Questions and Answers

and

Other Useful Info

*As you read below, any time you see "Medicare" you should also assume Medicaid as well if you are in a Medicaid approved state.

 

ANNOUNCEMENTS

 

HERE

Acceptable Insurance Updated 11.06.2019

- Medicare Part B

     DME - Current Insurance List (updated in real-time) - bit.ly/DMEInsRealTme

     PGx  - Patient must be on two medications for two different conditions.  Max age 80.

     CGx - Patient must have had a personal history of cancer.  Max age 75.

                  

- Any Advantage Plan PPO (Except Blue Cross Blue Shield.  BCBS PPO Only in Florida)

     DME - Current Insurance List (updated in real-time) - bit.ly/DMEInsRealTme

     PGx  - Patient must be on two medications for two different conditions.   Max age 80.

     CGx - Patient must have had a personal history of cancer.  Max age 75.

                         OR

               - If patient has no personal cancer history, then you need family history of:      
                         - 3 or more cancers

- Medicaid

     PGx - Patient must be on two medications for two different conditions.  Max age 80.

     CGx - Patient must have had a personal history of cancer.  Max age 75.

                         OR

               - If patient has no personal cancer history, then you need family history of:      
                         - 3 or more cancers

     

- NO HMO's, NO MCO's

Major Cancers:

Breast

Colorectal (Colon and/or Rectal)

Ovarian/Fallopian

Pancreatic

Prostate

 

Minor Cancers:

All Others

Nonhereditary / Environmental Cancers: 

Any Skin Cancer including Melanoma and Basal Cell

Lung

Liver

Kidney

Bladder

Opposite Gender

Approved Medicaid States for PGx/CGx:

Arkansas

Colorado

Georgia

Kentucky

Missouri

Nebraska

Oklahoma

South Carolina

Texas  -  TX Medicaid Verification link:  https://secure.tmhp.com/EligibilityVerification

EXCLUDED DME States:

Utah

Montana

North Dakota

Tennessee

PPO Only DME States (No Medicare Part B):

Alabama

Connecticut

Maryland

Montana

Nevada

North Dakota

Pennsylvania

 

DME Images:   CLICK HERE

 

Recorded Q&A Calls:   CLICK HERE

Medicare 2019 Guidelines for your reference:    bit.ly/Med2019Guide

1.  Exactly what is the DNA Project and what is the best way to explain it? 

 

You need to MEMORIZE this!

     

Before anything else, the DNA Project is an awareness campaign.  Our focus is to educate the Medicare and the Medicaid community that there are benefits available from Genetic Screenings that most Medicare and Medicaid recipients may not be aware of because in many cases their primary care physician may not be aware of them either.   Or, if they are aware of the screenings, they may be paralyzed by fear because of the misinformation in the media in regards to these tests.

 

Our mission is to educate people about these tests and how they could be important to the recipient as well as their immediate family.  If there is an interest in these benefits then obviously we will facilitate the administration of the tests.

 

2.  But I heard this is a scam!

Listen to this first.  Recorded 9/27/19:    

 

Part 1:  bit.ly/FraudTalk

Part 2:  bit.ly/FraudTalk2

You need to MEMORIZE this too!

As part of our awareness campaign, it is imperative that you understand how to address this issue because this WILL come up frequently.  In our current climate with all of the misinformation in the media about DNA screening, it is critical to your success that you bring up the issue of scams and fraud before someone else brings it up by saying the following:

 

For the first time ever, we are seeing Medicare and Medicaid becoming proactive instead of reactive with the benefits DNA testing offers to our Senior population.  Paying for PREVENTION today makes a lot more sense than paying for TREATMENT tomorrow.   An important aspect of our mission at the DNA Project is to educate people so that the fear of being "scammed" does not stand in the way of receiving the benefits of this testing. 

Unfortunately, there has been fraud for as long as there has been Medicare.  This type of fraud has been around much longer than DNA testing, and it is very unfortunate that the possibility of fraud may scare a patient to the extent of missing out on a valuable benefit they may be entitled to receive. 

 

Often there are obvious signs that can help to quickly identify what may be a scam from a legitimate program like ours.  

Sign # 1 - If anyone ever asks for any form of payment for any reason, that IS a scam.  There are no co-pays ever for this testing.  Also, there is no risk of being billed in arrears for anything not covered by Medicare.  The lab accepts what Medicare pays for the testing.   There will never be any "over-billing".

