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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You Make Far More Money From Medicare Advantage Than Any Other Insurance Contract

      If you’re participating financially in any kind of Medicare Advantage contract, the return on your time for those patients will far outstrip the return on your time caring for patients under a fee-for-service arrangement.   Do everything you can to preferentially care for those patients.   Take the steps outlined in the space to expand your patient panel and squeeze out the fee for service patients.   That’s the way you earn...

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A Three-Point Plan for Your Medicare Advantage Success

  It’s been a while, so it’s time to review.   Grow your panel Meet with your local insurers. Make yourself visible where beneficiaries congregate. Personally connect with your patients as they sign up so they won’t be quick to leave. Submit your codes Get 95% of you panel in to be seen for an annual visit every calendar year Systematically address the 12 most common “success codes” at least once a year. Use addendum...

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Educate Your Nurse Practitioner

  Educate your nurse practitioner in the workings of your Medicare Advantage contract.   They’re there to help you and are anxious to please.   I shouldn’t have to say this, but it’s amazing how few physicians take this simple step.   Buy ’em lunch, go through the mechanics and give them three simple things they should do with each Medicare Advantage patient.   Bonus: Whenever you teach something, you’ll understand it better as well....

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The Single Most Important Metric You Must Meet

    Has the patient been seen this calendar year for an annual visit?   Yes or No.   You must hit 95% or more on this metric for the patients on your panel by December 31 of each calendar year.   No other metric matters.   Not colonoscopy rates. Not immunization percentage. Not even inpatient days per thousand.   Nail this one first, then go after some of the others.   Have systems in...

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Mr. Biondo

Every few months I like to re-post my 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 sores from his outdated mobility...

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