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Insurance abuse
What would you do if you felt that your current employer is committing insurance abuse? I’m not sure it could be considered fraud, but it is abuse in the sense that they are ordering a repeat test that is unnecessary. They own the “lab” so they are billing OV along with nail debridement code when “taking a nail biopsy”, gets reimbursed for the lab fee, then bills another OV with nail debridement for biopsy review. Bills this every 6 months to the Medicare patients because Medicare will... Read more (Source: Student Doctor Network)
Source: Student Doctor Network - June 28, 2022 Category: Universities & Medical Training Authors: PMG03470 Tags: Podiatric Residents & Physicians Source Type: forums

Oncology Care Model, part deux
Enhancing Oncology Model | CMS Innovation Center The Enhancing Oncology Model (EOM) aims to drive transformation and improve care coordination in oncology care by preserving and enhancing the quality of care furnished to beneficiaries undergoing treatment for cancer while reducing program spending under Medicare fee-for-service. Under EOM... innovation.cms.gov Just announced by CMS. It is everything the RO APM is NOT, namely: 1. It is voluntary 2. You get paid extra money on top of fee for service (Source: Student Doctor Network)
Source: Student Doctor Network - June 28, 2022 Category: Universities & Medical Training Authors: Gfunk6 Tags: Radiation Oncology Source Type: forums

Private Insurance Reimbursement Rates
Is it normal for some private insurers to pay substantially less than Medicare? I'm new to CPT billing and my current position pays me based on a percentage of CPT code billed. I know what the 2021 Medicare rates are for common psych CPT codes, but the information provided from the company is showing some of the private large insurers as contracted for substantially less, most below $60 total for a 99213 across companies, or around $100 for a new 99204. Is this normal reimbursement or am I... Read more (Source: Student Doctor Network)
Source: Student Doctor Network - June 1, 2022 Category: Universities & Medical Training Authors: OriginalBlend Tags: Psychiatry Source Type: forums

Medicare reimbursement for RO services down 20% in inflation adjusted terms from 2010
DEFINE_ME Thank you to the authors for putting this together. Big shout out to the Chairs who doubled residency spots over the same time and all the programs that SOAPed this year. Bright futures abound. (Source: Student Doctor Network)
Source: Student Doctor Network - May 22, 2022 Category: Universities & Medical Training Authors: DebtRising Tags: Radiation Oncology Source Type: forums

WAMC + School List: MCAT 505/507, cGPA 3.69, sGPA 3.53
Academic Background: Degree: Bachelor of Science in Biology Public state school cGPA: 3.69 sGPA: 3.53 MCAT Scores: 1st Try: 507 2nd Try: 505 I took the MCAT twice during the COVID pandemic. I was, unfortunately, dealing with a lot of family issues throughout the pandemic. For example, I had to help my parents navigate job loss, obtain health insurance through Medicare, and their medical illnesses. This was all while I was working a full-time job... Read more (Source: Student Doctor Network)
Source: Student Doctor Network - May 18, 2022 Category: Universities & Medical Training Authors: jellybean_289 Tags: What Are My Chances? WAMC Medical Source Type: forums

Ciox medical record requests
We keep on getting phone calls and faxes for medical record requests from Ciox every year. They usually want all of the medical records from the previous year for patients we have seen under a certain medical insurance. Reading further into one of their requests, Ciox is requesting records for Medicare Advantage plans to "obtain health status documentation from diagnoses contained in claims and from information contained in the member's medical records." Have other offices been getting... Read more (Source: Student Doctor Network)
Source: Student Doctor Network - May 17, 2022 Category: Universities & Medical Training Authors: promethius Tags: Pain Medicine Source Type: forums

WAMC (CA Applicant)
Date of submission: Mid-June (hopefully) Overall GPA: 3.88 Science GPA: 3.80 DAT score (include AA and all sections): 24 AA, 23 TS, 22 Bio, 22 GC, 25 OC, 28 PAT, 28 RC, 21 QR State of Residence: California Major: Biology Minor: Psychology Minority? ORM Shadowing Experience: 220+ hours total: 2 general private practice dentist, 1 medicare dental office, and 1 pediatric dentist; 39 hours from virtual shadowing Volunteering Experience: 250 total: 100 hours hospital, 100 hours community food... Read more (Source: Student Doctor Network)
Source: Student Doctor Network - May 2, 2022 Category: Universities & Medical Training Authors: yuheng7 Tags: What Are My Chances? WAMC Dental Source Type: forums

