Dr. Cathy wrote me to ask:   “Thank you for all your writings. My comp formula is being changed so that I can lose or gain up to 20% of my RBV revenue based on how much my money my Medicare Advantage patients cost.  What should I do?”       Cathy, You don’t say how many Medicare Advantage patients you have, but suddenly those folks have become very valuable too you.    ...

Dr. Lee writes Thank you for all your generous information over the years. The nursing home I work with is intentionally working to switch my patients away from Medicare Advantage and onto other insurance programs. What do I do?   Dr. Lee, Approach the administrator. Tell her that Medicare Advantage is the only insurance program that compensates you adequately for the value you generate in the nursing home environment.     Advise them that, should...

Dr. Robert asks:   “My employer wants me to take a new compensation agreement in which I split the revenue of our Medicare Advantage contract 50-50 with no risk of loss.  How much can I expect to make?” Robert I can’t tell you exactly without more details, but in general and 50-50 split with no downside risk should net you $100 per patient per month. For a panel of 300 patients, that means $360k per...

  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...

    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...

    Dr. Amy writes;   “I’m being pressured to take care of a lot more patients than I’m comfortable with. How many Medicare Advantage patients is too many?   How many can you form a thorough therapeutic relationship with?   For some, it’s 100, for others it’s 300, for a few it’s 700.   For me, it was 500.   If you care for more than you are comfortable with, you’ll quickly find yourself...

    Dr. Ramone writes:     I’m having a lot of trouble getting people in to see me for their yearly visit. What’s the best way to get them in?     Anything is fair play     Call them. Write them a note. Arrange a house call (they don’t even need to be ill).     You can even drive them to your office yourself (I’ve done that more than once.)    ...

  Dr. Ahmed writes:   Thank you very much for your posts.   How were you so successful in your Medicare Advantage practice?   You’re welcome, Ahmed.   Here’s the system that worked best for us.   We had a certified coder review every Medicare Advantage encounter.   They added the codes that passed muster to an excel spreadsheet.   They submitted that spreadsheet to our insurer every quarter—and they submitted it to CMS.  ...

    Dr. Allen writes: Tom, Thanks for all the tips. What’s the best way to save money on patient care costs with Medicare Advantage besides just saying “no”?   Allen, you’re welcome for the help,   Just saying “no” pushes care costs into the future—and doing so ensures you will pay far more money in care costs then than you will now because your patients will be sicker.   But you can’t really control...

      Dr. Sara B. asks,  “Thank you for your tip last week about addenda, they seem like a powerful tool. But how do you best use them?”     Sara, as I review the laboratory and test results, I’m on the lookout for a dozen so conditions that commonly pop up. I cover them in my success codes blog series and in my upcoming book.     Class 1 diastolic dysfunction, atherosclerosis of...