Mastering Medicare

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 Haft What is the Maryland Primary Care Program Maryland All Payer Model Global Budget Revenue Hospital Payment Model What do Primary Care Practice Transformation Coaches do Advanced Alternative Payment Model Track 1 Track 2 Upfront payments Is the Maryland Primary Care Program only for Medicare Carefirst participation in the Maryland Primary Care Program How much extra can physicians earn from the Maryland Primary Care Program Average $40,000 per year per physician Care Transformation Organizations Administrative requirements of the Primary Care Program ECQMs Alex's mind gets blown Empathy in healthcare 20% Reduction in avoidable admissions Predicting high risk patients and avoidable admissions How Maryland is using machine learning to support primary care doctors Social Determinants of Health services in Maryland How to order SDOH services from CRISP How community-based organizations can work with the Maryland Primary Care Program 211 service in Maryland Global Budget contracts Maryland Stakeholder Innovation Group

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 colleagues original medicare telemedicine telemedicine requirements Medicare telemedicine geography requirement Medicare telemedicine originating site requirement COVID19 Medicare telemedicine reimbursement updates HHS won't audit preexisting relationship rule, but what about MACs? Provider licensure requirements for telemedicine Fee for service telemedicine billing guide Home health telemedicine RPM (Remote Patient Monitoring) COVID19 Connection between real estate tax code and healthcare opportunities Why is Medicare paying for RPM How does remote monitoring work Alex's Concierge Medicine RPM article How much does RPM pay Medicare eVisit non-face-to-face encounters Role of RPM with addressing loneliness in seniors Some states' Medicaid programs pay for RPM Kudos to Dr. Blake McKinney from CirrusMD Telemedicine pictures need to be treated like radiology films Accuhealth RPM website Email us at amy@masteringmedicare.net or alex@masteringmedicare.net for our RPM Workbook

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 Treatment POLST: Physician's Orders for Life-Sustaining Treatment In this episode, we discuss: What is a MOLST form What is a POLST form Why should we talk about end of life care Coronavirus / COVID-19 concerns When 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 options

Dr. Amy Schiffman and Dr. Alex Mohseni explore Medicare Part D, discussing its stages, premiums, donut hole, and tiered medications. They cover the complexities of selecting a plan, deductible calculations, and patient responsibilities throughout the coverage stages.

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 B Professional services Part B Physical Therapy Part B Outpatient Labs Part B Outpatient Radiology Does Medicare pay for DME When does Medicare pay for 911 Medicare Part B is opt in How much does Medicare Part B cost Medicare Part B monthly premium Medicare covers part only 80% Medicare secondary insurance / Medigap / supplemental Part A vs Part B Physical Therapy Cost sharing for radiology Cost sharing for lab tests under Medicare Medicare limits on lab tests DME How do you order DME, wheelchair, hospital bed in a patient's home 13 month lease to own DME Same and similar DME Parachute same and similar DME

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 Medicare Qualifying for Medicare via ALS Qualifying for Medicare via ESRD on dialysis Qualifying for Medicare via SSDI disability Medicare and VA insurance History of Medicare Inpatient hospitalization Rehab aka SNF aka nursing home Home health Hospice Medicare copays and cost sharing for hospitalization Medicare part A annual deductible Medicare cost sharing with rehab SNF Medicare part A home health What is Home health? Home health 485 form What is skilled nursing? What does part A PT/OT do? Copay for part A PT OT Home health "taxing effort" Certification of being homebound home health Certification periods for home health Recertification of medicare part A home health Home health aides Home health 45 minutes twice per week Will Medicare pay for wound care supplies? Medicare hospice What is hospice Will Medicare pay for hospice Qualifying for hospice Hospice certification periods What does hospice cover and pay for Hospice payment model Who pays for a hospice patient if they go to the ER? Hospice is a risk bearing entity Hospice certification and recertification periods What does it mean to be admitted to a hospital

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 themselves Medicare overview Part A overview, including cost sharing Part A: Hospital, Rehab, Home Health, Hospice Part B overview Part B 80/20 split, Medigap / supplemental Part D Inpatient vs outpatient medications Inpatient vs outpatient status Observation status Part C - Medicare Advantage Join our Subscriber List to get your copy of our Medicare Cheat Sheet https://www.masteringmedicare.net/subscribe