Saturday Quiz

Designed to enlighten and amaze   True or False There are some Medicare Advantage plans that don’t require the selection of a PCP or referrals for care. The astonishing 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 x x x x x Answer: True There are two types of Medicare Advantage plans: Health Maintenance Organizations (HMO) and Preferred Provider...

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You’re So Friendly!

I can’t tell you how often I hear that from my telemedicine patient.   “You’re so friendly!” “You’re not grumpy like so many of them all” “Usually, the others just want to get off the phone.”   If you want to be successful practicing telemedicine, then when you start a telemedicine encounter, be pleasant.   Telemedicine service providers want happy patients.   If you make patients unhappy, they will divert encounters away from you unless...

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Outside Testing Is a Key to Success

I made sure I checked the narrative of every test ordered on my Medicare Advantage patients.   You never know what the reader was going to put in there.   If a finding was associated with a risk code, it could mean a significant boost to my capitation.   How could I do it efficiently?   I taught myself what to look for.   “Diastolic dysfunction” in echos.   “Remote vertebral compression fractures” in plain...

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Why is my doctor suddenly bothering me about my blood pressure?

If your doctor starts to bother you about your blood pressure next year, know the reason why.   Read this article of mine that was selected for publication on the most popular healthcare information site on the web.   Now that you have, it’s important to know that, starting in 2019 if you’re on Medicare or Medicare Advantage, the government will penalize your insurer and their doctors financially if they don’t reach these new goals.  ...

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Medicare House-Call Only Practice—Update

It’s official, starting in 2019, you don’t need to be seriously ill to qualify for a house call under Medicare and Medicare Advantage—the government just officially changed the rules.     With that in mind, let me update you on the progress I’ve made in starting my own, boutique Medicare Advantage house call practice.     The best initial contract I can get with a payer is a 50-50 split with a $35 per member...

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Beware The “Carve-In”

“Carve-ins” are services paid for by you under the capitation you receive through your Medicare Advantage contract.   “Carve-outs” are services paid for by someone else outside your capitation.   An example of a “Carve-Out”: Under my contract, when someone enrolled in hospice service, the capitation adjustment for their terminal diagnosis was removed and I was no longer financially responsible for associated expenses. Instead, the hospice provider was paid directly by the Medicare Advantage Organization...

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Sunday Links

You’re Amazing!   Everybody’s up in arms about the return of extrapolation to Medicare Advantage internal audits. As mentioned in my newsletter this week, the audits are still internal, the results self-reported and enforcement increasingly difficult in this legal environment. Short of obvious fraud, the only thing these changes represent is a marketing opportunity for compliance companies. Be honest and all will be well.       How does Risk Selection Respond to Risk Adjustment?...

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Saturday Quiz

Designed to Amaze and Enlighten   Yes or No? In the course of a routine exam your patient undergoes an EKG where you discover evidence of a past MI.  He remembers some chest pain a month ago that went away—he put it down to heartburn. Can you diagnose him with an acute MI? The shocking answer below. x x x x x x x x x x x x x x x x Answer:  Yes...

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These Are Your New Enemy

There was one doctor who drove most of my referrals.   He was incredibly intelligent, omniscient even.   Ebola. Ovarian Cancer. Lupus.   He diagnosed them all and sent legions of unspeakably anxious patients to my office with unwavering regularity.   They came to me because for all his intellect, this doctor had zero wisdom—-and no sense of proportion.   Some days he was responsible for 10% of the total traffic through my practice.  ...

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