On this episode, we talk about the changes in the 2022 coding, with guest, Sonda Kunzi. She runs Coding Advantage, and is a leading biller and understands the world of not just medical billing, but medical billing as it applies to the functional medicine community. In this episode, we talked about some of the hot topics in coding, like chronic care management, remote patient monitoring, remote therapeutic monitoring. All the things that are from 2021 and into 2022, that is making it a lot more palatable for doctors who want to practice in this way to bill and have clinics insurance, both government and commercial. Very important for practitioners in our community who are in America to really understand how the system is changing, because it may mean that it’s time to make different decisions about how you run your practice.

Highlights include:

  • What time-based coding is and how it can be beneficial.
  • How groups can play a role with billing.
  • What remote monitoring can do for billing your patients.
  • And so much more!

2022 Coding Change and What it Means for the "Year of Growth" | ep265

James Maskell: Welcome to the Evolution of Medicine podcast, the place health professionals come to hear from innovators and agitators leading the charge. We cover the latest clinical breakthroughs in health technology, as well as practical tools to help you transform your practice and the health of your community. This podcast is brought to you by the Lifestyle Matrix Resource Center, who provide a range of options to help you deliver successful, effective, functional, and integrative medicine. To find out more and to get started, go to goevomed.com/lmrc. That’s goevomed.com/lmrc.

Hello, and welcome to the podcast. We are talking on the changes in the 2022 coding, and we’re talking with Sonda Kunzi. She runs Coding Advantage. She’s a leading biller and understands the world of not just medical billing, but medical billing as it applies to the functional medicine community. And you’ll hear why. In this podcast, we talked about some of the hot topics in coding, like chronic care management, remote patient monitoring, remote therapeutic monitoring. We talked about groups. We talked about time-based coding. All of the things that are from 2021 and into 2022, that is making it a lot more palatable for doctors who want to practice in this way to bill and have clinics [inaudible 00:01:49] insurance, both government and commercial. So it was a really fascinating 40 minutes. Very important for practitioners in our community who are in America to really understand how the system is changing, because it may mean that it’s time to make different decisions about how you run your practice. I think you’ll get a lot out of it and enjoy.

So a warm welcome to the podcast for the first time, Sonda Kunzi. Welcome, Sonda.

Sonda Kunzi: Hello, nice to be here.

James Maskell: Great to have you here on, and this is not actually a topic that we’ve talked that much about before on the Evolution of Medicine Podcast. If you’ve been listening to the podcast for what? Seven or eight years, you know that really the focus has been trying to get practitioners to leave the insurance system and start to practice in a new way. And back in 2014, 2015, 2016, it was really clear to me that it was very difficult for any physician to practice functional medicine, the way that it was being taught to practice in the common ways that it was being practiced and doing it inside the payer system and getting paid a reasonable way.

I’ve seen a lot of people try and do it. I’ve seen a lot of people burn out, and just seen that it wasn’t a very solid foundation by which to be a clinician entrepreneur, which if you go back to 2014, that was your only option for practicing functional medicine, as you had to hang your shingle and do it your way. And that’s why over the years, we focused on things like direct primary care and packages and fee for service and other sorts of payment structures because the baseline payment structure that is used in America was not conducive to some of the features of your classic functional medicine relationship, extended visits, behavior change, and so forth. Now, there’s a couple reasons why from my perspective, I’ve seen you all over the place in the last year speaking to functional medicine audiences. And I guess maybe let’s just start there, what has changed in the world that has meant that you as a sort of a coding leader, medical coding leader in America, that your knowledge is relevant to the functional medicine community.

Sonda Kunzi: Yeah. I mean, it’s an absolute great subject for functional medicine on how in the world did the insurance industry trained enough for them to be interested in going away from the cash model. And surprisingly, it was a change to the regulations for office visits that we refer to as evaluation and management codes in 2021. There was a significant change to the way providers had to document and how they’re even allowed to value those services in terms of getting a higher level from the insurance carrier.