Sign # 2 - If you ever hear the word "Free" in regard to DNA testing, that is a sign of either a scam or someone that has no understanding at all of what they are talking about.  THESE TESTS ARE NOT FREE!  As a matter of fact, the use of the word "Free" is STRICTLY forbidden by Medicare!  In reality, these tests are VERY expensive, but for a qualified Medicare recipient, these tests are available at NO OUT OF POCKET COST. 

Sign # 3 - If anyone ever represents that the involvement of a Medical Doctor is not required to order a DNA test then you ARE dealing with a scam!  A Medical Doctor is ABSOLUTELY REQUIRED in this process and WILL be provided by the DNA Project.  These tests can ONLY be ordered by a Medical Doctor that determines Medical Necessity as defined by Medicare. 

NOTE:  Many patients believe, and many of the publications and negative articles that are out there state that the patient's primary care physician is required to order these tests.  NOT TRUE!  A primary care physician IS required to order a DIAGNOSTIC test.  These tests are SCREENINGS and NOT Diagnostic, therefore any board-certified doctor can order these tests.

Sign # 4 - ANY offer of an incentive of any kind to submit to a DNA test is not only a sign of a scam but it is AGAINST THE LAW!  No incentives or offers of compensation of any kind are allowed!  Let me be clear...  If you say "Hey come take this test and I will buy you a Coke.", then you have broken the law!

Sign # 5 - Door to door solicitation for this testing is against the law!  If anyone ever knocks on your door uninvited to discuss this testing, it may or may not be a scam, but they are in fact breaking the law.  Beware.

Sign # 6 - Any offer to ship a DNA test kit to a patient in the mail for the patient to swab themselves and return the sample by mail should be viewed with extreme skepticism.  Unfortunately, there are several companies attempting to do this, and this practice is highly questionable to me.  How does the patient sign the Electronic Health Record that is used to create the requisition that is signed by a doctor and ultimately transmitted to the lab?  Although this practice may not directly be fraud, this is pushing the boundaries of the Medicare guidelines in my opinion.  The DNA Project does not condone this method of sample collection without a direct in-person consultation with the patient.

Sign # 7 - Any agent or representative of any legitimate organization should be willing to produce personal identification as well as provide personal contact information and the contact information of their manager.  (Andy Richards, 704.605.2000)  If a representative of any organization refuses to provide appropriate identification, especially in the current "fear-driven" climate that has been caused by the distribution of inaccurate information by the media, then you are very likely dealing with a fraud.

The nature of the type of fraud that can occur is two-fold.  First, it is usually an attempt to obtain a patient's Medicare information for the purpose of billing Medicare for products and/or services that are never provided.  Second is "identity theft" usually for the purpose of committing some form of credit fraud.  

I cannot emphasize enough the importance of building credibility and rapport with the facilities you may be visiting and the patients you are dealing with.  The facilities have their guard up because you will NOT be the first person to approach them and ask for permission to address their patients.  The patients will have their guard up because they watch the evening news and have heard about once per week not to provide their Medicare information to anyone other than a medical doctor.  This is an unfortunate reality that you must overcome, and you CAN!  Keep reading.

 

3.  How do I gain credibility and get past the gatekeeper?

First, you need to look the part by showing up in professional attire.  Many people have had the idea of wearing scrubs or a lab coat and this practice has been common in the past at fairs and trade shows.  I will admit, the idea sounded good to me as well.  Unfortunately, this practice has now been linked to companies committing fraud, and Medicare has suggested that this practice is best avoided.  

Remember the "Gatekeeper" is human too.  Find something to compliment them on and engage them in conversation if possible, listening twice as much as speaking.  Information gathered is power later on.

Second, you must bring up the issue of fraud and scams before they do.  Let them know that you are there to help them educate their people about the fraud and the scams that are taking place when it comes to Genetic Screenings and how to avoid it.  (See #2 above)

 

Third, never show up empty-handed.  I personally do not believe that business cards are necessary or as effective as having a professional Tri-Fold brochure or the full page two-sided flyer with your contact information printed on it.  Leave behind several, not just one.  (I am working on a better alternative to order and personalize these items rather than downloading them from the support site.)

