Med-Mgrs

09/08/2025

Attention Healthcare professionals:
We are excited to partner with PAHCOM to offer a special free 3-part webinar series: Turning Quality Care into Reliable Revenue – proven strategies to grow revenue without adding more patients.

When: September 10, 17, and 24 at 2:00 PM EST
Length: 30 minutes.
Bonus: Earn your CEUs and a certificate when you attend all three.

3 Part Webinar Series:

Remote Patient Monitoring – Turning Quality Care into Reliable Revenue

ERISA Essentials – Protecting & Growing Reimbursements

Mastering Medicare – Your Most Profitable Patient Segment

These are practical, actionable strategies you can use right away -

Register here https://us06web.zoom.us/webinar/register/WN_fFaa_AckSquty_I--GGm7g

07/15/2025

Most offices do not realize they are violating HIPAA when they send out records upon receiving the Record Requests or Demands. Check out this 2 minute video discussing our new one hour webinar we just released today at https://youtu.be/1En1YiDPVro

I would love to hear your thoughts before and after watching the trailer and after watching the full webinar.

A 2 minute video identifying how most clinics are violating HIPAA when they accede to and follow the Record Requests (Demands) by insurance companies, Medica...

06/21/2025

Yesterday, a doctor told me she had spoken with three different RPM companies before calling me. Two of the three wanted her to sign a contract that pays them a percentage of collections. She asked if I did the same.

I told her flat out: No. When I first got into RPM 6½ years ago, I ran the percentage-based model by multiple attorneys. Every one of them told me the same thing — it violates the federal Anti-Kickback Statute.

Then I explained something many folks don’t realize: if there’s a violation, the RPM company may skate by — but the doctor or clinic that submits the claims will be the one on the hook. It’s the clinic that risks audits, clawbacks, or even fines from the OIG or DOJ.

She said one RPM company showed her a letter from their attorney saying it was fine. I explained that an attorney hired by an RPM company is paid to protect that company — not the doctor or clinic they’re trying to sign.

Look — I’d love to do percentage-based billing. Our clients typically make a net profit of $62 to $94 per patient per month. But doing it on a percentage? In my opinion, that’s illegal — and I’ve spent over 40 years advising tens of thousands of physicians, billers, and managers. I won’t be part of putting a clinic in jeopardy.
If you're considering RPM — or already doing it — why not talk to us? We operate in a way that’s 100% cash-positive for your clinic, and we’ll explain it in plain English. You could even try us with a few dozen patients and compare our results to what you're seeing now.

We’re up for the challenge — and we play by the rules. Our pricing is transparent and even on our website. We are 100% veteran owned, also.

https://Telecare-USA.com/
and
www.Donself.com

Don Self, CMCS, CPC, CASA

12/19/2024

Everyone is kinda in limbo right now when we’re discussing Telemedicine or Telehealth coding and coverage for the new year because Congress is changing what they had planned, at the last minute. There was a 1500 page bill with all kinds of pork in it that Congressional members were adding at the last minute to try to “slip in”. It included $8 billion for a new football stadium in Washington, D.C., $50 million annually for an extended drinking water program, five years' worth of funding for a healthcare education program, a reauthorization of the Pandemic and All-Hazards Preparedness Act, and a future pay raise for members of Congress, among other things. Instead of the “let’s pass it and then we can read it later on” garbage we had years ago, this bill needs 72 hours between presentation and voting so folks can read it. They’re working on it. It may be at the last minute or they may have to do a partial shutdown again as they’ve done more than 20 times before (and the sky did not fall) and then we have changes to everything in January.

11/28/2024

Happy Thanksgiving Gifts to Everyone.
Here are a couple of free one hour webinars in our BUSINESS OF MEDICINE SERIES (with CEU from AAPC, PAHCOM & AMBA). By the way - if you like the webinars, please click like and subscribe so you can be updated on future free webinars.
Increasing 2025 Income by Hundreds of Thousands for FEE-FOR-SERVICE CLINICS, on Youtube at: https://youtu.be/2E5ohxh6fho This is a one hour webinar recorded on Nov. 26, 2024 regarding the new changes taking place in 2025 for fee-for-service clinics and how to easily increase the 2025 income by HUNDREDS of THOUSANDS per year. This video deals with the E&M documentation (Time v MDM), linking diagnosis to procedure codes on claims, why Primary Care providers make 4 to 5 times more money on Medicare than they do on anyone else, new codes for Caregiver Training as well as RPM and CCM, Cognitive testing, selecting your fees, and more. We even show you the income missed by quite a few physicians and how thousands of physicians currently charge less on the claims than Medicare or other carriers are willing to pay. This webinar also has 1 CEU from the AAPC, AMBA and PAHCOM. In order to get the CEU, you need to watch the video and then click on this link to go to the Quiz, where you must score a 70 or greater on the 10 questions. You only get two chances to pass the quiz, so you definitely want to watch this video first. After watching the video, go to: https://donself.formstack.com/forms/increasing_ffs_clinic_income_in_2025_quiz

