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Mastering Medicare
Mastering Medicare episodes
- Episode 19: ALFs (Assisted Living Facilities), a deep dive with Jonathan Edenbaum from Eden Homes
Dr. Amy Schiffman and Dr. Alex Mohseni do a deep dive interview with Jonathan Edenbaum, the owner of Eden Homes about the ALF industry.
What is an Assisted LivingWhat is a Group HomeSmall vs large assisted livingKosher assisted livingKey triggers for transitioning from independent living to assisted livingStandard ratios in assisted living days vs nightsIncontinence as a trigger for assisted livingWhat patients don't qualify for ALFsThey don't do ALFs, ventilators, certain bed sores (III or IV)Assessments required for qualifying for ALFRN needs to reevaluate the resident every 45 daysSome facilities charge more for level of careRomantic relationships between ALF seniorsState and county unannounced random checksHow to determine a low vs high quality ALFDo an unannounced visit to check qualityGet family referenceRPM in the ALFsZoning requirements for ALFsHOA issues for ALFsRisks in an ALFMarketing ALF servicesWhen an ALF resident gets hospitalizedEden Homes of Potomacwww.edenhomesofpotomac.com301-299-0090Jonathan recommends these finder services:CarePatrolFamilyTiesVideo version:https://youtu.be/pJgIa3EWxVA59 min - Episode 18: Medicaid Long Term Care: interview with Robert Bullock Esq., The Elder & Disability Law Center
In this amazing interview with Robert Bullock, a DC-based Elder Law attorney, from The Elder & Disability Law Center, Dr. Amy Schiffman and Dr. Alex Mohseni discuss Medicaid Long Term Care coverage. We cover these topics:
What is MedicaidMedica long term care eligibilityWhat does Medicaid waiver mean?How does one qualify for MedicaidMedical eligibility for Medicaid long term careFinancial eligibility for Medicaid long term careMost people are in crisis mode when trying to qualify for Medicaid long term careHow are patients assigned to rehabMedicaid 5 year lookbackPut your assets into an irrevocable trust at least 5 years before you think you made need MedicaidWhy doesn't Medicaid cover ALFMedicaid long term care payments are like a loanMedicaid estate recoveryAtlantic article on Medicaid estate recoveryLife care Planning and ManagementAt what age should everybody talk to an elder law attorneyVideo version of this episode: https://youtu.be/EIwz0kv_O1oRobert's contact information: 202-452-0000
https://www.edlc.com/on AVVO.comThank you to our sponsor:
The RISE Virtual Medicare Marketing & Sales Summit taking February 19, 22-23, 2021, is offering 15% off with promo code POD15 to our listeners. To learn more about this event visit medicaremarketingsalessummit.com #RISEMMS20211 hr 7 min - Episode 17: Palliative Care: interview with Dr. Danielle Doberman, Clinical Medical Director for Palliative Medicine at Johns Hopkins Hospital
Danielle Doberman, MD, MPH, HMDC, is the Clinical Medical Director for Palliative Medicine at Johns Hopkins Hospital. Dr. Amy Schiffman and Dr. Alex Mohseni dive deep into the world of Palliative Care to understand what this commonly misunderstood specialty is all about. We cover the following:
What is palliative care / palliative medicine?What symptoms does palliative focus on?How does palliative operate as a team?Hospital-based vs outpatient palliative carePalliative care vs hospicehttps://www.PrepareForYourCare.orgWho should be a palliative care patient?Where do most referrals to palliative care come from?https://getpalliativecare.orgCenter to Advance Palliative Care www.capc.orgInteraction and relationship between PCPs and palliative careContracting for safety and consent in palliative carePalliative care pain managementPalliative Sedation (aka Proportional Sedation)Article: "Best Case Worst Case"Youtube video "Best Case Worst Case"Palliative care is not giving upPalliative care services lose money but they help the hospital because they reduce inpatient length of stay$3,000 of Part A savings per palliative care patientTypical patient volumes for palliative careYoutube version of this interview: https://youtu.be/poYoZ807SWU1 hr 27 min - Episode 16: DME Durable Medical Equipment - interview with Steve Ackerman
Dr. Amy Schiffman and Dr. Alex Mohseni interview Steve Ackerman, the owner of Spectrum Medical, and do a deep dive into the world of Durable Medical Equipment (DME).