Fourth, make sure you are talking to the right person!  Find out who is responsible for scheduling the calendar of events for the facility and address any follow-up emails or letters to that individual.  This person's title is likely to be "Social Director". 

 

Even better than the Social Director would be the Executive Director of the facility.  Get both names.  The Executive Director will ultimately make the final decision about anything being presented that could lead to further questions or concerns by their patients.

 

Fifth, know what you are talking about!  You WILL be asked questions about these tests and you need to have the answers.  If you are asked a question that you do not know the answer to, simply say so, and do not try to BS your way through it.  If you need the proper verbiage to answer a question, or you just do not know, call me!

One very successful Agent offers a presentation about the problems that can be caused by drug interactions.  Leading with the benefits of the PGx is almost always best.  You will never go wrong by pulling together a presentation that offers real practical value to your audience.  Make your ultimate goal of offering these screenings secondary to the mission of delivering value and education in your presentation.

 

Last, once you get on the schedule at one facility, walk into the next facility and tell them you are doing a presentation down the street at "XYZ Facility" and someone mentioned that this facility could benefit from the same presentation.  THIS IS POWERFUL!  No facility wants their competition to have something they do not have themselves.  Declare that you are the expert in this field and you would be happy to help them just like you are helping the facility down the street.

 

4.  Where are the best places to go to find potential patients?

In no particular order, Senior Centers, Assisted Living Facilities, 55 and up communities, churches, bingo halls, Moose or Elks Lodge, County or State fairs, Health Fairs, Campgrounds.  Anywhere that you may find seniors or your Medicaid population. 

 

I have a successful rep that uses WalMart parking lots!  Seriously...  Think outside the box!  

 

 

5.  Okay, I'm at WalMart, but what if a person does not look 65 years old? 

 

They may have a living mother or father!  Remember, these test results have important implications for the immediate family too.  If you are lucky enough to be in a Medicaid state, 65 is not a concern.  How easy is it to go see mom or dad if their son or daughter sent you?  Talk to anyone that will listen to you!

By far the most powerful resource you will find will be your existing clients!  These people are grateful for the time you spend with them and the service you are providing.  They are appreciative that you have made them aware of these tests.  Many will ask you if you could go see "so and so" for them.  Ask for referrals!  If you host ONE successful event you may never have to do another event if you capitalize on referrals.  Just remember you cannot pay any form of an incentive or referral fee to a test recipient.

 

6.  Who is my Manager?

IF you are on the "DNA Project" team, me.  Andy Richards 704.605.2000.  (Yes... that is here because someone asks me that every day.)

 

 

7.  How much can I "really" make with this opportunity?

That is about like asking "How long is a piece of string?".  Get something to drink and a snack 'cause this is going to be a long one!

When you read the ad for this position, what was your goal in terms of income from this?  Did you want a few hundred dollars extra per week from a great side hustle?  If that was your goal, that is okay, but you need to get a bigger vision.  Let's talk about that for a minute. 

 

How many people go to work flipping burgers or working in convenience stores for 40 hours a week in this country, busting their a$$, but don't bring home $300 a week?  How do you think those same people would feel if they knew they could probably walk out into their place of business on their 15-minute break and talk to one person and earn more from that single contact than they are bringing home in a week?  Do you think they would try to do that at least once per day?  If they successfully did that once per day, they would make a minimum of $1500 per week, working 4 hours per week instead of 40.  Now I hope that doesn't happen because everyone flipping burgers would soon quit, and I love my burgers!

News flash... That won't happen.  Not because they couldn't do it if they tried, but they simply don't know anything like this exists.  Even if you told them it does, they still wouldn't believe you.  Trust me, I've done it.  It is called "limiting beliefs".  They believe that trading their 40 hours for $300 per week is "normal", and therefore that becomes their normal.  They fail to get a bigger vision.

So what does that have to do with you?  If you are reading these words right now, then you have a very real opportunity to earn $30,000 PER MONTH or more here!  Does that sound like a lot of money to you?  If it does, then you need to get a bigger vision!  Not only am I going to PROVE to you that is possible, but it is EASILY possible!

UPDATE - In July 2019 one rep made $66,000 in three days at a single event.

 

8.  $30,000 per month?