So one of the major changes that is relevant to the functional medicine providers is that you can bill by time. And it’s not that you couldn’t bill by time before, but there were lots of regulations surrounding it. And it all had to be face to face. In 2021 the big change was, if you’re looking at, let’s say, lab results prior to seeing the patient, and then you see the patient and you’re doing some things after the visit, all of that time is allowed to be included and billed for when you select the appropriate code to the insurance carrier, which gives these providers who have been spending a whole lot of time preparing, analyzing data, organizing the history, educating the functional medicine, they take a lot of time educating their patients and not just in the exam, they now have the opportunity to select a higher level of service and be compensated for their time, which was very difficult to do. Agreed on a fee for service.

James Maskell: Yeah, absolutely. You’ve wrapped it up really well there, I think that was a huge change. And I think a lot of people started to take note and think, okay, well, maybe that is possible. And our theme here at the Evolution of Medicine for 2022 is growth. And recently just come to the realization that if functional medicine wants to grow, it’s done an incredible job over the last say, 10 years in working out, spreading the message amongst physicians, making it easier for functional medicine doctors to build sustainable practices. You see now a functional medicine doctor in every town around America. And so, we’ve taken a lot of ground, but it seems to me that if we really want to take it to the next level, we have to work out how to integrate functional medicine into the system.

And that’s really the access that’s necessary to continue to grow the movement. And so I think this is really a convergence that was sort of unexpected maybe a couple years ago. So let’s just get into some of the other things. You mentioned the time thing there, but I think there’s a number of other things that set the stage for 2022. And one of the things I want to do today is really get into what’s changed in 2022 and what the opportunities are there, but let’s just go back to last year, and maybe you could flesh out some of the other areas in the functional medicine clients that you are working with that are billing for functional medicine and doing things a bit differently. What are some other leverage points or opening points that allow this time intensive, energy intensive medicine to be practiced in a way that could work for the bottom line of the practice?

Sonda Kunzi: Yeah, that’s a really good subject too, when we try to marry that to the insurance world, because prior to, a few years ago, we wouldn’t even be discussing a provider getting paid for services outside of the physical contact at the office. Obviously the public health emergency had a lot to do with forwarding telehealth, but in that aspect, we not only have a telehealth capability, but we have something called remote physiological or remote patient monitoring, which allows these providers that have people with hypertension, diabetes, all of these things that the functional medicine are doing their best to help reverse. When the patient first comes to functional medicine, there’s going to be a lot of opportunity obviously to monitor those outside of the office and be paid for that time for their staff time. There’s a remote therapeutic monitoring that came into play in 2022. And we can get there.

There’s chronic care management. That wasn’t anything prior to, let’s say, 2019 or 2020. That came around, and that is also taking care of that patient outside of the office for certain number of minutes per month. And again, it can be staff time or physician time. So there’s an opportunity to leverage staff and oversee that and make it a billable service. There is online evaluation and management, when a patient initiates a conversation through a patient portal. These are things that were traditionally never part of the reimbursement and they are now. And I think that’s huge when you’re considering from a functional medicine standpoint, maybe the insurance part of this isn’t so bad.

James Maskell: Yeah, absolutely. I mean, as someone who sits between clinics and the payer system, what would you say are the major barriers that, or the major post-traumatic stress disorders that practitioners are suffering from that has led them away from interacting with the payer system?

Sonda Kunzi: Yes, I think because of the traditional way that insurance has reimbursed the provider, in terms of, literally in order to make ends meet, what I have seen from these providers is that they had to see a great number of patients to make that work. And you and I both know that’s not how functional medicine works. So the stress was, if I’m going to take care of these patients in the insurance world, I’m going to have to see so many per day enable to get that to work out from a financial perspective. And that’s why we had always considered cash as the better method to that approach, that medicine approach. Now that we have the capability of having some payment for some outside services, some monitoring services, some group, which we can get into and talk about, and the opportunity to build by time when your patient really is there in front of you. And you’re taking all that time going through all their labs and everything, that should wrap better into the functional medicine space in terms of the reimbursement from the insurance carriers.

