Fri. May 3rd, 2024

I know we all left the system for a ton of reasons. One was getting out of the data gathering, quality metric garbage. And it is an awesome feeling. I know we sometimes have to give a diagnosis code for a Medicare lab now and then but here is a weird question. 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”. So here is my question. 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 has happened to you would you please email me at support at dpcnews.com (use an @ instead of “at”. I don’t here as the email gets scraped off the web and I get bombarded with spam).

176630cookie-checkFilling Out Forms, Adding New Dx, And Other Medicare Advantage Issues
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By Douglas Farrago, MD

Douglas Farrago MD is board certified in the specialty of Family Practice. He is the inventor of a product called the Knee Saver which is currently in the Baseball Hall of Fame. The Knee Saver and its knock-offs are worn by many major league baseball catchers. He is also the inventor of the CryoHelmet used by athletes for head injuries as well as migraine sufferers. From 2001 – 2011, Dr. Farrago was the editor and creator of the Placebo Journal which ran for 10 full years. Described as the Mad Magazine for doctors, he and the Placebo Journal were featured in the Washington Post, US News and World Report, the AP, and the NY Times. Douglas Farrago, MD received his Bachelor of Science from the University of Virginia in 1987, his Masters of Education degree in the area of Exercise Science from the University of Houston in 1990, and his Medical Degree from the University of Texas at Houston in 1994. His residency training occurred way up north at the Eastern Maine Medical Center in Bangor, Maine. In his final year, he was elected Chief Resident by his peers. Dr. Farrago has practiced family medicine for twenty-three years, first in Auburn, Maine and now in Forest, Virginia. He founded Forest Direct Primary Care in 2014, which quickly filled in 18 months. Dr. Farrago still blogs every day on his website Authenticmedicine.com and lectures worldwide about the present crisis in our healthcare system and the effect it has on the doctor-patient relationship. Dr. Farrago’s has written three books on direct primary care: The Official Guide to Starting Your Own Direct Primary Care Practice, The Direct Primary Care Doctor’s Daily Motivational Journal and Slowing the Churn in Direct Primary Care (While Also Keeping Your Sanity) are all best sellers in this genre. He is a leading expert in direct primary care model and lectures medical students, residents, and doctors on how to start their own DPC practice. He retired from clinical medicine in October, 2020.

One thought on “Filling Out Forms, Adding New Dx, And Other Medicare Advantage Issues”
  1. I worked briefly as a home visit NP for Medicare. I never added or changed diagnoses to a patient. I did get to see a lot of hazards in the home as well as sit down and discuss questions about medications, how to use medical equipment, and benefits of health screenings. I caught a lot of stuff that FFS patients couldn’t get addressed in the hamster wheel. So that’s why I went to DPC. Unfortunately everything in that system is ridiculous.

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