Let's break it down.  If you hold just ONE event per month at an assisted living facility that has 400 residents, half of those come to your event (not uncommon), and you end up with 100 sign-ups.  Congratulations, because you just earned $30,000 for the month!

Seem unbelievable?  Okay, so you don't like that math.  What if you really worked hard (not) and held two events and generated 50 leads at each of them.  Congratulations, you just did 30k again!

That doesn't work for you either?  Okay so you schedule one event each week, and only generate 25 leads per week.  There is your 30k!

Now someone is saying "But Andy I don't have the time or energy to go see 25 people per week.".  Speaking for myself only here, $30,000 per month is over $300,000 per year, IF I "only" take two months of vacation... I will personally find the time and the energy for that!

But okay, you still want to argue that you can't do it.  Fine.  So DON'T do it! 

 

How many people do you know that would like to make $1250 per week working 4 to 5 hours a day?  Hire that person, get them HIPAA certified, and pay them $50 per appointment to go spend 30 minutes creating a portal entry and collecting a DNA sample for you! 

 

Those 25 appointments are going to generate close to $8750 for you, less the $1250 you paid to your runner.  You cleared $7500 for the week DOING NOTHING but generating the leads!  Guess what... That is $30,000 per month - again.

BUT...  What about the referrals from those appointments?  We didn't even count that!  Wouldn't that be a good way for your runner to earn a bonus for generating a new lead?  Now let's think about this...  What if you had TWO people doing this for you each month???  I'll leave it to your imagination from here. 

 

Are you getting a bigger vision yet?

 

9.  Okay, that sounds great, but how do you know that "I" can do that?

So you are still having a little self-doubt still.  Let me fix that for you.  Strap in for the ride again!

Do you remember that L-O-N-G ad that you saw and replied to for this position?  In case you don't and would like to remind yourself what it looked like, you can see it again right here:

https://www.dnaprojectsupport.com/the-ad

Over 100,000 people per week see that same ad.  Less than .5% of those people actually reply to it.  That is about 500 people per week.  Out of that 500, a third of them will make it through the process to get where YOU are right now!  That is only 150 people out of more than 100,000!  Out of that 150, about 50 will actually do something with this.  The question is will you make that final cut and place a swab order and actually get started?  If you made it this far I am betting that you will.

Here is what you don't know...  That L-O-N-G ad and the several steps that followed it were VERY strategically designed to eliminate as many people as possible from ever making it this far!  But YOU did! 

 

Think about it...  You had to dig through that ad to find the link buried deep in it to apply.  After you submitted that form you were sent a long list of steps.  You had to go fill out another form to get a contract. 

 

Next, you actually had to dig into your pocket and make a $15 investment in yourself to complete the one hour HIPAA class (fun, wasn't it?).  Do you have any idea how many people actually ask me if they are going to get that money back?  I simply tell them "no" and then I suggest that this may not be a good fit for them.  (Anyone that would let $15 stop them from having a legitimate shot at earning 30K per month needs to flip burgers, and may God bless them.)

After your HIPAA you had to show up to our live online training.  We had some complicated instruction there, right?  We specifically told you that you must log in with your first name, last name, and email address.  Right beside that was a big red note that said any "Anonymous" logins would be rejected.  But at least one person logs in as "anonymous" in EVERY class.  We boot them out, and then I get a call saying "Andy I got disconnected and I can't get back in".  

Then you had to create your username and password to the Portal.  Now if I were a nice guy I would have simply done that for you and sent you your username and password.  My life would be much easier that way honestly.  Remember that special little part in those instructions that you must place "@momentum" behind your username when you log in? 

 

I get 5 emails per day minimum, and the conversation always goes like this:  "Andy this is Bob, I created my username and password and I can't log into the portal."  Hi Bob, how long ago did you do this?  "Twenty minutes ago".  Okay, did you read the part that says it takes 24 hours to be activated?  "Oh".

Next day.  "Andy It's Bob again, it has been a whole day and my login is still not working."  Okay, what username are you using to log in with?  "Bob".  Okay, Bob, did you see that part that told you that you have to put "@momentum" behind your username?  So go try "bob@momentum" and tell me if that works.  "Okay, I will".  Ten minutes later.   "Andy, I tried what you said and it still does not work".  Okay, send me exactly what you are trying to use to log in with, please.  "Bob@momentum.com".  Okay, Bob, go back and look again, I said to use "Bob@momentum", there is no ".com" on the end.  Ten minutes later "Oh okay that worked!".

