What to Negotiate In Your Next Medicare Advantage Contract—Advice From Someone Who’s Obviously Never Done It.
The AMA came out with this little summary of what to negotiate under your next Medicare Advantage Contract. I’m concerned someone will read this and take action on the assumption the authors know what they’re talking about. Over the next few weeks, we’ll dissect some of their recommendations in a series of short posts […]
Sunday Links
Your reference for excellence Medicare-for-All would be a boon for private insurers So says Fortune magazine. How did Great Britain get universal coverage passed in the face of overwhelming opposition from doctors? “I stuffed their mouths full of gold,” explained the founder. Those who run insurance companies are infinitely more sanguine than […]
Saturday Q and A
Dr. Beatrice (who refers to me as a coding “rock star”—preen!) asks: What’s the deal with spinal enthesopathy? It’s a risk code with a nice little bump in my RAF score. When should I code it and how do I support it? Spinal enthesopathy is a condition where tendons, muscles or ligaments come […]
Soft Risk Coding
There are “hard” risk codes and “soft” risk codes. “Hard” risk codes have objective data to back them up. Hip fractures, pressure ulcers, pneumonic infiltrates are examples of those. “Soft” risk codes are more judgement calls, You can had some objective evidence support your conclusion, but often you do […]
Traveling and Working
Many telemedicine services won’t let you perform encounters outside of the U.S. Create your own Virtual Private Network, perform your encounters through it, and they will never know. You can perform encounters anywhere you have an internet connection.
The New Home care Benefit is Not What it Seems
Beware of insurers trying to sell you on a new Medicare Advantage plan on the basis of the new home care benefit. They will tell you that your insurance will pay for your bathing and housecleaning, but the conditions under which the coverage kicks in is very limited—and could be associated […]
The Employed Clinician’s Dilemma
If the potential employer you’re considering is financially stable, chances are that healthcare is just a “loss leader” to them and they’re making money from other sources. If you work for them, you’ll be an afterthought. Monetizing your expertise will be a fight. If your potential employer is not […]
The Compensation Formula Test
If you can’t explain your organization’s comp formula while standing on one foot, it will be ineffective in incentivizing the behaviors you wish. I’m not saying it won’t move the needle, it just won’t meet your goal. “We get a set amount of money each month to take care […]
Sunday Links
Great information to make yourself look brilliant New bill designed to “streamline” prior authorizations introduced into Congress. It requires “real-time” prior authorization answers for all Medicare Advantage plans. Since fewer organizations are “opportunity-sharing” with their primes, more Medicare Advantage Organizations are relying on old-time tactics to limit care costs. The most prevalent of which […]
Saturday Q and A
Dr. Donna asks: What is the most common high-level risk code I’m probably missing? There are two: D 47.3 Essential thrombocytosis—defined as an elevation in platelet count of uncertain origin. A not uncommon incidental finding on CBCs. B37.81. Candidal esophagitis—a common and surprisingly uncoded finding in EGDs Both can increase your monthly capitation by […]