Click to access TELEMEDICINE.pdf
Filed under: Experts Invited | Tagged: teleHealth, Valuation of Telemedicine | Leave a comment »
Click to access TELEMEDICINE.pdf
Filed under: Experts Invited | Tagged: teleHealth, Valuation of Telemedicine | Leave a comment »
PART C
By John Kelly
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Medicare Advantage Plans (Private Medicare) are sold on a county-by-county basis. Attached is the market penetration of MA (compared to traditional FFS Medicare) for every county in the USA.
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Wonder why Medicare Advantage Premiums are going down (on average)? Because premiums are one of the measures by which the elderly decide what to purchase. Even though premiums are declining, not all MA plans are ‘cheaper’ than traditional FFS Medicare. Caveat Emptor.
It is also interesting to note that 3 carriers – Humana, UHC and BCBS Affiliates — cover 60% of all MA plan subscribers and use national networks of providers to offer broad service availability (compared to smaller plans, PSP’s and other narrow network options).
Medicare premiums per beneficiary typically exceed $10,000 per year. With effective ingenious use of benefit design, prior authorization, incentives, PBM contract rebates, etc., — there is a lot of money to be made in Medicare Advantage plans — accounting for the rapid growth in these plans over the last decade.
Filed under: Health Economics, Health Insurance, Healthcare Finance | Tagged: Medicare Advantage Plans, Medicare Part C | 4 Comments »
Of Shapes and Sizes!
By Staff Reporters
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Filed under: Investing | Tagged: economic recovery | 1 Comment »
Physician Practices Weathering the Storm of COVID-10?
By staff reporters
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Filed under: Health Economics, Health Insurance, Health Law & Policy | Tagged: corona, pandemic, pandemic unemployment | Leave a comment »
By Years of experience
Via Michael Kitces
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By Bertalan Mesk MD PhD
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Filed under: "Doctors Only", Experts Invited | Tagged: Bertalan Meskó, covid, pandemic | 2 Comments »
Future Fate: YES -or- NO?
[By staff reporters]
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Filed under: Ethics, Glossary Terms | Tagged: AI, artificial intelligence | 1 Comment »
Diagnosis and Treatment
By staff reporters
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Filed under: Glossary Terms, LifeStyle | Tagged: acute pericarditis, corona | Leave a comment »
Understanding the “Misery Index”
By Dan Ariely PhD
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Filed under: Glossary Terms, LifeStyle | Tagged: Dan Ariely PhD, Misery Index, Regret Principles | 1 Comment »
Do’s and Don’ts
By staff reporters
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Filed under: Glossary Terms, LifeStyle | Tagged: How to delegate? | Leave a comment »
Per Employee
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Filed under: Health Economics, Health Insurance, Healthcare Finance | Tagged: Employee Health Cost Projections | Leave a comment »
Waived Co-Pays for United Healthcare Medicare Advantage Plans
By Jessica M. Wade, MHA, Practice Manager
Just to clarify, the UHC copay waiver info is listed clearly on the UHC website as follows:
“Members will have a $0 copay for covered primary care provider (PCP) and specialist physician services, as well as other covered services (listed below) between May 11, 2020 until September 30, 2020″. By lowering our PCP and specialist copays to $0, along with our telehealth cost-share waiver, we hope to help make it easier for you to access care”
Services included
The following services, if covered by your plan, are eligible for a $0 copay under the cost-share waiver, but do not include diagnostic tests and certain other services.
• Primary care provider (PCP) office visits
• Specialist physician office visits
• Physician assistant or nurse practitioner office visits
• Medicare-covered chiropractic and acupuncture services
• Medical and Podiatry services and routine eye and hearing exams
• Physical therapy, occupational therapy and speech therapy
• Cardiac and pulmonary rehabilitation services
• Outpatient mental health and substance abuse visits
• Opioid treatment services
The $0 copay applies to services from a network provider and out-of-network services covered by the plan. Member cost-share is not waived for the
following services, unless they are related to COVID-19 testing or treatments:
• Lab and Diagnostic tests (radiological and non-radiological)
• Part B and Part D drugs
• Durable Medical Equipment, Prosthetics, Orthotics and Supplies
• Renal Dialysis
• Other services not covered by your plan
Co-pays, co-insurance and deductibles for services in the following settings are not waived. Members will be responsible for their share of the cost under their benefit:• Inpatient hospital and Outpatient surgery or observation services.
