Kanishka Monis, M.D.’s Post

Dealing with a chronic condition can be challenging, but Medicare is here to help you manage your health with comprehensive support. From covering essential medical treatments to providing access to specialized care, Medicare ensures you get the care you need to live a healthier life. 🔹 What Does Medicare Offer? Part A: Hospital stays, skilled nursing care, and home health services. Part B: Doctor visits, outpatient care, and preventive services. Part D: Prescription drug coverage to help manage medications for chronic conditions. 🔹 Tips for Managing Chronic Conditions with Medicare: Stay Informed: Regularly review your Medicare plan to ensure it meets your needs. Utilize Preventive Services: Take advantage of Medicare’s coverage for preventive screenings and services. Consult Your Provider: Work closely with your healthcare provider to manage your condition and make the most of your Medicare benefits. 💡 Need Help Navigating Medicare? Reach out to us for personalized assistance and find the plan that best fits your needs. Your health is our priority! ___ Looking for insurance solutions? Contact me today! Visit: www.klhbenefits.com Call: 903.413.6209 #Medicare #ChronicConditions #HealthManagement #SeniorCare #MedicareCoverage #HealthcareSupport

The UB-04 Claim Form: A Key Player in Healthcare Reimbursement The UB-04 claim form is a crucial document in the healthcare revenue cycle, serving as the primary means of billing Medicare, Medicaid, and commercial insurance companies for inpatient and outpatient services. Purpose: The UB-04 claim form facilitates the submission of claims for: 1.   Inpatient hospital stays 2.   Outpatient hospital services 3.   Rehabilitation services 4.   Skilled nursing facility care 5.   Home health services Information Collected: The UB-04 form collects essential data, including: 1.   Patient demographics 2.   Admission and discharge dates 3.   Diagnosis and procedure codes (ICD-10 and CPT) 4.   Charges and revenue codes 5.   Insurance information 6.   Provider details Accurate Submission: Accurate and timely submission of the UB-04 claim form ensures: 1.   Efficient claims processing 2.   Reduced errors and rejections 3.   Faster reimbursement 4.   Improved cash flow Healthcare Professionals: Ensure you understand the UB-04 claim form's purpose and requirements to facilitate seamless reimbursement for your patients' services. #UB04 #healthcare #reimbursement #medicalbilling #codingcommunity #healthinformationmanagement

As the new Trump administration begins shaping its agenda, healthcare policies are taking center stage. From reforms in insurance markets to changes in Medicare and Medicaid, these policies could have a significant impact on patients, providers, and businesses. https://lnkd.in/deVjQ9zT #HealthcarePolicy #TrumpAdministration #IndustryInsights #drugpricing #telemedicine

🔍 Navigating Medicare can often feel like solving a complex puzzle. But understanding its components, like Part A and Part D, is crucial for making the best healthcare decisions. Let’s simplify these parts! **Medicare Part A**: - Often referred to as Hospital Insurance - Covers inpatient hospital stays, skilled nursing facility care, hospice care, and some home health care - Usually, no monthly premium if you or your spouse paid Medicare taxes for a certain amount of time **Key benefits**: - Essential for those anticipating hospital stays or specialized nursing care - Ensures that major inpatient costs are covered **Medicare Part D**: - Known as Prescription Drug Coverage - Helps cover the cost of prescription medications - Available through private insurers approved by Medicare **Why it's important**: - Lowers the cost of both generic and brand-name prescription drugs - Critical for managing chronic conditions or unexpected illnesses that require medication Combining both parts can significantly enhance your healthcare coverage, ensuring peace of mind and financial protection. 👉 Always remember to review your Medicare options annually. Your health needs and medication requirements can change, making a reassessment crucial. 🔹 Choose wisely. Plan ahead. Secure the best coverage for your health needs. #Medicare #Healthcare #MedicarePartA #MedicarePartD #HealthCoverage

A February 2023 report from KFF estimated there were over 35 million prior authorization requests in 2021 • More than 2 million of these requests were denied by Medicare Advantage plan (MA) insurers, and just 11% of those were appealed ... ... 82% of the appeals resulted in an overturning of the initial prior authorization denial, highlighting the issue of inappropriate care denials. ✋ Stop the insanity! Toney Healthcare has you covered. Whether you need deep expertise to optimize your operations or staff to support your day-to-day UM activities our build a new line of business... 👍Our best in class UM experts can help you improve your operations and quality performance. #priorauthorization, #healthcare, #medicareadvantage, #healthcareoperations, #healthcareconsulting