Physicians Opposing Pharmacist Expanded Practice
Top News: APhA addresses AMA's inaccurate description of H.R. 7213 and viewpoints of most physicians working along pharmacists​APhA is reinforcing the importance of H.R. 7213, which would allow limited but significant Medicare reimbursement for pharmacists, after the American Medical Association (AMA) tried to undermine the bill. AMA laid out a case against the proposal in a letter to key lawmakers on April 12, but APhA says the medical society...​ Read more (Source: Student Doctor Network)
Source: Student Doctor Network - April 26, 2022 Category: Universities & Medical Training Authors: TranslationalRPh Tags: Pharmacy Source Type: forums

$4M PayDay for Spine Surgeon Whistleblower
It's like a feeding frenzy in the HOPD for employed spine surgeons... "Waldref’s office said Yam will receive $4.1 million from the settlement. As well, Medicare, Medicaid and other affected federal insurance programs will receive $10 million. The remainder will be returned to the federal Treasury, Waldref said."... Read more (Source: Student Doctor Network)
Source: Student Doctor Network - April 21, 2022 Category: Universities & Medical Training Authors: drusso Tags: Pain Medicine Source Type: forums

IMRT coverage for skin
For patient with node positive squamous of the skin I always have trouble getting IMRT covered for Medicare patients. When I see talks or ASTRO conference presentations they are always using IMRT. Anybody able to get IMRT covered for Medicare patients and why can't I? My billing folks tell me I can get medial canthus C44.121 covered but thats about it. Any tips for codes to use? (Source: Student Doctor Network)
Source: Student Doctor Network - April 16, 2022 Category: Universities & Medical Training Authors: xrt123 Tags: Radiation Oncology Source Type: forums

Medicare advantage plans VS Medicare
Can anyone expand on the diff btw commercial medicare adv plans and Medicare? Also type of patients typically socioeconomic /demographic etc (Source: Student Doctor Network)
Source: Student Doctor Network - April 13, 2022 Category: Universities & Medical Training Authors: liquidshadow22 Tags: Psychiatry Source Type: forums

"Lymphedema" Compression Pumps (and fraud)
I had a weird experience the other day that makes me think I wrote my last SCD type / lymphedema device (and I've written maybe 2-3 total). Without going into more details - how I think I wrote it and how the rep submitted it seemed to be two different things. Additionally, the more I read about it this morning the more I think this being covered by Medicare/insurance is supposed to be tight. My historic prescriptions were for long term ulcers. I'm curious - does anyone else have reps from... Read more (Source: Student Doctor Network)
Source: Student Doctor Network - April 9, 2022 Category: Universities & Medical Training Authors: heybrother Tags: Podiatric Residents & Physicians Source Type: forums

Payor mix at top hospitals
Overall excellent. Most are 40-50%+ commercial. No wonder they can have nice lobbies and no wonder why they care about USNWR. Payer mix in the nation's top 20 hospitals Becker's calculated the payer mix within the nation's top ranked hospitals to determine the share of their patients covered under commercial plans, Medicare, Medicaid, Medicare Advantage, uninsured/bad debt, and charity care. www.beckerspayer.com Payer mix in the nation's top 20 hospitals​Jako...
Source: Student Doctor Network - April 7, 2022 Category: Universities & Medical Training Authors: nimbus Tags: Anesthesiology Source Type: forums

Medicare guidelines for managed care
Has anyone worked for a managed medicare company like Humana or United doing to review for approval to IPR. I do peer to peers all the time and i swear its luck of the draw on getting patients approved for transfer from acute to ipr. The constant thing i hear is “they dont fit medicare criteria for ipr”. I know the basics and when i ask which criteria they never will say specifics. Just usually the same line about not fitting over and over. If they elaborate at all they just say the person... Read more (Source: Student Doctor Network)
Source: Student Doctor Network - April 1, 2022 Category: Universities & Medical Training Authors: Momentum70 Tags: PM&R Source Type: forums

Patients who don't pay
What do you all do when payments don't pay? Speaking about those of you guys who do inpatient, and for example have Medicare A but patients don't have Medicare B/supplement so the physician portion of costs are not covered by insurance, patients sent a bill and they refuse to pay. How do you deal with this issue? Thanks! (Source: Student Doctor Network)
Source: Student Doctor Network - March 29, 2022 Category: Universities & Medical Training Authors: Iamnew2 Tags: PM&R Source Type: forums