Telemedicine encounters for parts of the body the patient can’t see are problematic—none more so than problems with the rectum. Don’t assume any rectal problem is simply hemorrhoids—even if the patient identifies it as such. Fissures, fistulae, undiagnosed IBD are only a few of the problems that it’s not uncommon to miss. And don’t let the patient try to bully you into the use of video encounters to try to...
Read MoreUnder Medicare Advantage payments are based on information the insurance company sends to the government. The more information, the more money. Your insurer, health system, or clinicians may tell the government you have a sickness that you don’t have in order to get paid more. That information may end up on your medical record. And if you need medical care and can’t speak, that information may change...
Read More“If you contact me again, I’m going to call the police.” That’s what one patient on my panel once told me when I tried to get him in for his yearly visit. I knew from my sources in the community that for some reason—probably a good one—he absolutely despised me, yet he stayed on my panel year and year. And when he did get sick it was me he wanted to see. ...
Read MoreAccording to a little gem in this report, you might be. Enrollment growth for Medicare Advantage in 2018 was strong but out of pocket costs and monthly premiums for beneficiaries dropped across the board. This suggests that the growth isn’t as robust as it seems. As an insurer, health system or clinician you must make sure you’re generating real value for your Medicare Advantage patients or they may not...
Read MoreExtra. Extra. Read All About It. The pushback against Medicare Advantage in the popular press is growing. To whit: Fight a denied Medicare Advantage claim ( Chicago Tribune) The Medicare Advantage Advantage for insurers—A sweet deal The Personal Toll of a Medicare Advantage Whistleblower (New Yorker) Have you noticed movies now have statements in the credit that “the creation of this movie generated 15,000 jobs…” The studios are using their platforms to...
Read MoreRachelle S. writes My health system pays money to each Medicare Advantage Special Needs Plan patient who keeps their appointment. I know this is wrong from my compliance training and I’m afraid I’m going to get in trouble for seeing them. What should I do? Rachelle, this is not an uncommon practice among health systems trying to cash in on the high payments associated with dual-eligibles under special needs plans. If...
Read MoreGo to them. I struggled with this same problem when I started practice. I needed the revenue dual-eligible would generate in support of my Medicare Advantage contract. But they were hard to attract, hard to bond with and hard to retain. But one day a bowling league buddy asked me if I was taking new patients. He was dual-eligible. I said sure, and I asked...
Read MoreReceived from the same telemedicine provider on the same day: “WE NEED YOU!!!!! DUE TO HIGH, HIGH, VOLUME IN (THIS STATE) WE’RE ASKING YOU TO SIGN ON THE SYSTEM AND TAKE SOME ENCOUNTERS. HURRY, PATIENTS ARE WAITING!!!!” and “Dear Dr. You’re required to participate in this new training experience if you would like to continue to take encounters with our system. The experience can be accessed here (link). It...
Read MoreEver wonder how much your insurance agent gets paid to sign you up with or keep you enrolled in a Medicare Advantage plan? It’s probably less than you think. There are two approaches agents can take. They can provide great service as your insurance home. Or they can churn through sign-ups, getting signatures on the bottom line and moving on, Which approach did your agent use?
Read MoreHow do you connect with someone you don’t know at a professional event? What do you say to fill that awkward silence after that introduction? Try asking “So, what’s your passion?” People’s favorite subject is themselves. It’s validating, something they are comfortable speaking about and a topic they desperately desire to share—especially in the uncomfortable environment of networking. And if you ask someone about themselves it validates you...
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