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Mastering Medicare
Mastering Medicare episodes
- Episode 9: Alex starts a medical practice
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. Alex and Amy discuss Medicare enrollment for individuals, organizations and employee providers, choosing an EMR, choosing a telemedicine platform, setting up medical malpractice insurance, planning for NPs and PAs, rules for supervision of NPs and PAs, reimbursement models, and how to figure out how much you are going to get paid.
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/ebZZkHHBy301 hr 23 min - Episode 8: Andy Diamond, President of Diamond Medical Labs and Mobile Medical Imaging, Part 1
Amy and Alex interview Andy Diamond, the President of Diamond Medical Labs and Mobile Medical Imaging. In this amazing episode, Andy teaches us everything about how labs are done in nursing homes, rehabs, assisted livings and in patients' homes.
In part 1 we discuss:How and why do lab companies have contracts with nursing homes and assisted living facilities?Part A and Part B billing for labs in the same facilityFiguring out Same and Similar in the lab worldPatient financial responsibility for labs drawn in a nursing homeLack of centralized database of lab dataIntegration with state health information exchange / CRISPWhat is a health information exchange?Why does CRISP charge the lab company to participate?Nursing home is paying for some lab tests directlyLab billing denialsRevenue cycle management in the lab worldWhat are the most common mistakes and issues when nursing homes and assisted livings order labs?What labs aren't allowed to tell ordering physicians?Alex thinks the rules for ordering labs are stupidTrends in lab testingMolecular testing - why is molecular testing becoming more popular?Who collects urine samples in nursing homes and homebound patients?What is the cost of molecular testing and is the denial rate different?What things to consider other than just the cost of a lab test?Workflow requirements for molecular testingPGX testing - what is it and why would you order it?Cost of PGX testingAre the results from PGX testing easy to interpret?Effect of PAMA on labs and lookback for lab paymentsWhy doctors can't have their own labs58 min - Episode 7: Dr. Howard Haft, Executive Director of the Maryland Primary Care Program, and former Deputy Secretary for Public Health
Amy and Alex interview Dr. Howard Haft, the Executive Director of the Maryland Primary Care Program, and Tammy Liu, a Primary Care Transformation Coach. We do a deep dive into the Maryland Primary Care Program and understand how this amazing innovative program is helping physicians provide higher quality more holistic care while providing physicians the tools and resources they need to provide that care in an efficient and low-friction way.
We discuss so many valuable topics in this episode:
Who is Dr. Howard HaftWhat is the Maryland Primary Care ProgramMaryland All Payer ModelGlobal Budget Revenue Hospital Payment ModelWhat do Primary Care Practice Transformation Coaches doAdvanced Alternative Payment ModelTrack 1Track 2Upfront paymentsIs the Maryland Primary Care Program only for MedicareCarefirst participation in the Maryland Primary Care ProgramHow much extra can physicians earn from the Maryland Primary Care ProgramAverage $40,000 per year per physicianCare Transformation OrganizationsAdministrative requirements of the Primary Care ProgramECQMsAlex's mind gets blownEmpathy in healthcare20% Reduction in avoidable admissionsPredicting high risk patients and avoidable admissionsHow Maryland is using machine learning to support primary care doctorsSocial Determinants of Health services in MarylandHow to order SDOH services from CRISPHow community-based organizations can work with the Maryland Primary Care Program211 service in MarylandGlobal Budget contractsMaryland Stakeholder Innovation Group1 hr 25 min - Episode 6: Telemedicine and Remote Patient Monitoring in the COVID19 Era
Alex and Amy discuss telemedicine and RPM (remote patient monitoring) in the COVID-19 Era. Medicare has published new rules for telemedicine to help cope with the novel coronavirus epidemic. Medicare also published new rules for RPM that went live Jan 1 of 2020. These rules create valuable opportunities for medical providers, especially with COVID-19 quarantine and isolation requirements.
We discuss:appreciation for our emergency medicine colleaguesoriginal medicare telemedicine telemedicine requirementsMedicare telemedicine geography requirementMedicare telemedicine originating site requirementCOVID19 Medicare telemedicine reimbursement updatesHHS won't audit preexisting relationship rule, but what about MACs?Provider licensure requirements for telemedicineFee for service telemedicine billing guideHome health telemedicineRPM (Remote Patient Monitoring) COVID19Connection between real estate tax code and healthcare opportunitiesWhy is Medicare paying for RPMHow does remote monitoring workAlex's Concierge Medicine RPM articleHow much does RPM payMedicare eVisit non-face-to-face encountersRole of RPM with addressing loneliness in seniorsSome states' Medicaid programs pay for RPMKudos to Dr. Blake McKinney from CirrusMDTelemedicine pictures need to be treated like radiology filmsAccuhealth RPM websiteEmail us at [email protected] or [email protected] for our RPM Workbook1 hr 11 min - Episode 5: MOLST, POLST, and Advance Directives
Alex and Amy discuss the urgent need during this COVID-19 pandemic for folks to think about difficult end-of-life deicisions and they walk the audience through the details of filling out the MOLST form.
