
Scott Kobner
1K posts

Scott Kobner
@skobner
Emergency Physician. I believe that great education makes great clinicians, and great clinicians take great care of patients.





I am aware that medical students use Anki frequently to help them remember medical school concepts. How much are residents/fellows using Anki to remember advanced topics in their fields?


I appreciate your medical expertise and insights! Let me share something crucial from 25 years in healthcare finance. Most physicians I've worked with haven't been exposed to the coverage side of healthcare - and that knowledge could really strengthen private practices and physician-owned hospitals. Quick breakdown on how coverage works: Yes, denials DO generate revenues. Here's why: • Carriers must spend 80-85% on patient care (except self-funded plans) • Each denied claim helps them hit these ratios and generate revenues. • PBMs aren't bound by these rules, so drug denials = revenues. Different rules for different plans: - Individual/small group: 80% to care - Large group/Medicare Advantage: 85% to care - Self-funded employer plans: Different system entirely Self-funded plans are interesting - the TPAs generate fees by processing claims, not denying them. Understanding this side of healthcare isn't just about business - it's about being better equipped to serve patients and run sustainable practices.

How to Ace your United Healthcare Interview @UHC
























