Designed to amaze and enlighten Do you understand how your RAF score is calculated? Which of the following factors is NOT included in the calculation of your patient’s RAF score? A. Gender B. Patient’s home address C. Age D. Race E. The reason they qualify for Medicare in the first place F. All are included Scroll down for the answer The answer is D,...
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Throw your weight around. Physicians still enjoy considerable prestige within the healthcare system—use it. No CT scan for two weeks? Call yourself and get that appointment tomorrow. Ortho can’t get them in for month. Talk to the clinic manager. Or the doctors themselves. Under fee-for-service you actually get penalized for taking the time out to advocate for your patients, not so under Medicare Advantage. Efficient care is cost effective care. Deliver it.
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Does your organization need a game changing initiative to re-engage your medical staff? Embrace the power of curation. From a clinician standpoint, their greatest challenge is the growing amount of information they have to process—each piece requiring at least one decision. Research supports the conclusion that humans, even exceptional ones, can only make so many decisions between periods of sleep, before the quality of their decisions deteriorates. Steve Jobs hacked this by having a closet full...
Read MoreI was stunned by what I found. I’ve been delivering care by phone for 30 years. Before industrialized medicine, when one of my patients needed help after hours, they called me and I did my best. What’s old is new again. Except this time, it’s called “telemedicine” And you’re going to have to pay money for it—and the doctor on the other end of the line won’t know you. By 2023 one out of five...
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What’s the single most important clause in your employment contract? It’s not your comp, or even your loan repayment. It’s your “exclusive rights” language. Carrie Fischer once said that her first Star Wars contract was so restrictive on the use of her image that she couldn’t look in the mirror without sending George Lucas a quarter. It took her thirty years to get out of that agreement, until then, she was cursed to looking at...
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The VA Choice Bill was recently signed into law, and it represents yet another opportunity to strengthen your Medicare Advantage performance. Vets can now more easily get their care from physicians outside the VA system. The bill is an expansion and improvement on a previous attempt to do just that. The bill is directed at vets without any other kind of insurance, not even Medicare. But with the educational campaign that’s funded by the measure,...
Read MoreLinks to enlighten—and make you look like a genius! Medicare Advantage rankings hit underserved particularly hard To be fair, its much more difficult to have underserved patients hit their quality marks—still that’s why CMS is diverting revenue their way. It will take another 18-36 months for those changes in cashflow to show up on the Medicare Advantage Organization’s top line. Will the extra money change the rankings? Stay tuned! Whistleblower case can...
Read MoreCoding Conundrum Questions that amaze and inform! Which of the following conditions DOES NOT increase the monthly capitation of a Medicare Advantage patient? A. Atherosclerosis of the Aorta B. Atherosclerosis of the Brachial artery C. Atherosclerosis of the Femoral Artery D. Atherosclerosis of the native arteries of the extremities—unspecified E. Atherosclerosis of the Carotid Arteries Scroll down for the answer The...
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Wow, the student has surpassed the master. A field report by Dr. Wanda regarding dual-eligibles, that is patients who have both Medicare and Medicaid and whose capitation can be as much as 30% higher than beneficiaries with only Medicare Advantage. “I took your advice to heart about recruiting dual-eligibles and tapped a great source, older and disabled patients coming out of prison. I make contact with a local state social worker and she started sending...
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Medicare Advantage Enrollment A recently released regional analysis of Medicare Advantage growth is giving an early look at what happens to Medicare Advantage enrollment when markets become saturated and mature. The western US was an early adopter of Medicare Advantage coverage and their enrollment rates have now consistently leveled out at around 40%. The other regions of the US aren’t at the 40% plateau yet and are still enjoying exponential growth, but if the west...
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