Introduction to Steve Ackerman and Spectrum MedicalWhat is Durable Medical Equipment DME?Not disposable, has to be able to sustain repeated useCan't be used in the absence is disease or injuryCan't be an environment improvementCan't be a safety itemControversy with DME bedsSemi-electric bedPatients who need frequent immediate change in body positionDifferent types of DME wheelchairsWhat is a seating clinic?What are Assisted Device ProfessionalsChoices of wheelchairsK codes for wheelchairsHemi wheelchairsK3 standard wheelchair is the most ordered wheelchairParachute ordering portalWalkers as DMEMedicare local coverage determination (LCD)Every equipment has its own LCDClinical inferenceSecondary market for DME5-year limitIndoor vs outdoor use of DMEWhat is a transport wheelchair?Fraud and abuse in DMEHow PT/OT help with getting DMEHoardersDME company doesn't remove old equipmentImplications of having and MA plan for DMERollators are not coveredWalkers vs RollatorsHow quickly can DME be delivered?Aging in placeVideo version: https://youtu.be/m9dM7PT63M01 hr 8 min - Episode 15: Medicare Advantage (MA plans) - a deep dive with Michael Hughes
Dr. Amy Schiffman and Dr. Alex Mohseni interview Michael Hughes, principal at Mitchell-Lowey, LLC, and do a deep dive into Medicare Advantage plans, especially as they relate to supplemental benefits like private duty home care services. We discuss:
What is Medicare AdvantageMA plans offer supplemental benefitsCMS is realizing that SDOH determine health and cost outcomesWho costs the system the mostExamples of supplemental benefits include things like home care and pest controlHow many MA plans are thereSSBCI - special supplemental benefits for the chronically illHow does an MA plan measure effectiveness of supplemental benefitsHow do physicians order supplemental benefits for membersVBID modelConversion rate from MA plan to private payWhat are the downsides of choosing an MA planWhy MA plans care about the quality of supplemental benefitsMA plans as a percentage of total Medicare population by state (Link)Link to Michael Hughes: https://www.linkedin.com/in/michael-hughes-7010221/Video version: https://www.youtube.com/watch?v=7NrtiqkkHtQ1 hr 5 min - Episode 14: Hospice and Secrets of the Hospice Industry
In this episode we do a deep dive into Hospice with our guest, Cathy Gurson. She teaches us everything we ever wanted to know about Hospice. Here are some of the topics we cover:
How do people get referred to hospiceHospice is covered 100% by Medicare part AWhat does hospice coverHow to get Part B medical care covered while under hospiceHospice reimbursement modelHospice per diemThree levels of hospice carePier diem changes at the higher levels of careFor profit vs non-profit hospiceHospice certificate of need requirementsWhat questions you should ask about when interviewing a hospiceCHAP certification for hospiceTransitioning - what does transitioning mean in the context of hospice?How to know when a hospice patient is dyingDoes hospice pay for food and nutritionTube feeding hospice patientsMeasuring mean arm circumference (MAC) as a measure of nutritional declineWho is making the hospice recertification?Hospice patient’s relationships with their their PCP and hospice medical directorDNR status and resuscitating hospice patientsMost common reasons somebody leaves hospice statusWhat is the role of PCPs for patients in hospice statusWhat a PCP can bill for care plan oversight for a hospice patientRetroactive hospice status changesWhat happens if you don’t requalify for hospice recertification?Graduating from hospiceVideo version: https://youtu.be/qat1HZicdrA1 hr 24 min - Episode 13: Billing, coding, documentation, & EMR frustrations for physicians
Dr. Amy Schiffman and Dr. Alex Mohseni do a deep dive into Alex's frustrations with documentation, billing, coding and his EMR in setting up a solo practice. They discuss the issues that make it nearly impossible for small practices to thrive if they agree to accept health insurance.
Link to Youtube video version: https://youtu.be/kI5QqVA9NAQ49 min - Episode 12: Everything you ever wanted to know about PT, OT, and Speech Pathology
Dr. Amy Schiffman and Dr. Alex Mohseni talk with the team from Fox Rehab about physical therapy, occupational therapy and speech pathology and uncover all the hidden issues, challenges, and secrets of this huge industry. If you are a senior-serving professional or medical provider who orders PT, OT or Speech services for your clients, you need to listen to this episode.
