Mastering Medicare

In this episode, Amy Schiffman and Alex Moseni dig into the real challenges physicians and innovators face when working inside Medicare. They explore why CMS guidance is often incomplete, how this drives confusion and legal costs, and what it means for startups trying to build sustainable care models. Topics Covered • The Medicare information gap and why CMS publishes only partial guidance • How u...

Physicians and other senior-serving professionals trying to operate within the complicated Medicare ecosystem must be constantly learning, as the landscape, rules, tools, and vendors are in constant flux. We interview eldercare and Medicare industry experts, do deep dives into their companies, services, and experiences, and share their stories and insights with you.

E26: Deep dive into DeepScribe with Dr. Dean Dalili. Introduction : Amy and Alex introduce the episode on AI in healthcare, featuring Dr. Dean Dalili from DeepScribe, an AI-based medical documentation service. Dean's Background : Dr. Dean Dalili shares his journey from internist at Johns Hopkins to Chief Medical Officer at DeepScribe, with a career in hospitalist practice, digital health, and lead...

E25: Deep dive into the PACE program with Dr Rob Schreiber and Eric Patzelt from myPlace Health . PACE Overview : Program of All-Inclusive Care for the Elderly provides comprehensive care for seniors, allowing them to live in the community rather than nursing homes. Eligibility : Seniors must be 55+, certifiable for nursing home care, and safe in the community with PACE services. Funding : PACE is...

Introduction of the guest Matt Gibson from 90 Days from Retirement, a platform educating about insurance post-retirement. Discussion about the prevalence of insurance agents buying leads of people turning 65 and how 90 Days from Retirement differs by providing education instead. People turning 65 often receive unsolicited mail and phone calls offering help with Medicare, which can be overwhelming....

Introduction of a new product called Aging Here newsletter Request for subscriptions and feedback for Aging Here Introduction of guest Dr. Marc Gruner from Limber Health Marc's background as a physician and entrepreneur Marc's involvement in creating new CPT codes for RTM Introduction to Limber Health and its solution for improving therapy adherence Explanation of how Limber's app helps monitor an...

Discussion topic: Getting paid through the Medicare system Introduction to CPT codes and HICPICS codes Medicare's payment process for healthcare providers Future guests and topics related to Medicare reimbursement Mention of the Aging Here newsletter and interview opportunities Differentiating between CPT codes and ICD-10 codes History and purpose of CPT codes Explanation of RVUs (Relative Value U...

Physicians and other senior-serving professionals trying to operate within the complicated Medicare ecosystem must be constantly learning, as the landscape, rules, tools, and vendors are in constant flux. We interview eldercare and Medicare industry experts, do deep dives into their companies, services, and experiences, and share their stories and insights with you. The Mastering Medicare Podcast...

Dr. Amy Schiffman and Dr. Alex Mohseni do a deep dive interview with Jonathan Edenbaum, the owner of Eden Homes about the ALF industry. What is an Assisted Living What is a Group Home Small vs large assisted living Kosher assisted living Key triggers for transitioning from independent living to assisted living Standard ratios in assisted living days vs nights Incontinence as a trigger for assisted...

In this amazing interview with Robert Bullock, a DC-based Elder Law attorney, from The Elder & Disability Law Center , Dr. Amy Schiffman and Dr. Alex Mohseni discuss Medicaid Long Term Care coverage. We cover these topics: What is Medicaid Medica long term care eligibility What does Medicaid waiver mean? How does one qualify for Medicaid Medical eligibility for Medicaid long term care Financia...

Danielle Doberman, MD, MPH, HMDC, is the Clinical Medical Director for Palliative Medicine at Johns Hopkins Hospital. Dr. Amy Schiffman and Dr. Alex Mohseni dive deep into the world of Palliative Care to understand what this commonly misunderstood specialty is all about. We cover the following: What is palliative care / palliative medicine? What symptoms does palliative focus on? How does palliati...

Dr. Amy Schiffman and Dr. Alex Mohseni interview Steve Ackerman, the owner of Spectrum Medical, and do a deep dive into the world of Durable Medical Equipment (DME). Introduction to Steve Ackerman and Spectrum Medical What is Durable Medical Equipment DME? Not disposable, has to be able to sustain repeated use Can't be used in the absence is disease or injury Can't be an environment improvement Ca...