James Maskell: Absolutely. Yeah. I’d like to talk a little bit about chronic care management, because you mentioned that as one of the pieces. I do want to talk about remote patient monitoring too, but chronic care management, it strikes me, one of the things that we saw last year and having looked at this, that as you said, there’s an opportunity for like a physician prescribed coaching session. But one of the things that struck me was that those codes for some of the chronic care management, I mean, you’re assuming that these are chronically ill patients, the way that these are billed, it turns into a monthly billing. And it ends up almost looking a little bit more like a membership, as far as the way that it’s paid. Can you sort of get into how that works, and I know that there were some changes in the reimbursement in 2022 and I’d like to ask you about that too?

Sonda Kunzi: Yeah, that’s a good pickup. There was some significant increases in those types of service. So chronic care management in a definition is those particular codes. Now there’s a subset and several different kinds of, we just take CCM as everyone’s heard chronic care management. That is basically a like 20 minutes per patient of staff time managing at least two chronic conditions. So that could be hypertension and diabetes and managing could be anything. I could be calling the patient and checking on them, making sure they’re picking up their medications if they’re on meds, making sure that they’re eating a healthy diet, that they’re following the treatment plan of the provider that they have put out.

And there’s also a code, we call it add-on code. And when you do more than 20 minutes, you have a special add-on code. So you don’t have to stop at 20 minutes. It’s just assumed here’s where we are going to begin at managing these two chronic conditions. But absolutely, if your staff is doing more time with these patients then you have the opportunity to bill it. So that I believe has increased, I want to say 40% or more in terms of reimbursement than last year.

James Maskell: Yeah. When I saw that, and I saw that I think it had gone up from, let’s say, $40 per patient per month to over 60. What that tells me, I guess, is that somewhere, someone’s looking at all these algorithms and is saying, hey, the clinics that are billing these codes for chronic care management are getting better outcomes, like we should incentivize more people to do that. Is that what’s happening in the background?

Sonda Kunzi: It is absolutely what’s happening. And we saw it with something called transitional care management years ago. And transitional care management is when the patient comes out of the hospital, there is a provider who the patient is assigned to and it could be any provider. It doesn’t necessarily have to go to the insurance to be approved. It’s just, that’s your provider. And when you see them post discharge and make a treatment plan to keep them out, to keep them from going back in the hospital, it was reimbursing a certain amount of money. And that was, I’m going to say, 2019, 2020, and the following year, they started paying an additional know $60 per monthly charge for that as well.

So you are absolutely true that we are seeing that those patients who are taken care of outside of the office setting now, just not coming in, but beyond that, it’s like almost breaking the barriers of this brick and mortar thing that has existed in insurance reimbursement. Now we’re seeing that the carriers are definitely taking notice to outcomes and are reimbursing more and incentivizing in a way for physicians to pick up on this and take care of patients in that way.

James Maskell: Yeah, I’m glad you shared that. And obviously, having staff do it and let’s see, like who is the staff in your average functional medicine office? You’ve probably got some doctors, maybe you’ve got some nurse practitioners, some PAs, maybe you’ve got a health coach. Maybe you’ve got an MA, maybe you’ve got like a front desk person. My understanding with those codes is that, if your health coach or your MA is talking someone through their meal plan or checking in with them on how they’re doing with their meal plan, that counts.

Sonda Kunzi: Yes. That is truly time in managing that patient right there. The treatment plan will be written by the physician or the nurse practitioner. And that ancillary staff is just basically taking the treatment plan and making sure that the patients staying true to it.

James Maskell: That’s awesome. Yeah. Well, look, I think that’s a great one to just talk about, because forever, I think one of the biggest problems, even in the cash model in functional medicine was with coaches and other providers. We love the idea of having them, but how are they going to get paid? And I think this changes that. So let’s talk about remote patient monitoring. Again, you mentioned that quickly just to bring onto that, because again, like one, the remote patient monitoring fits very well with functional medicine. I mean, functional medicine is generally data-driven, in that doctors are getting a lot of data and making their plans based on a wider set of data than conventional medicine. Obviously there’s more and more data available to patients, and that’s being created through different places. Where’s the leverage point for remote patient monitoring and what infrastructure does a clinic have to have to get at that money?

