Is It Worth It? Yes!

Sara wrote to tell me about a Medicare Advantage patient with a lobar pneumonia seen on an x-ray at an outside Urgent Care.  The patient was diagnosed with an unspecified pneumonia.   Unspecified pneumonia has no additional compensation. Lobar pneumonia does.   She is being comped under a partial-risk contract. How can she make sure that the lobar pneumonia code gets submitted?   I advised her to get the patient in for a follow-up and do...

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Residential Care Facilities Can Boost Your Panel’s Growth

If you’re sharing financial risk in a Medicare Advantage plan, consider contacting one of the large residential care facilities in your area and offering an on-site clinic once a week.     You don’t even have to go there yourself, send your NP or PA and just plan on attending one time a month.     Your new patients will have great access and you’ll generate significant growth in your panel.     I did...

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Looking to Grow Your Panel? Consider Veterans.

There was a bar and grill in the basement of the local VFW where I practiced—and I loved going there.   The stories, the atmosphere. It was a great way to get out of the office for a half-hour lunch and recharge.   Little did I know that it was also a great way to recruit patients for my Medicare Advantage panel.   Back then, veterans were the best Medicare Advantage patients to have. They...

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Leave Them on a High Note

As more of our compensation depends on us being able to influence our patient’s behavior, it becomes important to use the tools of influence.     And a key tactic is to leave your patients on a positive note.     Humans associated their impression of an entire encounter with their last impressions of the interaction     And if they have a positive impression of the encounter, they are more likely to do as...

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Success Codes—Patient Condition Count Edition

You can be forgiven if you missed it among all your holiday frivolity, but CMS released a proposal for the latest risk-code update.  It’s significant.   And I read it so you don’t have to.   The bottom line?   If adopted, pay special attention to collecting all the HCC groups for your dual-eligible patients—that’s where the low hanging fruit is.   Details: There are two proposed models under discussion—one that includes two additional conditions...

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Is Your Employer Actually “Risk-Sharing” With You?

If your organization claims they’re risk-sharing but you’re not seeing any real financial benefit, they may just be pretending to risk-share to gain your compliance while having no actual intention sharing the financial benefits of your mutual success.   This is a sadly common situation.     Red flags to look for:   Your employer devotes great resources in encouraging you to perform the specific tasks which advance the value of their Medicare Advantage contracts—such as...

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Specialists, Doubling as Primes Can Support Your Declining Income

If you’re boarded in internal medicine as well as your subspecialty, consider adding a Medicare Advantage contract to your revenue mix.     A modestly sized panel of a couple hundred patients, an off the shelf contract and you’ll quickly find the extra revenue rivals that of your primary service lines.     I was weaned on this model in my practice.     A cardiologist and a GI both followed this model—and did very,...

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Nurse Practitioners and Medicare Advantage

Nurse practitioners can allow primary care physicians to care for much larger panels of patients—if they’re used in the right way.   For now, in most jurisdictions, NPs can’t be a PCP under the Medicare Advantage program.   However, with more studies like these getting published (as well as the lack PCPs getting trained), look for more insurance industry lobbying for that to change.   Most docs just use NPs for limited illnesses, like colds...

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Dr. Dan’s Medicare Advantage Practice

Submitted as a kinda fun example of just how valuable a robust knowledge of Medicare Advantage can be.   Just when I thought I’d seen it all—I met Dr. Dan.     He’s a snowbird Family Physician from the Northeast     Every winter for the past few years, he’s been staying in the same spot.  He’s made lots of friends from the same state. They stay down for the winter, too.     A...

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One Clinician’s Telemedicine Journey

On the way south for the winter, we stopped at an RV park for the night.   It was relatively expensive—so I turned on my phone, took two telemedicine encounters, and paid for it.   Diesel was about $50 every fill-up—so I turned on my phone, took another two telemedicine encounters, and paid for it.   The fancy restaurant?  That took ten telemedicine calls—about an hour.   The upscale RV resort?  That’s twelve calls every...

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