{"version":"https://jsonfeed.org/version/1","title":"Mastering Medicare","home_page_url":"https://www.masteringmedicare.net","feed_url":"https://www.masteringmedicare.net/json","description":"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?\r\n\r\nFor 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.\r\n\r\nWe 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. \r\n\r\nYour 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. \r\n\r\nJoin our Facebook group: https://www.facebook.com/groups/602747270479020/\r\n\r\nJoin our Subscriber List and get exclusive access to our Mastering Medicare Cheat Sheet and other goodies: https://www.masteringmedicare.net/subscribe","_fireside":{"subtitle":"Demystifying healthcare and Medicare for senior-serving professionals and providers. ","pubdate":"2024-10-09T06:00:00.000-04:00","explicit":false,"copyright":"2025 by Avicention LLC","owner":"Mastering Medicare","image":"https://media24.fireside.fm/file/fireside-images-2024/podcasts/images/7/7ad1df9b-b658-4830-80a6-91982f00740a/cover.jpg?v=1"},"items":[{"id":"aa37d0c0-a402-454b-ad34-a59ec8dc6290","title":"Episode 26: DeepScribe: ambient scribing deep dive","url":"https://www.masteringmedicare.net/26","content_text":"E26: Deep dive into DeepScribe with Dr. Dean Dalili.\n\n\nIntroduction: Amy and Alex introduce the episode on AI in healthcare, featuring Dr. Dean Dalili from DeepScribe, an AI-based medical documentation service.\nDean's Background: Dr. Dean Dalili shares his journey from internist at Johns Hopkins to Chief Medical Officer at DeepScribe, with a career in hospitalist practice, digital health, and leadership roles.\nMedical Scribes and Documentation: Discussion on the role of medical scribes, both in-person and AI-based, in reducing physician burnout and streamlining patient care documentation.\nDeepScribe Overview: DeepScribe uses AI to record and transcribe patient interactions, converting them into medical documentation, saving time, and improving patient engagement.\nImpact of AI on Healthcare: AI captures more detailed patient information, leading to improved patient outcomes. Physicians can review, edit, and sign off on AI-generated notes.\nAmbient Intelligence: DeepScribe aims to provide not just transcription but also data-driven insights and decision support for providers.\nAI’s Potential: Discussion on AI assisting clinicians, not replacing them, by handling documentation and improving diagnostic accuracy.\nPatient Interaction: AI helps providers maintain eye contact and focus on the patient, improving patient satisfaction and engagement.\nAI Challenges and Future: Discussion on the evolving role of AI in healthcare, with possibilities for AI taking on more decision-making roles while working alongside physicians.\nConclusion: The hosts reflect on the potential of AI to change healthcare workflows, and Dean invites listeners to learn more about DeepScribe and its applications in various healthcare settings.\n","content_html":"\u003cp\u003eE26: Deep dive into \u003ca href=\"https://www.deepscribe.ai/\" rel=\"nofollow\"\u003eDeepScribe\u003c/a\u003e with Dr. Dean Dalili.\u003c/p\u003e\n\n\u003cul\u003e\n\u003cli\u003e\u003cstrong\u003eIntroduction\u003c/strong\u003e: Amy and Alex introduce the episode on AI in healthcare, featuring Dr. Dean Dalili from DeepScribe, an AI-based medical documentation service.\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eDean\u0026#39;s Background\u003c/strong\u003e: Dr. Dean Dalili shares his journey from internist at Johns Hopkins to Chief Medical Officer at DeepScribe, with a career in hospitalist practice, digital health, and leadership roles.\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eMedical Scribes and Documentation\u003c/strong\u003e: Discussion on the role of medical scribes, both in-person and AI-based, in reducing physician burnout and streamlining patient care documentation.\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eDeepScribe Overview\u003c/strong\u003e: DeepScribe uses AI to record and transcribe patient interactions, converting them into medical documentation, saving time, and improving patient engagement.\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eImpact of AI on Healthcare\u003c/strong\u003e: AI captures more detailed patient information, leading to improved patient outcomes. Physicians can review, edit, and sign off on AI-generated notes.\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eAmbient Intelligence\u003c/strong\u003e: DeepScribe aims to provide not just transcription but also data-driven insights and decision support for providers.\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eAI’s Potential\u003c/strong\u003e: Discussion on AI assisting clinicians, not replacing them, by handling documentation and improving diagnostic accuracy.\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003ePatient Interaction\u003c/strong\u003e: AI helps providers maintain eye contact and focus on the patient, improving patient satisfaction and engagement.\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eAI Challenges and Future\u003c/strong\u003e: Discussion on the evolving role of AI in healthcare, with possibilities for AI taking on more decision-making roles while working alongside physicians.\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e: The hosts reflect on the potential of AI to change healthcare workflows, and Dean invites listeners to learn more about DeepScribe and its applications in various healthcare settings.\u003c/li\u003e\n\u003c/ul\u003e","summary":"Mastering Medicare is a podcast helping demystify healthcare and Medicare for senior-serving professionals and providers. ","date_published":"2024-10-09T06:00:00.000-04:00","attachments":[{"url":"https://aphid.fireside.fm/d/1437767933/7ad1df9b-b658-4830-80a6-91982f00740a/aa37d0c0-a402-454b-ad34-a59ec8dc6290.mp3","mime_type":"audio/mpeg","size_in_bytes":51305008,"duration_in_seconds":3206}]},{"id":"e2eac381-da74-431c-b144-76794d9279e0","title":"Episode 25: PACE Program deep dive","url":"https://www.masteringmedicare.net/25","content_text":"E25: Deep dive into the PACE program with Dr Rob Schreiber and Eric Patzelt from myPlace Health. \n\n\nPACE Overview: Program of All-Inclusive Care for the Elderly provides comprehensive care for seniors, allowing them to live in the community rather than nursing homes.\nEligibility: Seniors must be 55+, certifiable for nursing home care, and safe in the community with PACE services.\nFunding: PACE is funded by Medicare, Medicaid, and individual contributions, with high startup costs and a long-term recovery period.\nRevenue: PACE receives ~$9,500–11,000 PMPM for dual-eligible members and ~$7,000–8,000 for Medicaid-only members, higher than Medicare Advantage.\nServices Provided: Includes adult day care, primary care, home care, dental, therapy, nutrition, social work, and transportation.\nTarget Demographic: Serves high-need populations with complex health issues and short life expectancy, helping to manage costs and reduce hospitalizations.\nCoverage: PACE covers all care aspects except direct housing costs unless in a nursing home, where it covers the non-Social Security portion.\nHandling Health Declines: Provides immediate care and support, including home visits and temporary nursing home placements.\nTechnology Integration: Uses technology for communication, remote monitoring, and data analysis, especially accelerated by COVID-19.\nFinancial Implications: PACE can save money in the long run by reducing hospitalizations and emergency visits, though initial costs are high.\nEnrollment: Participants can leave voluntarily or be involuntarily disenrolled due to death, loss of coverage, or moving out of the service area.\nComparison to Medicare Models: PACE offers an integrated care model distinct from Medicare Parts A, B, C, and D, operating on a capitated model.\nHospice Care: PACE provides comprehensive end-of-life care, but participants must disenroll from PACE to fully access hospice services.\nSocial Work Role: Social workers in PACE advocate for participants, addressing needs and enhancing care through personal connections.\nHealthcare Innovation: Models like PACE demonstrate potential for improved care and outcomes, with ongoing support and adaptation crucial for success.\n","content_html":"\u003cp\u003eE25: Deep dive into the PACE program with Dr Rob Schreiber and Eric Patzelt from \u003ca href=\"https://www.myplacehealth.com/\" rel=\"nofollow\"\u003emyPlace Health\u003c/a\u003e. \u003c/p\u003e\n\n\u003cul\u003e\n\u003cli\u003e\u003cstrong\u003ePACE Overview\u003c/strong\u003e: Program of All-Inclusive Care for the Elderly provides comprehensive care for seniors, allowing them to live in the community rather than nursing homes.\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eEligibility\u003c/strong\u003e: Seniors must be 55+, certifiable for nursing home care, and safe in the community with PACE services.\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eFunding\u003c/strong\u003e: PACE is funded by Medicare, Medicaid, and individual contributions, with high startup costs and a long-term recovery period.\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eRevenue\u003c/strong\u003e: PACE receives ~$9,500–11,000 PMPM for dual-eligible members and ~$7,000–8,000 for Medicaid-only members, higher than Medicare Advantage.\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eServices Provided\u003c/strong\u003e: Includes adult day care, primary care, home care, dental, therapy, nutrition, social work, and transportation.\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eTarget Demographic\u003c/strong\u003e: Serves high-need populations with complex health issues and short life expectancy, helping to manage costs and reduce hospitalizations.\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eCoverage\u003c/strong\u003e: PACE covers all care aspects except direct housing costs unless in a nursing home, where it covers the non-Social Security portion.\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eHandling Health Declines\u003c/strong\u003e: Provides immediate care and support, including home visits and temporary nursing home placements.\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eTechnology Integration\u003c/strong\u003e: Uses technology for communication, remote monitoring, and data analysis, especially accelerated by COVID-19.\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eFinancial Implications\u003c/strong\u003e: PACE can save money in the long run by reducing hospitalizations and emergency visits, though initial costs are high.\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eEnrollment\u003c/strong\u003e: Participants can leave voluntarily or be involuntarily disenrolled due to death, loss of coverage, or moving out of the service area.\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eComparison to Medicare Models\u003c/strong\u003e: PACE offers an integrated care model distinct from Medicare Parts A, B, C, and D, operating on a capitated model.\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eHospice Care\u003c/strong\u003e: PACE provides comprehensive end-of-life care, but participants must disenroll from PACE to fully access hospice services.\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eSocial Work Role\u003c/strong\u003e: Social workers in PACE advocate for participants, addressing needs and enhancing care through personal connections.\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eHealthcare Innovation\u003c/strong\u003e: Models like PACE demonstrate potential for improved care and outcomes, with ongoing support and adaptation crucial for success.\u003c/li\u003e\n\u003c/ul\u003e","summary":"Mastering Medicare is a podcast helping demystify healthcare and Medicare for senior-serving professionals and providers. ","date_published":"2024-09-21T11:00:00.000-04:00","attachments":[{"url":"https://aphid.fireside.fm/d/1437767933/7ad1df9b-b658-4830-80a6-91982f00740a/e2eac381-da74-431c-b144-76794d9279e0.mp3","mime_type":"audio/mpeg","size_in_bytes":61243651,"duration_in_seconds":3827}]},{"id":"bd0d716a-3993-4681-9b5b-a5f1f2b2c9e5","title":"Episode 23: Medicare broker deep dive - interview with Matt Gibson from 90 Days From Retirement","url":"https://www.masteringmedicare.net/23","content_text":"\nIntroduction of the guest Matt Gibson from 90 Days from Retirement, a platform educating about insurance post-retirement.\nDiscussion about the prevalence of insurance agents buying leads of people turning 65 and how 90 Days from Retirement differs by providing education instead.\nPeople turning 65 often receive unsolicited mail and phone calls offering help with Medicare, which can be overwhelming.\nExplanation that data about people turning 65 is publicly available, and some businesses generate leads by buying and selling this data.\nMention of the lack of enforcement of rules against unsolicited phone calls to sell certain Medicare products.\nBrief explanation of the main products sold by Matt's agency, including Medicare supplement plans also known as Medigap plans.\nMedicare and Medigap: Medigap plans supplement Medicare by covering deductibles and co-insurance that Medicare doesn't cover. This is one path individuals can take when they start Medicare.\nMedicare Advantage (Part C): Contrary to Medigap, Medicare Advantage acts as a replacement policy for Medicare. When someone signs up for a Medicare Advantage plan, their Medicare parts A and B are essentially turned off and the responsibility for payment and administration is transferred to the insurer. In exchange, Medicare pays the insurer a monthly fee.\nMedicare Advantage Plan Payment: Most Advantage plans have zero monthly premium for the individual because the insurer receives payment from Medicare, which can be a substantial sum.