Now that is a TRUE, DAILY, Story.  So what is wrong with that picture?  Go back and look at the ad again.  Do you see that part where it says "YOU MUST BE ABLE TO FOLLOW SIMPLE WRITTEN INSTRUCTIONS."? 

 

Now you actually have an insight into why everything here is structured exactly the way that it is.  People ELIMINATE themselves in the process of trying to do this!  Are you eliminated, or are you still here?  You went through A LOT to get this far, and you are still here!  

At this point, whether you realize it or not, you have literally been through a process that makes you hand-picked for this project!  You should feel like a dolphin right now because I have made you jump through a bunch of hoops to get here - and you made it!  You have proven that you have what it takes, so now I am willing to work with you to make certain that you are successful.  

Let go of your limiting thoughts.  Get a bigger vision and let's go make it happen!

 

10.  What are the currently accepted Medicaid States?

Georgia (GA)

Kentucky (KY)

Arkansas (AR)

Colorado (CO)

Missouri (MO)

South Carolina (SC)

Nebraska (NE)

Oklahoma (OK)

Texas (TX)

*Currently, only TX has a Medicaid Verification link:  https://secure.tmhp.com/EligibilityVerification 

 

11.  Is training every week and why do you say I need to attend training at least three times?

Yes, the training is actually recorded and the Q&A schedule is available every week and is Eastern Standard Time.  The training is VISUAL!  You cannot log-in with audio-only.  I recommend you attend the training at least three times because every I have new agents fresh out of the training who call me and ask questions about things that were directly covered in the training they just attended.  I do not have time to re-train these reps.  

 

You may attend training as often as you wish.  I have personally attended the class over five times and each time I pick up on something that did not know.  As things change and you have questions, please go attend the training class again.

https://www.dnaprojectsupport.com/training

 

12.  I placed a Swab Kit order, what should I expect?

Expect delivery of your swab order between 5 and 7 business days from the date you placed your order.

 

Unfortunately, this is not a perfect process.  The lab has been in a backorder position in the past when they ran out of swabs and orders got delayed.  Recently the lab ran low on kits and sent out partial orders. 

The minimum order is 10 kits.  Remember you can order Swab Kits each week as you need them.  If you place an order for more than 25 kits, you need to provide a reason why you are requesting so many kits.  Once the lab sees that you are actually using the kits and they are being returned by you into the program they will question your orders less and less.  For now, we have a hard limit being imposed by the lab of 50 kits at a time.

 

13.  I created my username and password to the portal but it is not working.  What is wrong?

 

Contact me by email at Andy@DNAproject.net

 

 

14.  Exactly how does the payment schedule work?

Anything that you ship to the lab that is received, CHECKED IN, and APPROVED by the lab BEFORE the 15th of the month will pay you the following 5th.  Anything the lab receives and approves before the 30th will pay you the following 20th.  You will be paid on, or slightly before, the 5th and the 20th.  You will know that your file is going to pay out when you see the status change to "Received - Complete" and you see "Approved" with a payout date in your status log.  

*Please understand that we cannot, and will not, be held responsible for ANYTHING that may cause your file to roll over to the next pay period and there will be no exceptions.  There are way too many variables that can affect the time each step in this process takes and we cannot control any of them.  Once you have a steady flow of patients into the system and your cash-flow starts, it really should not make any difference if you have a file that misses the cut-off.  There is no perfect way to do this and it is going to happen.

________________________________________________________________________________________________

 

Private Survey Results

10.11.19

The results below are from a privately sanctioned survey conducted for the DNA Project.  The survey occurred on 9.28.19 in St. Petersburg Florida.  Patients in our target demographic age rang were randomly approached and asked if they were willing to participate in a non-political 6 question survey.  A significant number of prospective patients were surveyed to believe that the results are a fair and accurate representation of the general sentiments of our target demographic.

MEDICAL DNA TEST SURVEY

1)  Have you heard of the "Direct to Consumer" DNA tests by Ancestory.com, 23&me, or others?

YES           = 90%

NO           =  6%

UNSURE  =  4%

2)  If YES, have you ever considered one of these tests?

