Mastering Medicare

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 care Palliative care vs hospice https://www.PrepareForYourCare.org Who should be a palliative care patient? Where do most referrals to palliative care come from? https://getpalliativecare.org Center to Advance Palliative Care www.capc.org Interaction and relationship between PCPs and palliative care Contracting for safety and consent in palliative care Palliative care pain management Palliative Sedation (aka Proportional Sedation) Article: "Best Case Worst Case" Youtube video "Best Case Worst Case" Palliative care is not giving up Palliative 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 patient Typical patient volumes for palliative care Youtube version of this interview: https://youtu.be/poYoZ807SWU

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 Medical What is Durable Medical Equipment DME? Not disposable, has to be able to sustain repeated use Can't be used in the absence is disease or injury Can't be an environment improvement Can't be a safety item Controversy with DME beds Semi-electric bed Patients who need frequent immediate change in body position Different types of DME wheelchairs What is a seating clinic? What are Assisted Device Professionals Choices of wheelchairs K codes for wheelchairs Hemi wheelchairs K3 standard wheelchair is the most ordered wheelchair Parachute ordering portal Walkers as DME Medicare local coverage determination (LCD) Every equipment has its own LCD Clinical inference Secondary market for DME 5-year limit Indoor vs outdoor use of DME What is a transport wheelchair? Fraud and abuse in DME How PT/OT help with getting DME Hoarders DME company doesn't remove old equipment Implications of having and MA plan for DME Rollators are not covered Walkers vs Rollators How quickly can DME be delivered? Aging in place Video version: https://youtu.be/m9dM7PT63M0

Dr. Amy Schiffman and Dr. Alex Mohseni interview Michael Hughes, Principal at Mitchell-Lowey, LLC, discussing Medicare Advantage plans and their supplemental benefits, including private duty home care services. Topics include SDOH impact on health outcomes, special benefits for the chronically ill, measuring effectiveness of MA plans, downsides of choosing an MA plan, and the importance of quality in supplemental benefits.

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 hospice Hospice is covered 100% by Medicare part A What does hospice cover How to get Part B medical care covered while under hospice Hospice reimbursement model Hospice per diem Three levels of hospice care Pier diem changes at the higher levels of care For profit vs non-profit hospice Hospice certificate of need requirements What questions you should ask about when interviewing a hospice CHAP certification for hospice Transitioning - what does transitioning mean in the context of hospice? How to know when a hospice patient is dying Does hospice pay for food and nutrition Tube feeding hospice patients Measuring mean arm circumference (MAC) as a measure of nutritional decline Who is making the hospice recertification? Hospice patient’s relationships with their their PCP and hospice medical director DNR status and resuscitating hospice patients Most common reasons somebody leaves hospice status What is the role of PCPs for patients in hospice status What a PCP can bill for care plan oversight for a hospice patient Retroactive hospice status changes What happens if you don’t requalify for hospice recertification? Graduating from hospice Video version: https://youtu.be/qat1HZicdrA

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/kI5QqVA9NAQ

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 Pathologist In-home PT, OT and speech therapy for geriatric patients Part A rehab vs Part B rehab When 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 Speech Functional independence Activities of daily living What does Medicare pay for with Part B PT, OT and Speech Therapy Two requirements for Medicare to pay for Part B rehab: medical necessity and skilled need The Therapy Cap for PT and Speech Part B works on a calendar year basis How to get an exception to the Therapy Cap for PT, OT and Speech Pathology Coding and billing PT, OT and SLP encounter CPT codes What 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 health Which 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 weakness Do not have to be homebound for Part B rehab in the home Common mistakes when referring to rehab How to write an order for PT, OT, or speech and what CPT codes to include Part B rehab does medication reconciliation How to order DME What is a 3-in-1 commode How long does it take to get a hospital bed paid for by Medicare FoxRehab.org

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/MeRWrKF6eno

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 episode What 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 care Managing dispatchers for home-based services How 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 is What could providers do better when ordering labs and radiology? Training nursing home staff on anatomy Point Click Care No trip fee on EKG and ultrasound; trip fee only on x-rays Do 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?

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/ebZZkHHBy30

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 facility Figuring out Same and Similar in the lab world Patient financial responsibility for labs drawn in a nursing home Lack of centralized database of lab data Integration with state health information exchange / CRISP What is a health information exchange? Why does CRISP charge the lab company to participate? Nursing home is paying for some lab tests directly Lab billing denials Revenue cycle management in the lab world What 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 stupid Trends in lab testing Molecular 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 testing PGX testing - what is it and why would you order it? Cost of PGX testing Are the results from PGX testing easy to interpret? Effect of PAMA on labs and lookback for lab payments Why doctors can't have their own labs