\nBecoming a Medicare Broker: To become a broker, one must be health insurance licensed, contract with specific insurance companies, and pass carrier-specific training and certification. The process can be time-consuming and complex.\nCommission Structure: Brokers must contract with insurance companies to earn commission. The commission rates are standardized and set by CMS. They do not directly negotiate these commissions but rather work under the structures set by larger field marketing operations (FMOs).\nMedicare Advantage (MA) plans and Part D drug plans are highly regulated, and insurance carriers cannot incentivize brokers to sell more products through bonuses or rewards.\nWhen a broker facilitates the signup of a client for an MA plan, their name and broker ID number are included in the application (paper or electronic), enabling the insurance carrier to attribute the commission.\nBrokers must be certified and part of the network of the plan they are selling. They can't start selling a plan for which they haven't taken certification.\nThe availability of MA plans varies by zip code, influenced by factors such as population and medical resources. Brokers are licensed by state and may not have access to marketing materials or sell plans in states where they are not licensed.\nIf a broker is certified with a limited number of MA plans available in a client's region, they are expected to inform the client about the existence of other plans, even if they don't earn a commission on them.\nBrokers often have to narrow down the choice of plans based on the client's needs, including preferred doctors, medications, and hospital networks.\nAll telephonic or online consultations have to be recorded, and brokers are required to inform clients that they might not be licensed with every product in the area, even if they are.\nThere were approximately 60,000 complaints to Medicare from call centers in the previous year, likely because brokers were not fully representing all available products in their market.\nBrokers use tools to compare the cost of medications across carriers and to search for doctors within each carrier's network. However, some carriers choose not to participate with certain tools, requiring brokers to go directly to the carrier's website.\nThe discussion involves health insurance, Medicare Advantage (MA) plans, and how insurance agents/brokers operate.\nThe speaker mentions a preference for checking a carrier's site when looking for doctors or dentists.\nAgents often receive an upfront commission when clients sign up, followed by smaller, ongoing commissions for renewals.\nAfter signing clients, the speaker’s office offers full service, assisting with claims, billing, and more. They provide quarterly newsletters and communicate regularly, especially during annual election periods.\nIf a client's MA plan is changing significantly, the agent may recommend exploring other options. However, if the plan remains largely the same, clients are advised to continue with it.\nNot many clients switch from one MA plan to another, or from MA to original Medicare, or vice versa. Changes typically occur due to network alterations, alteration in benefits, or advertisements.\nSwitching from an MA plan to a supplement plan is not always easy and may involve health questions and underwriting. Outside of specific open enrollment windows, clients cannot switch.\nChurn within the MA system does occur, though it doesn't benefit the speaker's agency financially to regularly switch clients' plans. Other agents, however, may benefit from such churn.\nThere is no cost to the consumer to work with an agent. Agents are also not allowed to buy meals or gifts for potential clients, though smaller items such as coffee or appetizers are permitted.\nThere is no underwriting process for MA plans. Once you have Medicare and live within the service area, you are eligible.\nFor more information or assistance, the speaker invites people to visit their website, 90daysfromretirement.com.\n","content_html":"\u003cul\u003e\n\u003cli\u003eIntroduction of the guest Matt Gibson from 90 Days from Retirement, a platform educating about insurance post-retirement.\u003c/li\u003e\n\u003cli\u003eDiscussion about the prevalence of insurance agents buying leads of people turning 65 and how 90 Days from Retirement differs by providing education instead.\u003c/li\u003e\n\u003cli\u003ePeople turning 65 often receive unsolicited mail and phone calls offering help with Medicare, which can be overwhelming.\u003c/li\u003e\n\u003cli\u003eExplanation that data about people turning 65 is publicly available, and some businesses generate leads by buying and selling this data.\u003c/li\u003e\n\u003cli\u003eMention of the lack of enforcement of rules against unsolicited phone calls to sell certain Medicare products.\u003c/li\u003e\n\u003cli\u003eBrief explanation of the main products sold by Matt\u0026#39;s agency, including Medicare supplement plans also known as Medigap plans.\u003c/li\u003e\n\u003cli\u003eMedicare and Medigap: Medigap plans supplement Medicare by covering deductibles and co-insurance that Medicare doesn\u0026#39;t cover. This is one path individuals can take when they start Medicare.\u003c/li\u003e\n\u003cli\u003eMedicare Advantage (Part C): Contrary to Medigap, Medicare Advantage acts as a replacement policy for Medicare. When someone signs up for a Medicare Advantage plan, their Medicare parts A and B are essentially turned off and the responsibility for payment and administration is transferred to the insurer. In exchange, Medicare pays the insurer a monthly fee.\u003c/li\u003e\n\u003cli\u003eMedicare Advantage Plan Payment: Most Advantage plans have zero monthly premium for the individual because the insurer receives payment from Medicare, which can be a substantial sum.\u003c/li\u003e\n\u003cli\u003eBecoming a Medicare Broker: To become a broker, one must be health insurance licensed, contract with specific insurance companies, and pass carrier-specific training and certification. The process can be time-consuming and complex.\u003c/li\u003e\n\u003cli\u003eCommission Structure: Brokers must contract with insurance companies to earn commission. The commission rates are standardized and set by CMS. They do not directly negotiate these commissions but rather work under the structures set by larger field marketing operations (FMOs).\u003c/li\u003e\n\u003cli\u003eMedicare Advantage (MA) plans and Part D drug plans are highly regulated, and insurance carriers cannot incentivize brokers to sell more products through bonuses or rewards.\u003c/li\u003e\n\u003cli\u003eWhen a broker facilitates the signup of a client for an MA plan, their name and broker ID number are included in the application (paper or electronic), enabling the insurance carrier to attribute the commission.\u003c/li\u003e\n\u003cli\u003eBrokers must be certified and part of the network of the plan they are selling. They can\u0026#39;t start selling a plan for which they haven\u0026#39;t taken certification.\u003c/li\u003e\n\u003cli\u003eThe availability of MA plans varies by zip code, influenced by factors such as population and medical resources. Brokers are licensed by state and may not have access to marketing materials or sell plans in states where they are not licensed.\u003c/li\u003e\n\u003cli\u003eIf a broker is certified with a limited number of MA plans available in a client\u0026#39;s region, they are expected to inform the client about the existence of other plans, even if they don\u0026#39;t earn a commission on them.\u003c/li\u003e\n\u003cli\u003eBrokers often have to narrow down the choice of plans based on the client\u0026#39;s needs, including preferred doctors, medications, and hospital networks.\u003c/li\u003e\n\u003cli\u003eAll telephonic or online consultations have to be recorded, and brokers are required to inform clients that they might not be licensed with every product in the area, even if they are.\u003c/li\u003e\n\u003cli\u003eThere were approximately 60,000 complaints to Medicare from call centers in the previous year, likely because brokers were not fully representing all available products in their market.\u003c/li\u003e\n\u003cli\u003eBrokers use tools to compare the cost of medications across carriers and to search for doctors within each carrier\u0026#39;s network. However, some carriers choose not to participate with certain tools, requiring brokers to go directly to the carrier\u0026#39;s website.\u003c/li\u003e\n\u003cli\u003eThe discussion involves health insurance, Medicare Advantage (MA) plans, and how insurance agents/brokers operate.\u003c/li\u003e\n\u003cli\u003eThe speaker mentions a preference for checking a carrier\u0026#39;s site when looking for doctors or dentists.\u003c/li\u003e\n\u003cli\u003eAgents often receive an upfront commission when clients sign up, followed by smaller, ongoing commissions for renewals.\u003c/li\u003e\n\u003cli\u003eAfter signing clients, the speaker’s office offers full service, assisting with claims, billing, and more. They provide quarterly newsletters and communicate regularly, especially during annual election periods.\u003c/li\u003e\n\u003cli\u003eIf a client\u0026#39;s MA plan is changing significantly, the agent may recommend exploring other options. However, if the plan remains largely the same, clients are advised to continue with it.\u003c/li\u003e\n\u003cli\u003eNot many clients switch from one MA plan to another, or from MA to original Medicare, or vice versa. Changes typically occur due to network alterations, alteration in benefits, or advertisements.\u003c/li\u003e\n\u003cli\u003eSwitching from an MA plan to a supplement plan is not always easy and may involve health questions and underwriting. Outside of specific open enrollment windows, clients cannot switch.\u003c/li\u003e\n\u003cli\u003eChurn within the MA system does occur, though it doesn\u0026#39;t benefit the speaker\u0026#39;s agency financially to regularly switch clients\u0026#39; plans. Other agents, however, may benefit from such churn.\u003c/li\u003e\n\u003cli\u003eThere is no cost to the consumer to work with an agent. Agents are also not allowed to buy meals or gifts for potential clients, though smaller items such as coffee or appetizers are permitted.\u003c/li\u003e\n\u003cli\u003eThere is no underwriting process for MA plans. Once you have Medicare and live within the service area, you are eligible.\u003c/li\u003e\n\u003cli\u003eFor more information or assistance, the speaker invites people to visit their website, 90daysfromretirement.com.\u003c/li\u003e\n\u003c/ul\u003e","summary":"Mastering Medicare is a podcast helping demystify healthcare and Medicare for senior-serving professionals and providers. ","date_published":"2023-06-21T12:00:00.000-04:00","attachments":[{"url":"https://aphid.fireside.fm/d/1437767933/7ad1df9b-b658-4830-80a6-91982f00740a/bd0d716a-3993-4681-9b5b-a5f1f2b2c9e5.mp3","mime_type":"audio/mpeg","size_in_bytes":42198578,"duration_in_seconds":2637}]},{"id":"636ef8a9-654d-40ef-aa20-b1700fb03683","title":"Episode 22: Interview with Dr. Marc Gruner from Limber about Remote Therapeutic Monitoring","url":"https://www.masteringmedicare.net/22","content_text":"\nIntroduction of a new product called Aging Here newsletter\nRequest for subscriptions and feedback for Aging Here\nIntroduction of guest Dr. Marc Gruner from Limber Health\nMarc's background as a physician and entrepreneur\nMarc's involvement in creating new CPT codes for RTM\nIntroduction to Limber Health and its solution for improving therapy adherence\nExplanation of how Limber's app helps monitor and track exercises at home\nImportance of home exercise therapy for better outcomes\nPotential for house calls in physical therapy\nChallenges with traditional paper printouts for home exercises\nImportance of creating a sustainable lifestyle of exercising at home\nAverage age of patients receiving remote therapeutic monitoring (RTM)\nProblems solved by Limber: confusion, compliance, unnecessary surgeries, cost reduction\nFrustration as a physician prescribing physical therapy\nBarriers to successful therapy: cost, time, travel\nNeed for codes to support RTM model\nInvolvement in the development of new RTM codes\nImportance of a good business model for providers\nCollaboration with AMA and other stakeholders to develop new codes\nImportance of filling out forms and persevering through the process\nOverview of the process for physical therapists using Limber Health\nRisk stratification and evaluation of patients' pain and function\nSelection of exercises for patients to do at home through a portal\nCare navigators reaching out to patients and monitoring their progress\nRemote monitoring of exercises and tracking pain and function\nProviders are the buyers and pay for the services\nDifference between RTM and RPM billing: RTM can be billed by various providers including physical therapists\nPotential impact on revenue for physical therapists and improved patient outcomes\nProviders, including physicians, PAs, NPs, and physical therapists, can bill RTM codes\nReimbursement for RTM codes varies based on billable milestones achieved\nLimber and similar companies support providers with technology and clinical services\nRTM codes can be used in fee-for-service and value-based care models\nLimber aims to lower total cost of care and improve patient outcomes\nMaryland offers innovative value-based care models through programs like Equip\nProviders can sign up for Limber's services through a contract and training process\nParticipating providers may receive shared savings in value-based care models\nPatients are informed and consent is obtained for remote therapeutic monitoring\nPatient awareness of risk-taking in value-based care models may vary and can be addressed with the state of Maryland\nLimber does not have a direct-to-consumer model but works with provider groups in various states\nProviders using Limber's system can be identified through partnerships and collaborations\nCompliance with therapy can potentially offset or delay the cost of procedures like knee replacements.