DNA cancer screening tables are a medicare scam

[sheilaja]

so,myinsurebiz, you researched this ? and found company you think is legit ? Can I ask which one? I am still interested and also researching ..... and would consider doing this if not a scam

 

[LostDollar]

I spent much of yesterday and today talking with the Principals of 3 different companies on the Screening process. It is in fact allowable under CMS rules to assist with Intakes on these tests for individuals that want to have the tests preformed.

At the moment - these Tests are being reimbursed based on which codes are being submitted based on what tests / procedures were preformed.

The test can be ordered by any Board Certified Physician. Mostly via TeleMedicine at the moment.

CMS is making the reimbursements via Medicare and also Medicade. Naturally, Medicade is paying less . . .

Private Insurance Carriers are coming onboard as well.

The difference is in whether or not a Marketing Company is compliant in their marketing, intaking, submission, etc . . .

Someone can not initiate the contact via phone, text, email, etc. The lead MUST be initiated by the Patients - via Events, Direct Mail, Commercials, etc - very similar to Part C and Part D.

It does pay very, very well depending on which Cancer Screen is used and the depth of the Patient and Family history is submitted upon intake. Crazy but a sick person with a sick family, especially death by cancer, pays more - primarily based on the coding that is submitted.

The 3 companies that I spoke with are jumping all in. Only one of them is going to do it right, in my opinion, by performing background checks on the Intake Specialists, using HIPPA certifications and seeking those in professional capacities - ie: Insurance Agents, Doctors, Nurses, etc.

Don't know how long the window of opportunity will be on this - may last may not. But - the process isn't a scam or illegal as some state. Now - the process of gathering the leads could be, depending on the methods.

2 of the 3 are using a MLM model and charging someone a fee to join as an Intake Specialist and then paying portions of that fee to the MLM sponsor. That will cause a red flag for sure . . .

The one that I am joining, is the one doing it right, doing the Background Check, etc. They only charge for the Background Fee. They will use the traditional "hierarchy" structure - only 2 levels - personal and sponsor.

Maybe this is not a scam in the legal sense of the word, but if I had an agent try to sell me on this, I would get up and walk out of their office and if I was asked by others for Medicare insurance agent recommendations, I would give this person's name as an agent to avoid at all costs.

 

[myinsurebiz]

so,myinsurebiz, you researched this ? and found company you think is legit ? Can I ask which one? I am still interested and also researching ..... and would consider doing this if not a scam

Due to a NDA, I can't at the moment. But they'll open for business in 3 or 4 weeks. They are doing Beta tests on the swab procedure and Electronic Health Record implementations.

I'll post back when they open and offer you the opportunity to apply.

 

[myinsurebiz]

Maybe this is not a scam in the legal sense of the word, but if I had an agent try to sell me on this, I would get up and walk out of their office and if I was asked by others for Medicare insurance agent recommendations, I would give this person's name as an agent to avoid at all costs.

Why?

It would cost you $0 to possibly prevent and/or cure Cancer in your life or a family member's life.

This is just the beginning. Cancer screening is just the beginning. It's amazing the breadth of DNA . . .

Plus, if marketed correctly, the Marketer is not allowed to approach a consumer / patient in person. Has to be done in a general method via event, mail out, etc.

CMS recognizes and approves only marketing that is consistent with how a person markets Part C and Part D. The big difference is the marketer does not have to have a license nor be an Insurance Agent.

Now, if the Marketer is indeed a licensed Agent, then the same rules apply in that they can market to their existing book of business.

 

[myinsurebiz]

To assist in being compliant - a few of the "Testing" companies are having their clients complete a SOA similar to Medicare Part C & D. Nice move.

 

[rousemark]

To assist in being compliant - a few of the "Testing" companies are having their clients complete a SOA similar to Medicare Part C & D. Nice move.

That will not get around the fact that it is not a "medical necessity.".. This is on pie in the sky scheme you might be better not chasing..

https://www.kdads.ks.gov/docs/defau.../genetic-testing-kansas.pdf?sfvrsn=76a634ee_4

 

[LostDollar]

That will not get around the fact that it is not a "medical necessity.".. This is on pie in the sky scheme you might be better not chasing..

https://www.kdads.ks.gov/docs/defau.../genetic-testing-kansas.pdf?sfvrsn=76a634ee_4

You have an "Amen Brother!" from the front row on that one!

 

[myinsurebiz]

That will not get around the fact that it is not a "medical necessity.".. This is on pie in the sky scheme you might be better not chasing..

https://www.kdads.ks.gov/docs/defau.../genetic-testing-kansas.pdf?sfvrsn=76a634ee_4

The patient is evaluated by a Board Certified Physician and that same Physician orders the lab tests. The Marketer doesn't order the labs / screens - the Physician does.

The only issue that I see is that a Patient can only have one screen paid for by Medicare once per life.

 

[myinsurebiz]

That will not get around the fact that it is not a "medical necessity.".. This is on pie in the sky scheme you might be better not chasing..

https://www.kdads.ks.gov/docs/defau.../genetic-testing-kansas.pdf?sfvrsn=76a634ee_4

If someone " offers to provide an educational session to a group of seniors, takes their Medicare number, then does a DNA swab, this does not meet Medicare's criteria of medical necessity. "

The above isn't how a Marketer "correctly" assists a Patient.

 

[rousemark]

If someone " offers to provide an educational session to a group of seniors, takes their Medicare number, then does a DNA swab, this does not meet Medicare's criteria of medical necessity. "

The above isn't how a Marketer "correctly" assists a Patient.

As usual, you will not see anything that might contradict what you have already decided.. Perhaps that is the reason you are still chasing rainbows..