Alex and Amy cover the following topics:Speech Therapy vs Speech Language PathologistIn-home PT, OT and speech therapy for geriatric patientsPart A rehab vs Part B rehabWhen and why do you flip from Part A therapy/rehab to Part B rehab?How do you continue to qualify for Part A therapy?Who decides whether a patient has reached their therapy goal - the ordering provider or therapist?What does a physical therapist do?What does an occupational therapist do?What does a speech therapist do?PT vs OT vs SpeechFunctional independenceActivities of daily livingWhat does Medicare pay for with Part B PT, OT and Speech TherapyTwo requirements for Medicare to pay for Part B rehab: medical necessity and skilled needThe Therapy Cap for PT and SpeechPart B works on a calendar year basisHow to get an exception to the Therapy Cap for PT, OT and Speech PathologyCoding and billing PT, OT and SLP encounter CPT codesWhat is a low-tech augmentative communication device?What is the common work file in Medicare rehab?How often does a physical therapist usually go to a person's home?What is the patient responsibility or copy for Medicare Part B rehab and physical therapy?Part B rehab is not home healthWhich types of providers refer to Part B rehab the most?Most common reasons for referral for Part B Rehab all revolve around falls: gait, balance, and weaknessDo not have to be homebound for Part B rehab in the homeCommon mistakes when referring to rehabHow to write an order for PT, OT, or speech and what CPT codes to includePart B rehab does medication reconciliationHow to order DMEWhat is a 3-in-1 commodeHow long does it take to get a hospital bed paid for by MedicareFoxRehab.org1 hr 29 min - Episode 11: Alex starts a medical practice (part 2)
With COVID-19 causing lots of seniors to be stuck at home and not be able to access the medical care that they need, Alex decides to start his own medical practice to serve this population. Alex chronicles everything he's doing to start this practice and gets Amy's help in figuring out lots of the details and issues. In this episode Alex and Amy discuss Medicare enrollment for individuals, organizations and employee providers, deploying Athenahealth EMR, and getting the first patients. Alex's Medicare telemedicine practice is called Canary Doctor.
Dr. Alex Mohseni and Dr. Amy Schiffman are two Emergency Medicine doctors who are the hosts of MasteringMedicare.net, a podcast helping unearth the secrets of Medicare for healthcare providers and senior-serving professionals.Video version of episode: https://youtu.be/MeRWrKF6eno30 min - Episode 10: Andy Diamond, President of Diamond Medical Labs and Mobile Medical Imaging, Part 2
Part 2 of our incredible interview with Andy Diamond, the President of Diamond Medical Labs and Mobile Medical Imaging. In this amazing episode, Andy teaches us everything about how mobile medical imaging is done in nursing homes, rehabs, assisted livings and in patients' homes.
In part 2 we discuss:Brief summary of mobile labs episodeWhat sort of equipment do mobile medical imaging labs have in their cars?How do you get mobile imaging equipment up a flight of stairs?How much does a mobile digital x-ray machine cost?How quickly can you get imaging done in a patient's home?The logistics challenges of home-based medical careManaging dispatchers for home-based servicesHow is the logistics of labs more complicated than radiology?Is there a transportation fee for radiology done in the home?How do trip fees work when visiting an assisted living or nursing home?How do you split the trip fee?What technology is used to manage logistics for home-based care?Lab tests are not subject to Medicare deductible but imaging isWhat could providers do better when ordering labs and radiology?Training nursing home staff on anatomyPoint Click CareNo trip fee on EKG and ultrasound; trip fee only on x-raysDo lab and radiology providers need to get patient consent when they visit a nursing home or assisted living?What is the minimum percent of tests a lab must do in-house?How many patients per day can a mobile radiology tech perform?How quickly do labs need to be run?37 min
About Mastering Medicare
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What's the difference between Home Health and Home Care? How do Medicare Part A and Part B work? How do you order DME for your patient? When and how should you order home oxygen? What's new in the…
eldercare space? For physicians, other healthcare professionals, and senior-serving professionals, interacting with Medicare can be complicated and wrought with pitfalls, which, if not understood and managed, will mire your practice in endless paperwork and frustration. We interview industry experts in every aspect of healthcare, from insurance companies, DME companies, home health agencies, medical providers, and many others, to bring you their real world expertise in the American healthcare system. Your hosts are Dr. Amy Schiffman and Dr. Alex Mohseni, two Emergency Medicine physicians who have branched off from traditional Emergency Medicine to explore and build solutions with a particular focus on eldercare and population health. Join our Facebook group: https://www.facebook.com/groups/602747270479020/ Join our Subscriber List and get exclusive access to our Mastering Medicare Cheat Sheet and other goodies: https://www.masteringmedicare.net/subscribe
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