\n","content_html":"\u003cul\u003e\n\u003cli\u003eIntroduction of a new product called Aging Here newsletter\u003c/li\u003e\n\u003cli\u003eRequest for subscriptions and feedback for Aging Here\u003c/li\u003e\n\u003cli\u003eIntroduction of guest Dr. Marc Gruner from \u003ca href=\"https://www.limberhealth.com/\" rel=\"nofollow\"\u003eLimber Health\u003c/a\u003e\u003c/li\u003e\n\u003cli\u003eMarc\u0026#39;s background as a physician and entrepreneur\u003c/li\u003e\n\u003cli\u003eMarc\u0026#39;s involvement in creating new CPT codes for RTM\u003c/li\u003e\n\u003cli\u003eIntroduction to Limber Health and its solution for improving therapy adherence\u003c/li\u003e\n\u003cli\u003eExplanation of how Limber\u0026#39;s app helps monitor and track exercises at home\u003c/li\u003e\n\u003cli\u003eImportance of home exercise therapy for better outcomes\u003c/li\u003e\n\u003cli\u003ePotential for house calls in physical therapy\u003c/li\u003e\n\u003cli\u003eChallenges with traditional paper printouts for home exercises\u003c/li\u003e\n\u003cli\u003eImportance of creating a sustainable lifestyle of exercising at home\u003c/li\u003e\n\u003cli\u003eAverage age of patients receiving remote therapeutic monitoring (RTM)\u003c/li\u003e\n\u003cli\u003eProblems solved by Limber: confusion, compliance, unnecessary surgeries, cost reduction\u003c/li\u003e\n\u003cli\u003eFrustration as a physician prescribing physical therapy\u003c/li\u003e\n\u003cli\u003eBarriers to successful therapy: cost, time, travel\u003c/li\u003e\n\u003cli\u003eNeed for codes to support RTM model\u003c/li\u003e\n\u003cli\u003eInvolvement in the development of new RTM codes\u003c/li\u003e\n\u003cli\u003eImportance of a good business model for providers\u003c/li\u003e\n\u003cli\u003eCollaboration with AMA and other stakeholders to develop new codes\u003c/li\u003e\n\u003cli\u003eImportance of filling out forms and persevering through the process\u003c/li\u003e\n\u003cli\u003eOverview of the process for physical therapists using Limber Health\u003c/li\u003e\n\u003cli\u003eRisk stratification and evaluation of patients\u0026#39; pain and function\u003c/li\u003e\n\u003cli\u003eSelection of exercises for patients to do at home through a portal\u003c/li\u003e\n\u003cli\u003eCare navigators reaching out to patients and monitoring their progress\u003c/li\u003e\n\u003cli\u003eRemote monitoring of exercises and tracking pain and function\u003c/li\u003e\n\u003cli\u003eProviders are the buyers and pay for the services\u003c/li\u003e\n\u003cli\u003eDifference between RTM and RPM billing: RTM can be billed by various providers including physical therapists\u003c/li\u003e\n\u003cli\u003ePotential impact on revenue for physical therapists and improved patient outcomes\u003c/li\u003e\n\u003cli\u003eProviders, including physicians, PAs, NPs, and physical therapists, can bill RTM codes\u003c/li\u003e\n\u003cli\u003eReimbursement for RTM codes varies based on billable milestones achieved\u003c/li\u003e\n\u003cli\u003eLimber and similar companies support providers with technology and clinical services\u003c/li\u003e\n\u003cli\u003eRTM codes can be used in fee-for-service and value-based care models\u003c/li\u003e\n\u003cli\u003eLimber aims to lower total cost of care and improve patient outcomes\u003c/li\u003e\n\u003cli\u003eMaryland offers innovative value-based care models through programs like Equip\u003c/li\u003e\n\u003cli\u003eProviders can sign up for Limber\u0026#39;s services through a contract and training process\u003c/li\u003e\n\u003cli\u003eParticipating providers may receive shared savings in value-based care models\u003c/li\u003e\n\u003cli\u003ePatients are informed and consent is obtained for remote therapeutic monitoring\u003c/li\u003e\n\u003cli\u003ePatient awareness of risk-taking in value-based care models may vary and can be addressed with the state of Maryland\u003c/li\u003e\n\u003cli\u003eLimber does not have a direct-to-consumer model but works with provider groups in various states\u003c/li\u003e\n\u003cli\u003eProviders using Limber\u0026#39;s system can be identified through partnerships and collaborations\u003c/li\u003e\n\u003cli\u003eCompliance with therapy can potentially offset or delay the cost of procedures like knee replacements.\u003c/li\u003e\n\u003c/ul\u003e","summary":"Mastering Medicare is a podcast helping demystify healthcare and Medicare for senior-serving professionals and providers. ","date_published":"2023-06-20T13:00:00.000-04:00","attachments":[{"url":"https://aphid.fireside.fm/d/1437767933/7ad1df9b-b658-4830-80a6-91982f00740a/636ef8a9-654d-40ef-aa20-b1700fb03683.mp3","mime_type":"audio/mpeg","size_in_bytes":40919126,"duration_in_seconds":2557}]},{"id":"027b065a-1ecd-46c5-aa14-36474b19cc64","title":"Episode 21: CPT Codes and How You Get Paid in Medicare","url":"https://www.masteringmedicare.net/21","content_text":"\nDiscussion topic: Getting paid through the Medicare system\nIntroduction to CPT codes and HICPICS codes\nMedicare's payment process for healthcare providers\nFuture guests and topics related to Medicare reimbursement\nMention of the Aging Here newsletter and interview opportunities\nDifferentiating between CPT codes and ICD-10 codes\nHistory and purpose of CPT codes\nExplanation of RVUs (Relative Value Units) and how doctors are paid\nSimplified process of submitting CPT codes to Medicare for payment\nPotential fraud issues in fee-for-service Medicare\nImportance of documentation and medical necessity for CPT codes\nChallenges with lack of comprehensive guidelines for new codes\nProviders struggle with the interpretation and utilization of CPT codes.\nSome codes are rarely utilized, while others require expertise to maximize billing.\nCoding rules can be complex, with restrictions on code combinations and frequency of billing.\nProviders face the risk of financial penalties or legal consequences for incorrect coding.\nMedicare is a significant payer and requires compliance with its rules.\nPhysicians, nurse practitioners, and physician assistants primarily use CPT codes.\nModifiers can be used to bill for additional services or special circumstances.\nHospice CPT codes exist separately from Part B coding.\nCPT codes have RVUs (Relative Value Units) that determine payment.\nRVUs are divided into work RVUs, which assess the labor involved in a procedure.\nWork RVUs consider time, technical skill, physical effort, mental effort, judgment, and stress.\nWork RVUs are subject to negotiation and lobbying each year.\nThe conversion factor translates RVUs into payment amounts.\nThe conversion factor is subject to annual adjustments and can significantly impact reimbursement.\n","content_html":"\u003cul\u003e\n\u003cli\u003eDiscussion topic: Getting paid through the Medicare system\u003c/li\u003e\n\u003cli\u003eIntroduction to CPT codes and HICPICS codes\u003c/li\u003e\n\u003cli\u003eMedicare\u0026#39;s payment process for healthcare providers\u003c/li\u003e\n\u003cli\u003eFuture guests and topics related to Medicare reimbursement\u003c/li\u003e\n\u003cli\u003eMention of the Aging Here newsletter and interview opportunities\u003c/li\u003e\n\u003cli\u003eDifferentiating between CPT codes and ICD-10 codes\u003c/li\u003e\n\u003cli\u003eHistory and purpose of CPT codes\u003c/li\u003e\n\u003cli\u003eExplanation of RVUs (Relative Value Units) and how doctors are paid\u003c/li\u003e\n\u003cli\u003eSimplified process of submitting CPT codes to Medicare for payment\u003c/li\u003e\n\u003cli\u003ePotential fraud issues in fee-for-service Medicare\u003c/li\u003e\n\u003cli\u003eImportance of documentation and medical necessity for CPT codes\u003c/li\u003e\n\u003cli\u003eChallenges with lack of comprehensive guidelines for new codes\u003c/li\u003e\n\u003cli\u003eProviders struggle with the interpretation and utilization of CPT codes.\u003c/li\u003e\n\u003cli\u003eSome codes are rarely utilized, while others require expertise to maximize billing.\u003c/li\u003e\n\u003cli\u003eCoding rules can be complex, with restrictions on code combinations and frequency of billing.\u003c/li\u003e\n\u003cli\u003eProviders face the risk of financial penalties or legal consequences for incorrect coding.\u003c/li\u003e\n\u003cli\u003eMedicare is a significant payer and requires compliance with its rules.\u003c/li\u003e\n\u003cli\u003ePhysicians, nurse practitioners, and physician assistants primarily use CPT codes.\u003c/li\u003e\n\u003cli\u003eModifiers can be used to bill for additional services or special circumstances.\u003c/li\u003e\n\u003cli\u003eHospice CPT codes exist separately from Part B coding.\u003c/li\u003e\n\u003cli\u003eCPT codes have RVUs (Relative Value Units) that determine payment.\u003c/li\u003e\n\u003cli\u003eRVUs are divided into work RVUs, which assess the labor involved in a procedure.\u003c/li\u003e\n\u003cli\u003eWork RVUs consider time, technical skill, physical effort, mental effort, judgment, and stress.\u003c/li\u003e\n\u003cli\u003eWork RVUs are subject to negotiation and lobbying each year.\u003c/li\u003e\n\u003cli\u003eThe conversion factor translates RVUs into payment amounts.\u003c/li\u003e\n\u003cli\u003eThe conversion factor is subject to annual adjustments and can significantly impact reimbursement.\u003c/li\u003e\n\u003c/ul\u003e","summary":"Mastering Medicare is a podcast helping demystify healthcare and Medicare for senior-serving professionals and providers. ","date_published":"2023-06-06T13:00:00.000-04:00","attachments":[{"url":"https://aphid.fireside.fm/d/1437767933/7ad1df9b-b658-4830-80a6-91982f00740a/027b065a-1ecd-46c5-aa14-36474b19cc64.mp3","mime_type":"audio/mpeg","size_in_bytes":41014047,"duration_in_seconds":2563}]},{"id":"4959bc47-8d81-4191-8b12-397375ac99c2","title":"Episode 20: Medicare Advantage and Delegated Medical Group Deep Dive with Alex Mohseni","url":"https://www.masteringmedicare.net/20","content_text":"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. \nWe interview eldercare and Medicare industry experts, do deep dives into their companies, services, and experiences, and share their stories and insights with you. \n\n\nThe Mastering Medicare Podcast is back from a long hiatus caused by both hosts taking W2 jobs during the COVID-19 pandemic.\nDuring their time away, they learned a lot about the changing landscape of Medicare, especially with the rise of AI and value-based care models.\nValue-based care was a particular focus in the discussion, with Dr. Mohseni sharing his experiences working at Optum and learning about the value-based care model, particularly within Medicare Advantage.\nValue-based care is touted as the future care model for the US healthcare system. It aligns incentives for patients, providers, and health plans, reducing waste and delivering more effective care at lower costs.\nThe co-hosts contrasted value-based care with the fee-for-service model, pointing out that value-based care requires all parties to be financially invested in patient outcomes, incentivizing efficiency and effectiveness in care.\nThey also highlighted the importance of collaboration and communication in value-based care, contrasting it with the disjointed nature of fee-for-service care, where different health providers often work in silos.\nAn example of effective communication was shared from Dr. Mohseni’s time at Optum, where real-time notifications were used to coordinate care for patients who arrived at the emergency department, leading to better outcomes for the patients and more efficient care delivery.\nThe speaker expresses curiosity about why the value-based healthcare system isn't prevalent, considering its beneficial aspects, such as better access to specialists and greater collaboration between healthcare providers.\nQuestions are raised regarding the incentives for primary care doctors to transition from the regular fee-for-service model to a more complex value-based model, with no clear motivation at the moment.\nThe discussion mentions gradual efforts by Medicare and CMS (Centers for Medicare and Medicaid Services) to encourage a move towards value-based healthcare, through strategies such as upside gain, share upside models, and ACOs (Accountable Care Organizations).\nThe Medicare Advantage (MA) model, which has been fully at risk for some time, is described as an effective example of a value-based system.\nThe complexity of intermediary programs in the fee-for-service model is noted, as many providers either can't understand the rules or choose not to participate due to the complexity.\nThe speaker then elaborates on the workings of MA plans, wherein health plans are paid by the federal government per member per month to take full global risk on a patient for all of their professional medical expenses.\nThese MA plans then delegate this risk to a selected medical group, which then uses the allocated funds to manage the patient's healthcare. The remaining difference between the allocated funds and actual healthcare costs becomes the medical group's profit.\nThis model incentivizes medical groups to keep patients healthy and manage their costs efficiently.\nThe allocation of funds enables medical groups to acquire services like dieticians or care managers, which are often missing in the traditional fee-for-service model. This allows for a more holistic, patient-centered approach to healthcare.\nThe conversation discusses a situation where a patient contacts their doctor's office after hours, and rather than being directed to the emergency room, the doctor is willing to solve the issue over the phone. This is because the doctor is being compensated monthly, rather than by individual visits or treatments.\nIt is stated that any company can start a Medicare Advantage (MA) plan and people can sign up for it. However, these companies often contract with groups like Optum to handle the provision of care. This is paid for by a fraction of the funding that Medicare provides to the MA plan.