The Amplify OT Podcast Clarice Grote, MS, OTR/L

Decoding Medicare Advantage and Medicaid MCOs: Understanding the CoverageYou may have heard (or even said) that Medicare Advantage is great if you’re healthy but terrible if you’re sick. But why is that? This week on The Amplify OT Podcast, I’m sharing what Medicare Advantage is, why it’s popular, despite these claims, and how it has expanded into the Medicaid space with managed care organizations (MCOs).
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In this episode, I cover:
Benefits and barriers that come with Medicare Advantage plans.The difference between traditional Medicare and Medicare Advantage. Why managed care plans (MCOs) are popular, especially for governments. Current and proposed regulatory changes that affect these plans and us as practitioners. 
Thanks for listening! If you found this episode helpful, don’t forget to follow, rate and review the show. To learn more about Amplify OT head to https://amplifyot.com/ 

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LINKS MENTIONED IN THIS EPISODE:
Ep 50: Volume-Based vs. Value-Based Reimbursement Models in OTCMS Finalizes Rule to Expand Access to Health Information and Improve the Prior Authorization Process [CMS.gov Article]Medicare Advantage in 2023: Enrollment Update and Key Trends [KFF.org Article]Medicaid: Last Week Tonight with John Oliver [YouTube]

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Volume-Based vs. Value-Based Reimbursement Models in OT Reimbursement models, in healthcare and business in general, incentivize specific behaviors. The reimbursement model you work under will directly influence what is expected of you. Once you have a better understanding of the incentive structures, you can work better within that structure. That’s why this week on The Amplify OT Podcast, I am talking about volume-based vs. value-based reimbursement models.

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As an exclusive bonus for podcast listeners, you can join the Amplify OT Membership at any time! Join today to take control of your career! It’s time to become your own best resource on Medicare and advocacy.

In this episode, I cover:
Historically, the United States has leaned closer to a volume-based care system, only adopting value-based care alongside the Affordable Care Act of 2010.Pros and cons of volume-based and value-based care models.Fee-for-service (volume-based) can be compared to shopping at a grocery store and paying a specific price for each item you buy. Less common for OT practitioners, Capitated payments (value-based) can be compared to a gym membership where you pay a set dollar amount per month regardless of how many times you go to the gym. Bundled payments (value-based) are like getting a paycheck where a certain amount goes towards paying necessities like bills and groceries and the rest is up to you to spend as you choose. 

Amplify OT ResourcesWant to keep learning about how insurance and reimbursement impact you? Then head to AmplifyOT.com/Services to see what resources we have available!


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LINKS MENTIONED IN THIS EPISODE:
Reimbursement Models in OT: Do You Know What They Are? [Blog]How Understanding PDPM in Skilled Nursing Facilities Can Make You a Better Clinician [Blog and Podcast Episode]Sign Up for the Amplify Therapy Summit






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Amplifying Impact: Clarice’s Journey from Clinician to OT VisionaryI had the incredible honor of receiving AOTA’s Gary Kielhofner Emerging Leader Award this year. So in celebration of this career achievement, Lindsay Bright joins me as my guest host to interview me on my journey from practicing clinician to OT advocate, my goals and plans for Amplify OT, and my vision for the future of our profession. This week on The Amplify OT Podcast, we’re diving into Clarice’s journey from clinician to OT visionary. 

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As an exclusive bonus for podcast listeners, you can join the Amplify OT Membership at any time! Join today to take control of your career! It’s time to become your own best resource on Medicare and advocacy.

In this episode, Lindsay and I cover:
My journey from home health to acute care, to starting Amplify OT. What advocacy means for me both as a clinician and in my current role. The biggest challenges I have had to overcome through my advocacy work. What it feels like to be an online figure that people come to for information and resources.My hopes for Amplify OT in the years to come. Our goals and intentions for the Amplify Therapy Summit

Amplify OT ResourcesWant to keep learning about how insurance and reimbursement impact you? Then head to AmplifyOT.com/Services to see what resources we have available!


CLICK HERE to save 40% off Medbridge Today!


