Mind Your Risk-Coding Vendors
If you contract with an outside service to help you recover diagnostic risk-codes and those codes are rendered invalid through a whistleblower suit, it’s your revenue that’s going to be clawed back. I’m not just taking about the standard CMS audits (although if extrapolation becomes official policy, those audits will become […]
Sunday Links
Keeping you ahead of the curve It’s open enrollment season! And in a reflection of the impact Medicare Advantage is having on our industry here’s Bloomberg’s take on the “mad rush” to enroll payment. They’re not wrong. Another whistleblower lawsuit, this one instigated by a coder and, uniquely, […]
Saturday Q and A
Dr. Lee writes Thank you for all your generous information over the years. The nursing home I work with is intentionally working to switch my patients away from Medicare Advantage and onto other insurance programs. What do I do? Dr. Lee, Approach the administrator. Tell her that Medicare Advantage is the only insurance program […]
Nursing Homes are Your Key to Medicare Advantage Success
Employed or practicing on your own, if you have a risk-sharing arrangement under Medicare Advantage, a nursing home practice will supercharge your success. The details are shared in this work—it’s literally worth more than its weight in gold. Nursing homes are badly in need of clinicians who practice good medicine. […]
YourTelemedicineCommunity.com
Point your browser to YourTelemedicineCommunity.com and follow all my regular postings dedicated to your success in telemedicine. Industry insights. Actionable tactics. Business tips. The ONLY place on the net where you’ll find all this purely from a clinician’s perspective and 100% directed towards your success. YouTelemedicineCommunity.com Be […]
Don’t Get Distracted When Selecting Your Medicare Advantage Plan
Medicare Advantage plans are offering all sorts of goodies this year. Home health, house cleaning, even Apple Watches. Don’t get distracted. None of these have been proven to help your health. You’re not buying health insurance for all the add-ons, you’re buying […]
SEAK
Just back from serving on the faculty of the SEAK Non-Clinical Careers Conference where I’m privileged to serve as faculty. Over two days, I had direct contact for at least 15 minutes with over one hundred individual clinicians “seeking” information. It made for two very long days […]
A Better Approach to Risk-Coding?
I’ve seen this in two different organizations who don’t financially risk-share with their physicians. Their clinicians do no risk-coding. None. Zero. Their back office coders extract risk-codes from the documentation of every office encounter and submit them in aggregate to their insurance partner […]
Sunday Links
Open Enrollment Season is Here!!! The 2020 STAR Ratings are out! Who improved? UHC Who didn’t? Centene Five Starts earn you a 16% increase in you Medicare Advantage gross revenue. Considering that Medicare Advantage Organizations have been accused of keeping two sets of books for their quality stats, interpret them with care. And […]
Saturday Q and A
Dr. Robert asks: “My employer wants me to take a new compensation agreement in which I split the revenue of our Medicare Advantage contract 50-50 with no risk of loss. How much can I expect to make?” Robert I can’t tell you exactly without more details, but in general and 50-50 split with no […]