Sonda Kunzi: Yeah. So that’s super important in terms of having the infrastructure to handle that. It’s certainly having a health coach, whatever you have in that ancillary position, it could be an MA. A health coach is great. This is in terms of remote patient monitoring is having a piece of equipment, that is monitoring. And in order to qualify for this code, it just has to be something that the patient themselves doesn’t have to intervene in terms of writing down like your glucose. It’s just all data-driven through electronics and Bluetooth and things like that in which you can find services that take care of that whole software, data housing, things that need to be done in order to qualify for remote patient monitoring and your health coach can quarterback that whole thing.

Again, the patient sees the provider, the functional medicine are driving the treatment plan, still, and the care of the patient, but the folks underneath them that are working really close with the patients are doing the data transfer to make sure that’s happening, to check in with the patient, make sure that’s happening. And again, this is really facilitating, one of the big things is adherence in patient engagement. The more a patient is engaged in their care, the better the outcome is. And I think when working so closely with a health coach like that is really priceless. And again, this is, like you and I are saying that, this is an opportunity where we’re seeing reimbursement come from these services where it takes the health coach’s time, but they can manage many patients on these services.

James Maskell: That’s great. Well, yeah, look, I think those two are very complimentary and come together, the chronic care management and the remote patient monitoring. Let’s just talk about some new models for execution here. And just in Sonda and I have worked together over the last year to pull together the billing strategy for some of the virtual group work that we’ve been doing. And ultimately, if you go back to December 2020, we had been, essentially, we had run a pilot with a clinic in Sacramento to say, hey, look, what I’ve come to recognize, I guess, over the years is that if we have to put all of the execution risk on individual clinics to manage all of the things, even that you’ve just spoken about.

If every individual clinic is that the way that functional medicine started and started to grow was individual clinic. And most of them don’t take insurance, but some do. But if we are always having to hope that the individual physician entrepreneur could first of all, get their head around chronic care management, remote patient monitoring, and these ideas. Secondly, have to pull together the technology stack and all of those things to get at that money. Never mind everything else, I think it’s going to be slow going. And ultimately, came to this sort of understanding that group delivered functional medicine was really valuable, particularly for the lifestyle medicine portion of functional medicine, which is half of functional medicine, if you think precision medicine is the other half.

That group medicine, after I wrote my book, I thought this is what we really need to do, but what if we could take all of the annoying headaches out of running groups, some of which are clinical and some of which are administration and some of which are technological. And if we could partner with a clinic and essentially run that part of the business for them and use these new opportunities in telemedicine to, I guess, create some reduction and friction to onboarding this new way of thinking about group delivered functional medicine.

So back in December 2020, we had run a pilot, a successful pilot, and ultimately, came face to face with the fact that we needed to really have a solid, we knew that it worked clinically, but we wanted to try and work out, like how do we make it that this would bill in every clinic in America? And ultimately, I think what we came up with and what we worked together on was to find a way to take advantage of the 2021 coding to really think differently about how a group session could be billed. So do you want to just share, I guess some of the thinking process in that journey and what are some changes that have allowed this new iteration of virtual groups be organized inside the current payer system?

Sonda Kunzi: Yeah. So this is a really good subject because we talked about time and how the functional medicine provider spends a lot of time with the patient when they see them in the office. And so we can switch gears a little bit and still leverage new guidelines. And that is in 2021, they changed in terms of how to reach a specific level of service, they changed those guidelines as well. That freed up the ability to do these group sessions and bill by medical decision making. So just quickly previous, and some of the functional medicine providers that may have been part of insurance will know that it was very onerous on exactly how you had to document and bill for it. You had to do certain bullet points and a lot of things that, honestly, were just extra fluff in the note, they weren’t necessarily something that had a lot of meeting to the providers.

