The Best Reason for Practicing Telemedicine I’ve Heard Yet

Dr. Michelle writes:   I think you’ve completely missed the best reason for practicing telemedicine. In the office, I’m getting paid to prescribe meds for patients whose best treatment is a lifestyle change. I prescribe antipsychotics to restrain demented patients in the nursing home and anti-hypertensives to people who were doing fine before the guidelines changed and now are getting sick from the side effects. Telemedicine has helped me win back my self-respect. It’s healing...

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Compliance Week: Beware of False Diagnoses

Under Medicare Advantage, the government pays your doctor and health system based on how sick you are.     The government knows how sick you are based on the diagnoses your doctor and health system submit to them when you seek care.     There is no effective way to check to see if your doctor or health system are being honest.     The may be telling the government you have illnesses you don’t...

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Compliance Week: What Clinicians Can Learn From the College Admission Scandal

What is your employer doing over your signature?     What data are they submitting? What charges are they being paid for?     As an employee, you’ve signed your license and billing numbers over to your employer. You’re trusting them to use them honestly.     Because if they don’t, enforcement may not only fall on them—it can fall on you.       I’m certain the defendants in the college admission scandal felt...

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Compliance Week—What You Can Learn From The College Admission Scandal

The FBI was tipped off to the college admission scandal by a trader who was being investigated for insider trading.     He hoped by dropping a dime on someone, anyone he would gain favorable treatment.     The storm he touched off pretty much guarantees those convicted will find no mercy.     Who inside your organization knows about inappropriate data submission?       What would happen to them if they were arrested?...

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Sunday Links

It’s not who you know, it’s what you know!   CMS sends MAOs notification that they will start collecting data in 2020 and begin eliminating low performing plans in 2023 Three “3-STAR” ratings in a row and an MAO’s plan can be terminated by CMS.   Its authority to do this was temporarily rescinded by the 21st Century Care Act but that change was not extended past its expiration at the end of this year....

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Saturday Q and A

Dr. Carlos inquires: What’s the highest RAF score one of your patients has achieved?   18.6 That’s not a typo.   this patient had six hospitalizations in one year for multiple amputations and every complication you can think of—with some chronic illnesses on top—one of which, surprisingly wasn’t diabetes.     The care managers and I got him through them, and the next year when all his diagnoses popped up, he came in at an...

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Grow Your Panel With Personal Referrals

I once met the leading salesman for all of GM.     He was a short, fat, dumpy guy—the exact opposite of a slick car salesman.     But he personally had sold more cars for the company than anyone else—ever.     He was teaching the secret of sales and I wanted to know how much was applicable to growing the Medicare Advantage panels of myself and my partners.     Turned out, it...

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All The Characteristics of a Great Investment

One day, after paying all your bills and paying down your debt you might notice you have some money left over for you to save and invest—what should you do with it?     In case you haven’t noticed, we’re in the middle of the “everything bubble.” Every sort of asset:  stocks, bonds, rental property, precious metals, and even digital currencies have been mispriced. Even the dividends of large, formerly staid companies are being called...

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Did Your Insurance Deny You a Medicare Advantage Service? Appeal it. Here’s How.

If you’re denied a service under your Medicare Advantage plan, appeal it.     90% of the time, you’ll win.     Medicare Advantage Organizations (MAOs) like your insurance company routinely deny claims to save money.     Sometimes they have a reason, other times they do it at random.     Why?     Because they know that fewer than 10% of the time, you’ll appeal.     Show them who’s boss. When you’re...

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Avoid Pacifying Behaviors

Touching your face or the notch above your sternum is called a “pacifying behavior.”   It’s something you do to reassure yourself when you feel anxious. Touching your face gives you a small but significant boost of dopamine. It’s why dogs like to be petted. Petting does the same thing with them.   The administrators and executives you work with understand that when they see you do this, you’re nervous. They’re trained to pick up...

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