Saturday Q and A

Dr. B writes   “I’ve lost money on my Medicare Advantage panel three years in a row. When should I quit trying?”     Troubleshooting docs like Dr. B is what I do.   Make sure you know how your contract works. Make sure you’re getting more than 95% of your patients seen every calendar year. Make sure you understand the basics of how to code.   Once you have the systems in place to...

Read More

Saturday Q and A

Dr. Hassim writes   When is it ok to fire a patient who won’t be seen for their annual wellness visit? How can it be done?     I was the only doctor in a small town so I never felt comfortable firing patients. But my partners who worked in more broadly covered areas felt very differently.     If you’re not the only doc in town and they refuse to hold up their end...

Read More

Saturday Q and A

Dr. Donna asks:   “What’s the most effective method of getting a patient in for their yearly visit?”     Ask them personally. Leverage your credibility. Make a connection.     If a direct contact from me doesn’t work, like say through a phone a call or catching them at the store, then you have a decision to make.       I was the only doctor in a small town, so I didn’t believe...

Read More

Saturday Question

Nassim K. asks: How can I make money on my Medicare Advantage contract? Perform a qualified encounter with at least 95% of the patients on your panel once a year. Do whatever you have to do to achieve this—home visits, phone calls, anything. Bond with them, address their health issues, identify new ones, offer them appropriate health maintenance. Systematically collect their diagnostic codes for submission to their insurance company. This means having at least a passing...

Read More

Saturday Q and A

Dr. Colleen asks What’s the optimum split of financial risk-sharing for a prime to accept under a Medicare Advantage contract?   100% of the capitation for me, none for the insurer.   The best investment is in yourself, your skills, your talents.   You want as much of your compensation under your control as possible—and then take steps to do a good job.   In reality, no Medicare Advantage Organization ever shares “100%” of the...

Read More

Saturday Q and A

Rachelle S. writes   My health system pays money to each Medicare Advantage Special Needs Plan patient who keeps their appointment.  I know this is wrong from my compliance training and I’m afraid I’m going to get in trouble for seeing them.  What should I do?     Rachelle, this is not an uncommon practice among health systems trying to cash in on the high payments associated with dual-eligibles under special needs plans.     If...

Read More

Saturday Q and A

Sara M asks a follow-up to last week’s question   First here’s last week’s query:   Dr. Tom When a patient is seen outside of the office and their x-ray with a reading of pneumonia comes through my in-box, do I really have to have them come in for a visit to make sure it’s submitted?  Can’t I just code it from the x-ray?   Sara Excellent (and common) question. No. You can’t submit codes...

Read More

Saturday Q and A

Sara M. writes:   Dr. Tom When a patient is seen outside of the office and their x-ray with a reading of pneumonia comes through my in-box, do I really have to have them come in for a visit to make sure it’s submitted?  Can’t I just code it from the x-ray?   Sara Excellent (and common) question. No. You can’t submit codes directly off of imaging reports, you have to address the issue with...

Read More