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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Get Regular Information

  If you’re taking downside financial risk your employer must give you transparent, and verifiable financial information on. a regular basis—otherwise they will just use the opportunity to pay you what they decide and massage the numbers to support it.       If you’re not getting these numbers—and they’re not independently verified, then you have to assume your employer is not being honest with you.     Best practice is to have  organizations which...

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The First Advice to Medicare Advantage Primes

When I’m retained to help a PCP improve their Medicare Advantage performance under a shared-risk contract, what’s my first piece of advice?     Relax.     If they’re working under a shared-risk contract, Medicare Advantage will reward them for doing what they do best—taking great care of their patients.     Sure, they’ll be bombarded with metrics they have to meet and risk-codes they have to submit.     I tell them to forget...

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The Only Metric You Need to Meet Under Medicare Advantage

    Medicare Advantage can be very overwhelming.     Administrators and insurance companies are trying to leverage your position to extract the last dollar of revenue from your patient’s insurance.     They can overwhelm you and drive you nuts with their demands—making you feel “substandard” in the process.     Here’s a tactic.     Don’t worry about it.     Don’t worry about any metric, about any goal they want you to meet....

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Mr. Biondo

    Every few months I like to re-post my very first blog entry and remind myself why we’re doing what we do.       Mr. Biondo is a real person and a good man. He gave me permission to tell his story if I thought it might help someone.       When I first met Mr. Biondo he was not at all well.  He had lost a leg through misfortune. The bed...

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See Your Patients in the Hospital

    How do you do really, really well under a shared-risk compensation system such as Medicare Advantage.     The title gives it away.     Round on your inpatients. Twice a day if necessary.     You don’t have to care for them, just coming . Your physical presence is is enormously valuable.     Coming in to the hospital to see your patients is so rare these days, just doing it once...

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Check Your Contracts for Carve-In Rates

      “Carve-ins” are benefits offered to your patients the cost of which are included in your capitation.     If you’re financially risk-sharing, that means part of the costs of those carve-ins are are coming out of your pocket.     Yet you have no control over how much you pay for those benefits, your Medicare Advantage insurance partner does. And they have many other objectives other than maximizing the value of the...

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