Power of Attorney TV

Wednesday, November 4, 2015

Why Not Learn The Difference Between Action And one Action | #10 | Why Not Huddle with Sean Callagy

Dear Kindred Spirits:

Happy Wednesday Folks!!!

I am fired up today and want to give a shout out to my mom, Maureen. My mom had double knee replacement in late August of this year, which was a little over two months ago. Yesterday, my mom hit the critical goal of 120 degrees for her knees range of motion!!!!!!!! Awesome job Mom!!!!!!!! I love you and am so proud of and happy for, you.

Not long ago, they physical therapy folks were telling my mom that she was behind schedule, and if she didn’t get to where she needed to be, she would have to face this brutal surgery all over again. Instead of shrinking back, my Mom took on the pain, kicked into gear, worked out at home relentlessly consistently and now walks without a cane and has met the goal for her rehab. Also, big props to her significant other Jerry. Jerry has been there all the way helping and supporting this process. As Willy Wonka says (Gene Wilder not the genuinely creepy and wacky Johnny Depp version), says you’re a good egg!

Now Grammi, as my mom is known by her grandchildren, it’s time to get you back scuba diving and on skis (note: my mom has dove once and been on skis once, crashing into a house on the mountain in Vail last time she went). Let’s all start posting on Facebook challenging Grammi to hit the bubbles and the slopes!!!!!!!

For the record, my mom has been an indispensable teacher, guide and support throughout my life. No matter what, she’s always been there to gently guide me back to the path of my greatest me. While she may not have read all these books on personal development, she lives Why Not principals and always has an awesome core desire to continue to improve. She’s been conducting Bible study in a jail in New York for over a decade, she works with my law firm and has been an indispensable part of my business world for 16 years, and she even went zip lining 3 years ago at Whistler on the West Coast of Canada at night, in the pitch black walking through feet of snow in the woods, trekking 100 feet plus over the abyss. Yes, I admit on the last one I left out a few details before we all piled into the van to head off into the forest at night!

With all that said, let’s talk about the critical difference in our results formula between no action, action and zone action. Remember, there is a 3 part formula for producing or not producing any result you ever desire in your life. The entire formula is based on the concept of always knowing or figuring out quickly, how to remain in massive, consistent, relentless, zone action.

I’ve had the privilege of coaching hundreds of people whether it be for one session or a regular ongoing coaching relationship. The vast majority of people I coach, in fact, almost all of them, are so easy to help.

Yesterday, we launched our Why Not Talks with Mike Just, the owner of Just Hits. Mike has goals he’s not achieving, although he already is a rare success: a person who started a business and is successfully operating more than 5 years after starting it.

Mike said he wanted a team of 6 fully dedicated baseball trainers and better pipelines referring clients.

As almost always happens, when we discussed it on our Why Not Talk, Mike wasn’t really doing anything to achieve these goals. By the way, that always happens for folks in life and business. You’re working hard, you form habitual patters for your day and life and you think you’re working on your goals. You also begin to feel like they’re not achievable as you mistake thinking or stressing about something for “action.”

Therein lies the obvious difference between action and NO action.

However, there is a more critical distinction. I believe the greatest difference for success doesn’t lie in the difference between no action and action, but rather between action and zone action.

Why? It is simply because when people take action, as opposed to zone action, and don’t get the results they want, then they begin to really believe there goals are not reachable. They lie to themselves and say, “I tried. It doesn’t work.”

Mike was doing just, yes a pun-figure it out, that. Mr. Just, get it?!, told me he did follow my suggestion and begin to speak in schools, BUT, he couldn’t expect the young students to bring information home to their families. I said, to quote Mr. Wonka again, “Wrong Sir!! Wrong!!!!!”

Mike was in action, but missing the “secret of small distinctions”, and, therefore, he wasn’t in Zone Action”. Accordingly, he didn’t get the results he wanted.

So, what would Zone Action have been?? Watch today’s Why Not Huddle, and I will share it!!!!!!!!!!!!!

Please spread the word. Share these articles and the Why Not Huddles and Why Not Talks with other folks on Facebook, LinkedIn and subscribe on YouTube!!!!!!!!!!! Please post your comments, thoughts and questions as well!!!! Have an amazing day. It’s YOUR life, love it and say Why Not!!! In your service, Sean Callagy

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You can see all of our WHY NOT – HUDDLE videos by clicking here and subscribing! If you have questions about any of the content you see or to have your questions answered on an upcoming show by Sean, please email your questions directly to him by clicking here.

The Daily Why Not Huddle is for you if you want more money, time, or fulfillment. The Why Not Huddle with business coaching expert, successful entrepreneur, and attorney Sean Callagy provide the essential daily ingredients for you to create and achieve your destiny.

