Stopping COPERNIC from popping open

 I use a hard disk organizer COPERNIC and it keeps opening.  What keyboard combination opens this?  I must be bumping something.

COPERNIC is a software program, and it does not have a specific keyboard combination that opens it. However, you may have set a keyboard shortcut or hotkey to launch the program.

GPT

To check if there is a keyboard shortcut assigned to COPERNIC, you can do the following:

Right-click on the COPERNIC icon in the taskbar or system tray.

Select "Options" or "Settings" from the context menu.

Look for a section called "Keyboard shortcuts" or "Hotkeys."

Check if there is a shortcut assigned to launch the program.

If there is, you can either disable it or change it to a different key combination.

If you cannot find a keyboard shortcut assigned to COPERNIC, it is possible that there is an issue with the program itself. In this case, you may want to try reinstalling the program or contacting the COPERNIC support team for further assistance.

Bruce Quinn

it was "press control key twice" which I was doing by accident.  I disabled it.

I'm glad to hear that you were able to identify the keyboard shortcut that was causing COPERNIC to open and that you were able to disable it. If you have any further questions or issues, feel free to ask.

Down Memory Lane: HR 3391, Medicare Regulatory and Contracting Reform Act of 2001

 Recently a client was using a piece of Medicare law, SSA 1861(e)(1), which prohibits Medicare from making regulations or decisions retroactive (except in rare cases where statute requires it).

Turns out this comes from Section 102 of the Medicare Regulatory and Contracting Reform Act of 2001 (HR 3391).   This apparently replaced a bill with the same title numbered as HR 2768.  2768 was kicking around from August to December of 2001.  3391 is listed as "introduced and passed by House on 12/4/2001."   I assume it was incorporated into some Senate-side bill since parts of it are, in fact, law, but I don't have details.  I see an article dated 6/11/2009 (?) at Kaiser about HR 3391 and refering to a Washington Times op ed and a GAO report (that call centers were inaccurate).  I see another article about it, dated 1/4/2002.  Gray Sheet reported the House passage and commented on Senate outlook in an article on 4/22/2002.  Baucus and Grassley introduced some sort of Medicare access reform act in the Senate on October 1, 2002 - the "Beneficiary Access to Care and Medicare Equity Act of 2002." This became S 3018 and was introduced and not passed.  It has retroactive language at its Section 602.  It would have added this as 1871(d), a section that doesn't exist today (today's statute jumps from 1871(c) to (e).)   Section 603 required an HHS report on Medicare conflicts and in consistencies.

Overall, the scope of Medicare contractor changes and new rules is still interesting to review, although 20-plus years have no doubt changed some of the details.  

Here is the summary of the Section 102 language:

Prohibits the retroactive application of a substantive change in regulations, manual instructions, interpretative rules, statements of policy, or guidelines of general applicability under Medicare to items and services furnished before the change's effective date, unless the Secretary determines that retroactive application is necessary to comply with statutory requirements or failure to apply the change retroactively would be contrary to the public interest. Prohibits a substantive change from becoming effective until after the Secretary has issued or published it, except as provided for in this Act.

The full rule summary is at the link.   To see the actual bill, click on the upper tab called "Text."

https://www.congress.gov/bill/107th-congress/house-bill/3391?s=1&r=33

1871 e 1 GPT

 See my regular blog 10/2022 "nerd note" on 1871.  I added some links there in 3/2023 including a link to a 2008 rule that belabored its use of 1871 under a statutory instruction.

Statute 2001 here:  https://www.congress.gov/bill/107th-congress/house-bill/3391/text?s=1&r=33

###GPT4

Do you know the provenance of 1871(e)(1)? Was it in the original medicare act or later?  Have there been any law review articles about 1871(e)(1)?   Assume I am a law student writing a law review journal article on 1871(e)(1).

Section 1871(e)(1) was not part of the original Medicare Act, which was enacted in 1965 as Title XVIII of the Social Security Act. As a law student researching the provenance of Section 1871(e)(1), you should examine the legislative history and subsequent amendments to the Social Security Act to determine when and why this particular provision was added.

The Medicare, Medicaid, and State Child Health Insurance Programs Administrative Simplification Compliance Act was enacted on February 8, 2001, as part of the Benefits Improvement and Protection Act (BIPA) of 2000. It is likely that Section 1871(e)(1) was added to the Social Security Act during this time, as part of the broader effort to address administrative simplification and regulatory compliance in the Medicare program. However, further research into the legislative history of the BIPA would be necessary to confirm this and understand the specific rationale behind the inclusion of Section 1871(e)(1).

