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𝙃𝙤𝙬 𝙙𝙤𝙚𝙨 𝙩𝙝𝙚 𝙈𝙚𝙙𝙞𝙘𝙖𝙡 𝘼𝙛𝙛𝙖𝙞𝙧𝙨 𝙛𝙪𝙣𝙘𝙩𝙞𝙤𝙣 𝙨𝙪𝙥𝙥𝙤𝙧𝙩 𝙥𝙧𝙞𝙫𝙖𝙩𝙚 𝙥𝙝𝙮𝙨𝙞𝙘𝙞𝙖𝙣𝙨 𝙬𝙞𝙩𝙝 𝙙𝙞𝙖𝙜𝙣𝙤𝙨𝙞𝙣𝙜 𝙧𝙖𝙧𝙚 𝙙𝙞𝙨𝙚𝙖𝙨𝙚𝙨 𝙩𝙝𝙖𝙩 𝙝𝙖𝙫𝙚 𝙛𝙚𝙬, 𝙚𝙭𝙥𝙚𝙣𝙨𝙞𝙫𝙚 𝙩𝙧𝙚𝙖𝙩𝙢𝙚𝙣𝙩 𝙤𝙥𝙩𝙞𝙤𝙣𝙨? 𝗧𝗵𝗲 𝗶𝘀𝘀𝘂𝗲 𝗮𝗿𝗼𝘂𝗻𝗱 𝘁𝗵𝗶𝘀 𝘁𝗼𝗽𝗶𝗰: Private physicians are sometimes investigated by insurance companies as a result of diagnosing a patient with a rare disease that has few, and very expensive treatment options. On some occasions, these physicians have become personally liable to pay for the treatment if found to have misdiagnosed. As a result, in some cases, doctors are cautious to diagnose patients with certain rare diseases and instead refer them to larger hospitals which can be miles away from home. Ultimately, making things difficult for the patient as they are not always able to travel so far. 𝗪𝗵𝗮𝘁 𝗽𝗮𝗿𝘁 𝗱𝗼𝗲𝘀 𝗠𝗲𝗱𝗶𝗰𝗮𝗹 𝗔𝗳𝗳𝗮𝗶𝗿𝘀 𝗽𝗹𝗮𝘆 𝗶𝗻 𝘁𝗵𝗶𝘀 𝘀𝗰𝗲𝗻𝗮𝗿𝗶𝗼? By working closely with even one physician to support with education and information around the disease, they can help build confidence to correctly diagnose which largely reduces the need to refer patients away from their care. Are there any other ways that you believe Medical Affairs plays a part in supporting this issue? #raredisease #rarediseaseawareness #orphandrugs #medicalaffairs #awarenessprogram

Fewer than 10% of medically qualified patients can access a GLP-1 through their insurance plans. How can GLP-1 manufacturers enable greater access to GLP-1 therapy? We expect strong outcomes data, lower GLP-1 pricing, advocacy efforts, and rising self-pay and employer demand to improve payer policies on obesity treatment and GLP-1 coverage over the next 5 years. In our latest blog, we discuss these factors as they contribute to the evolving market access landscape for GLP-1s in the US and Europe. Read here: https://bit.ly/3wh7bfT #obesity #marketaccess #biopharma Sheela Hegde, Alexis Froistad, Rita Sá Ferreira, PhD, Brian M. Duda

The whole crew is back today to take on more of the coding, billing and compliance issues impacting health care operations! John Paul Spencer, Christine Hall CHC, Terry A Fletcher BS CPC CEMC CCC CCS CCSP CMC ACS-CA SCP-CA, QMPM, Scott Kraft and Stephanie Allard, CPC, CEMA, RHIT join me to discuss: 1. The targeting of UDTs for opioid prescribers and the potential ties to large scale laboratories who create these panels. 2. Medicaid overpayments targeting the QW Modifier / Reporting Guidance and valid non-payment... 3. Signature Requirements and the impact on claims process and adjudication. 4. Virtual Supervision and the dilemma it poses to incident-to services.  

Did you know The National Practitioner Data Bank (NPDB) works to prevent medical malpractice by preventing practitioners from assuming the identity of deceased practitioners? See the requirements to prevent incompetent practitioners from practicing in our newest blog. 👀 https://lnkd.in/dVSwK26K #healthcare #verificationservices #healthcareindustry #medicalcredentialing #credentialing #credentialingfraud #healthcarenews #medicalmalpractice #medicalnews

Join Sean, Terry, Paul, Scott, Stephanie, and myself to discuss billing, coding, and compliance issues in the medical business. We have impactful topics to dive into TODAY! #medicalbilling #medicalcoding #compliance #healthcarebusiness

#PressureInjuries are a serious concern in #NursingHomes. MedPro's free #RiskManagement checklist can help these organizations assess their processes and pinpoint areas for improvement: https://ow.ly/3Usu50QgBaO #SeniorCare

This is an example about a system that does not believe in treatment being medically necessary at a certain level of care . Guidelines were abruptly changed to save monies. Red tape and layers of bureaucracy are hurdles to personalized care. #cms #specialtypharmacy #medicare

Through PEPPER (Program for Evaluating Payment Patterns Electronic Report), Medicare provides hospice-specific data statistics for Medicare claims that may be at risk for improper Medicare payments. Discover how Optum data can highlight actionable details not provided to your hospice by Medicare. Learn more: https://bit.ly/41VAgcU #palliativecare #hospice #pharmacy

Regulatory hurdles - led by, you guessed it - prior authorization - continue to plague medical practices/groups and pose major administrative and resource challenges/headaches for staff and threaten patient access. CMS’s proposed  streamlining rule for states and payers - by 2026! - can’t come quickly enough. https://lnkd.in/ecifN9zM

The medical system harms both patients and physicians. Last Thursday, March 14, I spoke at the 168th Waterbury Medical Association meeting on “Wellbeing in the 21st Century: The Doctor and Patient Dilemma.” With personal experience as a physician, I've witnessed the toll of our evolving healthcare system. I've dedicated years to easing the distress caused by medical, pharmaceutical, and insurance systems. This dilemma stems from a system prioritizing profit over human needs, leaving physicians disempowered and patients reduced to mere IDs. Physicians are trained to prioritize others' needs over their own, leading to soul distress and moral injury. Consequently, many are leaving the profession, and their children are deterred from joining. Patients, too, suffer as the system overlooks vital aspects like nutrition and connection, exacerbating illnesses with temporary solutions. I advocate for empowering both physicians and patients to reclaim their humanity. It's time to reshape our medical system to prioritize humans and their wellbeing. #physicianburnout #womeninmedicine #healingphysicians #counteringepidemics #patientwellbeing #doctorwellbeing #awareness #selfcompassion #vulnerability #moralinjury #souldistress #physiciansuicide #mindbodymedicine #mindfulleadership #mindbodysecrets