Sunday Links

The lucky person is they who knows what to leave to chance.       A summary by Axios of the “Legal Questions Hovering Over Medicare Advantage.” Spoiler: it’s alleged coding and STAR rating fraud.       CNBC weighs in on Medicare consumer education Included so you can check out what the lay media is saying about Medicare Advantage open enrollment. Their take, if you’re sick don’t sign up for Medicare Advantage. The actual reality,...

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Saturday Quiz

Designed to Amuse and Enlighten   Which artificial opening is NOT associated with an increase in your monthly capitation? A. Enterostomy B. Urostomy C. Gastrostomy D. Tracheostomy E. All are associated with a capitation increase.     The shocking answer below x x x x x x x x x x x x x x x x x x x x x x x   The answer is E. All are associated with an increase...

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Saturday Quiz

Designed to enlighten and amaze   Which of the following patients offers you the greatest potential financial return under a full-risk Medicare Advantage contract? A. A 65 year-old male with COPD B. A 70 year-old female with Diabetes and an amputated toe. C. An 85 year-old male with hypertension D. A 60 year-old woman on dialysis, a remote history of lymphoma, Congestive Heart Failure, and left-sided weakness from a stroke. E. A 67 year-old female...

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House Call Only Practice Live Blog

Readers will recall I took the challenge of commenters and started the process of creating my own house call only Medicare Advantage practice.  CMS has proposed changing the rules in 2019 so that any beneficiary can qualify for a Medicare Advantage house call, not just the infirm.   The idea is, with no office and little overhead beyond my malpractice insurance and a compliant cloud-based EHR, I could generate significant net revenue with a very...

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Pathologic Vertebral Fractures from Osteoporosis

These can only be diagnosed once, at the time of diagnosis.   I see organizations have their coders submit old fractures year-after-year to get the risk adjustment. This is just plain wrong.   I know we’ve been discussing recently about how there is now really no enforcement mechanism to recover payment from over-coding.   Oh, sure. Medicare Advantage Organizations (MAOs) are conducting validation audits. But in the end they are returning the amount of overpayments...

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Don’t Sign Up for ANY Medicare Advantage Plan Until You’ve Done This.

Call every doctor you’ll want to see during 2019 and ask them if they take the specific plan you’re considering. Don’t believe the provider directory—it’s wrong more than half the time. Don’t believe the insurance company on the phone—they mostly want to get your name on the bottom line. Don’t believe the insurance agent—unless they’re your trusted long term “insurance home.” Call up and speak to the office manager of every physician office that’s important...

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Telemedicine vs. Office Practice Smackdown

Looking for clarity about your work as a physician?   Telemedicine Office Practice Earn $25 to $39 per encounter—and your employer will cover the cost of your malpractice.     Earn $98-$102 per encounter—and your employer will cover the cost of your malpractice   Less the taxes.   Less the cost of benefits.   Less the taxes.   Less the cost of benefits.   The cost of your phone, your home office, your internet connection...

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The One Thing You Absolutely Must Do to Experience a Great Open Enrollment Period

Have you had someone check the accuracy of all the online directories for the Medicare Advantage insurers you work with?   They’re most likely riddled with errors. Yet they are the information potential patients will be using to make coverage decisions.   It amazes me how many large organizations spend millions on advertising and marketing yet never make this quick check.   Open enrollment is upon us. Check the accuracies of these listings now.  ...

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The One Thing You Absolutely Must Do to Experience a Great Open Enrollment Period

Have you had someone check the accuracy of all the online directories for the Medicare Advantage insurers you work with?   They’re most likely riddled with errors. Yet they are the information potential patients will be using to make coverage decisions.   It amazes me how many large organizations spend millions on advertising and marketing yet never make this quick check.   Open enrollment is upon us. Check the accuracies of these listings now.  ...

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Sunday Updates

Success, distilled   Medicare Advantage premiums decrease by 6% in 2019 Medicare Advantage Organizations (MAO) are looking to buy market share—and if you’re in a risk share with them, part of the cost is coming from your pocket. If your plan is to dump the new covered lives on your already busy primes, chances are you won’t realize back most of the money your MAO is spending for you. Busy primes are poorly productive primes....

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