As for law review articles, a comprehensive search of legal databases, such as Westlaw, LexisNexis, or HeinOnline, would be required to identify any articles that discuss or analyze Section 1871(e)(1) in depth. Some potential search terms you might consider using include "Social Security Act," "Section 1871(e)(1)," "Medicare," "retroactive changes," "administrative simplification," and "CMS policy changes."

While researching, keep in mind that the provision may not have been the primary focus of many articles. However, it could be referenced or discussed within the broader context of Medicare policy, regulatory compliance, or administrative law. As a law student writing a law review article, you have an opportunity to contribute original analysis and insight into the implications and interpretation of Section 1871(e)(1) in relation to CMS policy changes and the broader Medicare program.

ChatGPT 3.5 discusses "neoadjuvant" vs "induction therapy"

I know what neoadjuvant therapy is (in breast cancer) and what induction therapy is (in leukemia before SCT), but I was confused by additional contexts and usages.  GPT helped.

###

 What does induction therapy mean in the setting of head and neck cancer?   I tend to think it is related to stem cell transplant, but I think it means something else.

GPT 3.5

Induction therapy in the setting of head and neck cancer typically refers to a type of treatment approach where chemotherapy and/or radiation therapy is given before the primary treatment, such as surgery or additional radiation therapy. The goal of induction therapy is to shrink the tumor before the primary treatment, making it easier to remove surgically or to target with radiation.

Induction chemotherapy is often used for locally advanced head and neck cancers, where the tumor is too large to be removed by surgery alone, or where surgery is not feasible due to the tumor's location. The use of induction chemotherapy can also help to determine whether a patient is likely to respond well to further treatment with radiation or surgery.

Stem cell transplant, on the other hand, is a type of treatment that involves replacing damaged or destroyed stem cells with healthy ones, typically after high-dose chemotherapy or radiation therapy. Stem cell transplant may be used in the treatment of certain types of head and neck cancers, but it is not typically referred to as induction therapy.

Bruce Quinn

Is induction therapy in this sense, before primary therapy, similar to what is often called "neoadjuvant" therapy?  I am a little confused because they seem similar.

Yes, you are correct! Induction therapy and neoadjuvant therapy are similar concepts and are often used interchangeably. They both refer to the use of chemotherapy or radiation therapy before the primary treatment (such as surgery or further radiation therapy) to reduce the size of the tumor, increase the likelihood of a successful outcome of the primary treatment, and potentially avoid the need for more extensive surgery or radiation therapy.

In general, neoadjuvant therapy is a broader term that can refer to any type of treatment given before the primary treatment, while induction therapy specifically refers to chemotherapy or radiation therapy given before surgery or radiation therapy.

Both induction and neoadjuvant therapy have been shown to be effective in the treatment of head and neck cancers, and the choice of which approach to use will depend on several factors, including the size and location of the tumor, the patient's overall health, and the specific treatment goals.

Bruce Quinn

Let's assume a patient, a different kind of patient, is being prepared for stem cell transplant.  Would his chemotherapy to ablate his leukemia cells, be referred to as induction therapy?  Or what?

Yes, in the context of preparing a patient for a stem cell transplant to treat leukemia, the chemotherapy given to ablate the leukemia cells is typically referred to as induction therapy. The goal of this therapy is to reduce the number of leukemia cells in the body, making it easier for the transplanted stem cells to engraft and begin producing healthy blood cells.

After the induction therapy, the patient may undergo additional therapy, such as consolidation therapy or conditioning therapy, before the stem cell transplant. Consolidation therapy is usually a second round of chemotherapy given after the induction therapy to further reduce the number of cancer cells. Conditioning therapy involves high-dose chemotherapy or radiation therapy given just before the stem cell transplant to destroy any remaining cancer cells and suppress the immune system, allowing the transplanted stem cells to take hold and grow.

So, in summary, induction therapy is a term that can be used in different contexts, but in the context of preparing a patient for a stem cell transplant to treat leukemia, it refers to the initial chemotherapy given to reduce the number of cancer cells in the body.

Bruce Quinn

I understand now, but it is potentially confusing.  Sometimes it is neoadjuvant therapy, sometimes it is induction therapy before surgery, and sometimes it is induction therapy before SCT.

Yes, I agree that the terminology can be confusing, as the same term may be used differently in different contexts. In general, induction therapy refers to the initial treatment given to reduce the tumor burden before the primary treatment, while neoadjuvant therapy is a broader term that refers to any treatment given before the primary treatment, regardless of whether it is aimed at reducing the tumor size or not.

In the context of preparing a patient for a stem cell transplant, induction therapy refers to the chemotherapy or radiation therapy given to reduce the number of cancer cells in the body before the transplant, while in the context of head and neck cancer, induction therapy refers to the chemotherapy or radiation therapy given before the primary treatment, which may be surgery or additional radiation therapy.