and
Increasing 2025 Income by Hundreds of Thousands for RHC/FQHC CLINICS at https://youtu.be/Owz5FQMRgP8 The Second of the BUSINESS OF MEDICINE SERIES that Don Self & Associates is teaching. Don has taught more than 1100 seminars and webinars over the past 39 years and this one is full of information to help clinics and medical providers. This is a one hour webinar recorded on Nov. 27, 2024 regarding the new changes taking place in 2025 for RHC & FQHC clinics and how to easily increase the 2025 income by HUNDREDS of THOUSANDS per year. This video deals with the E&M documentation (Time v MDM), linking diagnosis to procedure codes on claims, new coverage for G0511 for RPM, CCM and more. We discuss Cognitive testing, selecting your fees, and more. In order to get the CEU, you need to watch the video and then click on this link to go to the Quiz, where you must score a 70 or greater on the 10 questions. You only get two chances to pass the quiz, so you definitely want to watch this video first. After watching the video, go to: https://donself.formstack.com/forms/increasing_rhc_fqhc_clinic_income_in_2025

The First of the BUSINESS OF MEDICINE SERIES that Don Self & Associates is teaching. Don has taught more than 1100 seminars and webinars over the past 39 y...

09/28/2024

Just an update on our travels. Today, we're in Indiana at Raccoon State Recreational Area. Last night we were about 20 miles south but did not have electricity so moved up here.

OK - as most know, the Louisiana Interstate Pothole System , LIPS totaled our 2016 Grand Design. It's still sitting in Mississippi in the yard of an RV repairman waiting on USAA to come look at it and then decide to send us a check.

We went from Mississippi to Tampa where we taught a seminar and then over to Daytona to visit with Kelly Jo Self Taylor and her family and then worked our way back up to St Louis Missouri where we taught another seminar 3 days ago. Tomorrow, we'll drive a couple hundred miles up to Elkhart Indiana and spend the night in a museum parking lot. On Monday, we'll drop the RV off at RVMP in Elkhart so they can put a generator in it. We could of used that last night as the area in Indiana where we parked was out of power.

After Elkhart, we'll move up Michigan towards Wilderness State Park where we'll be for 5 nights. During that time, we'll go over to see Mackinac island and up to Sault St Marie. We can't take the RV up there as the bridge to that island has a 12.4 foot restriction and our RV needs a 13.5 foot clearance. After sightseeing for a few days, we'll head down to Lansing where we'll teach the next to the last of our full day seminars this year.

After that, we'll drop off a long arm sewing machine near Akron for our neice Callie Taylor and then over through Pennsylvania to New Jersey for the last seminar in Mt Laurel on the 15th. Then, up to Washingtonville NY to visit with family and then over to Boston for several days and then up to the tip of Maine and turn around and head home.

07/28/2024

A 5 ½ minute short video listing 21 lies told daily to medical offices, physicians, clinics and hospitals that most people believe. For more information, visit www.donself.com/shop after watching the video. You will be surprised at how many of these lies that you've been believing. Keep count and then post in the comment section how many of them that you believed.

06/17/2024

How do you know which seminars to attend? There are great ones out there - many of them. If you own a medical billing agency, you need to know some coding, some modifier knowledge - ICD-10 coding, etc. Do any of those make YOU invaluable to practices? Does any of that knowledge set you apart and opens doors for you?

Yes - we're teaching another seminar in 14 cities across the USA this year. As the owner or manager of a billing agency, what could be so important to make you travel to another city to attend this one? Why did 2 billing agency owners travel from Tampa 6 hours to Macon Georgia? Why did 2 travel from Maryland to Asheville NC? What can be so important to make 2 more fly from Phoenix to San Diego to attend? (Yes - we have letters from each of these people saying how glad they did, we can share with you).

* Less than 1% of people working medical billing know how to make Part C carriers refund the 2% they have called sequester - which they are not allowed legally to withhold.

* Less than 2% know that the clinics do NOT have to respond and send post-payment records just because a commercial or Part C carrier requested it. In fact, less than 2% know the clinic will be violating HIPAA when they comply with those letters.