YES          = 44%

NO          = 47%

MAYBE   =  9%

3)  Have you heard of certain Genetic Tests that can determine the possible negative drug interactions (PGx) or markers that may indicate increased odds of the possibility of developing certain cancers?

YES           = 47%

NO           = 40%

UNSURE  = 13%

4)  Have you heard of the recent arrests of the 35 individuals nationwide alleged to be involved in Medicare Fraud RE: Genetic Testing?

YES           = 3%

NO           = 97%

5)  If it was determined by a licensed board-certified medical doctor that you were qualified by the medical necessity standards as outlined by The Center of Medicare and Medicaid Services (CMS), would you consider being tested for possible negative drug interactions and/or susceptibility to certain cancers?

YES           = 40%

NO           = 43%

UNSURE  = 17%

*Notice there was no mention of "No out of pocket costs" in this question!  How many of the people that said "no" or "unsure" would have said "yes" if they had known there was no cost?  Cost is usually the main consideration.  This is a significant observation.

6)  Would you consider it important to learn how to prevent Medicare fraud?

YES           = 84%

NO           =  6%

MAYBE    = 10%

CONCLUSIONS BY QUESTION #:  

*I highlighted the results that I feel were the most significant in green

1)  Our audience is VERY aware of DNA testing in general.  We should have NO fears or concerns about sharing what we have to offer with these people.

2)  53% of our audience would consider DNA testing in general.  This indicates there are no particular concerns or fear of DNA testing.  We should have NO fears or concerns about sharing what we have to offer with these people.

3)  53% of our audience has never even heard of the Genetic Screenings we offer.  We should have NO fears or concerns about sharing what we have to offer with these people.

4)  97% of our audience has never heard of the negativity in the news or in print about the screenings that we offer.  We should have NO fears or concerns about sharing what we have to offer with these people.

5)  57% of our audience WOULD consider these tests!  But the likelihood is that MANY more than that would consider it if they had known there was no out of pocket costs.  We should have NO fears or concerns about sharing what we have to offer with these people.

6)  94% of our audience would like to be educated on how to prevent Medicare fraud.  If we position ourselves as educators first, and an authority on fraud when it comes to Genetic Screenings, there should be no doors that we cannot open if we take the appropriate approach.

FINAL CONCLUSION:  Because we work in this field, obviously any news good or bad tends to make it's way back to us.  When the news is "bad", we tend to react as if everyone out there saw this news when in fact they are not seeing any news at all!  The message these people will hear will be the message that you deliver.  Position yourself as an expert in this area and express that your desire is to educate and prevent fraud.  We should have NO fears or concerns about sharing what we have to offer with these people.  Let's do it!

________________________________________________________________________________________________

Educational Outline

*This area is being used to temporarily host an outline of topics

that are under development for our future training website.

 

Module 1

WHY MOST PEOPLE FAIL TO SUCCEED IN NEW ENDEAVORS

 

There are three stages of learning.

 

1.  I hear what you are saying.

At the time, the presentation makes sense. Later, a day, a week, month or worse, in front of a patient or prospect, one goes blank.

 

The solution is twofold, first, learn with a pen and paper in hand.  Write down important sections and questions for later review.

Have you ever heard a word that you were going to look up and then forgot the word?  Write it down.

 

Also, repetition. Go over the material more than once. Often the second or third time makes more sense.

 

2.  Being able to "do".

This is accomplished by PRACTICE and REPETITION.

Repeat your presentation out loud or to someone that you are comfortable with.  Don't practice in the field.

 

 

3.  Being able to "teach".

This is the final level of mastery.  Simply, can you explain what you do or know in a few sentences and make sense to someone else to whom the concept is new?

How?  Go through steps one and two as instructed.  I know you can do it if you put in the effort.

 

 

Okay, So Let's Play!!!

 

Medicare will pay for certain genetic tests.  See the link below.  Please read the entire, short article.

 

You will find that Medicare only covers very specific, limited tests.  This article, however, shows that Medicare is coming around to the future of medicine.

 

The next link will answer questions that you may have (Written down.)

 

With Medicare Support, Genetic Cancer Testing goes Mainstream.

https://www.wired.com/story/with-medicare-support-genetic-cancer-testing-goes-mainstream/

 

Module 2

SO, WHAT DOES MEDICARE COVER?