MOLST: Medical Orders for Life-Sustaining TreatmentPOLST: Physician's Orders for Life-Sustaining TreatmentIn this episode, we discuss:What is a MOLST formWhat is a POLST formWhy should we talk about end of life careCoronavirus / COVID-19 concernsWhen should you fill out a MOLST form?Who should fill out a MOLST form?Can you make copies of a MOLST form?Where should you keep your MOLST form?What is CPR?What is intubation?MOLST form options35 min - Episode 4: Medicare Part D
In this Mastering Medicare episode, Dr. Amy Schiffman and Dr. Alex Mohseni do a moderate dive into Medicare Part D. We discuss the following topics:
What is Part D Medicare
Opt in Part DPremium calculation for Medicare Part DWhat is the Medicare Donut Hole?Medicare Part D Donut Hole4 stages of Part DPart D deductible stage: first $435Part D initial coverage stage: first $4,020, up to 25% of cost of medicationTiers of medications in Part DPart D tier 1 medicationsPart D stage 3: donut hole, 25% patient responsibilityPart D stage 4: catastrophic stage, copayVisit Mastering Medicare at MasteringMedicare.NET
16 min - Episode 3: Medicare Part B
Physicians and other senior-serving professionals trying to operate within the complicated Medicare ecosystem must be constantly learning, as the landscape, rules, tools, and vendors are in constant flux.
We interview eldercare and Medicare industry experts, do deep dives into their companies, services, and experiences, and share their stories and insights with you.Here are some of the topics that we cover:
What is Medicare Part B
What services are included in Part BProfessional servicesPart B Physical TherapyPart B Outpatient LabsPart B Outpatient RadiologyDoes Medicare pay for DMEWhen does Medicare pay for 911Medicare Part B is opt inHow much does Medicare Part B costMedicare Part B monthly premiumMedicare covers part only 80%Medicare secondary insurance / Medigap / supplementalPart A vs Part B Physical TherapyCost sharing for radiologyCost sharing for lab tests under MedicareMedicare limits on lab testsDMEHow do you order DME, wheelchair, hospital bed in a patient's home13 month lease to own DMESame and similar DMEParachute same and similar DME30 min - Episode 2: Medicare Part A
Physicians and other senior-serving professionals trying to operate within the complicated Medicare ecosystem must be constantly learning, as the landscape, rules, tools, and vendors are in constant flux.
We interview eldercare and Medicare industry experts, do deep dives into their companies, services, and experiences, and share their stories and insights with you.In this Mastering Medicare episode, we cover:
How you qualify for MedicareQualifying for Medicare via ALSQualifying for Medicare via ESRD on dialysisQualifying for Medicare via SSDI disabilityMedicare and VA insuranceHistory of MedicareInpatient hospitalizationRehab aka SNF aka nursing homeHome healthHospiceMedicare copays and cost sharing for hospitalizationMedicare part A annual deductibleMedicare cost sharing with rehab SNFMedicare part A home healthWhat is Home health?Home health 485 formWhat is skilled nursing?What does part A PT/OT do?Copay for part A PT OTHome health "taxing effort"Certification of being homebound home healthCertification periods for home healthRecertification of medicare part A home healthHome health aidesHome health 45 minutes twice per weekWill Medicare pay for wound care supplies?Medicare hospiceWhat is hospiceWill Medicare pay for hospiceQualifying for hospiceHospice certification periodsWhat does hospice cover and pay forHospice payment modelWho pays for a hospice patient if they go to the ER?Hospice is a risk bearing entityHospice certification and recertification periodsWhat does it mean to be admitted to a hospital44 min - Episode 1: Introduction to Medicare
Physicians and other senior-serving professionals trying to operate within the complicated Medicare ecosystem must be constantly learning, as the landscape, rules, tools, and vendors are in constant flux.
We interview eldercare and Medicare industry experts, do deep dives into their companies, services, and experiences, and share their stories and insights with you.Brought to you by two passionate but critical physicians who broke away from the conventional career paths of their specialty.In this episode we cover:
Dr. Amy Schiffman and Dr. Alex Mohseni introduce themselvesMedicare overviewPart A overview, including cost sharingPart A: Hospital, Rehab, Home Health, HospicePart B overviewPart B 80/20 split, Medigap / supplementalPart DInpatient vs outpatient medicationsInpatient vs outpatient statusObservation statusPart C - Medicare AdvantageJoin our Subscriber List to get your copy of our Medicare Cheat Sheet
https://www.masteringmedicare.net/subscribe36 min
About Mastering Medicare
From the publisher's feed
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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