\nDoctors are incentivized to provide extra value in their services and keep costs low because they receive a chunk of money to provide the necessary services, and they keep the difference of what they don't spend.\nIn the case of a patient with more serious health conditions, a system of risk adjustment is in place. This means that doctors annually document the patient's conditions, which contributes to their Health Condition Category (HCC) score. The higher the score, the more funding the medical group receives.\nThe conversation suggests that the Medicare Advantage world has been increasingly focused on risk adjustment, given its substantial impact on revenue. However, this has raised concerns about gaming the system and potential fraud.\nIn the future, it is suggested that there will be a greater focus on better patient outcomes and coordination to maintain profit margins, rather than on risk adjustment. This is expected to spur innovation and the creation of improved solutions for patients.\nThe conversation discusses the idea of reducing healthcare utilization with a focus on reducing Emergency Department (ED) visits and hospitalizations.\nThe speakers note that much of the current thinking centers on reducing the need for hospital care through better patient services, new tech, and addressing social determinants of health.\nTwo additional areas of potential reduction in healthcare spending are identified: pharmacy (particularly unnecessary use of expensive brand name drugs when generics would suffice) and unnecessary surgeries or inefficient surgical procedures.\nThe speakers emphasize that a lot of care currently delivered in hospitals could be effectively and more cost-efficiently delivered at home.\nThe conversation then transitions to discussing how the home-based care trend can connect with value-based systems and the opportunities for innovation this brings. There's a focus on how different players in the healthcare system (from family caregivers to healthcare professionals to tech innovators) can collaborate to improve patient care.\nThey mention the establishment of Medicare Advantage (MA) programs, where healthcare groups receive a capitated payment from Medicare based on a patient's Health Condition Categories (HCC) score.\nThe speakers then introduce a new initiative, AgingHere.com, a newsletter focused on facilitating a community around aging in place and home-based care. They invite ideas and stories from their audience to share in this platform.\n","content_html":"\u003cp\u003ePhysicians 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. \u003cbr\u003e\nWe interview eldercare and Medicare industry experts, do deep dives into their companies, services, and experiences, and share their stories and insights with you. \u003c/p\u003e\n\n\u003cul\u003e\n\u003cli\u003eThe Mastering Medicare Podcast is back from a long hiatus caused by both hosts taking W2 jobs during the COVID-19 pandemic.\u003c/li\u003e\n\u003cli\u003eDuring their time away, they learned a lot about the changing landscape of Medicare, especially with the rise of AI and value-based care models.\u003c/li\u003e\n\u003cli\u003eValue-based care was a particular focus in the discussion, with Dr. Mohseni sharing his experiences working at Optum and learning about the value-based care model, particularly within Medicare Advantage.\u003c/li\u003e\n\u003cli\u003eValue-based care is touted as the future care model for the US healthcare system. It aligns incentives for patients, providers, and health plans, reducing waste and delivering more effective care at lower costs.\u003c/li\u003e\n\u003cli\u003eThe co-hosts contrasted value-based care with the fee-for-service model, pointing out that value-based care requires all parties to be financially invested in patient outcomes, incentivizing efficiency and effectiveness in care.\u003c/li\u003e\n\u003cli\u003eThey also highlighted the importance of collaboration and communication in value-based care, contrasting it with the disjointed nature of fee-for-service care, where different health providers often work in silos.\u003c/li\u003e\n\u003cli\u003eAn example of effective communication was shared from Dr. Mohseni’s time at Optum, where real-time notifications were used to coordinate care for patients who arrived at the emergency department, leading to better outcomes for the patients and more efficient care delivery.\u003c/li\u003e\n\u003cli\u003eThe speaker expresses curiosity about why the value-based healthcare system isn\u0026#39;t prevalent, considering its beneficial aspects, such as better access to specialists and greater collaboration between healthcare providers.\u003c/li\u003e\n\u003cli\u003eQuestions are raised regarding the incentives for primary care doctors to transition from the regular fee-for-service model to a more complex value-based model, with no clear motivation at the moment.\u003c/li\u003e\n\u003cli\u003eThe discussion mentions gradual efforts by Medicare and CMS (Centers for Medicare and Medicaid Services) to encourage a move towards value-based healthcare, through strategies such as upside gain, share upside models, and ACOs (Accountable Care Organizations).\u003c/li\u003e\n\u003cli\u003eThe Medicare Advantage (MA) model, which has been fully at risk for some time, is described as an effective example of a value-based system.\u003c/li\u003e\n\u003cli\u003eThe complexity of intermediary programs in the fee-for-service model is noted, as many providers either can\u0026#39;t understand the rules or choose not to participate due to the complexity.\u003c/li\u003e\n\u003cli\u003eThe speaker then elaborates on the workings of MA plans, wherein health plans are paid by the federal government per member per month to take full global risk on a patient for all of their professional medical expenses.\u003c/li\u003e\n\u003cli\u003eThese MA plans then delegate this risk to a selected medical group, which then uses the allocated funds to manage the patient\u0026#39;s healthcare. The remaining difference between the allocated funds and actual healthcare costs becomes the medical group\u0026#39;s profit.\u003c/li\u003e\n\u003cli\u003eThis model incentivizes medical groups to keep patients healthy and manage their costs efficiently.\u003c/li\u003e\n\u003cli\u003eThe allocation of funds enables medical groups to acquire services like dieticians or care managers, which are often missing in the traditional fee-for-service model. This allows for a more holistic, patient-centered approach to healthcare.\u003c/li\u003e\n\u003cli\u003eThe conversation discusses a situation where a patient contacts their doctor\u0026#39;s office after hours, and rather than being directed to the emergency room, the doctor is willing to solve the issue over the phone. This is because the doctor is being compensated monthly, rather than by individual visits or treatments.\u003c/li\u003e\n\u003cli\u003eIt is stated that any company can start a Medicare Advantage (MA) plan and people can sign up for it. However, these companies often contract with groups like Optum to handle the provision of care. This is paid for by a fraction of the funding that Medicare provides to the MA plan.\u003c/li\u003e\n\u003cli\u003eDoctors are incentivized to provide extra value in their services and keep costs low because they receive a chunk of money to provide the necessary services, and they keep the difference of what they don\u0026#39;t spend.\u003c/li\u003e\n\u003cli\u003eIn the case of a patient with more serious health conditions, a system of risk adjustment is in place. This means that doctors annually document the patient\u0026#39;s conditions, which contributes to their Health Condition Category (HCC) score. The higher the score, the more funding the medical group receives.\u003c/li\u003e\n\u003cli\u003eThe conversation suggests that the Medicare Advantage world has been increasingly focused on risk adjustment, given its substantial impact on revenue. However, this has raised concerns about gaming the system and potential fraud.\u003c/li\u003e\n\u003cli\u003eIn the future, it is suggested that there will be a greater focus on better patient outcomes and coordination to maintain profit margins, rather than on risk adjustment. This is expected to spur innovation and the creation of improved solutions for patients.\u003c/li\u003e\n\u003cli\u003eThe conversation discusses the idea of reducing healthcare utilization with a focus on reducing Emergency Department (ED) visits and hospitalizations.\u003c/li\u003e\n\u003cli\u003eThe speakers note that much of the current thinking centers on reducing the need for hospital care through better patient services, new tech, and addressing social determinants of health.\u003c/li\u003e\n\u003cli\u003eTwo additional areas of potential reduction in healthcare spending are identified: pharmacy (particularly unnecessary use of expensive brand name drugs when generics would suffice) and unnecessary surgeries or inefficient surgical procedures.\u003c/li\u003e\n\u003cli\u003eThe speakers emphasize that a lot of care currently delivered in hospitals could be effectively and more cost-efficiently delivered at home.\u003c/li\u003e\n\u003cli\u003eThe conversation then transitions to discussing how the home-based care trend can connect with value-based systems and the opportunities for innovation this brings. There\u0026#39;s a focus on how different players in the healthcare system (from family caregivers to healthcare professionals to tech innovators) can collaborate to improve patient care.\u003c/li\u003e\n\u003cli\u003eThey mention the establishment of Medicare Advantage (MA) programs, where healthcare groups receive a capitated payment from Medicare based on a patient\u0026#39;s Health Condition Categories (HCC) score.\u003c/li\u003e\n\u003cli\u003eThe speakers then introduce a new initiative, AgingHere.com, a newsletter focused on facilitating a community around aging in place and home-based care. They invite ideas and stories from their audience to share in this platform.\u003c/li\u003e\n\u003c/ul\u003e","summary":"Mastering Medicare is a podcast helping demystify healthcare and Medicare for senior-serving professionals and providers. ","date_published":"2023-05-31T06:00:00.000-04:00","attachments":[{"url":"https://aphid.fireside.fm/d/1437767933/7ad1df9b-b658-4830-80a6-91982f00740a/4959bc47-8d81-4191-8b12-397375ac99c2.mp3","mime_type":"audio/mpeg","size_in_bytes":33059585,"duration_in_seconds":2754}]},{"id":"5c520147-62f3-49c4-b0a7-0d7be1bf0d25","title":"Episode 19: ALFs (Assisted Living Facilities), a deep dive with Jonathan Edenbaum from Eden Homes","url":"https://www.masteringmedicare.net/19","content_text":"Dr. Amy Schiffman and Dr. Alex Mohseni do a deep dive interview with Jonathan Edenbaum, the owner of Eden Homes about the ALF industry. \nWhat is an Assisted Living\nWhat is a Group Home\nSmall vs large assisted living\nKosher assisted living\nKey triggers for transitioning from independent living to assisted living\nStandard ratios in assisted living days vs nights\nIncontinence as a trigger for assisted living\nWhat patients don't qualify for ALFs\nThey don't do ALFs, ventilators, certain bed sores (III or IV)\nAssessments required for qualifying for ALF\nRN needs to reevaluate the resident every 45 days\nSome facilities charge more for level of care\nRomantic relationships between ALF seniors\nState and county unannounced random checks\nHow to determine a low vs high quality ALF\nDo an unannounced visit to check quality\nGet family reference\nRPM in the ALFs\nZoning requirements for ALFs\nHOA issues for ALFs\nRisks in an ALF\nMarketing ALF services\nWhen an ALF resident gets hospitalized\nEden Homes of Potomac\nwww.edenhomesofpotomac.com\n301-299-0090\nJonathan recommends these finder services:\nCarePatrol\nFamilyTies\nVideo version:\nhttps://youtu.be/pJgIa3EWxVA","content_html":"\u003cp\u003eDr. Amy Schiffman and Dr. Alex Mohseni do a deep dive interview with Jonathan Edenbaum, the owner of Eden Homes about the ALF industry. \u003cbr\u003e\nWhat is an Assisted Living\u003cbr\u003e\nWhat is a Group Home\u003cbr\u003e\nSmall vs large assisted living\u003cbr\u003e\nKosher assisted living\u003cbr\u003e\nKey triggers for transitioning from independent living to assisted living\u003cbr\u003e\nStandard ratios in assisted living days vs nights\u003cbr\u003e\nIncontinence as a trigger for assisted living\u003cbr\u003e\nWhat patients don\u0026#39;t qualify for ALFs\u003cbr\u003e\nThey don\u0026#39;t do ALFs, ventilators, certain bed sores (III or IV)\u003cbr\u003e\nAssessments required for qualifying for ALF\u003cbr\u003e\nRN needs to reevaluate the resident every 45 days\u003cbr\u003e\nSome facilities charge more for level of care\u003cbr\u003e\nRomantic relationships between ALF seniors\u003cbr\u003e\nState and county unannounced random checks\u003cbr\u003e\nHow to determine a low vs high quality ALF\u003cbr\u003e\nDo an unannounced visit to check quality\u003cbr\u003e\nGet family reference\u003cbr\u003e\nRPM in the ALFs\u003cbr\u003e\nZoning requirements for ALFs\u003cbr\u003e\nHOA issues for ALFs\u003cbr\u003e\nRisks in an ALF\u003cbr\u003e\nMarketing ALF services\u003cbr\u003e\nWhen an ALF resident gets hospitalized\u003cbr\u003e\nEden Homes of Potomac\u003cbr\u003e\n\u003ca href=\"http://www.edenhomesofpotomac.com\" rel=\"nofollow\"\u003ewww.edenhomesofpotomac.com\u003c/a\u003e\u003cbr\u003e\n301-299-0090\u003cbr\u003e\nJonathan recommends these finder services:\u003cbr\u003e\nCarePatrol\u003cbr\u003e\nFamilyTies\u003cbr\u003e\nVideo version:\u003cbr\u003e\n\u003ca href=\"https://youtu.be/pJgIa3EWxVA\" rel=\"nofollow\"\u003ehttps://youtu.be/pJgIa3EWxVA\u003c/a\u003e\u003c/p\u003e","summary":"Mastering Medicare is a podcast helping demystify healthcare and Medicare for senior-serving professionals and providers. ","date_published":"2021-03-05T09:00:00.000-05:00","attachments":[{"url":"https://aphid.fireside.fm/d/1437767933/7ad1df9b-b658-4830-80a6-91982f00740a/5c520147-62f3-49c4-b0a7-0d7be1bf0d25.mp3","mime_type":"audio/mpeg","size_in_bytes":42410259,"duration_in_seconds":3534}]},{"id":"02a3f72d-dd11-4227-bab9-4d21733981d0","title":"Episode 18: Medicaid Long Term Care: interview with Robert Bullock Esq., The Elder \u0026 Disability Law Center","url":"https://www.masteringmedicare.net/18","content_text":"In this amazing interview with Robert Bullock, a DC-based Elder Law attorney, from The Elder \u0026amp; Disability Law Center, Dr. Amy Schiffman and Dr. Alex Mohseni discuss Medicaid Long Term Care coverage. We cover these topics:\nWhat is Medicaid\nMedica long term care eligibility\nWhat does Medicaid waiver mean?