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View Diary: Netroots Nation: Let's Write a Platform! (UPDATED) (47 comments)

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  •  Medical billing (0+ / 0-)

    All new medical billing of natural persons should be based on Medicare amount multiples.

    In emergency and ER care appropriate cases, the person should only be charged the Medicare amount, even if the provider doesn't take Medicare.

    In other cases [where shopping is practical], providers should have to bill not exceeding a provider selected and posted DRG multiple of the Medicare DRG amount not exceeding two and other services and products provided based on a provider selected and posted non-DRG multiple not exceeding three of the Medicare non-DRG amount.

    Independent providers working in the facilities of hospitals should be limited to a multiple of two unless they contract with the patient separately at least twenty-four hours in advance and the contract clearly lists the applicable multiple.

    Each provider should have to post the two multiples on each outside door of their business premises and provide them on telephone request if they have a business phone line and on their website, if any.

    The multiples should only be changed on IRS estimated tax due dates and by no more than ten percent a quarter.

    Unpaid bills after 30 days would be subject to interest at the IRS rate[or less if contracted for or limited by state law].

    Examples:
    If a hospital gets $12,000 from Medicare [exclusive of disproportionate share used to pay for the indigent] for an operation, then if the hospital posts a DRG multiple of 1.5, the maximum allowed charge to a person like me would be $18,000.

    If the anesthesiologist posts a multiple of 2 and Medicare would pay her $325, then she could bill me $650.

    If the surgeon posts a multiple of 1.7 and Medicare would pay him $800, then he could charge me $1,360.

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