We work with Medicare Part B.  What's that?

 

Let's look at the relevant Medicare site itself for the answers so as to avoid confusion or question.

 

What does Medicare Part B cover?

https://www.medicare.gov/what-medicare-covers/what-part-b-covers

 

As you see, Part B, an addition to basic Medicare coverage, covers:

- MEDICALLY NECESSARY SERVICES 

- PREVENTATIVE SERVICES.

 

OK. How do we know what services we provide are covered?

Here is a beautiful 20-page document from UnitedHealthcare describing what constitutes Medical Necessity, dated July 1, 2019.  Don't worry you only have to review the first 3 pages to get the drift.  The application of those rules is done through our intake portal and is covered in that separate training.  All automatic-with prompts, easy.

 

From UnitedHealthcare-Short version, Medical Necessity:

https://www.uhcprovider.com/content/dam/provider/docs/public/policies/medadv-coverage-sum/genetic-testing.pdf

 

UnitedHealthcare Genetic Testing for Hereditary Cancer:

https://www.uhcprovider.com/content/dam/provider/docs/public/policies/index/sv-mmg/genetic-testing-hboc-sv-10012019.pdf

 

So, can we work with ANYONE who has Medicare Part B?

Not so fast.  There are two types of Medicare Part B coverage:

- PPO (Preferred Provider Organizaton)

- HMO (Health Maintenance Organization)

We can only work with PPOs NOT HMOs.

Remember, ( write this down)

PPO = GO! HMO = NO!!!

It also helps me to remember that "PPO" has "Prefered" in its name.

 

What's the difference?

- PPO -   https://en.wikipedia.org/wiki/Preferred_provider_organization

- HMO - https://en.wikipedia.org/wiki/Health_maintenance_organization

 

ONLY PPO's NO HMO's. Got it? Good!

 

Module 3

WELL, WHAT IS THIS GENETIC STUFF ALL ABOUT?

 

While this won't make you a professor of Genetics the next few videos, it should give you an idea of what we're talking about.

 

What is DNA?

DNA, Genes and Genomes

https://www.youtube.com/watch?v=ictAm2wSwtY

 

What is Genetic testing?

https://www.youtube.com/watch?v=D_RChuIqMRQ

 

What is Genetic Sequencing?  (From the Mayo Clinic.)

https://www.youtube.com/watch?v=2JUu1WqidC4&list=WL&index=152&t=0s

 

So then what?

This is most important because we may help save lives! Really!

The role of Genetic Counselors.

What is Genetic Counseling? Jaklyn Haden Ted Helena

https://www.youtube.com/watch?v=7yIW0L9dLCQ&list=WL&index=34&t=0s

 

Next, we will review some videos regarding

- PGx (Pharmacogenetics) Drug sensitivity.

- CGx (Cancer Genetic Screening)

 

Module 4

WHAT IS PGx?

"Pharmacogenetics"

Why is it important?

 

First, let's look at how your body processes medicine.

How your body processes medicine by Celine Valery

https://www.youtube.com/watch?v=uOcpsXMJcJk&t=8s

 

Just what is Pharmacogenetics?

Pharmacogenetics: right drug, for the right patient, at the right dose.

(By The Mayo Clinic)

https://www.youtube.com/watch?v=WSf6vyP11aQ

 

Finally, a GREAT video by The Mayo Clinic.

Lots of relevant information and case for our patients carrying

a "MEDICAL ALERT CARD." 

*See your Team Lead or contact Terry Williams at info@willentco.com.

 

Pharmacogenetics Testing: Mayo Clinic Radio

https://www.youtube.com/watch?v=3gQS2ZePu1A&t=13s

 

Next-Genetic Cancer Screening

 

Module 5

 

WHAT IS CGx?

"Genetic Cancer Screening"

Very, very good introduction video:

Intro to Hereditary Cancer

https://www.youtube.com/watch?v=F-VBzoRzCrw

 

You should probably have the overview of genetic testing by now

so here's the best CGx video so far.  Well done by the Mayo Clinic it gives you some wonderful information.

 

Again, qualifying your patients for this screening is covered in your portal under "Training".

 

Here we go--

 

Hereditary Cancers and Genetic Testing: Mayo Clinic Radio:

https://www.youtube.com/watch?v=HHlttufky5E

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