\nHow does one qualify for Medicaid\nMedical eligibility for Medicaid long term care\nFinancial eligibility for Medicaid long term care\nMost people are in crisis mode when trying to qualify for Medicaid long term care\nHow are patients assigned to rehab\nMedicaid 5 year lookback\nPut your assets into an irrevocable trust at least 5 years before you think you made need Medicaid\nWhy doesn't Medicaid cover ALF\nMedicaid long term care payments are like a loan\nMedicaid estate recovery\nAtlantic article on Medicaid estate recovery\nLife care Planning and Management\nAt what age should everybody talk to an elder law attorney\nVideo version of this episode:  https://youtu.be/EIwz0kv_O1o\n\nRobert's contact information: 202-452-0000\nhttps://www.edlc.com/\non AVVO.com\n\nThank you to our sponsor:\nThe RISE Virtual Medicare Marketing \u0026amp; 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  #RISEMMS2021","content_html":"\u003cp\u003eIn this amazing interview with Robert Bullock, a DC-based Elder Law attorney, from \u003ca href=\"https://www.edlc.com/\" rel=\"nofollow\"\u003eThe Elder \u0026amp; Disability Law Center\u003c/a\u003e, Dr. Amy Schiffman and Dr. Alex Mohseni discuss Medicaid Long Term Care coverage. We cover these topics:\u003cbr\u003e\nWhat is Medicaid\u003cbr\u003e\nMedica long term care eligibility\u003cbr\u003e\nWhat does Medicaid waiver mean?\u003cbr\u003e\nHow does one qualify for Medicaid\u003cbr\u003e\nMedical eligibility for Medicaid long term care\u003cbr\u003e\nFinancial eligibility for Medicaid long term care\u003cbr\u003e\nMost people are in crisis mode when trying to qualify for Medicaid long term care\u003cbr\u003e\nHow are patients assigned to rehab\u003cbr\u003e\nMedicaid 5 year lookback\u003cbr\u003e\nPut your assets into an irrevocable trust at least 5 years before you think you made need Medicaid\u003cbr\u003e\nWhy doesn\u0026#39;t Medicaid cover ALF\u003cbr\u003e\nMedicaid long term care payments are like a loan\u003cbr\u003e\nMedicaid estate recovery\u003cbr\u003e\n\u003ca href=\"https://www.theatlantic.com/magazine/archive/2019/10/when-medicaid-takes-everything-you-own/596671/\" rel=\"nofollow\"\u003eAtlantic article on Medicaid estate recovery\u003c/a\u003e\u003cbr\u003e\nLife care Planning and Management\u003cbr\u003e\nAt what age should everybody talk to an elder law attorney\u003cbr\u003e\nVideo version of this episode:  \u003ca href=\"https://youtu.be/EIwz0kv_O1o\" rel=\"nofollow\"\u003ehttps://youtu.be/EIwz0kv_O1o\u003c/a\u003e\u003c/p\u003e\n\n\u003cp\u003eRobert\u0026#39;s contact information: 202-452-0000\u003cbr\u003e\n\u003ca href=\"https://www.edlc.com/\" rel=\"nofollow\"\u003ehttps://www.edlc.com/\u003c/a\u003e\u003cbr\u003e\non \u003ca href=\"https://www.avvo.com/attorneys/20036-dc-robert-bullock-672970.html\" rel=\"nofollow\"\u003eAVVO.com\u003c/a\u003e\u003c/p\u003e\n\n\u003cp\u003eThank you to our sponsor:\u003cbr\u003e\nThe RISE Virtual Medicare Marketing \u0026amp; 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 \u003ca href=\"https://www.medicaremarketingsalessummit.com/\" rel=\"nofollow\"\u003emedicaremarketingsalessummit.com\u003c/a\u003e  #RISEMMS2021\u003c/p\u003e","summary":"Mastering Medicare is a podcast helping demystify healthcare and Medicare for senior-serving professionals and providers. ","date_published":"2021-02-04T08:00:00.000-05:00","attachments":[{"url":"https://aphid.fireside.fm/d/1437767933/7ad1df9b-b658-4830-80a6-91982f00740a/02a3f72d-dd11-4227-bab9-4d21733981d0.mp3","mime_type":"audio/mpeg","size_in_bytes":47632032,"duration_in_seconds":3969}]},{"id":"14cf241b-2805-4928-b0b1-7f940e55fade","title":"Episode 17: Palliative Care: interview with Dr. Danielle Doberman, Clinical Medical Director for Palliative Medicine at Johns Hopkins Hospital","url":"https://www.masteringmedicare.net/17","content_text":"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:\nWhat is palliative care / palliative medicine?\nWhat symptoms does palliative focus on?\nHow does palliative operate as a team?\nHospital-based vs outpatient palliative care\nPalliative care vs hospice\nhttps://www.PrepareForYourCare.org\nWho should be a palliative care patient?\nWhere do most referrals to palliative care come from?\nhttps://getpalliativecare.org\nCenter to Advance Palliative Care www.capc.org\nInteraction and relationship between PCPs and palliative care\nContracting for safety and consent in palliative care\nPalliative care pain management\nPalliative Sedation (aka Proportional Sedation)\nArticle: \"Best Case Worst Case\"  \nYoutube video \"Best Case Worst Case\"\nPalliative care is not giving up\nPalliative care services lose money but they help the hospital because they reduce inpatient length of stay\n$3,000 of Part A savings per palliative care patient\nTypical patient volumes for palliative care\nYoutube version of this interview: https://youtu.be/poYoZ807SWU","content_html":"\u003cp\u003eDanielle 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:\u003cbr\u003e\nWhat is palliative care / palliative medicine?\u003cbr\u003e\nWhat symptoms does palliative focus on?\u003cbr\u003e\nHow does palliative operate as a team?\u003cbr\u003e\nHospital-based vs outpatient palliative care\u003cbr\u003e\nPalliative care vs hospice\u003cbr\u003e\n\u003ca href=\"https://www.PrepareForYourCare.org\" rel=\"nofollow\"\u003ehttps://www.PrepareForYourCare.org\u003c/a\u003e\u003cbr\u003e\nWho should be a palliative care patient?\u003cbr\u003e\nWhere do most referrals to palliative care come from?\u003cbr\u003e\n\u003ca href=\"https://getpalliativecare.org\" rel=\"nofollow\"\u003ehttps://getpalliativecare.org\u003c/a\u003e\u003cbr\u003e\nCenter to Advance Palliative Care \u003ca href=\"http://www.capc.org\" rel=\"nofollow\"\u003ewww.capc.org\u003c/a\u003e\u003cbr\u003e\nInteraction and relationship between PCPs and palliative care\u003cbr\u003e\nContracting for safety and consent in palliative care\u003cbr\u003e\nPalliative care pain management\u003cbr\u003e\nPalliative Sedation (aka Proportional Sedation)\u003cbr\u003e\n\u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4747100/\" rel=\"nofollow\"\u003eArticle: \u0026quot;Best Case Worst Case\u0026quot; \u003c/a\u003e \u003cbr\u003e\n\u003ca href=\"https://www.youtube.com/watch?v=FnS3K44sbu0\" rel=\"nofollow\"\u003eYoutube video \u0026quot;Best Case Worst Case\u0026quot;\u003c/a\u003e\u003cbr\u003e\nPalliative care is not giving up\u003cbr\u003e\nPalliative care services lose money but they help the hospital because they reduce inpatient length of stay\u003cbr\u003e\n$3,000 of Part A savings per palliative care patient\u003cbr\u003e\nTypical patient volumes for palliative care\u003cbr\u003e\nYoutube version of this interview: \u003ca href=\"https://youtu.be/poYoZ807SWU\" rel=\"nofollow\"\u003ehttps://youtu.be/poYoZ807SWU\u003c/a\u003e\u003c/p\u003e","summary":"Mastering Medicare is a podcast helping demystify healthcare and Medicare for senior-serving professionals and providers. ","date_published":"2021-01-03T15:00:00.000-05:00","attachments":[{"url":"https://aphid.fireside.fm/d/1437767933/7ad1df9b-b658-4830-80a6-91982f00740a/14cf241b-2805-4928-b0b1-7f940e55fade.mp3","mime_type":"audio/mpeg","size_in_bytes":62406471,"duration_in_seconds":5200}]},{"id":"59d890fd-a27d-4a60-9a1c-6d2928ce4f7e","title":"Episode 16: DME Durable Medical Equipment - interview with Steve Ackerman","url":"https://www.masteringmedicare.net/16","content_text":"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). \nIntroduction to Steve Ackerman and Spectrum Medical\nWhat is Durable Medical Equipment DME?\nNot disposable, has to be able to sustain repeated use\nCan't be used in the absence is disease or injury\nCan't be an environment improvement\nCan't be a safety item\nControversy with DME beds\nSemi-electric bed\nPatients who need frequent immediate change in body position\nDifferent types of DME wheelchairs\nWhat is a seating clinic?\nWhat are Assisted Device Professionals\nChoices of wheelchairs\nK codes for wheelchairs\nHemi wheelchairs\nK3 standard wheelchair is the most ordered wheelchair\nParachute ordering portal\nWalkers as DME\nMedicare local coverage determination (LCD)\nEvery equipment has its own LCD\nClinical inference\nSecondary market for DME\n5-year limit\nIndoor vs outdoor use of DME\nWhat is a transport wheelchair?\nFraud and abuse in DME\nHow PT/OT help with getting DME\nHoarders\nDME company doesn't remove old equipment\nImplications of having and MA plan for DME\nRollators are not covered\nWalkers vs Rollators\nHow quickly can DME be delivered?\nAging in place\nVideo version:  https://youtu.be/m9dM7PT63M0","content_html":"\u003cp\u003eDr. 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). \u003cbr\u003e\nIntroduction to Steve Ackerman and \u003ca href=\"https://www.spectrummedical.net/\" rel=\"nofollow\"\u003eSpectrum Medical\u003c/a\u003e\u003cbr\u003e\nWhat is Durable Medical Equipment DME?\u003cbr\u003e\nNot disposable, has to be able to sustain repeated use\u003cbr\u003e\nCan\u0026#39;t be used in the absence is disease or injury\u003cbr\u003e\nCan\u0026#39;t be an environment improvement\u003cbr\u003e\nCan\u0026#39;t be a safety item\u003cbr\u003e\nControversy with DME beds\u003cbr\u003e\nSemi-electric bed\u003cbr\u003e\nPatients who need frequent immediate change in body position\u003cbr\u003e\nDifferent types of DME wheelchairs\u003cbr\u003e\nWhat is a seating clinic?\u003cbr\u003e\nWhat are Assisted Device Professionals\u003cbr\u003e\nChoices of wheelchairs\u003cbr\u003e\nK codes for wheelchairs\u003cbr\u003e\nHemi wheelchairs\u003cbr\u003e\nK3 standard wheelchair is the most ordered wheelchair\u003cbr\u003e\nParachute ordering portal\u003cbr\u003e\nWalkers as DME\u003cbr\u003e\nMedicare local coverage determination (LCD)\u003cbr\u003e\nEvery equipment has its own LCD\u003cbr\u003e\nClinical inference\u003cbr\u003e\nSecondary market for DME\u003cbr\u003e\n5-year limit\u003cbr\u003e\nIndoor vs outdoor use of DME\u003cbr\u003e\nWhat is a transport wheelchair?\u003cbr\u003e\nFraud and abuse in DME\u003cbr\u003e\nHow PT/OT help with getting DME\u003cbr\u003e\nHoarders\u003cbr\u003e\nDME company doesn\u0026#39;t remove old equipment\u003cbr\u003e\nImplications of having and MA plan for DME\u003cbr\u003e\nRollators are not covered\u003cbr\u003e\nWalkers vs Rollators\u003cbr\u003e\nHow quickly can DME be delivered?\u003cbr\u003e\nAging in place\u003cbr\u003e\nVideo version:  \u003ca href=\"https://youtu.be/m9dM7PT63M0\" rel=\"nofollow\"\u003ehttps://youtu.be/m9dM7PT63M0\u003c/a\u003e\u003c/p\u003e","summary":"Mastering Medicare is a podcast helping demystify healthcare and Medicare for senior-serving professionals and providers. ","date_published":"2020-10-19T18:00:00.000-04:00","attachments":[{"url":"https://aphid.fireside.fm/d/1437767933/7ad1df9b-b658-4830-80a6-91982f00740a/59d890fd-a27d-4a60-9a1c-6d2928ce4f7e.mp3","mime_type":"audio/mpeg","size_in_bytes":48966785,"duration_in_seconds":4080}]},{"id":"141c7ce5-c8f3-4acf-a981-3ca94fc1a458","title":"Episode 15: Medicare Advantage (MA plans) - a deep dive with Michael Hughes","url":"https://www.masteringmedicare.net/15","content_text":"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:\nWhat is Medicare Advantage\nMA plans offer supplemental benefits\nCMS is realizing that SDOH determine health and cost outcomes\nWho costs the system the most\nExamples of supplemental benefits include things like home care and pest control\nHow many MA plans are there\nSSBCI - special supplemental benefits for the chronically ill\nHow does an MA plan measure effectiveness of supplemental benefits\nHow do physicians order supplemental benefits for members\nVBID model\nConversion rate from MA plan to private pay\nWhat are the downsides of choosing an MA plan\nWhy MA plans care about the quality of supplemental benefits\nMA plans as a percentage of total Medicare population by state (Link)\nLink to Michael Hughes: https://www.linkedin.com/in/michael-hughes-7010221/\nVideo version: https://www.youtube.com/watch?v=7NrtiqkkHtQ","content_html":"\u003cp\u003eDr. 