The Healthcare Compliance Step-By-Step Podcast · EPICompliance

#100 - The Cost of Inequity: Delayed Care and Its Financial Impact

·47 min·3 clips

HRSA designations can raise Medicaid reimbursement from $20 to $60 for the same patient.

1. The Healthcare Compliance Step-By-Step Podcast episode centers on "The Cost of Inequity: Delayed Care and Its Financial Impact." 2. Ray Walters hosts for EpiCompliance, and Jose Delgado Jr. from Tano Consultants brings 20-plus years of healthcare and consulting experience plus a mental telehealth clinic. 3. The episode asks how practices can serve underserved rural patients without losing money. 4. Jose says rural access problems start with distance, because specialties like surgery centers and dialysis machines require more resources and investment. 5. He points out that many rural towns depend on one major employer, such as a mine, a factory, or a farm. 6. He argues that the first question is whether the population needs the service, and the second is whether reimbursement makes it worth offering. 7. Jose introduces HRSA.gov as a database that can identify medically underserved areas, underrepresented locations, and areas of critical need. 8. He says the federal government tracks primary care, dental, and mental health most closely. 9. He explains that a practice in an area of critical need can sometimes submit paperwork to become a special location and receive higher reimbursement. 10. He gives Florida as an example, where a medically underserved area or population can include the outskirts of a county even when the county itself is populated. 11. Jose says a Medicaid rate of $20 can become $60, which changes the business model for a practice. 12. He describes a specialist in "flyover country" who serves three states because there are so few people and even fewer specialists of that type. 13. He says mid-levels, lower-level staff training, and telemedicine help maximize one provider across multiple locations. 14. He notes that telemedicine predates video platforms and used to be billed as phone-based care with specific codes. 15. He says current video tools such as Zoom and secure EHR platforms can handle about 85% of an in-person visit. 16. He warns that billing must stay accurate, because applying a special modifier to every location or patient can create fraud risk and legal trouble. 17. Jose and Ray discuss the style as practical, conversational, and heavily focused on examples, with audience questions and chat interaction. 18. The format mixes compliance discussion, business planning, and live Q&A, including references to HRSA, the Census Bureau, and the Bureau of Labor Statistics. 19. Healthcare administrators, rural clinic owners, and compliance staff looking for reimbursement strategies would get the most from this episode. 20. Listeners seeking abstract policy debate or non-operational theory may skip it.

Listen to the show on

Apple Podcasts Spotify

Play clips from this episode More from The Healthcare Compliance Step-By-Step Podcast