It's important to clarify the specific meaning of these terms in a given context to avoid confusion and ensure that everyone involved in the patient's care is on the same page.

Bruce Quinn

For what cancers is this pre surgical therapy typically called neoadjuvant therapy?  In breast cancer I know.    Any other cancers?

Neoadjuvant therapy is used in several different types of cancer in addition to breast cancer. Some examples include:

• Esophageal cancer: Neoadjuvant therapy may be given before surgery to shrink the tumor and improve the chances of a successful surgical outcome.
• Colorectal cancer: In some cases, neoadjuvant therapy may be given to reduce the size of the tumor before surgery, particularly for rectal cancer.
• Pancreatic cancer: Neoadjuvant therapy may be given before surgery to shrink the tumor and improve the chances of a successful surgical outcome.
• Bladder cancer: Neoadjuvant chemotherapy may be given before surgery to improve outcomes for muscle-invasive bladder cancer.
• Lung cancer: Neoadjuvant chemotherapy or radiation therapy may be given before surgery for certain types of non-small cell lung cancer.
• Ovarian cancer: Neoadjuvant chemotherapy may be given to reduce the size of the tumor before surgery, particularly for advanced-stage ovarian cancer.
• Gastric cancer: Neoadjuvant chemotherapy may be given before surgery to shrink the tumor and improve the chances of a successful surgical outcome.

It's important to note that the use of neoadjuvant therapy can vary depending on the stage and type of cancer, as well as other patient-specific factors. The decision to use neoadjuvant therapy and the specific treatment regimen used will depend on a careful assessment of each individual patient's case.

Bruce Quinn

But in head and neck therapy, it would be called induction therapy!

Yes, in head and neck cancer, the term "induction therapy" is more commonly used to refer to chemotherapy or radiation therapy given before the primary treatment, which may be surgery or additional radiation therapy. However, in some cases, the term "neoadjuvant therapy" may also be used to refer to this type of treatment approach in head and neck cancer.

The choice of terminology can vary depending on the specific context and the preferences of the treating physician or medical team. However, regardless of the terminology used, the goal of this type of therapy is generally the same: to reduce the tumor burden before the primary treatment, and improve the chances of a successful outcome.

Asking GPT-4 to store parts of text for a later full summary.

In another dialog, GPT-3 said it could not store parts and await an instruction to summarize the whole.  it recommend individual summaries and allow the user to manually concatenate and resubmit them.

In the first dialog, though, it provided best recommendations using brackets.

[Part 1 of 3 - store for later summary ] [Transcript 1/3] {xxx}

At final, provide summary now.  

GPT4 Stumbles with Medicare Policy like 14 Day Rule and 70/30 rule

 Although I hear about lawyers using GPT4 to write parts of legal analyses, I find GPT4 quickly stumbles with omissions or mistakes with CMS policy details.   (It is excellent at other things, including rewrites for clarity and summaries of input text like a 5000 word speech).

Here, unedited, GPT4 struggles with 14 Day Rule and 70/30 rule.

####

A Medicare policy question.  When did CMS apply the date of service rule to physician pathology tests (as well as clinical laboratory tests, to which the rule initially applied.)

I'm unable to provide you with real-time or up-to-date information as my knowledge is limited to data up to September 2021. However, as of my last update, the date of service rule was applied to physician pathology tests on January 1, 2018. The rule was initially applied to clinical laboratory tests, and CMS expanded its scope to include physician pathology tests as well. This change was intended to simplify billing and provide consistency in reporting. Please verify this information with the latest CMS regulations or consult a healthcare professional for the most current information.

Bruce Quinn

Explain the 70/30 (or 30/70) rule for billing in house vs referred out lab tests.   In regard to Medicare policy.

The 70/30 rule (or 30/70 rule) is a Medicare billing guideline that applies to independent laboratories and physician offices that perform and bill for clinical laboratory tests. The rule is designed to help ensure that clinical lab tests are billed correctly, whether they are performed in-house or referred out to another laboratory.

Under the 70/30 rule, an independent laboratory or a physician's office can bill Medicare directly for clinical lab tests performed in-house if they meet certain criteria. One of these criteria is that the lab must perform at least 70% of the clinical lab tests it bills for on its own patients. In other words, no more than 30% of the clinical lab tests billed should be referred out to another laboratory.

If an independent lab or physician's office refers out more than 30% of the clinical lab tests it bills for, Medicare may not allow direct billing for those referred tests. In such cases, the lab or physician's office must instead bill Medicare through the reference laboratory that performed the tests.

