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Mastering MedicareDemystifying healthcare and Medicare for senior-serving professionals and providers. Author: Mastering Medicare
What's the difference between Home Health and Home Care? How do Medicare Part A and Part B work? How do you order DME for your patient? When and how should you order home oxygen? What's new in the eldercare space? For physicians, other healthcare professionals, and senior-serving professionals, interacting with Medicare can be complicated and wrought with pitfalls, which, if not understood and managed, will mire your practice in endless paperwork and frustration. We interview industry experts in every aspect of healthcare, from insurance companies, DME companies, home health agencies, medical providers, and many others, to bring you their real world expertise in the American healthcare system. Your hosts are Dr. Amy Schiffman and Dr. Alex Mohseni, two Emergency Medicine physicians who have branched off from traditional Emergency Medicine to explore and build solutions with a particular focus on eldercare and population health. Join our Facebook group: https://www.facebook.com/groups/602747270479020/ Join our Subscriber List and get exclusive access to our Mastering Medicare Cheat Sheet and other goodies: https://www.masteringmedicare.net/subscribe Language: en-us Genres: Business, Health & Fitness, Medicine Contact email: Get it Feed URL: Get it iTunes ID: Get it |
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Episode 28: Navigating the Medicare Information Desert: Ambiguity, Audits, and the Innovator’s Burden
Monday, 15 December, 2025
In this episode, Amy Schiffman and Alex Moseni dig into the real challenges physicians and innovators face when working inside Medicare. They explore why CMS guidance is often incomplete, how this drives confusion and legal costs, and what it means for startups trying to build sustainable care models. Topics Covered • The Medicare information gap and why CMS publishes only partial guidance • How unclear rules increase legal expense and slow down innovation • Fragmented CMS communication and the absence of a unified how to guide • The complexity of care management codes and EMRs that cannot keep up • Why many clinicians rely on third party spreadsheets for compliance • Hidden payer controls such as Medical Unlikely Edits and their impact on reimbursement • Why physicians must understand financial tools to succeed as leaders • How to segment the 65 plus population for better patient acquisition • Resources for physician executives including the ClinX Academy program • Amy Schiffman’s work with Inter Mezzo Health and Coordology • How ambiguity from CMS affects planning, proformas, and capital raising • Persistent hurdles for startups including credentialing and physician activation