It’s a good thing, obviously, to have a history, to have some type of exam and the medical decision making, those are all very core pieces to the note, but there were other things involved in documentation. In 2021, it got a little, we had the time thing, but in the group, we have this ability to do medical decision making in which we can have in the, we’ll do a little code speak here. I won’t get too deep, but the evaluation management codes of 99213 and 99214, which are very typical office services leveraged at the group level. For many people, let’s say, we have a group of 10 patients, we could be leveraging number one, the technology could be Zoom. I mean, you have to have things in place and make sure HIPAA is covered. And that’s probably a real deep subject.

We’re not going to go there, but you can do it. And the Zoom has breakout sessions. So you can leverage Zoom to have, let’s just use health coach, as an example, providing this really great educational piece for like problem patients. They have the condition that could be roughly the same. And as they’re in this education session, the provider can pull them out into the breakout session that does not have to be calculated by time. It can be calculated by medical decision making, have that time with them to check in specifics and put them back into the group to continue learning while we’re leveraging for that whole time period, with this group of patients, time with a physician that’s separate and identifiable, easy to document based on the new guidelines. And there you’re leveraging your time in a really great way.

James Maskell: Well, thanks for sharing that. And some of the details, and if what you just heard sounds is interesting, but overwhelming, then that’s kind of my expectation. That it’s interesting in that we can find a way to deliver group functional medicine and to get the billing done in an effective way. I think anyone who’s used the breakout room functionality in any of Zoom knows how cool it is, and it works really well. And ultimately, all of these things can be a little bit overwhelming. That’s why I’ve been really focused on this because I think that this is a big area where functional medicine could take a lot of ground into the rest of medicine, because most doctors are very understanding of the fact that there are lifestyle deficits in their patients.

And they understand that many conditions can be helped with lifestyle transformation, but don’t really know where to start. Don’t have the team to do it, don’t have the tools to do it, not just the clinical team, but all those other things. And that’s why a year later here, at HealCommunity, we’ve now working with dozens of clinics and hospitals and ACOs to run these virtual groups. So if that’s interesting, definitely get in touch with us at HealCommunity. Sonda, let’s talk a little bit about some of the 2022 changes and get into that. Because I know we scheduled this actually, when we were first going to talk back in November and you said there’s a big conference every year and that’s when you sort of get some of the updated information. So what’s changed in 2022? Are there other things, on top of what we spoken about that are relevant for the functional medicine community?

Sonda Kunzi: Yeah. So in 2022, besides the point that we still want to make that we’ve seen a lot of these outside services have the reimbursement rates raised, that’s one thing that remember in 2022 is a big piece of this. We also had something called principle care management. And the reason this is important is it adds to already, we have two or three different types out there. We have something called chronic care management. We have something called complex chronic care management, which is a little bit more of a lift than chronic care. But then we ended up with a new one called principal care management. And the definition of that is very similar to chronic care management, but you only need one chronic condition. And there are some guidelines about that. And we could get into that at another time. But generally speaking, this patient has to have a chronic condition that is debilitating them from a lifestyle aspect.

And it certainly could be, the physician who’s intervening could be keeping them out of a hospital for just that one thing. We don’t need to stack a bunch of chronic conditions. It’s just one particular condition in order to manage that. So seeing those codes come out in addition to the chronic care that were two or more seems to me that they’re saying, let’s give the opportunity for those patients who have one problem, but this one problem seems to be getting in the way of good lifestyle, good nutrition, less intervention from a hospital or diagnostic testing perspective that they can be managed with a good nutrition and things like that. And it works about the same way, where we could have our ancillary staff doing the work after the treatment plan is written and taking care of that and billing for it outside the evaluation management.

Another one is the remote therapeutic monitoring. And I know this was really a hot topic again, when we were talking and that’s when I said, well, let’s see what information comes out from the American Medical Association. That’s what I attend every year. And it’s a really great session because they do take every new procedure code that has come out and they do their best to explain the intent for it and what they think they’re going to see. And for remote therapeutic monitoring, that was definitely compared to the physiological monitoring. The physiological monitoring has a couple of things that are required of it. And one of the main things that we know is that the patient cannot intervene, as I said before, in terms of writing down a glucose level or their weight, everything has to be Bluetooth. with the therapeutic monitoring, it doesn’t need to be.

