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View Diary: One thing ACA won't fix…Medical Billing! (15 comments)

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  •  And here's how it works elsewhere... (5+ / 0-)

    1) Go to the doctor.
    2) If there's a copay, pay the copay.
    3) Get treated.

    That's it. No bills, no EOB's.

    On the doctor's side.
    1) Treat the patient.
    2) Document the treatment
    3) Submit the billing at the end of the business day.
    4) Within a week, payment is deposited in your practice account.

    In the U.S.
    1) Look at the patient's insurance because the rules are different for every insurer, and every plan issued by the same insurer.
    3) Figure out which combination of CPT and ICD10 code is most likely to be approved
    4) Check which drugs are in the insurance company's formulary.
    5) Treat the patient according to which treatments are likely going to be reimbursed.
    6) Submit the billing.
    7) Billing is rejected
    8) Write an appeal to the insurance company
    9) Billing is rejected, but paid for a modified code that pays less.
    10) Figure out the difference between what you billed and what the insurer paid.
    11) Bill the patient for the difference (if permitted under the in network agreement you have with the insurer, else eat the difference)
    12) Try to collect from the patient.

    But the US system is so much more cost effective and efficient because, free markets.

    •  You are talking about a games playing doctor. (0+ / 0-)

      Too many are billing for inflated coding for what they did. Or billing for what they never did do.

      You whole analysis falls apart on your "treat the patient" item.

      And most of you you describe is about doctors trying to game the system

      What treatment? what tests? Those doctors with scanners associated with the practices call for those scans far more often than other doctors. Those patients with lower backache who get an MRI don't do any better than those who don't but they cost 5 X more.

      The quality range in treatment in the US is vast and the cost range is likewise vast.

      Changing to single payer won't help. Medicare is a single payer system but in the US doctors game that system too. It too has a formulary and sometimes had to meet standards for receiving some benefits. And it does send EOBs. That is in part so a patient gets information that they can report items that were billed but never occurred.

      The problem is that the US has a culture of profit. Too many people seem to think high earners are some how better and too many people strive to expand their take without regard to other people. It is greed.

      I'm asking you to believe. Not in my ability to bring about real change in Washington ... *I'm asking you to believe in yours.* Barack Obama

      by samddobermann on Sun Dec 22, 2013 at 02:01:08 AM PST

      [ Parent ]

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