The Medicare Advantage Diagnosethon
This is a shout-out to all my physician friends. Medicare Advantage is basically an HMO or capitated plan so the more they deny patients services the more money the insurance company makes. Also, the more diagnoses they give to the patient the more money they make. This has created a “Diagnosethon”. Have any of you received any letters from Medicare Advantage plans stating they found new diagnoses in your patients? Many of these companies use contractors to send nurses, PAs, NPs to the patients’ houses for a visit and all of a sudden you get a letter stating your patient now has diabetes, HTN, PVD, etc. You may have read articles in the NYT or Post about this. If this happened to you would you please email me at doug at authenticmedicine.com (use the @ in my email. I don’t here as the email gets scraped off the web and I get bombarded with spam).
AAFP is pushing physicians to do the exact same thing with HCC codes.
HOw low will we go?
KOM,
Not sure if you heard about this related news.
Couldn’t happen to nicer people….
https://www.justice.gov/opa/pr/martins-point-health-care-inc-pay-22485000-resolve-false-claims-act-allegations
yup, that’s part of the diagnosethon.
No wonder these companies audit virtually every one of my records. There are a variety of grab bag diagnoses you can pin on anyone and especially as our patients agemost everybody gets more and more of these “problems”. IT IS HILARIOUS AND TRAGIC………