* Less than 4% know how to stop carriers from recouping when they issue retroactive denials or adverse benefit determinations.
* The same amount know how to get the carriers to return the amounts that they recouped back to the medical provider they stole it from.

* Few know that carriers only have a certain number of days to issue a denial on a claim and the same know exactly what the federal law says must be shown in the EOB before the appeal period begins.
Not many know that you can legally appeal a claim up to six years later - regardless of what commercial carriers tell them.

These are only SOME of the vital things that Karlene Dittrich, Chris and I are teaching in these 8 hour seminars. Imagine how many doors that will open for you when you point out what YOU can do for the clinics you want to bill for - since their current biller is NOT doing these things and getting these results.
Yes - this is why YOU want to attend - even if it means you will have an expense of getting on a plane or driving several hours.
How long do you think it will take to recover those travel funds when you can pretty will pick up whatever clients you want with this knowledge?

Get more information on these webinars by clicking on the first comment or visit www.donself.com/shop The size of these are limited to the first 25 people each. Some are already filling up - and if we get enough people wanting in - we may do a 2nd day in some of these cities like we did in Georgia.

04/25/2024

I am looking for an Orthopedic Knee surgeon that specializes in difficult knees to discuss another REVISION for my left knee. I was told by two different doctors in different practices in Georgia that my lower knee revision is loose - which is causing my left knee to be twice the size of my right one with swelling and the pain has progressed from a 4 to a 7-9 most of the time.

I'm willing to travel the country to find the right doctor but I want someone that specializes in difficult knees as this will be the 3rd LEFT knee replacement (1 original - and 2 revisions). I was told that I might need to have all of the mechanics taken out - entire left leg immobilized for months to let it heal before they start with a 3rd revision - so not sure what that will do to my expected travel schedule - but fortunately - it's my left one and I don't drive two footed.

So - if you work for an Orthopedic doctor, please ask them who they would send their family member to for a 3rd replacement and let me know. My sister, Kelly Jo Self Taylor suggested a doctor Hugate in Denver she read about that specializes in troubled replacements but I would like to double check to see what others suggest also so I can talk to a couple of different ones to get opinions.

04/13/2024

PULLING THE 5TH WHEEL RV ABOUT 17,000 MILES THIS YEAR...

We will be in 12 cities teaching full 8 hour classes on Denial Management this year along with Karlene Dittrich and Chris Chapman. While they will be flying to the cities, my wife and I will be pulling our 40 foot Momentum behind our ¾ ton pickup.. ALL over the country (as you can see on this map). The only time I plan on being on a plane is when I leave my wife at one of the national parks in Utah with my son and his family (they're in a 42 foot Momentum 5th wheel) while I fly over to Chicago to teach a one day session in Schaumburg, Illinois and then I'll fly back to the family and continue on the driving trip.

Karlene, Chris, Angie and I are also kicking around an idea to do one in St Crois next year also.

This will be fun. The only place I don't plan on teaching is at Yellowstone National Park as that part will be vacation with my family in both of our RVs.

You may be thinking "i wish he was going to be closer so i could attend". Some folks are so intrigued that we show them how to win on 99% of their denials that they jump on planes and fly to the cities we're in. Some of those who have already paid and registered to attend this year flew to destinations last year and attended (they realized how much they learned).

If you're on our route, we would love to say howdy. This trip started a week ago when we left home in east Texas through Arkansas and Tennessee to the webinar we taught folks here in Asheville NC. On Monday we head over by Marietta GA for another 8 hour class and then on to Adrian GA for a retreat where we're both speaking and then to Savannah for an 8 hour class and then back to Macon for another 8 hour class. From there, Angie and I will head southwest to Navarra Florida to see a couple of clients before turning west to head home for a couple of weeks before heading out again to teach one in Dallas (Richardson TX) in mid May.

Yes - we will be home at the first of June as we have Royal Family Kids Camps then!

02/29/2024

MAJOR DISRUPTION IN CLAIMS

Roughly eight days back, Change Healthcare disclosed a major cyberattack causing extensive network issues. It's suspected the breach entered through Optum, affecting millions of daily claims. The resulting system outage has impacted over 1.6 million healthcare providers, pharmacies, and insurers, disrupting medical claims processing. This breach also extends to handling claims for CVS, U.S. Military Tricare, Medicare Part C, Metlife, among others, and is utilized by practice management systems like Kareo and Tebra. Reports suggest up to a third of U.S. patient records could be affected, raising concerns over the muted response from some quarters.

