If you have Medicare Advantage, you’re insurance company is being paid based on how sick you are. The sicker they tell the government you are, the more money you get. This has led to insurance companies, health systems, and doctors telling the government you have sickness you don’t actually have purely to make a buck. Check the list of illnesses your doctor says you have whenever you can. Your...
Read MoreWhen evaluating your employment contract, check out your “paid vacation.” Since you’re paid on production, your vacation isn’t “paid” unless your employer attributes to you your average RBV production for every day you are on vacation—and pays you for them. If they don’t do this (and they probably won’t), they are not offering “paid vacation.” They are giving you a paycheck while you’re on vacation—paying you what you earned the...
Read MoreRecently a faithful reader asked me to review the “Big 12,” that is the twelve diagnostic codes I always keep in mind whenever I see a Medicare Advantage patient. Here they are with the documentation requirements to keep you out of trouble (and a couple of acute codes thrown in): Atherosclerosis of the Aorta I70—need radiographic evidence. Chronic Bronchitis J41.0—h/o smoking or other chronic irritants (dust...
Read MoreLinks: Group 1 HHS Secretary Speech Group 2 CMS Administrator’s Speech New Shared-Risk Payment Models Group 3 Going all-in on Medicare Advantage Centene Oscar United Healthcare’s enrollment numbers Subscribe to our newsletter now! Tomism You can’t cure everyone, but you can care for everyone. Medicare Advantage pays you to care.
Read MoreShallam askes How do I deal with patients who leave my Medicare Advantage panel? The question’s a bit ambiguous but here’s what I do. I’m familiar enough with my panel that I know the ones I want to stay and who I don’t want back. The ones I don’t want back are either too time intensive, non-compliant, or simply a pain to deal with. The ones I want to...
Read MoreIt’s been a while, so it’s time to review. Grow your panel Meet with your local insurers. Make yourself visible where beneficiaries congregate. Personally connect with your patients as they sign up so they won’t be quick to leave. Submit your codes Get 95% of you panel in to be seen for an annual visit every calendar year Systematically address the 12 most common “success codes” at least once a year. Use addendum...
Read MoreMedicare Advantage is changing the ways it pays for hospice—and that could dramatically limit your freedom to choose the hospice you want. When you re-enroll in your Medicare Advantage plan, ask your insurance agent about whether or not you get to choose your own hospice if you need. This sounds morbid and unless you’re seriously ill the chances of you needing hospice in any given year is low. But the difference between...
Read MoreIt’s behind a paywall, but it’s a must read. Gaslighting. Telling someone that reality is actually untrue in an effort to manipulate their actions. Your employer is doing this all the time. E. g. “We can’t pay you any more than we are because Federal law won’t permit us.” The best defense against gaslighting is a recognition of what is real and what is a lie. This article...
Read MoreAn informal survey recently showed that of more than 20 telemedicine services, not one was compliant with the rules established by the medical boards in every state they practiced in. Not one. Don’t take a consultant’s word for it. Internally check with your states’ board of health. The real risk here is that there’s a malpractice action. If you’re not complying with the rules, that really impairs your defense—and cost you...
Read MoreAhead of the curve! Hospice Association Questioning Medicare Advantage “Carve-Ins” Carve-out= Hospice benefits not paid through the Medicare Advantage capitation Carve-in= Hospice benefits paid through the Medicare Advantage capitation Carve-outs allow hospices to compete for business within the Medicare “marketplace Carve-ins force hospice to compete for business from private insurers Thesis: Carve-ins will reduce payments to Hospice providers over time. Currently, Medicare decides what hospices will be paid. Look for case rates...
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