However, there are some specifics on it, and that is the care of the patient has to deal with the respiratory system or the musculoskeletal system. So those are two, what we call, organ systems that have to be the thing that’s monitoring. So a COPD emphysema, things like that would be a respiratory. Musculoskeletal could be some debilitating muscle disease or progression of some problem or injury in which there’d be a way of my monitoring, and obviously, improving the outcomes of the patient. So those are the things, but they generally go the same way as remote patient monitoring in terms of educating the patient on a new piece of equipment, monitoring them monthly, checking on the transmissions, and again, the health coach, or whoever’s the ancillary person, talking with the patient for additional times in the month to make sure things are going good.

James Maskell: That’s great. Yeah. I think there’s some great opportunities here for the kinds of clinics that we’re working with. I think there’s also a good opportunity for clinics to really think about their business model. I guess, just to take it in a different direction, and by the way, if you’re listening, you want to get in touch with Sonda, check out Coding Advantage, that’s her company. You can get in touch with her and can chat with her directly. I guess, one of the things that I’ve been thinking about coming into this year of growth and thinking about, okay, how do we create models in functional medicine that create more access, because that’s what’s really going to fuel the growth.

I’ve been thinking about this and I’ve been interviewing people as well. And I had a very interesting interview actually with a clinic on the last functional forum where they had actually had a catastrophic failure of their business in 2015 around Snowmageddon where there was no telemedicine and their practice just fell apart with 120 employees. And when they came back to really thinking through the model to build functional medicine from scratch again, they ended up coming to a model that did take insurance because they wanted to create access and they wanted to be able to work with everyone. There was a direct payment on top of that for being in with a certain doctor, I think like a membership on top of that. And then there was, if you wanted to see one of the two main doctors and not the primary care nurse practitioner, the functional medicine doctors, and then obviously you had some ancillaries like supplements and those type of things.

And in their mind, this gave them the certainty of the membership income. It gave them, for their own panels, it gave them the access and ongoing ease of billing to create few barriers for people to come into the practice. And then now we are working with them to run some virtual groups in the way that you’ve shared and so forth. So I just wanted to sort of, I know you are not lawyer, but I guess I just wanted to just, I guess, run that by you because, ultimately, what I’ve seen in 10 years of helping doctors make the switch to functional medicine and in many cases, make the switch to cash, doctors really underestimate what it’s going to take to convince regular people to part with their cash to come and see them as opposed to just using their insurance.

And so ultimately, if there was a way to, I guess, have a little bit more of a wider funnel to bring people into the office, to have them work with someone on the team, to be able to start to do some of these other codes and to find new ways to monetize that relationship that still maintain some stability for the doctor. It seems like it resonated with me in a number of ways. And I just wanted to get your thoughts on it.

Sonda Kunzi: Yeah, absolutely. This is a great subject because I think that you’re right, providers underestimate the speaking and communicating how they’re going to approach the medicine and how there are opportunities and just the patients taking a hold of their care. But I think we’re really in a shift mode. And when I say that, I’m saying like, I have kids that are 28, in their 20s, and they are wholeheartedly about apps, about telehealth, about not going into the office. And I think that these providers need to just shift in their minds saying, well, we can do this. We can take care of patients like this, but how do we leverage this? What do we have? And you and I have said the word before the infrastructure is huge. It’s not only about having a great functional medicine provider, but it’s about having the people in your clinic be all, as much as they can gather information about billable services, information about how to market, to patients, really leveraging having a health coach and that person who’s going to quarterback their care.

And I think that’s the cell that it’s so different than what I’ll just call traditional medicine. And this doesn’t, not to stereotype, but many of us and even myself will see a provider that if you’re in and out and at 15 minutes and you get in your car and you go, and you forget, you needed to ask a question where I think functional medicine has a much better approach to having a longer period of time with the patient, other ways outside of just that office visit to take care of patients.

