A Novel Approach to Success

  An executive recently contacted me asking how to transition their medical staff to a financial-risk compensation model which included a downside for the clinician.     Here’s what I told her:   Create a model you are comfortable with and that meets your goals—define the population, the split, the frequency of reconciliation, etc… Invest in the infrastructure required for regular financial reporting in an understandable manner as we’ve discussed so frequently in this space....

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Sunday Q and A

  Where you become an overachiever.     The “reality” of success in Medicare Advantage Written by a non-MD consultant who’s never had to take financial risk in his life. Population selection, data extraction, care limitation, case management. No mention of financially partnering with the primes. This works while the program is over-funded—indeed, it’s the model most Medicare Advantage Organizations use now. Once the funding gets cut back to the equivalent of regular Medicare—this model...

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Saturday Q and A

  Dr. Kathy writes:   I’m just separating from my partners and need to know how to get find a Medicare Advantage plan to participate in. I can’t use any of my partner’s contract nor contract through our IPA.   Kathy,, In order: Contact your state medical association, they may have group contracts you can access—they’re increasingly offering this service as they try to stay relavent. Go to Medicare.gov. search for Medicare Advantage plans in...

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Spondylitic Changes in Inflammatory Bowel Disease

If your patient with IBD has back pain, make sure you note any spondylitic changes on the plan films of the spine you may order.     Other inflammatory spondylitis (ICD-10 48.8x depending on location) is the appropriate code for such changes—-and can increase the monthy payment for this patient’s care by the government by as much as 30%     This is not something the back office is going to pick up. Neither is...

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YourTelemedicineCommunity.com

    Point your browser to YourTelemedicineCommunity.com and follow all my regular postings dedicated to your success in telemedicine.     Industry insights. Actionable tactics. Business tips.     The ONLY place on the net where you’ll find all this purely from a clinician’s perspective and 100% directed towards your success.   YouTelemedicineCommunity.com   Be there!    

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Online Scammers

    There are many online Medicare Advantage buying guides that scam you into thinking they are the official one sponsored by the government even though they are not.       They use that false credibility to steer you to plans they prefer instead of what’s best for you.       This is the link to the government website—note that it ends in .gov.       Finding an “insurance home” is the...

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Secret Shopping

    When looking for a job, it pays to be a “secret shopper.”       Make a routine appointment with a physician in the health system at an office where they don’t know you’re applying for a job.       Do the whole thing, the scheduling, the office visit, the exam.       Make it for a limited problem.       Pay cash, it should only cost a couple of...

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New MAO Insures is Your Opportunity to Innovate

    As new insurers enter the Medicare Advantage market, that’s you’re opportunity for taking advantage the many opportunities we discuss in these pages.       Shop around for your own reinsurance coverage (don’t take theirs at an initial low rate, they’ll just jack it up later when they’ve become established). Ensure that you have vendor options for carve-ins like home health and hospice. Enshrine escalators into your monthly stipend payments so as you...

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Sunday Links

Where you come to get the knowledge first.     Medicare Advantage Beneficiary Premiums Lowest in 13 Years. That’s because the most valuable item an insurer can get from the beneficiary is not their money, it’s their signature.         Journalists file lawsuits to force release of Medicare Advantage audits. Medicare Advantage coding fraud will be the Enron/Maddoff/Sub-Prime scandal of the 2020s. It will do to healthcare what those did to the financial...

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Saturday Q and A

    Dr. Aziz asks   Thank you very much for all the excellent information. Which insurance companies offer the best Medicare Advantage contracts?  How do I find them?     Thanks for the kind words, doctor.     Experience has taught that the best Medicare Advantage contract for you may not be the best for some of your patients, so take all that you can.     You’ll prevent yourself from being too dependent...

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