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  • David E. Marcinko [Editor-in-Chief]

    As a former Dean and appointed University Professor and Endowed Department Chair, Dr. David Edward Marcinko MBA was a NYSE broker and investment banker for a decade who was respected for his unique perspectives, balanced contrarian thinking and measured judgment to influence key decision makers in strategic education, health economics, finance, investing and public policy management.

    Dr. Marcinko is originally from Loyola University MD, Temple University in Philadelphia and the Milton S. Hershey Medical Center in PA; as well as Oglethorpe University and Emory University in Georgia, the Atlanta Hospital & Medical Center; Kellogg-Keller Graduate School of Business and Management in Chicago, and the Aachen City University Hospital, Koln-Germany. He became one of the most innovative global thought leaders in medical business entrepreneurship today by leveraging and adding value with strategies to grow revenues and EBITDA while reducing non-essential expenditures and improving dated operational in-efficiencies.

    Professor David Marcinko was a board certified surgical fellow, hospital medical staff President, public and population health advocate, and Chief Executive & Education Officer with more than 425 published papers; 5,150 op-ed pieces and over 135+ domestic / international presentations to his credit; including the top ten [10] biggest drug, DME and pharmaceutical companies and financial services firms in the nation. He is also a best-selling Amazon author with 30 published academic text books in four languages [National Institute of Health, Library of Congress and Library of Medicine].

    Dr. David E. Marcinko is past Editor-in-Chief of the prestigious “Journal of Health Care Finance”, and a former Certified Financial Planner® who was named “Health Economist of the Year” in 2010. He is a Federal and State court approved expert witness featured in hundreds of peer reviewed medical, business, economics trade journals and publications [AMA, ADA, APMA, AAOS, Physicians Practice, Investment Advisor, Physician’s Money Digest and MD News] etc.

    Later, Dr. Marcinko was a vital and recruited BOD  member of several innovative companies like Physicians Nexus, First Global Financial Advisors and the Physician Services Group Inc; as well as mentor and coach for Deloitte-Touche and other start-up firms in Silicon Valley, CA.

    As a state licensed life, P&C and health insurance agent; and dual SEC registered investment advisor and representative, Marcinko was Founding Dean of the fiduciary and niche focused CERTIFIED MEDICAL PLANNER® chartered professional designation education program; as well as Chief Editor of the three print format HEALTH DICTIONARY SERIES® and online Wiki Project.

    Dr. David E. Marcinko’s professional memberships included: ASHE, AHIMA, ACHE, ACME, ACPE, MGMA, FMMA, FPA and HIMSS. He was a MSFT Beta tester, Google Scholar, “H” Index favorite and one of LinkedIn’s “Top Cited Voices”.

    Marcinko is “ex-officio” and R&D Scholar-on-Sabbatical for iMBA, Inc. who was recently appointed to the MedBlob® [military encrypted medical data warehouse and health information exchange] Advisory Board.



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Social HMOs for the Elderly

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Extended Health Coverage for Unconventional Expenses

By Dr. David Edward Marcinko; MBA, CMP™ 


A social HMO offers extended coverage for some of the unconventional expenses associated with senior healthcare, such as transportation and in-home day care not covered by traditional MCOs.  

AAHP Definition 

According to the American Association of Health Plans (AAHP), social HMOs provide coordinated services by uniting federal and state funds and services, to benefit the elderly.

Real Life Example: 

One such social HMO is the 21 year-old Elderplan, based in Brooklyn, New York.*  It is a Medicare Advantage Plan (MA-PD) with the following characteristics:

Elderplan Classic:

  • $0 monthly premium
  • $0 to see a doctor
  • Unlimited brand name drugs
  • Unlimited generic drugs
  • $0 for approved generic drugs

 Elderplan Extra:

  • $0 plan premium
  • Low prescription co-payments
  • $40 reduction in Part B premium every month
  • Coverage for dental, hearing and vision services

 Elderplan Access:

  • $0 regular doctor visits
  • $0 monthly premium for you
  • Unlimited brand name drugs
  • Unlimited generic drugs

 Elderplan Advantage:

  • Coverage designed for individuals living in a skilled nursing facility
  • A personal registered nurse care practitioner
  • Complete coordinated care
  • Treatment for some medical issues at residence
  • $0 co-payment for skilled nursing facility stays


Are you familiar with the social HMO concept and what has been your experience with it? Please comment and opine. 

*illustrative purposes only. Not an endorsement of http://www.Elderplan.org.


Your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com


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Enhancing Revenue Cycle Accounting

Hospital Claims Denial Management

By Karen White; PhD 

Typically, denied and rejected hospital and health systems claims quickly surface as a source of multi-millions in revenue leakage and unnecessary expense.

And, it is the same for medical practice accounting, regardless of size. 

Increasing Costs 

Payers have been struggling with increased costs for the past decade. They thoroughly inspect claims for errors and have become adept at using their rules to deny and delay claims.

For example, Zimmerman reported the denied percentage of gross charges climbed from 4% in 1990 to 11% in 2001, and even more by 2008. In contrast, some hospitals and many more medical providers still typically lack the tools to aggressively manage current denied claims and prevent future ones. 

Denial Tracking 

Without current denial tracking systems, a hospital or healthcare organization may not recognize the heavy financial impact of denied medical claims.  The HARA report indicates that bad debt and gross days are declining.

However, a majority of providers write off denials as contractual allowance, distorting the numbers but not the resulting lower margins and reduced cash flow. 

For example, H*Works reports that the typical 350-bed hospital loses between $4 million and $9 million each year in earned revenue from denials and underpayments (assume $103 million annual gross revenue and 40% contractual allowance).

And, the situation is similarly depressing for private practices. Recouping lost revenue from denials and underpayments will, according to H*Works, increase an organization’s operating margin by 2.6%.


Health industry estimates report that at least 50% of denials are recoverable and 90% are preventable with the appropriate workflow processes, management commitment, strong change leadership, and the correct health information technology.  

H*Works estimates that for a revenue capture of $3 million from denials and underpayments, the recovery infrastructure costs are only about 3%.


With all this in mind, better management as well as the information necessary to resolve and prevent them, surfaces as probably the best strategy to the improved financial management of any healthcare organization.  

And, streamlining the revenue cycles and managing rejected claims and denials, proves to be less expensive and provides faster returns than initiating any new ancillary healthcare services. Your thoughts and comments are appreciated. 

More info: http://www.springerpub.com/prod.aspx?prod_id=23759 

Institutional: www.HealthcareFinancials.com 

Terms: www.HealthDictionarySeries.com 

Link: http://www.podiatrytoday.com/article/5916   

  • Zimmerman & Associates, LLC. Best Practices of Denial Management. Presentation at HFMA Annual Networking Institute (ANI) conference (2004).
  • Joann Petaschnick, Sr. Editor. HARA. Aspen Publishers. (Fourth Quarter 2001).
  • For further information, see http://www.advisoryboardcompany.com.
  • H*Works (The Advisory Board). Capturing Lost Revenues. Washington, D.C. 2001-05.


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