• Skilled Nursing Facilities
• Emergency, Urgent and Ambulance services
Furthermore, reimbursement is based on the Medicare fee schedule as these plans waiving copay are Medicare Advantage plans and subject
to Medicare guidelines and reimbursement models.
THANK YOU
Filed under: iMBA, Inc. | Tagged: corona virus, Medicare Advantage, Medicare Part C, UHG, United Healthcare | 3 Comments »
Among US Workers
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Filed under: Health Insurance, LifeStyle, Quality Initiatives | Tagged: lung cancer, lung disease, mcol.com | Leave a comment »
Understanding the 2% & 20% Rule
By D. Muthukrishnan
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Filed under: Investing | Tagged: 2% & 20% Rule, D. Muthukrishnan, hedge funds | Leave a comment »
US Patent Publication – Who Owns Your Medical Info?
Filed under: Information Technology | Tagged: EHRs, EMRs, health information data storage, HIT, medical records, Optum, US Patents | Leave a comment »
By The Economist
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Filed under: Investing | Tagged: The Economist, US stimulus payments | 1 Comment »
Screwed-Up Decision Making
[By Staff reporters]
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Filed under: Experts Invited, Glossary Terms, Quality Initiatives | Tagged: Biases investing, cognitve science, Decision Biases, decision-making | 1 Comment »
Eases Burden on Rural Medical Providers
By Health Capital Consultants, LLC
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Executive Order Expands Telemedicine and Eases Burden on Rural Providers
On August 3, 2020, President Donald Trump signed an executive order aimed at expanding access to care through two avenues: telemedicine and eased financial burdens on rural providers. The executive order builds on President Trump’s original expansion of coverage for telemedicine services in early March 2020, an order which was praised by the American Telehealth Association (ATA) and American Medical Association (AMA) for swiftly responding to the growing healthcare crisis. This Health Capital Topics article will discuss the executive rule and the subsequent agency actions on these fronts. (Read more…)
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Filed under: Glossary Terms, Health Law & Policy, Information Technology | Tagged: Health Capital Consultants LLC, Medicare Telehealth, Tele-Health, telemedicine | 2 Comments »
Get Ready – Get Set – Go!
By staff reporters
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Filed under: Health Insurance, LifeStyle, Quality Initiatives | Tagged: corona cure, corona vaccine, COVOD-19 Vaccine Race | Leave a comment »
Among U.S. Workers
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Filed under: Glossary Terms, Health Economics, Health Insurance, LifeStyle | Tagged: corona, Covid-19, lung, lung disease, mcol.com, vaping | 1 Comment »
CMS Includes Several Changes in OPPS Proposed Rule
By Health Capital Consultants, LLC
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On August 4, 2020, CMS released the latest in a series of recently-published proposed rules, the Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) proposed rule for fiscal year (FY) 2021.
This proposed rule builds upon executive orders such as “Protecting and Improving Medicare for Our Nation’s Seniors,” signed by President Trump in October 2019 and Trump Administration initiatives such as “Patients Over Paperwork.” In a press release, CMS highlighted the proposed rule’s focus on increasing competition among providers to give patients more choice, lowering out-of-pocket surgery costs, increasing provider flexibility, and allowing patients to make more informed decisions about their care. (Read more…)
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Filed under: iMBA, Inc. | Tagged: CMS, OPPS | Leave a comment »
2021 Physician Fee Schedule & Quality Payment Program Proposed Rules Released
[By Health Capital Consultants]
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On August 3, 2020, the Centers for Medicare & Medicaid Services (CMS) released two proposed payment rules for calendar year (CY) 2021: the Medicare Physician Fee Schedule (MPFS) and the Quality Payment Program (QPP). CMS included in the MPFS proposed rule adjustments to physician payment rates and an expansion of telemedicine services.
The proposed QPP rule, meanwhile, takes into account adjustments made for the COVID-19 public health emergency (PHE) and seeks to reduce unnecessary regulatory burden on providers by eliminating some requirements. These rules, which have garnered mixed reactions from stakeholders, are both open for comment until October 5, 2020. (Read more…)
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Filed under: Health Economics, Health Insurance, Healthcare Finance | Tagged: 2021 Physician Fee Schedule, CMS, Health Capital Consultants LLC, Quality Payment Program CMS | Leave a comment »