tomfoolery wrote: ↑Sun Nov 15, 2020 5:30 pm
vnatale wrote: ↑Sun Nov 15, 2020 5:20 pm
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When it comes to Medicare it seems that one central way of processing information with ALL the same rules is going to be inherently more efficient than 1,000's (?) of different companies each coming up with their different methods of processing, none of them with the same economy of scale that Medicare has. Plus, on the medical provider side. They don't have to spend time negotiating with Medicare or having to learn how to process their claims as they have to do with innumerable insurance companies. IF medical providers were presented with the option of getting the same reimbursements from both Medicare and all the other insurance companies and had the choice or choosing all Medicare participants or all private insurance participants which would they chose? The one where all submissions for reimbursements are identical, e.g., same codes, same forms? Or, the one where they have to know 1,00o's (?0 of different codes and forms? How many less people would each medical provider need to process insurance claims if it was all Medicare-like (I guess I'm describing a single payer system?) compared to the present system?
Vinny
I’m not an expert on medical billing but I’m the best we have here probably and from my limited experience it’s not as onerous as you make it out to be.
Everyone uses industry standard ICD diagnosis codes and CPT billing codes. CMS creates these codes and everyone uses them. All of the EMRs are configured with the same code set and are updated annually or as needed with an import.
It’s 2020 so there’s not forms anymore, it’s all just an extract of the digital EMR system and they all generally want the same stuff.
It’s been my experience CMS wants
more documentation than private insurers and CMS has restrictions that don’t exist in private payors. For example, with CMS if you readmit a patient within 30 days for COPD, the hospital can’t bill for that readmission. CMS says you didn’t do a good enough job the first time. But the rule scope creeps and now the readmission includes bronchitis this year. So now hospitals can’t bill for a readmission for a similar but totally different lung problem. Why? No one knows, it’s what CMS said, and they make the rules and it favors CMS since it cuts money to hospitals.
What you probably didn’t know is there’s 50 different CMS’s since each state runs their own Medicaid program and CMS pays for half and the state pays for half so states make their own rules too. And they can be totally different state to state. Fun.
It’s not the bastion of efficiency politicians claim it is. Have politicians ever told the truth on anything before?
I was not at all basing my argument or assumptions on what I have ever heard from any politician. I was basing it on what my own experience and suppositions have been. You have swept away some of those suppositions.
Over a decade ago, for about five years I did all the accounting / financial reporting for a pediatrics group, including determining each month how much each doctor earned.
Since it was a pediatrics group there was zero Medicare involved. Maybe Medicaid? I'm sure MA Health.
We had two columns of income. The gross amount billed. Then the amount realized from the insurance companies. That latter was about 1/3 lower than the former.
I remember discussing with the practice's managing partner this vast discrepancy. He told he that it was all "funny" money. Meaning that the gross billings were all highly theoretical with the ultimate realized being upon what had been negotiated with each of the individual health insurance companies.
When I was referring to "forms" I was not referring to paper forms. I was referring to filling them out in whatever manner they get filled out. This particular practice, under the guidance of this particular managing partner, was way ahead of the rest of its competitors with all of its doctors using no paper but, instead, touch screen computers. We are talking early 2000's so well before the availability of iPads / tablets.
Vinny
