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How Government Killed the Medical Profession
My current project, and several that I've worked on before, lie squarely in the middle of this, and the writer is spot on, as I'm sure Doc Steve will attest. Medicare and Medicaid compensation drag physicians' income down, for which they compensate by over-coding. Some claims or practice management systems have space for up to eight ICDs (diagnoses). Others allow as many as the practice can think up. The CPTs--treatments--are paid based on an allowed amount, which is not the amount that the practice actually bills. The allowed amount in other than Medicare/Medicaid cases are usually a percentage of the Medi/Medi rates. If you're going to get paid at half rate for doing something, it makes sense to claim you did two things and get your full rate or close to it. If your practice is primarily Medicare/Medicaid you might have to claim you did four or five things to be fairly compensated for one. All of this managed by interlocking bureaucracies of HMOs, PPOs, utilization managers, case managers, risk managers, and who the hell knows what else managers, plus claims processing. The feds, in the name of economy, try to keep the compensation per CPT down, the docs have to "perform" more procedures to pay for their own increasing overhead and the overhead of the institutions. And there's always political hay to be made when anybody makes a move toward changing the system. If you just keep squeezing his neck a little harder that goose will lay a few more golden eggs. Posted by: DarthVader 2013-04-23 |
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