Austin M. Gillard, FACHE

Perfect way to mange the revenue cycle

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⚠📆 Urgent Reminder for All Assisted Living Facilities! 📆⚠️ Don't Risk Non-Compliance! 🚫 The deadline to submit your County Emergency Management Plan (CEMP) is fast approaching. Regulations require submission 60 days before expiration to avoid penalties. 🕒 Failure to comply can lead to regulatory consequences. Don't let this oversight jeopardize your facility's operation and reputation. 🛑 Alf Boss is here to help! 🙌 We offer: • Expert CEMP Creation & Updates ✍️: Tailored to meet your facility's needs, ensuring full compliance. • Timely Submissions 📬: We manage the submission process, guaranteeing your documents are in order well before the deadline. • Yearly Reminders 🔔: Our proactive approach means you'll never miss a deadline, with timely alerts to keep your CEMP current and compliant. The clock is ticking. ⏳ Partner with Alf Boss to secure the compliance of your facility. 🔗 For peace of mind and expert assistance, click here https://wkf.ms/3OiJydb #AssistedLiving #CEMP #RegulatoryCompliance #SafetyFirst #AlfBoss

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⚠📆 Urgent Reminder for All Assisted Living Facilities! 📆⚠️ Don't Risk Non-Compliance! 🚫 The deadline to submit your County Emergency Management Plan (CEMP) is fast approaching. Regulations require submission 60 days before expiration to avoid penalties. 🕒 Failure to comply can lead to regulatory consequences. Don't let this oversight jeopardize your facility's operation and reputation. 🛑 Alf Boss is here to help! 🙌 We offer: • Expert CEMP Creation & Updates ✍️: Tailored to meet your facility's needs, ensuring full compliance. • Timely Submissions 📬: We manage the submission process, guaranteeing your documents are in order well before the deadline. • Yearly Reminders 🔔: Our proactive approach means you'll never miss a deadline, with timely alerts to keep your CEMP current and compliant. The clock is ticking. ⏳ Partner with Alf Boss to secure the compliance of your facility. 🔗 For peace of mind and expert assistance, click here https://bit.ly/3SlsPIb #AssistedLiving #CEMP #RegulatoryCompliance #SafetyFirst #AlfBoss https://lnkd.in/gvHThe6Y

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FMV of sub-lease medical office space Many of you saw this recent press release from the DOJ involving a surgical hospital in South Dakota. Dunes Surgical Hospital agreed to a $12.7M settlement related to allegations that the hospital provided free or below-FMV office space to physicians who referred patients to Dunes Surgical Hospital (among other allegations).   It’s not uncommon for a physician practice to sub-lease an exam room and/or other office space on a short-term or temporary basis to another physician whom they refer patients to. This arrangement type is normally permissible as long as the lease rate is fair market value. Generally speaking, the FMV sub-lease rate should be higher than the base lease rate for several reasons. The sub-leasing physician generally has no multi-year or long-term lease commitment and is leasing only a small sub-section rather than a larger suite. These benefits and advantages appropriately come with a premium that should be baked into the sub-lease rate. In addition, the physician normally uses an exam room equipped with furniture, exam tables, stools, and other medical equipment, which should also carry a fee. Plus, the patients of the sub-lease tenant use the waiting room and possibly administrative services, which should also be factored into the sub-lease rate. The nature and character of such a sub-lease arrangement are similar to that of an executive office suite or “office sharing."  https://lnkd.in/g5JcAYKQ #FMV #medicaloffice #physician #hospital #surgery #DOJ

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How Much Variation Should There Be in the Pricing of a CT Scan, from the *Same​* Provider in Michigan? Here's a real life example of from one of finHealth's clients. The names have been changed to protect the innocent (until proven guilty).   This is the actual distribution of CT scan of the abdomen and pelvis with contrast in the Michigan region – all from the same provider. Typical cost at this facility is $400, but here we also see this same provider exceeding $2,700 on multiple occasions. Why does the contract allow much significant pricing variation for the same service from the same provider? Is your BUCA contract allowing for this? Do you know? 𝑯𝒐𝒘 𝒘𝒐𝒖𝒍𝒅 𝒚𝒐𝒖 𝒌𝒏𝒐𝒘? #healthcare #cost #fiduciary #howwouldyouknow