And now we’re seeing where, okay, this is going to be billable, but it’s just not that moment of going, I could now engage insurance companies, but we need to have that moment of time where they had the infrastructure. Either someone internally who’s trained in how billing should be or knowledgeable about billing or bringing on a consultant, that’s there sort of like handholding saying, “Okay, you tell me what services you want to provide. And I can give you the backup to that in terms of, is that billable or not, or is it certain circumstances and how do I keep you compliant?” And that’s of course, the attorney side that comes in where we not only are these codes billable, but you have to take a moment and find out what are the ways that I can make sure that I’m protected while I’m leveraging these codes to take care of the patients that I’m used to taking care of.

James Maskell: Absolutely. Yeah. Well, look on that final, I guess, piece there, and I think it does take some innovation, it does take some thinking, but what I am seeing is a lot of that happening out in the market, people really thinking about how should I be setting up my clinic for success? Always it’s important as physicians or physician entrepreneurs in the system to really understand what the system’s doing, because it may be that the fundamentals have changed that much, that it does make sense. For doctors that are thinking of going back, maybe they’ve previously canceled their relationships with insurance and thinking about going back, do you have any tips for them? Has anything changed in that regard. What sort of process are you looking at for doctors to get insurance contracts back or to start insurance contracts are new?

Sonda Kunzi: Yeah. That’s also a good point and that is know your patients well, you need to know your demographic. So somebody who’s sitting in the middle of Kansas, let’s say, is going to have a completely different payer structure than a clinic based in New York City. And that is designed based on who the employers are in the area, who the major carrier is in the area, that people get marketed to all the time. Like Humana might be very prevalent in Florida, where you have little to no Humana in New York. So you have to know what your demographic base is and what your five top payers are. Obviously with everyone, you have to make the choice, am I going to participate with Medicare? Am I going to stay opt out. Because you can stay opt out and still do some things with the insurance carriers. It’s a choice.

I know a practice that got ahold of me who had a major amount of Medicare patients, and it just was the right thing to do. And you’d be surprised to know that Medicare turns around pays a claim faster than any commercial carrier out there right now. So that’s a fact for you to know, is what is your patient base and what would their carriers be if you were to migrate away from cash and decide to get on some panels and then you’d need to do your due diligence on, okay, so what does that particular carrier pay for my top 10 things that I’m going to be doing? And that’s negotiating with the carriers and doing the due diligence, and then you can do some projections and say, we can do this, and this is how we’re going to do it.

James Maskell: Yeah, absolutely. Well, it’s such a wealth of information Sonda, and thank you for being part of this Evolution Medicine Podcast. This isn’t the typical content that we’ve had, but we wanted to start this year by just jumping into this because this is the year of growth and I’m just wholeheartedly convinced that if the next step for our movement is to work out how to create as much access to this care as possible. And that is going to mean working with insurance, both government and commercial. And that’s why I’ve spent the last year and a half really trying to learn as much as I can about it and wanted to share some of that with our community. So again, if you want to get in touch with Sonda, check out Coding Advantage. If you want to get ahold of HealCommunity, you can go to healcommunity.com.

I am actually going to work on a new version of my first book called The Evolution of Medicine with just some, I guess, sort of updates to my thinking about how doctors can practice in this new way. I think in 2016, when I wrote the book, it was reasonable advice to say, “Look, you shouldn’t be participating in the payer system if you want a solid foundation to build a practice, practicing this new way,” but times change. And if anything, this is showing me that the powers that we are recognizing that some of this stuff is working and that’s why they are reimbursing more forward and shifting the guidelines. So I think that’s maybe what success looks like. So thanks so much for tuning in. This has been the Evolution of Medicine Podcast. We’ve been talking about the 2022 coding changes. We’ve been with Sonda Kunzi. I’m your host, James Maskell. And we’ll see you next time.

James Maskell: Thanks for listening to the evolution of medicine podcast. Please share this with colleagues who need to hear it. Thanks so much to our sponsors, the Lifestyle Matrix Resource Center. This podcast is really possible because of them. Please visit goevomed.com/lmrc to find out more about their clinical tools like the group visit toolkit. That’s goevomed.com/lmrc. Thanks so much for listening and we’ll see you next time.


RSS Feed


Click here to download this podcast

music provided by intomusic.co