Valuation of Tele-Medicine Services

Click to access TELEMEDICINE.pdf

On Medicare Advantage Plans (Private Medicare)

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.

The Patron of Physicians, Surgeons, Pharmacists and Barbers

PRAY FOR US – Feast Day!

By Anonymous

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Nothing is known of their lives except that they suffered martyrdom in Syria during the persecution of the Emperor Diocletian. According to Christian traditions, the twin brothers were born in Arabia and became skilled doctors.

Saladino d’Ascoli, a 15th century Italian physician, claims that the medieval electuary, a pasty mass consisting of a drug mixed with sugar and water or honey suitable for oral administration, known as opopira, a complex compound medicine used to treat diverse maladies including paralysis, was invented by Cosmas and Damian.

During the persecution under Diocletian, Cosmas and Damian were arrested by order of the Prefect of Cilicia, one Lysias who is otherwise unknown, who ordered them under torture to recant. However, according to legend they stayed true to their faith, enduring being hung on a cross, stoned and shot by arrows and finally suffered execution by beheading. Anthimus, Leontius and Euprepius, their younger brothers, who were inseparable from them throughout life, shared in their martyrdom.

WIKIPEDIA

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Education, Degrees, Start-Ups and IPOs?

FOR TOP MANAGERS AND BODs

By Dr. Jeffery Funk

Did you know that far more MBAs and bachelor-degree holders were among top managers and board of directors among startups filing for IPOs between 1990 and 2018 than were other degree holders?

About 55% of them had an MBA for their highest degree vs. 20% for bachelors, 7% for PhD, 3% for MD, 12% for MS, and 3% for JD. The high percentage of MBAs and bachelor-degree holders reflects the move away from #science-based #technologies such as semiconductors, and electronic, communications, and medical equipment that once dominated Silicon Valley (hence the name), and towards Internet commerce, content, and services over last 25 years.

In fact, most PhDs among top managers and board of directors at IPO time studied life sciences and were employed in #biotech #startups, a sector that continues to thrive. Creating successful science-based startups in other sectors continues to be a big challenge, one that may be partially overcome by #AI in near future.

As for which #universities train these people, Harvard, Stanford, Berkeley and MIT had the most graduates in many categories, representing almost 20% of PhDs for instance.

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Graphical Shapes of Economic Recovery

Of Shapes and Sizes!

By Staff Reporters

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Physician Practices Weathering the Storm of COVID-10?

Physician Practices Weathering the Storm of COVID-10?

By staff reporters

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Income for Financial Advisors

By Years of experience

Via Michael Kitces

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THE DIFFERENT SCHOOLS OF PSYCHOLOGY

Five [5] Schools

By staff reporters

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How Did We Screw Up the Pandemic So Badly?

By Bertalan Mesk MD PhD

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https://www.linkedin.com/pulse/how-did-we-screw-pandemic-up-so-bad-bertalan-mesk%C3%B3-md-phd/?trk=eml-email_series_follow_newsletter_01-hero-257-title_link&midToken=AQGGg4QStFgVOA&fromEmail=fromEmail&ut=0zs6pcrWG-_9o1

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Update on ARTIFICIAL INTELLIGENCE [A.I.]

Future Fate: YES -or- NO?

[By staff reporters]

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What Doctors Must Do to File an AETNA® Claim to Get Paid?

WITH ADJUDICATION CONSIDERATIONS

By Anonymous MD

Now you will learn and know just one reason why doctors are pulling their hair out, felling stress, burn out and may even consider suicide?

Only 54 pages of steps for one electronic claim.

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REPEAT: FOR EVERY PATIENT CLAIM

  AETNA® – We are not glad we met ya!

About Acute Pericarditis?

Diagnosis and Treatment

By staff reporters

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Our “Regret” Principles

Understanding the “Misery Index”

By Dan Ariely PhD

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Update on Medical “Prior Authorization”

Survey Highlights on Pre-Certification

By wedi

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Product Details

“DICTIONARY OF TERMS FOR THE BUSINESS OF MEDICINE”
DHEF: https://lnkd.in/dqdbWM9
DHIMC: https://lnkd.in/e9AmEhd
DHITS: https://lnkd.in/eWx3WjZ
MORE: https://lnkd.in/eVGcji5

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How to Delegate Authority?

Do’s and Don’ts

By staff reporters

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Employee Health Cost Projections

Per Employee

By: http://www.MCOL.com

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Waived Co-Pays for United Healthcare Medicare Advantage Plans

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

Source: https://www.uhc.com/health-and-wellness/health-topics/covid-19/coverage-and-resources/cost-sharing-waived

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

 

The Economic Impact of Lung Diseases

Among US Workers

By: http://www.MCOL.com

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The HEDGE-FUND Fee “Haircut”

Understanding the 2% & 20% Rule

By D. Muthukrishnan

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Comprehensive Financial Planning Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™

 

Patient Health Information Data Processing and Storage

US Patent Publication – Who Owns Your Medical Info?

By staff reporters

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US Stimulus Payment By Household Income Percentage

By The Economist

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Comprehensive Financial Planning Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™

20 Cognitive Biases That Affect Decision Making

Screwed-Up Decision Making

[By Staff reporters]

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Executive Order Expands Tele-Medicine

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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The COVOD-19 Vaccine Race?

Get Ready – Get Set – Go!

By staff reporters

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The Economic Impact of Lung Disease

Among U.S. Workers

By http://www.MCOL.com

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Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC)

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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2021 Physician Fee Schedule

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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