Why Not Learn The Difference Between Action And one Action | #10 | Why Not Huddle with Sean Callagy

Callagy Law Library TV – Episode #10, ‪#‎AskSeanCallagy‬ November 4, 2015

Law Library – TV is an original series from Sean Callagy, President and Founder of Callagy Law; to help the general public with every day legal questions and information. For more information about Sean Callagy, Callagy Law, or any questions you have, please email scallagy@callagylaw.com

If you’d like to have your legal questions answered on the show, email Sean: scallagy@callagylaw.com

See more here: www.callagylaw.com/blog

In this article / video, Sean Callagy will focus on topics to help people better their legal knowledge of vital information. Clients often come to Sean Callagy’s team with questions about their businesses, ranging from contracts, disputes, and other common legal issues in the business world. Our mission is to answer any legal questions and provide information to anyone who may need it. If you have questions about any of the content you see or to have your questions answered on an upcoming show by Sean, please email your questions directly to him by clicking here.

Callagy Law Library TV – Episode #10, ‪#‎AskSeanCallagy‬ November 4, 2015

Why Not Talk | Sean Callagy with Guest Mike Just | November 4, 2015

The first Why Not Talk with Sean Callagy and Guest Mike Just.

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Why Not Talk | Sean Callagy with Guest Mike Just | November 4, 2015

Tuesday, November 3, 2015

PPO Contracts and PIP Arbitration | Callagy Law

The purpose of this post is to help assist healthcare providers and owners with questions they have concerning their business or relevant knowledge in the field. The Callagy Law team is knowledgeable in many law practice areas and will frequently post topics ranging from Medical Revenue Recovery, PIP, Workers Compensation, and Commercial Insurance. We hope to have this blog shed a light on many common questions.

N.J.A.C. 11:3-29.1(b) “. . . establish(s) medical fee schedules on a regional basis for the reimbursement of health care providers providing services or equipment for medical expense benefits for which payment is required to be made by automobile insurers under PIP coverage and by motor bus insurers under medical expense benefits coverage.”

However, medical providers often participate in a preferred provider organization, commonly referred to as a “PPO” agreement. Simply, medical providers participate in PPO agreements and accept discounted payments in exchange for certain benefits outlined in the contract.

Payment disputes often arise when an insurance carrier pays PIP coverage benefits in according to the PIP Fee Schedule Rates instead of according to the PPO discount rates. When an insurance carrier and a medical provider cannot settle such disputes, the medical provider may elect to have the matter resolved in binding arbitration, a forum administered by the New Jersey Department of Banking and Insurance (DOBI). Such matters are decided by a Dispute Resolution Professional (DRP).

Often, claimant medical providers argue that any improper PIP coverage payments constitute a violation of the PPO payment terms, resulting in a loss of the PPO discount. Suppose the PPO contract allows the insurance carrier to take a 20% discount of the billed charges, but payment was made per the PIP Fee Schedule. If DOBI regulations provide for payment to be made according to billed charges, then the claimant was entitled to payment at 80% of the billed charges, as outlined by the PPO contract in this scenario. In arbitration, the medical provider may seek the full amount of the billed charges, if the PPO contract allows for such redress.

Recently, a DRP agreed with this position in the matter Meadowlands Hospital a/s/o Walter Martinez v. GEICO (NJ-1540551). The DRP made the following finding:

Based upon a review of the record evidence, claimant’s argument is meritorious. . . . respondent did not pay claimant at 65% of the charges but rather inexplicably paid this facility at the New Jersey Physician’s Fee Schedule for CPT code 62310 and 62311. Clearly, this action was in violation of the terms of the PPO agreements and respondent loses the benefit of the PPO contract reduced payment rate. Claimant is awarded the balance sought for CPT codes 62310 and 62311 . . .

Similarly, in Raritan Bay Medical Center a/s/o D.H. v. GEICO (NJ-1596762), the DRP decided that the respondent insurance carrier had “failed to issue proper reimbursement . . . [, and] that the PPO Agreement states that Respondent is not permitted to apply any discount and Claimant is entitled to receive 100% of billed charges. Claimant is awarded $11,777.45 for codes 70450, 70486 and 72125.”

In NJ-1596762, the DRP construed the PPO contract as requiring the insurance carrier to issue payments within 30 days of receipt, per the contract’s payment terms. Because the insurance carrier issued payment per the PIP Fee Schedule instead of the PPO discounted rate, the DRP found contact payment terms were violated, resulting in the discount being forfeited.

Careful review of a PPO contract payment terms is essential for any medical provider participating in an binding arbitration.

We hope you have found this information helpful and interesting. Please reach out to us here with any questions or comments regarding healthcare legal matters, or if you are a medical provider that has questions regarding Medical Revenue Recovery, PIP, Workers Compensation, and Commercial Insurance.. Feel free to search us on Facebook, Twitter or LinkedIn!

PPO Contracts and PIP Arbitration | Callagy Law