The International Ransomware gang, Blackcat is claiming they are responsible and claiming to have stolen 6 Terabytes of Change Healthcare data in this attack. 6 TB of data would be equivalent to 6,000 hours (250 days at 24 hours a day) of high-definition video. If they did steal this information, you may be wondering what kind of data? Since UHC, Optum and Change process claims for pharmacies and medical offices, I suspect that it could include:

o Patient medical and patient financial records, passwords and more
o Pharmacy bank information since they pay the pharmacies electronically
o Medical office bank information, since they pay clinics electronically
o Who knows what else?

So – has your own Practice Management or EMR system contacted you to tell you to change passwords or to even hold claims? Is UHC or Optum being completely 100% honest with us yet? Their daily updates since the attack began all say the same thing: “We have a high-level of confidence that Optum, UnitedHealthcare and UnitedHealth Group systems have not been affected by this issue” Are these the same people that tell you:

• That you have a timely filing deadline on commercial claims – which you do not?
• That you have to refund them money when you don’t owe it?
• That your appeal period is less than 180 days?
• That you have to send them massive amounts of records, when you do not?

And now, they want you to believe that they are being completely truthful on this breach that will probably cost them $Billions?
Folks – I don’t have the answers yet – but if I were responsible for filing insurance claims and all of my claims were going through Change Healthcare or Optum – I would be holding those claims and looking for another clearinghouse. If I saw a patient with UHC insurance right now, I’d hold the claim and not send it. Remember – if YOU have a reason to suspect that a covered entity that you deal with is not HIPAA secure, should you be releasing data to that entity – thereby putting yourself at risk with the HHS Office of Civil Rights for the kinds of penalties that the government agency can hit you with? You may need to reach out to your HIPAA Compliance officer or your Liability carrier to see what they are advising right now to protect yourself.

I’ve had people ask me whether this will be over soon. I don’t know but I strongly suspect that this is only the beginning. If they were able to breach Optum and UHC, which clearinghouse or which major insurance player is next? If the FBI was correct that Blackcat has already made more than $300 Million on their ransomware and we have no idea who is behind Blackcat, perhaps we should be investing in medical pegboard systems and paper CMS-1500 claim forms.
I will try to keep my readers updated as I get more information.

DON & ANGIE ARE HEADED YOUR WAY

Too many offices have been having carriers recoup and carriers demanding massive numbers of patient records or issuing improper or illegal denials. Far too many offices have believed the insurance companies when they denied claims for a timely filing period when the federal law says the timely filing period does not apply. To help address this, Angie and I (along with our Yorkie) are getting back onto the road again pulling our 5th wheel RV and we'll headed on a USA tour to teach in-person, full 8 hour day courses on Wrangling Denials Into Dollars along with the master of appeals, Karlene Dittrich. (Yes - these have 8 CEUs)

These are not going to be superficial seminars telling you that something can be done - these courses will tell you exactly How to stop the carriers from stealing money from YOU or your clinics or hospitals. We will be going into great detail on how to make the Medicare Part C plan pay at least the same amount that traditional Medicare allows and how that your appeal period is NEVER less than 180 days on any claim. This will be the most intense training your billing, coding or management staff has ever had on Denial management.

You do not have to let the carriers recoup and if they have - we'll show you how to make them return that money back to you. We'll go into detail on how to address it when UHC sends you a demand letter for $315,000 (which they are doing quite often now) or how to handle a commercial carrier when you get a letter from their Special Investigations Unit, plus more. We are starting in April:

▪April 12: Asheville NC▪April 16 & 17: Marietta GA▪April 23: Savanna, GA▪April 26: Macon, GA▪June 26: Boston, MA▪July 12: Tampa, FL▪July 24: Schaumburg IL▪Aug 15: San Diego, CA▪Aug ?: Salt Lake City, UT▪Oct 16: Albany, NY▪Oct ?: Cherry Hill, NJ

We may be scheduling one in Salt Lake City in August as well as other cities. In June, we are also planning on a trip up to Kansas, South Dakota, over to Yellowstone, back through Colorado, Arizona, California and Utah before heading back to Texas. If you know we are coming near you and you would like us to stop by for coffee or to teach your local group of professionals - reach out and let us know.

You can buy and watch the one hour webinar on this subject (shows you what can happen) at www.donself.com/appeals or go ahead and register for the 8 hour in-person courses we already have set up at: www.donself.com/shop

Thank you, Don Self, CPC, CMCS, CASA
Don Self & Associates
903 343-2454
www.donself.com
donself@donself.com