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:\u003cbr\u003e\nWhat is Medicare Advantage\u003cbr\u003e\nMA plans offer supplemental benefits\u003cbr\u003e\nCMS is realizing that SDOH determine health and cost outcomes\u003cbr\u003e\nWho costs the system the most\u003cbr\u003e\nExamples of supplemental benefits include things like home care and pest control\u003cbr\u003e\nHow many MA plans are there\u003cbr\u003e\nSSBCI - special supplemental benefits for the chronically ill\u003cbr\u003e\nHow does an MA plan measure effectiveness of supplemental benefits\u003cbr\u003e\nHow do physicians order supplemental benefits for members\u003cbr\u003e\nVBID model\u003cbr\u003e\nConversion rate from MA plan to private pay\u003cbr\u003e\nWhat are the downsides of choosing an MA plan\u003cbr\u003e\nWhy MA plans care about the quality of supplemental benefits\u003cbr\u003e\nMA plans as a percentage of total Medicare population by state (\u003ca href=\"https://www.kff.org/medicare/state-indicator/enrollees-as-a-of-total-medicare-population/?activeTab=map\u0026currentTimeframe=0\u0026selectedDistributions=overall\u0026sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D\" rel=\"nofollow\"\u003eLink\u003c/a\u003e)\u003cbr\u003e\nLink to Michael Hughes: \u003ca href=\"https://www.linkedin.com/in/michael-hughes-7010221/\" rel=\"nofollow\"\u003ehttps://www.linkedin.com/in/michael-hughes-7010221/\u003c/a\u003e\u003cbr\u003e\nVideo version: \u003ca href=\"https://www.youtube.com/watch?v=7NrtiqkkHtQ\" rel=\"nofollow\"\u003ehttps://www.youtube.com/watch?v=7NrtiqkkHtQ\u003c/a\u003e\u003c/p\u003e","summary":"Mastering Medicare is a podcast helping demystify healthcare and Medicare for senior-serving professionals and providers. ","date_published":"2020-10-12T06:00:00.000-04:00","attachments":[{"url":"https://aphid.fireside.fm/d/1437767933/7ad1df9b-b658-4830-80a6-91982f00740a/141c7ce5-c8f3-4acf-a981-3ca94fc1a458.mp3","mime_type":"audio/mpeg","size_in_bytes":46697580,"duration_in_seconds":3891}]},{"id":"6ae3508f-565d-4423-8c45-960ba761fac1","title":"Episode 14: Hospice and Secrets of the Hospice Industry","url":"https://www.masteringmedicare.net/14","content_text":"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:\nHow do people get referred to hospice\nHospice is covered 100% by Medicare part A\nWhat does hospice cover\nHow to get Part B medical care covered while under hospice\nHospice reimbursement model\nHospice per diem\nThree levels of hospice care\nPier diem changes at the higher levels of care\nFor profit vs non-profit hospice\nHospice certificate of need requirements\nWhat questions you should ask about when interviewing a hospice\nCHAP certification for hospice\nTransitioning - what does transitioning mean in the context of hospice?\nHow to know when a hospice patient is dying\nDoes hospice pay for food and nutrition\nTube feeding hospice patients\nMeasuring mean arm circumference (MAC) as a measure of nutritional decline\nWho is making the hospice recertification?\nHospice patient’s relationships with their their PCP and hospice medical director\nDNR status and resuscitating hospice patients\nMost common reasons somebody leaves hospice status\nWhat is the role of PCPs for patients in hospice status\nWhat a PCP can bill for care plan oversight for a hospice patient\nRetroactive hospice status changes\nWhat happens if you don’t requalify for hospice recertification?\nGraduating from hospice\nVideo version: https://youtu.be/qat1HZicdrA","content_html":"\u003cp\u003eIn 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:\u003cbr\u003e\nHow do people get referred to hospice\u003cbr\u003e\nHospice is covered 100% by Medicare part A\u003cbr\u003e\nWhat does hospice cover\u003cbr\u003e\nHow to get Part B medical care covered while under hospice\u003cbr\u003e\nHospice reimbursement model\u003cbr\u003e\nHospice per diem\u003cbr\u003e\nThree levels of hospice care\u003cbr\u003e\nPier diem changes at the higher levels of care\u003cbr\u003e\nFor profit vs non-profit hospice\u003cbr\u003e\nHospice certificate of need requirements\u003cbr\u003e\nWhat questions you should ask about when interviewing a hospice\u003cbr\u003e\nCHAP certification for hospice\u003cbr\u003e\nTransitioning - what does transitioning mean in the context of hospice?\u003cbr\u003e\nHow to know when a hospice patient is dying\u003cbr\u003e\nDoes hospice pay for food and nutrition\u003cbr\u003e\nTube feeding hospice patients\u003cbr\u003e\nMeasuring mean arm circumference (MAC) as a measure of nutritional decline\u003cbr\u003e\nWho is making the hospice recertification?\u003cbr\u003e\nHospice patient’s relationships with their their PCP and hospice medical director\u003cbr\u003e\nDNR status and resuscitating hospice patients\u003cbr\u003e\nMost common reasons somebody leaves hospice status\u003cbr\u003e\nWhat is the role of PCPs for patients in hospice status\u003cbr\u003e\nWhat a PCP can bill for care plan oversight for a hospice patient\u003cbr\u003e\nRetroactive hospice status changes\u003cbr\u003e\nWhat happens if you don’t requalify for hospice recertification?\u003cbr\u003e\nGraduating from hospice\u003cbr\u003e\nVideo version: \u003ca href=\"https://youtu.be/qat1HZicdrA\" rel=\"nofollow\"\u003ehttps://youtu.be/qat1HZicdrA\u003c/a\u003e\u003c/p\u003e","summary":"Mastering Medicare is a podcast helping demystify healthcare and Medicare for senior-serving professionals and providers. ","date_published":"2020-09-11T06:00:00.000-04:00","attachments":[{"url":"https://aphid.fireside.fm/d/1437767933/7ad1df9b-b658-4830-80a6-91982f00740a/6ae3508f-565d-4423-8c45-960ba761fac1.mp3","mime_type":"audio/mpeg","size_in_bytes":61041320,"duration_in_seconds":5018}]},{"id":"e2699aa2-51b3-42db-bfac-38543d353e71","title":"Episode 13: Billing, coding, documentation, \u0026 EMR frustrations for physicians","url":"https://www.masteringmedicare.net/13","content_text":"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. \nLink to Youtube video version: https://youtu.be/kI5QqVA9NAQ","content_html":"\u003cp\u003eDr. Amy Schiffman and Dr. Alex Mohseni do a deep dive into Alex\u0026#39;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. \u003cbr\u003e\nLink to Youtube video version: \u003ca href=\"https://youtu.be/kI5QqVA9NAQ\" rel=\"nofollow\"\u003ehttps://youtu.be/kI5QqVA9NAQ\u003c/a\u003e\u003c/p\u003e","summary":"Mastering Medicare is a podcast helping demystify healthcare and Medicare for senior-serving professionals and providers. ","date_published":"2020-08-24T05:00:00.000-04:00","attachments":[{"url":"https://aphid.fireside.fm/d/1437767933/7ad1df9b-b658-4830-80a6-91982f00740a/e2699aa2-51b3-42db-bfac-38543d353e71.mp3","mime_type":"audio/mpeg","size_in_bytes":35061596,"duration_in_seconds":2921}]},{"id":"149b2aca-5a4d-4aa0-91ad-653e06816362","title":"Episode 12: Everything you ever wanted to know about PT, OT, and Speech Pathology","url":"https://www.masteringmedicare.net/12","content_text":"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.\nAlex and Amy cover the following topics:\nSpeech Therapy vs Speech Language Pathologist\nIn-home PT, OT and speech therapy for geriatric patients\nPart A rehab vs Part B rehab\nWhen and why do you flip from Part A therapy/rehab to Part B rehab?\nHow do you continue to qualify for Part A therapy?\nWho decides whether a patient has reached their therapy goal - the ordering provider or therapist?\nWhat does a physical therapist do?\nWhat does an occupational therapist do?\nWhat does a speech therapist do?\nPT vs OT vs Speech\nFunctional independence\nActivities of daily living\nWhat does Medicare pay for with Part B PT, OT and Speech Therapy\nTwo requirements for Medicare to pay for Part B rehab: medical necessity and skilled need\nThe Therapy Cap for PT and Speech\nPart B works on a calendar year basis\nHow to get an exception to the Therapy Cap for PT, OT and Speech Pathology\nCoding and billing PT, OT and SLP encounter CPT codes\nWhat is a low-tech augmentative communication device?\nWhat is the common work file in Medicare rehab?\nHow often does a physical therapist usually go to a person's home?\nWhat is the patient responsibility or copy for Medicare Part B rehab and physical therapy?\nPart B rehab is not home health\nWhich types of providers refer to Part B rehab the most?\nMost common reasons for referral for Part B Rehab all revolve around falls: gait, balance, and weakness\nDo not have to be homebound for Part B rehab in the home\nCommon mistakes when referring to rehab\nHow to write an order for PT, OT, or speech and what CPT codes to include\nPart B rehab does medication reconciliation\nHow to order DME\nWhat is a 3-in-1 commode\nHow long does it take to get a hospital bed paid for by Medicare\nFoxRehab.org","content_html":"\u003cp\u003eDr. Amy Schiffman and Dr. Alex Mohseni talk with the team from \u003ca href=\"https://www.foxrehab.org/\" rel=\"nofollow\"\u003eFox Rehab\u003c/a\u003e 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.\u003cbr\u003e\nAlex and Amy cover the following topics:\u003cbr\u003e\nSpeech Therapy vs Speech Language Pathologist\u003cbr\u003e\nIn-home PT, OT and speech therapy for geriatric patients\u003cbr\u003e\nPart A rehab vs Part B rehab\u003cbr\u003e\nWhen and why do you flip from Part A therapy/rehab to Part B rehab?\u003cbr\u003e\nHow do you continue to qualify for Part A therapy?\u003cbr\u003e\nWho decides whether a patient has reached their therapy goal - the ordering provider or therapist?\u003cbr\u003e\nWhat does a physical therapist do?\u003cbr\u003e\nWhat does an occupational therapist do?\u003cbr\u003e\nWhat does a speech therapist do?\u003cbr\u003e\nPT vs OT vs Speech\u003cbr\u003e\nFunctional independence\u003cbr\u003e\nActivities of daily living\u003cbr\u003e\nWhat does Medicare pay for with Part B PT, OT and Speech Therapy\u003cbr\u003e\nTwo requirements for Medicare to pay for Part B rehab: medical necessity and skilled need\u003cbr\u003e\nThe Therapy Cap for PT and Speech\u003cbr\u003e\nPart B works on a calendar year basis\u003cbr\u003e\nHow to get an exception to the Therapy Cap for PT, OT and Speech Pathology\u003cbr\u003e\nCoding and billing PT, OT and SLP encounter CPT codes\u003cbr\u003e\nWhat is a low-tech augmentative communication device?\u003cbr\u003e\nWhat is the common work file in Medicare rehab?\u003cbr\u003e\nHow often does a physical therapist usually go to a person\u0026#39;s home?\u003cbr\u003e\nWhat is the patient responsibility or copy for Medicare Part B rehab and physical therapy?\u003cbr\u003e\nPart B rehab is not home health\u003cbr\u003e\nWhich types of providers refer to Part B rehab the most?\u003cbr\u003e\nMost common reasons for referral for Part B Rehab all revolve around falls: gait, balance, and weakness\u003cbr\u003e\nDo not have to be homebound for Part B rehab in the home\u003cbr\u003e\nCommon mistakes when referring to rehab\u003cbr\u003e\nHow to write an order for PT, OT, or speech and what CPT codes to include\u003cbr\u003e\nPart B rehab does medication reconciliation\u003cbr\u003e\nHow to order DME\u003cbr\u003e\nWhat is a 3-in-1 commode\u003cbr\u003e\nHow long does it take to get a hospital bed paid for by Medicare\u003cbr\u003e\nFoxRehab.org\u003c/p\u003e","summary":"Mastering Medicare is a podcast helping demystify healthcare and Medicare for senior-serving professionals and providers. ","date_published":"2020-06-24T07:00:00.000-04:00","attachments":[{"url":"https://aphid.fireside.fm/d/1437767933/7ad1df9b-b658-4830-80a6-91982f00740a/149b2aca-5a4d-4aa0-91ad-653e06816362.mp3","mime_type":"audio/mpeg","size_in_bytes":63904227,"duration_in_seconds":5325}]},{"id":"9c54d87f-277e-4391-9f31-253f86359432","title":"Episode 11: Alex starts a medical practice (part 2)","url":"https://www.masteringmedicare.net/11","content_text":"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. \nDr. 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. \nVideo version of episode: https://youtu.be/MeRWrKF6eno","content_html":"\u003cp\u003eWith 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\u0026#39;s doing to start this practice and gets Amy\u0026#39;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\u0026#39;s \u003ca href=\"https://www.canarydoc.com\" rel=\"nofollow\"\u003eMedicare telemedicine practice is called Canary Doctor\u003c/a\u003e. \u003cbr\u003e\nDr. 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. \u003cbr\u003e\nVideo version of episode: \u003ca href=\"https://youtu.be/MeRWrKF6eno\" rel=\"nofollow\"\u003ehttps://youtu.be/MeRWrKF6eno\u003c/a\u003e\u003c/p\u003e","summary":"Mastering Medicare is a podcast helping demystify healthcare and Medicare for senior-serving professionals and providers. ","date_published":"2020-05-13T09:00:00.000-04:00","attachments":[{"url":"https://aphid.fireside.fm/d/1437767933/7ad1df9b-b658-4830-80a6-91982f00740a/9c54d87f-277e-4391-9f31-253f86359432.mp3","mime_type":"audio/mpeg","size_in_bytes":21421916,"duration_in_seconds":1785}]},{"id":"8e6bd6ea-0996-4869-9c64-25e8754ec529","title":"Episode 10: Andy Diamond, President of Diamond Medical Labs and Mobile Medical Imaging, Part 2","url":"https://www.masteringmedicare.net/10","content_text":"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. \nIn part 2 we discuss:\nBrief summary of mobile labs episode\nWhat sort of equipment do mobile medical imaging labs have in their cars?\nHow do you get mobile imaging equipment up a flight of stairs?\nHow much does a mobile digital x-ray machine cost?\nHow quickly can you get imaging done in a patient's home?\nThe logistics challenges of home-based medical care\nManaging dispatchers for home-based services\nHow is the logistics of labs more complicated than radiology?\nIs there a transportation fee for radiology done in the home?\nHow do trip fees work when visiting an assisted living or nursing home?\nHow do you split the trip fee?\nWhat technology is used to manage logistics for home-based care?\nLab tests are not subject to Medicare deductible but imaging is\nWhat could providers do better when ordering labs and radiology?\nTraining nursing home staff on anatomy\nPoint Click Care\nNo trip fee on EKG and ultrasound; trip fee only on x-rays\nDo lab and radiology providers need to get patient consent when they visit a nursing home or assisted living?\nWhat is the minimum percent of tests a lab must do in-house?\nHow many patients per day can a mobile radiology tech perform?\nHow quickly do labs need to be run?","content_html":"\u003cp\u003ePart 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\u0026#39; homes. \u003cbr\u003e\nIn part 2 we discuss:\u003cbr\u003e\nBrief summary of mobile labs episode\u003cbr\u003e\nWhat sort of equipment do mobile medical imaging labs have in their cars?\u003cbr\u003e\nHow do you get mobile imaging equipment up a flight of stairs?\u003cbr\u003e\nHow much does a mobile digital x-ray machine cost?\u003cbr\u003e\nHow quickly can you get imaging done in a patient\u0026#39;s home?\u003cbr\u003e\nThe logistics challenges of home-based medical care\u003cbr\u003e\nManaging dispatchers for home-based services\u003cbr\u003e\nHow is the logistics of labs more complicated than radiology?\u003cbr\u003e\nIs there a transportation fee for radiology done in the home?\u003cbr\u003e\nHow do trip fees work when visiting an assisted living or nursing home?