TELEHEALTH BUSINESS SOLUTIONS
Practice Analysis
To determine patient eligibility for Remote Physiologic Monitoring (RPM), Chronic Care Management (CCM), and Remote Therapeutic Monitoring (RTM), a medical practice analysis should include the following components, organized by ICD-10 codes, payer-specific coverage rules:
RPM: ICD-10 codes for chronic/acute conditions requiring physiological monitoring.
CCM: ICD-10 codes for ≥2 chronic conditions expected to last ≥12 months. Medicare: Requires a comprehensive care plan and ≥20 minutes of monthly care coordination.
RTM: ICD-10 codes for respiratory, musculoskeletal, or therapy adherence-related conditions. Medicare: Requires an established treatment plan and monitoring of non-physiologic data.
Risk Stratification
KaiCare Ai can deliver Risk Stratification to accurately predict expected health care costs, so our clients can compete for beneficiaries based on price and quality, not health status. An accurate risk adjustment model ensures that payments to Medicare Advantage plans adequately compensate for the costs of treating and managing both high- and low-cost individuals.
Risk Stratification affects plan payment in three important ways: First, Medicare Advantage plans bid against FFS Medicare county benchmarks to determine payment. CMS adjusts benchmarks based on the average FFS Medicare risk score in the county. These adjusted benchmarks represent the maximum amount CMS will pay to an individual plan. Second, CMS uses the difference between the county benchmarks (described above) and the plan’s bid to determine the level of rebates, which are used by plans to provide additional benefits to beneficiaries. Third, after a benchmark is set, CMS adjusts the payments to health plans on an individual level based on the risk score.
- Ensure a predictable and stable risk adjustment model;
- Maintain coding intensity adjustment at the statutory minimum level;
- Improve risk model accuracy for individuals with multiple chronic conditions;
- Incorporate social determinants of health into the risk model;
- Validate the Encounter Data System;
- Implement the Encounter Data System at a slow and measured pace;
- Consider impact of the Encounter Data System on the coding intensity adjustment;
- Guarantee a transparent process when modifying the risk adjustment model.
Tax Mitigation Strategy
HOW IT WORKS: EXAMPLE: $700K PARTICIPATION
Participant acquires software for $700k
- Participant pays $100k in cash
- Signs a note for $600k plus interest
Participant receives bonus depreciation
- Participant may save $180k in taxes based on 168 (k)
- Participant may save $286k in taxes based on 179
Participant sells the right to use (RTU) software back to the company
- Company agrees to pay $42k per year
- Participant makes note payment of $36k after receipt of RTU payment
Participant nets $6k annually
- Positive cash from RTU revenue equates to 6% of the cash portion paid
Professional Documentation: Software Purchase Agreement, Promissory Note, Right To Use Agreement, Tax Memorandum from Tax Attorney
