Is it illegal for licensed insurance agents to process cancer screening test?

[NormMitchell]

I can't find any statement / regulation from CMS that dictates the test has to be ordered / prescribed by someone's "personal" physician.

Did you read the letter and pull up the copy of the document from the 1st page of this thread? I guess you'll just have to wait and let the Office of Inspector General educate you.

 

[myinsurebiz]

Did you read the letter and pull up the copy of the document from the 1st page of this thread? I guess you'll just have to wait and let the Office of Inspector General educate you.

There is only 1 page in this thread.

Most of the other stuff you posted on the other thread is older than Golini.

Post some relevant facts please.

 

[NormMitchell]

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Hey, you're a Guru, I'm sure you can figure it out. There are two pages in this discussion. You actually posted on the first page too, but you can also find a copy of the letter and the document from CMS in the other thread you mentioned. The relevant fact is that the information is being reported to the OIG per the letter. We'll have to wait and see what they have to say about the Multi-Level Marketing and kickbacks for referrals to teledocs who submit the OK for testing.

 

[myinsurebiz]

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.

 

[sshafran]

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.

Cross-selling cancer screening to your security system client?

 

[myinsurebiz]

Cross-selling cancer screening to your security system client?

Just using the same marketing vehicles to market the Screens.

The money is insane.

 

[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.

 

[Sethb2]

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.

Which company are you with? I have joined a company to perform cancer screening too. Compensation is great. The idea is mostly preventive.

 

[myinsurebiz]

Which company are you with? I have joined a company to perform cancer screening too. Compensation is great. The idea is mostly preventive.

Still looking at two. Can't decide. Message me about yours - it may be better than what I'm looking at . . .

Also in contact with my buddy at Ocenture. May just do a private label.

 

[Sethb2]

Still looking at two. Can't decide. Message me about yours - it may be better than what I'm looking at . . .

Also in contact with my buddy at Ocenture. May just do a private label.

From what I read I think we are talking about the same 2 new Companies that just started a few months ago. The pay structure is the same.

I know people who are screening patients or clients with a different company that pays $440 per screen with no entry fee. And another company that pays $200 per screen.