Episode 28: Navigating the Medicare Information Desert: Ambiguity, Audits, and the Innovator’s Burden

In this episode, Amy Schiffman and Alex Moseni dig into the real challenges physicians and innovators face when working inside Medicare. They explore why CMS guidance is often incomplete, how this drives confusion and legal costs, and what it means for startups trying to build sustainable care models.

Topics Covered

• The Medicare information gap and why CMS publishes only partial guidance
• How unclear rules increase legal expense and slow down innovation
• Fragmented CMS communication and the absence of a unified how to guide
• The complexity of care management codes and EMRs that cannot keep up
• Why many clinicians rely on third party spreadsheets for compliance
• Hidden payer controls such as Medical Unlikely Edits and their impact on reimbursement
• Why physicians must understand financial tools to succeed as leaders
• How to segment the 65 plus population for better patient acquisition
• Resources for physician executives including the ClinX Academy program
• Amy Schiffman’s work with Inter Mezzo Health and Coordology
• How ambiguity from CMS affects planning, proformas, and capital raising
• Persistent hurdles for startups including credentialing and physician activation