Text 28701, 100 rader
Skriven 2009-03-06 06:23:44 av Bob Ackley (1:300/3)
  Kommentar till text 28568 av Roy Witt (1:397/22)
Ärende: (1/2) Health Insurance
==============================
Replying to a message of Roy Witt to Bob Ackley:

 RW> 04 Mar 09 06:29, Bob Ackley wrote to Robert Bashe:

 RB>>> Sorry, Bob, but you'll have to explain that to me, since I can't see
 RB>>> much US government involvement in the health care system at all
 RB>>> (except naturally for Medicare).

 BA>> That's most of the problem.  Just about sixty percent of the
 BA>> inpatients in any general hospital are Medicare patients, and today

 RW> Not true.

It certainly is, Roy.

 BA>> most general hospitals are operating at less than half capacity.  The
 BA>> popular conception is that Medicare pays for health care for the
 BA>> elderly population; it doesn't and hever has.

 RW> Also not true. My father always bragged about the 4 months he spent in
 RW> intensive care at 74yo and it didn't cost him a dime.

Which is fine and dandy for your father.  My father too, FTM.  The fact that
they didn't get billed doesn't mean that the provider got paid.

 BA>> What Medicare does is (1) sit on bills for at least 90 days before
 BA>> taking any action,

 RW> Wrong again. There can be no action upon bills while they're not
 RW> submitted to the system. Many health care providers take up to a
 RW> month to file them.

Medicare does or did sit on the *received* bills for 90 days or longer before
taking action.

 BA>> (2) disallow as many charges on the bills as it thinks it can get
 BA>> away with and

 RW> The Medicare Guidelines printed for the enlightenment of the people
 RW> using the system should be well aware of the charges allowed by that
 RW> system. What are rejected are charges for items not covered.

Which is whatever Medicare says is not covered at the moment.  

 BA>> (3) writes itself a discount of up to 50% on the remaining
 BA>> balance - and providers are forbidden by law from billing the patient
 BA>> for the unpaid amount of the bill.

 RW> This is also true of your everyday health care insurance companies. My
 RW> 2003 surgery and 5 day stay in intensive care was billed to my
 RW> insurance company for $22,500...the insurance company gave themselves
 RW> a very nice discount and paid the hospital and doctor/surgeon a grand
 RW> total of $5400...

I don't deny that, and I have a problem with that too.  FWIW I used to study 
this stuff, I have a bachelor's degree in hospital administration and completed
everything in a master's degree program in the field except the thesis.

 BA>> The military's 'Tricare' system ("Medicare for the Military" as I
 BA>> call it) works exactly the same way.  In 2004 I was hospitalized for
 BA>> 3 days in a coronary care unit, and had an angioplasty and stent
 BA>> insertion.  The total bill was just shy of $50,000.  Tricare sent
 BA>> the hospital a check for something under $10,000 as payment in full.
 BA>> That $40,000+ in unpaid charges went someplace - into other people's
 BA>> bills, just like retail merchants include the cost of shoplifting
 BA>> and 'inventory shrinkage' (employee theft) into the prices of the
 BA>> goods they sell.

 RW> It goes into the bills of those without healthcare coverage. Although,
 RW> the costs are reduced by negotiations between Tricare and your
 RW> healthcare provider.

 BA>> An enormous amount of money is spent by health care providers in
 BA>> compliance with various government (federal and state, mostly)
 BA>> diktats, and on filing multiple weekly/monthly/quarterly/annual
 BA>> reports with various government agencies.  In addition, the invention
 BA>> of 'diagnostic related groups' (DRGs) 25 or so years ago has
 BA>> resulted in a subset of the Medical Records profession (you can
 BA>> actually get a bachelor's degree in it) that's dedicated to insuring
 BA>> that the various diagnoses are correctly coded so that the provider
 BA>> receives the maximum payment for the problem (under the system, a
 BA>> single particular problem can be correctly coded with multiple DRG
 BA>> codes, all of which have differing reimbursement rates and only one
 BA>> of which can be used).

 RW> Those codes are what they call in the business 'shorthand'...That
 RW> makes it easy to look up in their journals under medical conditions
 RW> and symptoms. See: 497.1 and 21.2 - etc...which is a whole lot
 RW> shorter to write than the actual definition. By using the shorthand
 RW> and penning a note of symptoms to look for can take a lot of work out
 RW> of it.

 BA>> Just over a decade ago when I parted company with the
 BA>> hospital I had been working in, the hospital had six full time
 BA>> employees checking and correcting DRG coding in medical and billing
 BA>> records - none of whom had anything to do with either the quantity
 BA>> or quality of care being provided to the patients.

--- FleetStreet 1.19+
 * Origin: Bob's Boneyard, Emerson, Iowa (1:300/3)