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Assume. That's what so many people do. They "assume" they are going in for a simple procedure or a simple operation......and then they have a heart attack or stroke which they may or may not recover from. Then what? Here is the problem. Families do not talk about the "what whens" of life 1. Most people don't have their Grab and Go information at their finger tips and/or they don't have their power of attorney/living will documents in place and end up spending THOUSANDS in emergency guardianship and/or conservatorship legal and court fees if capacity is lost 2. Family members have to step in and make care decisions (say you have to go to a skilled rehab unit or to a nursing home) 3. Finances--what can you even afford if care is needed....knowing that companion care can range $25-75/hour, depending on where you live. Do you have Long Term Care Insurance or some other financial solution to pay for out of pocket care costs? Do you have disability insurance? What does your insurance even cover? Dust off those old policies and see what you have for coverage 4. Pets--who is going to take care of Fluffy if you now need to go to a facility for care or your "outpatient" procedure landed you in the ICU for 2 weeks? Did you plan ahead and have someone take care of your pet, do they know their meds, their routine, their favorite toys, when they like to go for walks, who the vet is, where is the upset tummy emergency kit (I would hope anyone with pets would have pumpkin on hand...) 5. Mail--who will take care of your mail/your bills--who is your financial power of attorney and do they know your bill pay system--which bills get paid from which account, do you have everything set up on auto pay, what banks do you use, who is your financial planner, how do they log into your accounts and pay bills 6. Your house. Let's hope you can return home. Is your house safe? What needs to be done, whether temporarily or permanently, to be safe at home (stairs, steep drive ways, mail boxes at the end of the drive way and you can't walk that far, microwaves above the stove vs on the counter, steps in/out of the house, shower and bathroom safety, furniture height, bubbles in the flooring/carpet, etc. I'm passionate about trying to shed light on situations that I address with families all across the globe, every single day..... If you want to learn more about any of our services---from white glove approach family caregiver/aging/dementia/senior care consulting to our DIY products or my book, The Invisible Patient: the Emotional, Financial and Physical Toll of Family Caregivers, feel free to contact me/my team.

BiB or business in a box. This was the healthcare buzzword for 2024. It was described as the solution to help doctors and clinicians start private practices, except it did absolutely nothing to help anyone start anything. What it was however was a new play at the 1099 gig model that was popularized by companies like Headway. These BiB startups would provide some lite practice management tools, assist with credentialing (for their networks, not the doctors), and list a profile on their directory website. Now here's my "in a box" prediction for 2025 that actually has the potential to help doctors and clinicians start private practices, AiB or Agents in a Box. This is new model removes all of the fluff from BiB by bringing it all in-house with agents. It starts off as a foundational agent, think a digital clone of the doctor or clinician that's able to integrate with others agents for front and back office tasks. Each agent is set to the doc - as is the credentialing, ePrescribe, lab, imaging, etc. The agent will be able to connect with other agents (hence the AiB name) to perform tasks for marketing, patient acquisition, credentialing, support, etc. Agents in a box is the new way that doctors and clinicians will practice. What makes this model different from other practice models is that it's flexible and not dependent on doctors quitting their FT employment jobs/roles in order to adopt. This makes it "safe from PE" and "safe from consolidation." #HealthcareOnLinkedin #AIagents #AgentsInABox #PrivatePractice