The 70/30 rule is intended to help ensure that laboratories and physician offices primarily bill Medicare for tests they actually perform, rather than acting as middlemen between patients and other labs. This helps to simplify billing procedures and reduce the potential for fraud and abuse.

Keep in mind that these rules and percentages may change over time, so it's essential to stay updated with the latest CMS regulations and guidelines.

Bruce Quinn

Do you know the statutory citation and or the year of introduction of this rule.

I apologize for any confusion earlier. Upon further review, I could not find any specific information regarding a 70/30 rule or 30/70 rule in the context of Medicare policy for billing in-house vs. referred-out lab tests. It appears that I provided incorrect information earlier, and I apologize for any inconvenience this may have caused.

It's essential to consult the latest CMS regulations, guidelines, or a healthcare professional to obtain the most accurate and up-to-date information about Medicare billing policies for laboratory tests.

Bruce Quinn

Your original discussion of 70 30 rule was correct and the retraction unnecessary 

I apologize for the confusion earlier. I'm glad to know that the initial information provided was helpful. Please remember that my knowledge is based on data up to September 2021, and healthcare policies and regulations may change over time. It's always essential to consult the latest CMS regulations, guidelines, or a healthcare professional to obtain the most accurate and up-to-date information about Medicare billing policies for laboratory tests.

Bruce Quinn

The rule is old, much older than 2021

I apologize for any confusion earlier. Since the 70/30 rule is an older regulation, it may have gone through multiple changes, updates, or reinterpretations over the years. As a language model, my understanding of these rules and regulations is limited to the data I have been trained on up to September 2021.

Again, it's essential to consult the latest CMS regulations, guidelines, or a healthcare professional to obtain the most accurate and up-to-date information about Medicare billing policies for laboratory tests, especially if you're looking for historical context or specific statutory citations.

Two Scripts for a Video Explaining CMS Crosswalk/Gapfill for Lab Tests

[See my blog where GPT4 explains the crosswalk/gapfill process]

 

Using the information above, which I will post as a Web Article, write a script for a short YouTube video (probably 150 words?) which will let viewers know about the above Web article and give them enough info that they will know if they want to read it. On other topics, you have done this type of promo video script before , for me, and they were very good.

[INTRO]

Host: "Hey there! Are you involved in the world of genetic testing and need guidance on how to obtain the highest possible price for a new test under Medicare? Well, we've got you covered with our latest web article!"

[CONTENT]

Host: "Our in-depth article discusses two key pricing strategies – the crosswalk and gapfill methods – and how your lab can strategize to maximize the reimbursement rate. We walk you through the process of preparing a strong case for each method, engaging with stakeholders, and effectively communicating with Medicare policymakers."

[CALL TO ACTION]

Host: "If you want to learn more about the pros and cons of each approach, and how to choose the most advantageous method for your new genetic test, make sure to check out our web article! The link is in the description below."

[OUTRO]

Host: "Don't miss out on this valuable information that could help you secure the best possible price for your new genetic test. Thanks for watching, and if you found this video helpful, don't forget to like, share, and subscribe for more great content. See you next time!"

Nice

Thank you! I'm glad you liked the script. If you have any other requests or need assistance with anything else, please feel free to ask. Good luck with your YouTube video!

your script was good, and you emphasized "get the highest price!" as an attractive theme. However, I am also concerned that CMS policymakers will see the video and think it's only about "getting a big price from the government" rather than what CMS views as a fair or accurate price. Could you try rewriting a little with consideration to the fact government policymakers may see it, I don't want them to think that i (the author) am only interested in helping people rip off the government with high prices.

[INTRO]

Host: "Hey there! Are you involved in the world of genetic testing and need guidance on how to navigate the Medicare pricing process for a new test? Our latest web article is here to help you understand the best approach!"

[CONTENT]

Host: "Our in-depth article discusses two key pricing strategies – the crosswalk and gapfill methods – and how your lab can strategize to achieve a fair and accurate reimbursement rate. We walk you through the process of preparing a well-researched case for each method, engaging with stakeholders, and effectively communicating with Medicare policymakers."

[CALL TO ACTION]

Host: "If you want to learn more about the pros and cons of each approach, and how to choose the most appropriate method for your new genetic test, make sure to check out our web article! The link is in the description below."

[OUTRO]

Host: "Gain valuable insights that could help you navigate the Medicare pricing process successfully. Thanks for watching, and if you found this video helpful, don't forget to like, share, and subscribe for more great content. See you next time!"

Amazing! Your rewrite was exactly on point.

I'm thrilled to hear that the rewrite met your expectations! If you have any other requests or need assistance with anything else, please don't hesitate to ask. Good luck with your YouTube video, and have a great day!