Saturday Q and A

    Dr. Holly asks   The only patients who sign up on my Medicare Advantage panel are the sickest ones. What should I do?   Prosper.   The sicker the patient, the more value your expertise will generate.   Every sick patient is an opportunity to ply your trade.   The difference is, under Traditional Medicare, the sick patient just means more work.   With Medicare Advantage, it means more pay.    

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Saturday Q. and A.

    Dr. Greta asks: Do insurance companies allow nurse practitioners to be PCPs for their Medicare Advantage plans?   Not yet.   But it’s coming.   Your best bet is to find an independent practice with a thriving MA population and speak to the physician about working with them. Make sure you check about their non-competes. Most aren’t expecting you to compete with them, so it shouldn’t be a problem.   Learn all you...

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Saturday Q and A

Dr. Barbara asks: What’s the optimal patient panel size under a 50/50 risk-share split under a Medicare Advantage Contract? Fewer than 200 patients will leave you with a level of volatility in your performance that will be distracting and cause you unnecessary anxiety. The upper level is up to you. Once you reach it, you can scale it by adding APNs With that tactic, there is no upper limit.    

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Saturday Q and A

    Dr. Beatrice (who refers to me as a coding “rock star”—preen!) asks: What’s the deal with spinal enthesopathy?  It’s a risk code with a nice little bump in my RAF score. When should I code it and how do I support it?   Spinal enthesopathy is a condition where tendons, muscles or ligaments come into contact with the bones or joint capsules, resulting in inflammation, degeneration, and even affected function.   Tendon calcifications on...

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Saturday Q and A

  Dr. Donna asks: What is the most common high-level risk code I’m probably missing? There are two: D 47.3 Essential thrombocytosis—defined as an elevation in platelet count of uncertain origin. A not uncommon incidental finding on CBCs. B37.81. Candidal esophagitis—a common and surprisingly uncoded finding in EGDs Both can increase your monthly capitation by 50%. Watch for them. Address, code and submit as appropriate. And succeed.    

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Saturday Q and A

  Dr. William asks:   What’s the best way to limit specialty care costs without denying my patients needed care?   Efficient care is excellent care (and cost effective care).   Make referrals to your specialists as seamless as possible.   Don’t try to change your health system’s referral systems—that will take too of your time and energy— and will likely fail.   Set up your own referral and care systems within your health systems....

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Saturday Q and A

Dr. Doris writes:   How do I decrease my patient’s hospitalization costs under my Medicare Advantage plan?   Engage.   The best way is to care for your patients while they’re in the hospital.   If that’s not possible, “virtually round” on them with the hospitalists caring for them.  They will love you for bringing your perspective. It makes their job much easier.   Next, don’t depend on your care management staff to perform follow-up...

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Saturday Q and A

    Dr. Dianne asks:   The specialists I refer patients to are very uncooperative. They rarely send me notes and even bad mouth me both me and the Medicare Advantage insurance to their patients.  What do I do?   Get new specialists, but create those relationships intentionally.   Having a great network of specialists can be the difference between incredible performance and performance that’s just “ok.”   Create a stable of great collaborators. Contact...

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Saturday Q and A

Dr. Ned writes:   “What’s the most common diagnostic risk code that clinicians miss, i.e. what’s the lowest hanging fruit?”     Atherosclerosis of the Aorta. I70.0—hands down.   Take a couple of hours   Go through their imaging   Get it on their problem list   Address it the next time they come in   Congratulations, you just increased your monthly capitation by as much as 20%    

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Saturday Q and A

    Dr. Salim asks What’s the most cost-effective way to scale your Medicare Advantage panel? Use your nurse practitioners Pay them well. Allow them to become their patient’s personal clinician. Be there to support them. Don’t overwork them. Your performance will astonish.    

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