Navigating the Medicare Maze: Billing Strategies for Functional Medicine Practitioners

In the ever-evolving landscape of healthcare regulations and reimbursement, functional medicine practitioners face unique challenges when interfacing with traditional insurance systems. This week on the Functional Lawyer podcast, I'm joined by healthcare consultant Sonda Kunzi, whose extensive expertise in medical coding, compliance, and reimbursement offers invaluable insights for our community.

Episode 202 dives deep into the complexities of Medicare billing, insurance compliance, and the strategic considerations for practices contemplating cash-based or hybrid models. If you've ever found yourself confused by the labyrinth of local coverage determinations, telehealth regulations, or the implications of opting out of Medicare, this conversation provides the clarity you've been seeking.

Sonda unpacks several critical distinctions that can make or break your practice's financial sustainability:

• The often misunderstood differences between "preventive" and "wellness" care (and why this matters for reimbursement)

• How COVID-era telehealth waivers are evolving and what this means for your practice

• Strategic approaches to membership models that enhance patient care while maintaining compliance

• Common billing errors that create compliance risks for functional medicine practitioners

What makes this episode particularly valuable is Sonda's practical approach to integrating functional medicine principles within insurance-based practices, while also outlining clear pathways for those considering the transition to cash-based models.

With the looming changes to telehealth coverage as pandemic-era waivers expire, her insights on geographic restrictions and potential regulatory shifts are especially timely. Whether you're an established practice or just starting out, understanding these nuances can save you significant time, money, and compliance headaches.

The conversation concludes with actionable strategies for patient education around billing practices – a crucial component of practice management that is often overlooked but can dramatically improve patient satisfaction and retention.

Join us for this information-packed discussion that bridges the gap between legal compliance and functional medicine practice management. 

Or listen on the go at

• Apple Podcasts: The Junto w/ Scott Rattigan, J.D.

• Spotify: The Junto w/ Scott Rattigan, J.D.

• Amazon Music: The Junto w/ Scott Rattigan, J.D.

Until next time,
Scott Rattigan, JD