\u003cbr\u003e\nHow do you split the trip fee?\u003cbr\u003e\nWhat technology is used to manage logistics for home-based care?\u003cbr\u003e\nLab tests are not subject to Medicare deductible but imaging is\u003cbr\u003e\nWhat could providers do better when ordering labs and radiology?\u003cbr\u003e\nTraining nursing home staff on anatomy\u003cbr\u003e\nPoint Click Care\u003cbr\u003e\nNo trip fee on EKG and ultrasound; trip fee only on x-rays\u003cbr\u003e\nDo lab and radiology providers need to get patient consent when they visit a nursing home or assisted living?\u003cbr\u003e\nWhat is the minimum percent of tests a lab must do in-house?\u003cbr\u003e\nHow many patients per day can a mobile radiology tech perform?\u003cbr\u003e\nHow quickly do labs need to be run?\u003c/p\u003e","summary":"Mastering Medicare is a podcast helping demystify healthcare and Medicare for senior-serving professionals and providers. ","date_published":"2020-04-26T11:00:00.000-04:00","attachments":[{"url":"https://aphid.fireside.fm/d/1437767933/7ad1df9b-b658-4830-80a6-91982f00740a/8e6bd6ea-0996-4869-9c64-25e8754ec529.mp3","mime_type":"audio/mp3","size_in_bytes":26596668,"duration_in_seconds":2216}]},{"id":"87c85f78-d5bf-4af0-bb9d-7507273ada1f","title":"Episode 9: Alex starts a medical practice","url":"https://www.masteringmedicare.net/9","content_text":"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. \nDr. 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. \nVideo version of episode: https://youtu.be/ebZZkHHBy30","content_html":"\u003cp\u003eWith 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\u0026#39;s doing to start this practice and gets Amy\u0026#39;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. \u003cbr\u003e\nDr. 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. \u003cbr\u003e\nVideo version of episode: \u003ca href=\"https://youtu.be/ebZZkHHBy30\" rel=\"nofollow\"\u003ehttps://youtu.be/ebZZkHHBy30\u003c/a\u003e\u003c/p\u003e","summary":"Mastering Medicare is a podcast helping demystify healthcare and Medicare for senior-serving professionals and providers. ","date_published":"2020-04-19T12:00:00.000-04:00","attachments":[{"url":"https://aphid.fireside.fm/d/1437767933/7ad1df9b-b658-4830-80a6-91982f00740a/87c85f78-d5bf-4af0-bb9d-7507273ada1f.mp3","mime_type":"audio/mp3","size_in_bytes":59614712,"duration_in_seconds":4967}]},{"id":"bb327906-18ef-428e-93c1-1d51917a7fac","title":"Episode 8: Andy Diamond, President of Diamond Medical Labs and Mobile Medical Imaging, Part 1","url":"https://www.masteringmedicare.net/8","content_text":"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. \nIn part 1 we discuss:\nHow and why do lab companies have contracts with nursing homes and assisted living facilities?\nPart A and Part B billing for labs in the same facility\nFiguring out Same and Similar in the lab world\nPatient financial responsibility for labs drawn in a nursing home\nLack of centralized database of lab data\nIntegration with state health information exchange / CRISP\nWhat is a health information exchange?\nWhy does CRISP charge the lab company to participate?\nNursing home is paying for some lab tests directly\nLab billing denials\nRevenue cycle management in the lab world\nWhat are the most common mistakes and issues when nursing homes and assisted livings order labs?\nWhat labs aren't allowed to tell ordering physicians?\nAlex thinks the rules for ordering labs are stupid\nTrends in lab testing\nMolecular testing - why is molecular testing becoming more popular?\nWho collects urine samples in nursing homes and homebound patients?\nWhat is the cost of molecular testing and is the denial rate different?\nWhat things to consider other than just the cost of a lab test?\nWorkflow requirements for molecular testing\nPGX testing - what is it and why would you order it?\nCost of PGX testing\nAre the results from PGX testing easy to interpret?\nEffect of PAMA on labs and lookback for lab payments\nWhy doctors can't have their own labs","content_html":"\u003cp\u003eAmy 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\u0026#39; homes. \u003cbr\u003e\nIn part 1 we discuss:\u003cbr\u003e\nHow and why do lab companies have contracts with nursing homes and assisted living facilities?\u003cbr\u003e\nPart A and Part B billing for labs in the same facility\u003cbr\u003e\nFiguring out Same and Similar in the lab world\u003cbr\u003e\nPatient financial responsibility for labs drawn in a nursing home\u003cbr\u003e\nLack of centralized database of lab data\u003cbr\u003e\nIntegration with state health information exchange / CRISP\u003cbr\u003e\nWhat is a health information exchange?\u003cbr\u003e\nWhy does CRISP charge the lab company to participate?\u003cbr\u003e\nNursing home is paying for some lab tests directly\u003cbr\u003e\nLab billing denials\u003cbr\u003e\nRevenue cycle management in the lab world\u003cbr\u003e\nWhat are the most common mistakes and issues when nursing homes and assisted livings order labs?\u003cbr\u003e\nWhat labs aren\u0026#39;t allowed to tell ordering physicians?\u003cbr\u003e\nAlex thinks the rules for ordering labs are stupid\u003cbr\u003e\nTrends in lab testing\u003cbr\u003e\nMolecular testing - why is molecular testing becoming more popular?\u003cbr\u003e\nWho collects urine samples in nursing homes and homebound patients?\u003cbr\u003e\nWhat is the cost of molecular testing and is the denial rate different?\u003cbr\u003e\nWhat things to consider other than just the cost of a lab test?\u003cbr\u003e\nWorkflow requirements for molecular testing\u003cbr\u003e\nPGX testing - what is it and why would you order it?\u003cbr\u003e\nCost of PGX testing\u003cbr\u003e\nAre the results from PGX testing easy to interpret?\u003cbr\u003e\nEffect of PAMA on labs and lookback for lab payments\u003cbr\u003e\nWhy doctors can\u0026#39;t have their own labs\u003c/p\u003e","summary":"Mastering Medicare is a podcast helping demystify healthcare and Medicare for senior-serving professionals and providers. ","date_published":"2020-04-17T05:00:00.000-04:00","attachments":[{"url":"https://aphid.fireside.fm/d/1437767933/7ad1df9b-b658-4830-80a6-91982f00740a/bb327906-18ef-428e-93c1-1d51917a7fac.mp3","mime_type":"audio/mp3","size_in_bytes":41120332,"duration_in_seconds":3426}]},{"id":"247a62fc-a5d7-4eb8-82df-122c0ffb12f4","title":"Episode 7: Dr. Howard Haft, Executive Director of the Maryland Primary Care Program, and former Deputy Secretary for Public Health","url":"https://www.masteringmedicare.net/7","content_text":"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. \n\nWe discuss so many valuable topics in this episode:\nWho is Dr. Howard Haft\nWhat is the Maryland Primary Care Program\nMaryland All Payer Model\nGlobal Budget Revenue Hospital Payment Model\nWhat do Primary Care Practice Transformation Coaches do\nAdvanced Alternative Payment Model\nTrack 1\nTrack 2\nUpfront payments\nIs the Maryland Primary Care Program only for Medicare\nCarefirst participation in the Maryland Primary Care Program\nHow much extra can physicians earn from the Maryland Primary Care Program\nAverage $40,000 per year per physician\nCare Transformation Organizations\nAdministrative requirements of the Primary Care Program\nECQMs\nAlex's mind gets blown\nEmpathy in healthcare\n20% Reduction in avoidable admissions\nPredicting high risk patients and avoidable admissions\nHow Maryland is using machine learning to support primary care doctors\nSocial Determinants of Health services in Maryland\nHow to order SDOH services from CRISP\nHow community-based organizations can work with the Maryland Primary Care Program\n211 service in Maryland\nGlobal Budget contracts\nMaryland Stakeholder Innovation Group","content_html":"\u003cp\u003eAmy 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. \u003c/p\u003e\n\n\u003cp\u003eWe discuss so many valuable topics in this episode:\u003cbr\u003e\nWho is Dr. Howard Haft\u003cbr\u003e\n\u003ca href=\"https://health.maryland.gov/mdpcp/Pages/home.aspx\" rel=\"nofollow\"\u003eWhat is the Maryland Primary Care Program\u003c/a\u003e\u003cbr\u003e\nMaryland All Payer Model\u003cbr\u003e\nGlobal Budget Revenue Hospital Payment Model\u003cbr\u003e\nWhat do Primary Care Practice Transformation Coaches do\u003cbr\u003e\nAdvanced Alternative Payment Model\u003cbr\u003e\nTrack 1\u003cbr\u003e\nTrack 2\u003cbr\u003e\nUpfront payments\u003cbr\u003e\nIs the Maryland Primary Care Program only for Medicare\u003cbr\u003e\nCarefirst participation in the Maryland Primary Care Program\u003cbr\u003e\nHow much extra can physicians earn from the Maryland Primary Care Program\u003cbr\u003e\nAverage $40,000 per year per physician\u003cbr\u003e\nCare Transformation Organizations\u003cbr\u003e\nAdministrative requirements of the Primary Care Program\u003cbr\u003e\nECQMs\u003cbr\u003e\nAlex\u0026#39;s mind gets blown\u003cbr\u003e\nEmpathy in healthcare\u003cbr\u003e\n20% Reduction in avoidable admissions\u003cbr\u003e\nPredicting high risk patients and avoidable admissions\u003cbr\u003e\nHow Maryland is using machine learning to support primary care doctors\u003cbr\u003e\nSocial Determinants of Health services in Maryland\u003cbr\u003e\nHow to order SDOH services from CRISP\u003cbr\u003e\nHow community-based organizations can work with the Maryland Primary Care Program\u003cbr\u003e\n\u003ca href=\"https://211md.org/\" rel=\"nofollow\"\u003e211 service in Maryland\u003c/a\u003e\u003cbr\u003e\nGlobal Budget contracts\u003cbr\u003e\n\u003ca href=\"https://www.mhaonline.org/transforming-health-care/tracking-our-all-payer-experiment/stakeholder-innovation-group\" rel=\"nofollow\"\u003eMaryland Stakeholder Innovation Group\u003c/a\u003e\u003c/p\u003e","summary":"Mastering Medicare is a podcast helping demystify healthcare and Medicare for senior-serving professionals and providers. ","date_published":"2020-03-25T08:00:00.000-04:00","attachments":[{"url":"https://aphid.fireside.fm/d/1437767933/7ad1df9b-b658-4830-80a6-91982f00740a/247a62fc-a5d7-4eb8-82df-122c0ffb12f4.mp3","mime_type":"audio/mpeg","size_in_bytes":61098587,"duration_in_seconds":5048}]},{"id":"b474b463-3073-4d59-8a8a-142dc670d155","title":"Episode 6: Telemedicine and Remote Patient Monitoring in the COVID19 Era","url":"https://www.masteringmedicare.net/6","content_text":"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. \nWe discuss:\nappreciation for our emergency medicine colleagues\noriginal medicare telemedicine telemedicine requirements\nMedicare telemedicine geography requirement\nMedicare telemedicine originating site requirement\nCOVID19 Medicare telemedicine reimbursement updates\nHHS won't audit preexisting relationship rule, but what about MACs?\nProvider licensure requirements for telemedicine\nFee for service telemedicine billing guide\nHome health telemedicine\nRPM (Remote Patient Monitoring) COVID19\nConnection between real estate tax code and healthcare opportunities\nWhy is Medicare paying for RPM\nHow does remote monitoring work\nAlex's Concierge Medicine RPM article\nHow much does RPM pay\nMedicare eVisit non-face-to-face encounters\nRole of RPM with addressing loneliness in seniors\nSome states' Medicaid programs pay for RPM\nKudos to Dr. Blake McKinney from CirrusMD\nTelemedicine pictures need to be treated like radiology films\nAccuhealth RPM website\nEmail us at amy@masteringmedicare.net or alex@masteringmedicare.net for our RPM Workbook","content_html":"\u003cp\u003eAlex 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. \u003cbr\u003e\nWe discuss:\u003cbr\u003e\nappreciation for our emergency medicine colleagues\u003cbr\u003e\noriginal medicare telemedicine telemedicine requirements\u003cbr\u003e\nMedicare telemedicine geography requirement\u003cbr\u003e\nMedicare telemedicine originating site requirement\u003cbr\u003e\nCOVID19 Medicare telemedicine reimbursement updates\u003cbr\u003e\nHHS won\u0026#39;t audit preexisting relationship rule, but what about MACs?\u003cbr\u003e\nProvider licensure requirements for telemedicine\u003cbr\u003e\n\u003ca href=\"https://www.cchpca.org/sites/default/files/2020-01/Billing%20Guide%20for%20Telehealth%20Encounters_FINAL.pdf\" rel=\"nofollow\"\u003eFee for service telemedicine billing guide\u003c/a\u003e\u003cbr\u003e\nHome health telemedicine\u003cbr\u003e\nRPM (Remote Patient Monitoring) COVID19\u003cbr\u003e\nConnection between real estate tax code and healthcare opportunities\u003cbr\u003e\nWhy is Medicare paying for RPM\u003cbr\u003e\nHow does remote monitoring work\u003cbr\u003e\n\u003ca href=\"https://www.linkedin.com/pulse/medicare-now-pays-concierge-medicine-subscription-fees-alex-mohseni/?trackingId=sIjYed4wsIb9nGMn0rorQg%3D%3D\" rel=\"nofollow\"\u003eAlex\u0026#39;s Concierge Medicine RPM article\u003c/a\u003e\u003cbr\u003e\nHow much does RPM pay\u003cbr\u003e\nMedicare eVisit non-face-to-face encounters\u003cbr\u003e\nRole of RPM with addressing loneliness in seniors\u003cbr\u003e\nSome states\u0026#39; Medicaid programs pay for RPM\u003cbr\u003e\nKudos to Dr. Blake McKinney from \u003ca href=\"https://www.cirrusmd.com/\" rel=\"nofollow\"\u003eCirrusMD\u003c/a\u003e\u003cbr\u003e\nTelemedicine pictures need to be treated like radiology films\u003cbr\u003e\n\u003ca href=\"https://accuhealth.tech/en/home\" rel=\"nofollow\"\u003eAccuhealth RPM website\u003c/a\u003e\u003cbr\u003e\nEmail us at \u003ca href=\"mailto:amy@masteringmedicare.net\" rel=\"nofollow\"\u003eamy@masteringmedicare.net\u003c/a\u003e or \u003ca href=\"mailto:alex@masteringmedicare.net\" rel=\"nofollow\"\u003ealex@masteringmedicare.net\u003c/a\u003e for our RPM Workbook\u003c/p\u003e","summary":"Mastering Medicare is a podcast helping demystify healthcare and Medicare for senior-serving professionals and providers. ","date_published":"2020-03-20T09:00:00.000-04:00","attachments":[{"url":"https://aphid.fireside.fm/d/1437767933/7ad1df9b-b658-4830-80a6-91982f00740a/b474b463-3073-4d59-8a8a-142dc670d155.mp3","mime_type":"audio/mp3","size_in_bytes":50460779,"duration_in_seconds":4205}]},{"id":"19f32b3f-8580-4648-8efa-b4bae9ee0246","title":"Episode 5: MOLST, POLST, and Advance Directives","url":"https://www.masteringmedicare.net/5","content_text":"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.