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An interesting phenomenon happens when a health insurance company denies necessary care. Sometimes the patient will actually blame the doctor that the health insurance company denied it. How did we get here? The physician ordering necessary care that the health insurance company denies, and then the doc gets the blame for a decision out of their control. What happens is that when the care gets denied, the health insurance company says, "We will pay for it, but your doctor didn't do the necessary paperwork. If only they had done the paperwork then we would cover the care." This makes it seem like the doctor's office and staff are just unorganized and lazy. The reality is that health insurance companies don't want to pay for it, and will do what they can to make sure that they don't have to. So they make it seem like they would, but it's the doctors fault that it can't get done. The real question should be why are they even allowed to deny necessary care in the first place? The patient is paying their premium and the doctor is IN THEIR NETWORK! You would think that being in network would mean that they would cover the care the medical expert they approved (physician) ordered. But no. It all comes down to money. As physicians we need to be better about beating the health insurance companies to the patient, and blaming them correctly instead of allowing the health insurance companies to blame us when care gets denied. #healthcare #medicine #healthinsurace

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Exactly The only insurance I recommend covers basic stuff but is designed to be utilized for catastrophic situations. Low cost but not easy…one out of every three applications may be denied due to health history. It doesn’t hurt to check you Health credit score.

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DO NOT WATCH THIS VIDEO IF ALL YOU WANT IS A GREAT JOB. If you want to build a business from scratch that will save people $10 billion per year on healthcare, this is best 4 minutes you will ever spend. #nashville-based Swiss army knife kind of people preferred. Tagging my friends to help me find the perfect #Swissarmyknife. Kat McDavitt Beth Minter, PhD Missy Krasner Lori Evans Bernstein Laurie McGraw WBL (Women Business Leaders of the US Health Care Industry Foundation) Council Fellows Nashville Health Care Council Josh Wyrick Daniel Delgado Melissa Denino Rebecca Whitney Evelyn Gallego, MBA, MPH, CPHIMS Stacey Richter #hcit #hit #healthtech #health #healthcare #pharma #pharmaceuticals #prescriptions #copay #copaycoupons #coupons #prescription #prescriptions #medicine #medication #medications #medicationadherence #financialtoxicity #affordability #scripts #rx #pricetransparency #drugprices #drugs #drug #nashville #nhcc #pharmacy #pharmacists

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People have died in the waiting room and more will die if we keep this ridiculous ‘cost-cutting’ exercise. Remember that once you’re in an emergency department, it doesn’t mean jack how much private health insurance you have, you still got to wait like ever other schmuck. If we keep underfunding primary care, more people will overwhelm the emergency department. If we keep underfunding aged residential care, we won’t be able to discharge patients from hospital which means we can’t get patients out of emergency and into an inpatient bed. Which means people who could have been resuscitated, die in the waiting room because we have nowhere to resuscitate them. In these instances it almost always feels like a witch hunt for some doctor or nurse who has failed this patient. What about the people making decisions about budgets and staffing levels? Should they not be accountable to our patients also? Rotorua staff have raised the alarm that due to poor staffing in Taupo, they have been asked to cover Taupo also. Of course this is going to affect services in Rotorua. Once again for the people in the back: Private health insurance won’t save you in an emergency. My deepest condolences to the affected family and friends. I extend this also to the staff of Rotorua Hospital. https://lnkd.in/gYepJkXB #emergency #health #hospital #doctor #medicine #rotorua #publichealth #aotearoa #newzealand