How can you care for patients you don't know? Patient attribution accuracy plays a crucial role in the realm of value-based care. The recent study focusing on Medicaid Managed Care Organizations (MCOs) in Phoenix revealed we have work to do. Improving patient attribution precision is imperative for the advancement of Value-Based Care (VBC), particularly within rural healthcare setups characterized by significant Medicaid enrollees. To delve deeper into the details of this study and explore my insights, click on the link below. #valuebasedcare #healthcaretransformation Link to the research article:

UnitedHealthcare wins major legal battle against Centers for Medicare & Medicaid Services over 2025 Medicare Advantage star ratings! 🌟 A federal judge has ordered CMS to recalculate UnitedHealthcare's ratings without considering a disputed test call. This decision could significantly impact the insurer's quality bonus payments and enrollment for 2026. Key takeaway: A single phone call can make or break an insurer's star rating, potentially costing millions in revenue. This case highlights the critical importance of accurate performance metrics in healthcare administration. #HealthcarePolicy #MedicareAdvantage #StarRatings #UnitedHealthcare

This is Part Two of my Substack post addressing a movement of physicians resuming control of healthcare and the provision of quality for patients in the form of receiving preventive care and real advocacy. It’s imperative for patients to secure a relationship with an expert healthcare expert who can optimally direct them in times of acute illness, such as during an emergency room visit or hospitalization. The system is too complex and too revenue-driven to go it alone. At the same time, the incorporation of lifestyle guidance including dietary strategies during regular office visits should be a mandate when shopping for a doctor. Presently this isn’t easy to find or for a physician to execute in the present day, ill-structured disastrous healthcare system. Third party payment structure effectively prohibits both of these important aspects of primary care. However, direct primary care, or #DPC is a promising direction that can potentially spawn both. https://lnkd.in/gqv82HpB

𝗨𝗻𝗱𝗲𝗿𝘀𝘁𝗮𝗻𝗱𝗶𝗻𝗴 𝗠𝗲𝗱𝗶𝗰𝗮𝗿𝗲 𝘃𝘀. 𝗠𝗲𝗱𝗶𝗰𝗮𝗶𝗱 𝗶𝗻 𝘁𝗵𝗲 𝗨𝗦𝗔 𝗠𝗲𝗱𝗶𝗰𝗮𝗿𝗲: Eligibility: Age 65+ or certain disabilities. Coverage: Part A: Inpatient care. Part B: Outpatient services. Part C: Private insurance option. Part D: Prescription drugs. Funding: Federally funded and standardized nationwide. 𝗠𝗲𝗱𝗶𝗰𝗮𝗶𝗱: Eligibility: Low-income individuals; criteria vary by state. Coverage: Comprehensive (hospital visits, long-term care, home health). Funding: Joint federal and state funding, varies by state. Key Differences: Medicare: Age/disability-based, federal funding, standardized. Medicaid: Income-based, joint funding, state-specific coverage. Understanding these programs helps in making informed healthcare decisions. #Medicare #Medicaid #HealthcareCoverage #HealthInsurance #SeniorHealth #LowIncomeSupport #MedicalBilling #Healthcare #InsuranceEducation #HealthPolicy

As a company dedicated to assisting #valuebased organizations with #technology and services, we eagerly await Congress's vote on the Advanced APM Incentive Payment Extension. This bipartisan bill extends incentives for advanced alternative payment models (APMs) and addresses Medicare payment cuts for doctors. It includes a 1.88 percent incentive payment for Performance Year 2024 and raises the Medicare conversion factor by 1.68 percent. Congress will vote on the budget bill soon, and discussions about long-term solutions for doctor payments, like changing the Medicare Access and CHIP Reauthorization Act (MACRA), are happening. We stand behind National Association of ACOs efforts on this issue and remain dedicated to supporting changes that make #healthcare better and more sustainable. Read #NAACOs statement: https://lnkd.in/eaFENPKy The actual resolution: https://lnkd.in/eTjpMwMS #MACRA #HealthcarePolicy #MedicareReform #ValueBasedCare