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LINKS MENTIONED IN THIS EPISODE:
Sign Up for the Amplify Therapy Summit





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Mentioned in this episode:
Join the Amplify OT Membership
As a exclusive bonus for podcast listeners, you can join the Amplify OT Membership at any time! Join today to take control of your career! It’s time to become your own best resource on Medicare and advocacy.

Join the Membership Today

Spring 2024 Amplify OT and Healthcare Advocacy Updates2023 was a big year for passing healthcare legislation. A lot of what came through Congress in 2023 is starting to be implemented early in 2024, impacting OT in a big way. That’s why this week on The Amplify OT Podcast, I am talking about OT advocacy updates for spring 2024. 
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As an exclusive bonus for podcast listeners, you can join the Amplify OT Membership at any time! Join today to take control of your career! It’s time to become your own best resource on Medicare and advocacy.

In this episode, I cover:
With the passing of the 2022 Omnibus Bill, Congress established a new Medicare mental health benefit known as the intensive outpatient program (IOP). With the passing of the Lymphedema Treatment Act in 2022, Medicare Part B will now cover standard and custom-fitted lymphedema compression treatment items for each affected body part for patients with lymphedema.CMS rolled out new Caregiver Training codes that can be used as of January 1, 2024. This is the first time OT practitioners can be reimbursed for services that do not directly involve a service provided directly to the client. In a rare turn of events, CMS is increasing Medicare Part A payments to home health agencies by 0.8% in 2024, equating to $140 million.Home health will see some changes to their quality reporting program and value-based purchasing in addition to the payment increase.OT services paid for under Medicare Part B will face a 3.37% decrease compared to 2023. For 2024, the updated KX Modifier therapy threshold is $2,330 for OT and $2,330 for physical and speech therapy services combined.General supervision of OTAs in private practice was unexpectedly extended until the end of Calendar Year 2024.Aetna is delaying the implementation of the OTA payment differential from December 2023 to March 2024.The Consolidated Appropriations Act...

Patient-Driven Payment Model (PDPM) in Skilled Nursing Facilities [Replay]Today's episode is all about the Patient-Driven Payment Model (PDPM) in Skilled Nursing Facilities (SNF).

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As an exclusive bonus for podcast listeners, you can join the Amplify OT Membership at any time! Join today to take control of your career! It’s time to become your own best resource on Medicare and advocacy.

Amplify OT ResourcesWant to keep learning about how insurance and reimbursement impact you? Then head to AmplifyOT.com/Services to see what resources we have available!


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LINKS MENTIONED IN THIS EPISODE:
Amplify OT SNF Resources






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Mentioned in this episode:
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Join the Membership Today

From Policy to Practice: Everything You Need to Know About Section GGSection GG is one of my favorite topics to talk about because it was really one of the first indications of CMS starting to pay attention to function, mobility, and self-care as an outcome desired from healthcare services. This assessment continues to play an important role in functional assessments, quality measures, and reimbursements across post-acute care settings. That’s why this week on The Amplify OT Podcast, I am sharing what you need to know about Section GG.

Join the Amplify OT Membership
As an exclusive bonus for podcast listeners, you can join the Amplify OT Membership at any time! Join today to take control of your career! It’s time to become your own best resource on Medicare and advocacy.

In this episode, I cover:
Uncovering why Section GG came about in the first place helps us better understand the purpose it serves today. Breaking down the 2 categories within Section GG: self-care and mobility. Knowing how to score is so important because accurate (or inaccurate) scoring deeply impacts the perceived value of OT and future reimbursement.  Helpful advice you need to know when it comes to scoring Section GG. 

Amplify OT ResourcesWant to keep learning about how insurance and reimbursement impact you? Then head to AmplifyOT.com/Services to see what resources we have available!


CLICK HERE to save 40% off Medbridge Today!


CONNECT WITH AMPLIFY OT:
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LINKS MENTIONED IN THIS EPISODE:
Patient-Driven Payment Model (PDPM) in Skilled Nursing FacilitiesPatient-Driven Groupings Model (PDGM) in Home HealthAOT: Everything You Need to Know About Section GG
*CMS links and training are included in the AOT article. 







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Mentioned in this episode:
Join the Amplify OT Membership
As a exclusive bonus for podcast listeners, you can join the Amplify OT Membership at any time! Join today to take control of your career! It’s time to become your own best resource on Medicare and advocacy.

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