mobility

A person diagnosed with spastic CP may lead a normal life, especially with the proper care and treatment during the early stages of the disorder. However, the degree of independence depends on the severity and type of spastic CP.

Regardless of the type and severity of CP, the long-term consequences can include significant physical, emotional, social, intellectual, and psychological issues. If your child’s CP was caused by the negligence of a physician or other third party, you may be able to get compensation for your child.

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