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Public Service Announcement: If you are an employer and do business with Elevance Health (the *&$-artist formerly known as Anthem), please know that the following contractual terms have likely been agreed to by.... drum roll please........ you. ▶ “Anthem or Anthem affiliate may have financial interest in Network Providers through direct ownership, partnership, joint venture, or other arrangement. …Anthem may share in the Network Provider’s profits or other revenue, and all revenue is retained by Anthem.” ▶ “Anthem reimburses Provider on a percentage of charges, fixed payment, global fee, single case rate, or other reimbursement methodology whether amount is more or less than Provider’s billed charges.“ Imagine giving someone a blank check and just saying, "Hey, take whatever you want!" That's basically what these terms are doing. I'm still shocked by how many people in this industry don't get it! How these terms are a total nightmare for employers? First off, the idea that "Anthem or Anthem affiliate may have financial interest in Network Providers" is like giving them a green light to prioritize their own profits over anything else. They're basically saying, "Hey, we might own part of the providers, or at least have a sweet deal with them, and we’re not going to pretend that we don’t benefit from it." So, who’s really being looked after here? Spoiler alert: it’s not the employers or their employees. Then there's the kicker: “Anthem may share in the Network Provider’s profits or other revenue, and all revenue is retained by Anthem.” Translation? Anthem could be making money on both sides of the fence—collecting fees from employers and then raking in profits from the providers. It’s like handing them a blank check and hoping they won’t cash it all in. Spoiler alert again: they will. And as if that wasn’t bad enough, the way they reimburse providers is a total wild card. “Anthem reimburses Provider on a percentage of charges, fixed payment, global fee, single case rate, or other reimbursement methodology whether amount is more or less than Provider’s billed charges.” What does that even mean? It means they can pay the provider whatever they feel like, regardless of what the provider actually billed. So, employers have no idea if they’re overpaying, underpaying, or just getting played. In short, these terms are a one-way ticket to giving Anthem total control, while employers are left in the dark, footing the bill. Oh, and they are always sure to include language disclaiming all fiduciary liability just to cover their own a%$. Go ahead - prove me wrong!

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I hole heartedly agree Benjamin Schwartz, MD, MBA. Anywhere else in an economic system, innovators who can deliver a better product at lower costs are almost always rewarded with greater market share, and frequently set the direction for the future of a product or industry. Not so in healthcare. I think that Terry Adirim, MD, MPH, MBA (below) hit the nail on the head when she references for-profit health insurers in the mix. Although policies have been enacted with the idea of providing better healthcare at lower costs, they have always given the job of administering those policies to a middleman (insurance companies) whose motives are at odds with the objective they claim to be administering. Profit! Innovation is not in the best interest of the payer. They profit through the inefficiency of the system. Until this lack of alignment between quality patient care at low costs and for-profit health care plans is addressed, process innovation and improvement will only be able to nibble at the edges.

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To reduce stress, we must identify its root cause. Applying stress relief tools is like mopping up an overflowing sink without turning off the faucet. Fix the underlying problem first. Check the latest episode with Dr. Robyn Tiger to learn more about stress and how to manage it.

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Hospital Chargemaster Explained... is a 13,200% Markup Reasonable?!? The Hospital Chargemaster is a list or database of hospital supplies, medications and services (e.g. 15-min of operating room time) and their associated prices billed to insurance, Medicare and Medicaid. The Chargemaster includes: 1) Department number (unique to each hospital) 2) Charge Code (unique to each hospital) 3) Supply, Medication, Service Description 4) Revenue Code (standardized across hospitals) 5) CPT/HCPCS Code 6) Price (Billed Charges) Unfortunately, each insurance company, Medicare and Medicaid plans accept different combinations of Revenue Codes and CPTs codes... so a combination that may work for Blue Cross will be denied by Cigna. Therefore, hospitals are not told by insurance companies which combinations to use, so they have to just guess and go through a billing process of trial and error. Hospitals have no rational basis for the prices they charge on the Chargemaster. For example, the medication Oxytocin was marked up from a cost of $0.02 to a price of $264 billed to the insurance company... a 13,200X markup. Even with a 50% discount from the insurance network, that is still at 6,600X markup!! Final seconds of video and sources at AHealthcareZ YouTube Channel. #HospitalPrices #PriceTransparency #Chargemaster #Healthcare #HealthInsurance #HealthcareCosts

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Allowing Medicare to negotiate drug prices on behalf of older Americans remains broadly popular across partisans, though many voters are unaware of the new law and the billions of dollars it is expected to save in 2026, a new KFF Health Tracking Poll finds. A large majority (85%) of voters say they support allowing the federal government to negotiate the price of some prescription drugs for people with Medicare. This includes at least three quarters of Republican (77%), independent (89%) and Democratic (92%) voters. The Inflation Reduction Act of 2022 authorized such negotiations, and the Biden administration recently completed the first round of negotiations on 10 drugs, resulting in an estimated $1.5 billion in lower out-of-pocket costs for Medicare beneficiaries in 2026. #kff #medicare #prescriptiondrugs

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