Dr. Amy Schiffman and Dr. Alex Mohseni interview Michael Hughes, principal at Mitchell-Lowey, LLC, and do a deep dive into Medicare Advantage plans, especially as they relate to supplemental benefits like private duty home care services. We discuss: What is Medicare Advantage MA plans offer supplemental benefits CMS is realizing that SDOH determine health and cost outcomes Who costs the system the...

In this episode we do a deep dive into Hospice with our guest, Cathy Gurson. She teaches us everything we ever wanted to know about Hospice. Here are some of the topics we cover: How do people get referred to hospice Hospice is covered 100% by Medicare part A What does hospice cover How to get Part B medical care covered while under hospice Hospice reimbursement model Hospice per diem Three levels...

Dr. Amy Schiffman and Dr. Alex Mohseni do a deep dive into Alex's frustrations with documentation, billing, coding and his EMR in setting up a solo practice. They discuss the issues that make it nearly impossible for small practices to thrive if they agree to accept health insurance. Link to Youtube video version: https://youtu.be/kI5QqVA9NAQ

Dr. Amy Schiffman and Dr. Alex Mohseni talk with the team from Fox Rehab about physical therapy, occupational therapy and speech pathology and uncover all the hidden issues, challenges, and secrets of this huge industry. If you are a senior-serving professional or medical provider who orders PT, OT or Speech services for your clients, you need to listen to this episode. Alex and Amy cover the foll...

With COVID-19 causing lots of seniors to be stuck at home and not be able to access the medical care that they need, Alex decides to start his own medical practice to serve this population. Alex chronicles everything he's doing to start this practice and gets Amy's help in figuring out lots of the details and issues. In this episode Alex and Amy discuss Medicare enrollment for individuals, organiz...

Part 2 of our incredible interview with Andy Diamond, the President of Diamond Medical Labs and Mobile Medical Imaging. In this amazing episode, Andy teaches us everything about how mobile medical imaging is done in nursing homes, rehabs, assisted livings and in patients' homes. In part 2 we discuss: Brief summary of mobile labs episode What sort of equipment do mobile medical imaging labs have in...

With COVID-19 causing lots of seniors to be stuck at home and not be able to access the medical care that they need, Alex decides to start his own medical practice to serve this population. Alex chronicles everything he's doing to start this practice and gets Amy's help in figuring out lots of the details and issues. Alex and Amy discuss Medicare enrollment for individuals, organizations and emplo...

Amy and Alex interview Andy Diamond, the President of Diamond Medical Labs and Mobile Medical Imaging. In this amazing episode, Andy teaches us everything about how labs are done in nursing homes, rehabs, assisted livings and in patients' homes. In part 1 we discuss: How and why do lab companies have contracts with nursing homes and assisted living facilities? Part A and Part B billing for labs in...

Amy and Alex interview Dr. Howard Haft, the Executive Director of the Maryland Primary Care Program, and Tammy Liu, a Primary Care Transformation Coach. We do a deep dive into the Maryland Primary Care Program and understand how this amazing innovative program is helping physicians provide higher quality more holistic care while providing physicians the tools and resources they need to provide tha...

Alex and Amy discuss telemedicine and RPM (remote patient monitoring) in the COVID-19 Era. Medicare has published new rules for telemedicine to help cope with the novel coronavirus epidemic. Medicare also published new rules for RPM that went live Jan 1 of 2020. These rules create valuable opportunities for medical providers, especially with COVID-19 quarantine and isolation requirements. We discu...

Alex and Amy discuss the urgent need during this COVID-19 pandemic for folks to think about difficult end-of-life deicisions and they walk the audience through the details of filling out the MOLST form. MOLST: Medical Orders for Life-Sustaining Treatment POLST: Physician's Orders for Life-Sustaining Treatment In this episode, we discuss: What is a MOLST form What is a POLST form Why should we talk...

In this Mastering Medicare episode, Dr. Amy Schiffman and Dr. Alex Mohseni do a moderate dive into Medicare Part D. We discuss the following topics: What is Part D Medicare Opt in Part D Premium calculation for Medicare Part D What is the Medicare Donut Hole? Medicare Part D Donut Hole 4 stages of Part D Part D deductible stage: first $435 Part D initial coverage stage: first $4,020, up to 25% of...

Physicians and other senior-serving professionals trying to operate within the complicated Medicare ecosystem must be constantly learning, as the landscape, rules, tools, and vendors are in constant flux. We interview eldercare and Medicare industry experts, do deep dives into their companies, services, and experiences, and share their stories and insights with you. Here are some of the topics tha...