\nMOLST: Medical Orders for Life-Sustaining Treatment\nPOLST: Physician's Orders for Life-Sustaining Treatment\nIn this episode, we discuss:\nWhat is a MOLST form\nWhat is a POLST form\nWhy should we talk about end of life care\nCoronavirus / COVID-19 concerns\nWhen should you fill out a MOLST form?\nWho should fill out a MOLST form?\nCan you make copies of a MOLST form?\nWhere should you keep your MOLST form?\nWhat is CPR?\nWhat is intubation?\nMOLST form options","content_html":"\u003cp\u003eAlex 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.\u003cbr\u003e\nMOLST: Medical Orders for Life-Sustaining Treatment\u003cbr\u003e\nPOLST: Physician\u0026#39;s Orders for Life-Sustaining Treatment\u003cbr\u003e\nIn this episode, we discuss:\u003cbr\u003e\nWhat is a MOLST form\u003cbr\u003e\nWhat is a POLST form\u003cbr\u003e\nWhy should we talk about end of life care\u003cbr\u003e\nCoronavirus / COVID-19 concerns\u003cbr\u003e\nWhen should you fill out a MOLST form?\u003cbr\u003e\nWho should fill out a MOLST form?\u003cbr\u003e\nCan you make copies of a MOLST form?\u003cbr\u003e\nWhere should you keep your MOLST form?\u003cbr\u003e\nWhat is CPR?\u003cbr\u003e\nWhat is intubation?\u003cbr\u003e\nMOLST form options\u003c/p\u003e","summary":"Mastering Medicare is a podcast helping demystify healthcare and Medicare for senior-serving professionals and providers. ","date_published":"2020-03-14T13:00:00.000-04:00","attachments":[{"url":"https://aphid.fireside.fm/d/1437767933/7ad1df9b-b658-4830-80a6-91982f00740a/19f32b3f-8580-4648-8efa-b4bae9ee0246.mp3","mime_type":"audio/mp3","size_in_bytes":25070699,"duration_in_seconds":2089}]},{"id":"16de9237-3312-4017-b302-9195abd6f851","title":"Episode 4: Medicare Part D","url":"https://www.masteringmedicare.net/4","content_text":"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:\n\nWhat is Part D Medicare\nOpt in Part D\nPremium calculation for Medicare Part D\nWhat is the Medicare Donut Hole?\nMedicare Part D Donut Hole \n4 stages of Part D\nPart D deductible stage: first $435\nPart D initial coverage stage: first $4,020, up to 25% of cost of medication\nTiers of medications in Part D\nPart D tier 1 medications\nPart D stage 3: donut hole, 25% patient responsibility\nPart D stage 4: catastrophic stage, copay\n\nVisit Mastering Medicare at MasteringMedicare.NET","content_html":"\u003cp\u003eIn this Mastering Medicare episode, Dr. Amy Schiffman and Dr. Alex Mohseni do a moderate dive into Medicare Part D. We discuss the following topics:\u003c/p\u003e\n\n\u003cp\u003eWhat is Part D Medicare\u003cbr\u003e\nOpt in Part D\u003cbr\u003e\nPremium calculation for Medicare Part D\u003cbr\u003e\nWhat is the Medicare Donut Hole?\u003cbr\u003e\nMedicare Part D Donut Hole \u003cbr\u003e\n4 stages of Part D\u003cbr\u003e\nPart D deductible stage: first $435\u003cbr\u003e\nPart D initial coverage stage: first $4,020, up to 25% of cost of medication\u003cbr\u003e\nTiers of medications in Part D\u003cbr\u003e\nPart D tier 1 medications\u003cbr\u003e\nPart D stage 3: donut hole, 25% patient responsibility\u003cbr\u003e\nPart D stage 4: catastrophic stage, copay\u003c/p\u003e\n\n\u003cp\u003eVisit Mastering Medicare at \u003ca href=\"https://www.masteringmedicare.net/\" rel=\"nofollow\"\u003eMasteringMedicare.NET\u003c/a\u003e\u003c/p\u003e","summary":"Mastering Medicare is a podcast helping demystify healthcare and Medicare for senior-serving professionals and providers. ","date_published":"2020-03-10T14:00:00.000-04:00","attachments":[{"url":"https://aphid.fireside.fm/d/1437767933/7ad1df9b-b658-4830-80a6-91982f00740a/16de9237-3312-4017-b302-9195abd6f851.mp3","mime_type":"audio/mp3","size_in_bytes":11438856,"duration_in_seconds":953}]},{"id":"0b53d4f0-8427-4aff-948f-7f8ce5891ead","title":"Episode 3: Medicare Part B","url":"https://www.masteringmedicare.net/3","content_text":"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. \nWe interview eldercare and Medicare industry experts, do deep dives into their companies, services, and experiences, and share their stories and insights with you. \n\nHere are some of the topics that we cover:\n\nWhat is Medicare Part B\nWhat services are included in Part B\nProfessional services\nPart B Physical Therapy\nPart B Outpatient Labs\nPart B Outpatient Radiology\nDoes Medicare pay for DME\nWhen does Medicare pay for 911\nMedicare Part B is opt in\nHow much does Medicare Part B cost\nMedicare Part B monthly premium\nMedicare covers part only 80%\nMedicare secondary insurance / Medigap / supplemental\nPart A vs Part B Physical Therapy\nCost sharing for radiology\nCost sharing for lab tests under Medicare\nMedicare limits on lab tests\nDME\nHow do you order DME, wheelchair, hospital bed in a patient's home\n13 month lease to own DME\nSame and similar DME\nParachute same and similar DME","content_html":"\u003cp\u003ePhysicians 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. \u003cbr\u003e\nWe interview eldercare and Medicare industry experts, do deep dives into their companies, services, and experiences, and share their stories and insights with you. \u003c/p\u003e\n\n\u003cp\u003eHere are some of the topics that we cover:\u003c/p\u003e\n\n\u003cp\u003eWhat is Medicare Part B\u003cbr\u003e\nWhat services are included in Part B\u003cbr\u003e\nProfessional services\u003cbr\u003e\nPart B Physical Therapy\u003cbr\u003e\nPart B Outpatient Labs\u003cbr\u003e\nPart B Outpatient Radiology\u003cbr\u003e\nDoes Medicare pay for DME\u003cbr\u003e\nWhen does Medicare pay for 911\u003cbr\u003e\nMedicare Part B is opt in\u003cbr\u003e\nHow much does Medicare Part B cost\u003cbr\u003e\nMedicare Part B monthly premium\u003cbr\u003e\nMedicare covers part only 80%\u003cbr\u003e\nMedicare secondary insurance / Medigap / supplemental\u003cbr\u003e\nPart A vs Part B Physical Therapy\u003cbr\u003e\nCost sharing for radiology\u003cbr\u003e\nCost sharing for lab tests under Medicare\u003cbr\u003e\nMedicare limits on lab tests\u003cbr\u003e\nDME\u003cbr\u003e\nHow do you order DME, wheelchair, hospital bed in a patient\u0026#39;s home\u003cbr\u003e\n13 month lease to own DME\u003cbr\u003e\nSame and similar DME\u003cbr\u003e\nParachute same and similar DME\u003c/p\u003e","summary":"Mastering Medicare is a podcast helping demystify healthcare and Medicare for senior-serving professionals and providers. In this episode we do a deep dive into Medicare Part B. ","date_published":"2020-03-05T08:00:00.000-05:00","attachments":[{"url":"https://aphid.fireside.fm/d/1437767933/7ad1df9b-b658-4830-80a6-91982f00740a/0b53d4f0-8427-4aff-948f-7f8ce5891ead.mp3","mime_type":"audio/mp3","size_in_bytes":21211578,"duration_in_seconds":1767}]},{"id":"08848e81-05b1-42cd-bcdf-47db4496617c","title":"Episode 2: Medicare Part A","url":"https://www.masteringmedicare.net/2","content_text":"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. \nWe interview eldercare and Medicare industry experts, do deep dives into their companies, services, and experiences, and share their stories and insights with you. \n\nIn this Mastering Medicare episode, we cover: \nHow you qualify for Medicare\nQualifying for Medicare via ALS\nQualifying for Medicare via ESRD on dialysis\nQualifying for Medicare via SSDI disability\nMedicare and VA insurance\nHistory of Medicare\nInpatient hospitalization\nRehab aka SNF aka nursing home\nHome health\nHospice\nMedicare copays and cost sharing for hospitalization\nMedicare part A annual deductible\nMedicare cost sharing with rehab SNF\nMedicare part A home health\nWhat is Home health?\nHome health 485 form\nWhat is skilled nursing?\nWhat does part A PT/OT do?\nCopay for part A PT OT\nHome health \"taxing effort\"\nCertification of being homebound home health\nCertification periods for home health\nRecertification of medicare part A home health\nHome health aides\nHome health 45 minutes twice per week\nWill Medicare pay for wound care supplies?\nMedicare hospice\nWhat is hospice\nWill Medicare pay for hospice\nQualifying for hospice\nHospice certification periods\nWhat does hospice cover and pay for\nHospice payment model\nWho pays for a hospice patient if they go to the ER?\nHospice is a risk bearing entity\nHospice certification and recertification periods\nWhat does it mean to be admitted to a hospital","content_html":"\u003cp\u003ePhysicians 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. \u003cbr\u003e\nWe interview eldercare and Medicare industry experts, do deep dives into their companies, services, and experiences, and share their stories and insights with you. \u003c/p\u003e\n\n\u003cp\u003eIn this Mastering Medicare episode, we cover: \u003cbr\u003e\nHow you qualify for Medicare\u003cbr\u003e\nQualifying for Medicare via ALS\u003cbr\u003e\nQualifying for Medicare via ESRD on dialysis\u003cbr\u003e\nQualifying for Medicare via SSDI disability\u003cbr\u003e\nMedicare and VA insurance\u003cbr\u003e\nHistory of Medicare\u003cbr\u003e\nInpatient hospitalization\u003cbr\u003e\nRehab aka SNF aka nursing home\u003cbr\u003e\nHome health\u003cbr\u003e\nHospice\u003cbr\u003e\nMedicare copays and cost sharing for hospitalization\u003cbr\u003e\nMedicare part A annual deductible\u003cbr\u003e\nMedicare cost sharing with rehab SNF\u003cbr\u003e\nMedicare part A home health\u003cbr\u003e\nWhat is Home health?\u003cbr\u003e\nHome health 485 form\u003cbr\u003e\nWhat is skilled nursing?\u003cbr\u003e\nWhat does part A PT/OT do?\u003cbr\u003e\nCopay for part A PT OT\u003cbr\u003e\nHome health \u0026quot;taxing effort\u0026quot;\u003cbr\u003e\nCertification of being homebound home health\u003cbr\u003e\nCertification periods for home health\u003cbr\u003e\nRecertification of medicare part A home health\u003cbr\u003e\nHome health aides\u003cbr\u003e\nHome health 45 minutes twice per week\u003cbr\u003e\nWill Medicare pay for wound care supplies?\u003cbr\u003e\nMedicare hospice\u003cbr\u003e\nWhat is hospice\u003cbr\u003e\nWill Medicare pay for hospice\u003cbr\u003e\nQualifying for hospice\u003cbr\u003e\nHospice certification periods\u003cbr\u003e\nWhat does hospice cover and pay for\u003cbr\u003e\nHospice payment model\u003cbr\u003e\nWho pays for a hospice patient if they go to the ER?\u003cbr\u003e\nHospice is a risk bearing entity\u003cbr\u003e\nHospice certification and recertification periods\u003cbr\u003e\nWhat does it mean to be admitted to a hospital\u003c/p\u003e","summary":"Mastering Medicare is a podcast helping demystify healthcare and Medicare for senior-serving professionals and providers. We help physicians, NPs, APPs, healthcare executives, eldercare professionals, and other healthcare stakeholders understand and succeed in the Medicare and senior care world. ","date_published":"2020-02-26T10:00:00.000-05:00","attachments":[{"url":"https://aphid.fireside.fm/d/1437767933/7ad1df9b-b658-4830-80a6-91982f00740a/08848e81-05b1-42cd-bcdf-47db4496617c.mp3","mime_type":"audio/mp3","size_in_bytes":31234134,"duration_in_seconds":2602}]},{"id":"3d05a2bb-826f-4a9f-ab72-f27b0e684116","title":"Episode 1: Introduction to Medicare","url":"https://www.masteringmedicare.net/1","content_text":"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. \nWe interview eldercare and Medicare industry experts, do deep dives into their companies, services, and experiences, and share their stories and insights with you. \nBrought to you by two passionate but critical physicians who broke away from the conventional career paths of their specialty. \n\nIn this episode we cover:\nDr. Amy Schiffman and Dr. Alex Mohseni introduce themselves\nMedicare overview\nPart A overview, including cost sharing\nPart A: Hospital, Rehab, Home Health, Hospice\nPart B overview\nPart B 80/20 split, Medigap / supplemental \nPart D\nInpatient vs outpatient medications\nInpatient vs outpatient status\nObservation status\nPart C - Medicare Advantage\n\nJoin our Subscriber List to get your copy of our Medicare Cheat Sheet\nhttps://www.masteringmedicare.net/subscribe","content_html":"\u003cp\u003ePhysicians 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. \u003cbr\u003e\nWe interview eldercare and Medicare industry experts, do deep dives into their companies, services, and experiences, and share their stories and insights with you. \u003cbr\u003e\nBrought to you by two passionate but critical physicians who broke away from the conventional career paths of their specialty. \u003c/p\u003e\n\n\u003cp\u003eIn this episode we cover:\u003cbr\u003e\nDr. Amy Schiffman and Dr. Alex Mohseni introduce themselves\u003cbr\u003e\nMedicare overview\u003cbr\u003e\nPart A overview, including cost sharing\u003cbr\u003e\nPart A: Hospital, Rehab, Home Health, Hospice\u003cbr\u003e\nPart B overview\u003cbr\u003e\nPart B 80/20 split, Medigap / supplemental \u003cbr\u003e\nPart D\u003cbr\u003e\nInpatient vs outpatient medications\u003cbr\u003e\nInpatient vs outpatient status\u003cbr\u003e\nObservation status\u003cbr\u003e\nPart C - Medicare Advantage\u003c/p\u003e\n\n\u003cp\u003eJoin our Subscriber List to get your copy of our Medicare Cheat Sheet\u003cbr\u003e\n\u003ca href=\"https://www.masteringmedicare.net/subscribe\" rel=\"nofollow\"\u003ehttps://www.masteringmedicare.net/subscribe\u003c/a\u003e\u003c/p\u003e","summary":"Mastering Medicare is a podcast helping demystify healthcare and Medicare for senior-serving professionals and providers. We help physicians, NPs, APPs, healthcare executives, eldercare professionals, and other healthcare stakeholders understand and succeed in the Medicare and senior care world. ","date_published":"2020-02-19T08:00:00.000-05:00","attachments":[{"url":"https://aphid.fireside.fm/d/1437767933/7ad1df9b-b658-4830-80a6-91982f00740a/3d05a2bb-826f-4a9f-ab72-f27b0e684116.mp3","mime_type":"audio/mp3","size_in_bytes":86399480,"duration_in_seconds":2159}]}]}