Quote:To put it simply, his terminology is wrong, his understanding of how, why and what he's paid is wrong, and his explaination of coding is wrong. If I were teaching you math and said something like "the sum of 4 minus 2 is 8" would you put a lot of stock in my conclusions about Calculus? But hey, he's an Internist with a website and HuffPo cred so he must know what he's talking about, right? The only part he got right was admitting that he doesn't really understand all that stuff he wrote about there.


And I'm not asserting that climate is the reason, that's gross oversimplification. The whole deal with wrong_box about what we eat just one part of what causes our problems.


But what Dr. Belk writes sure sounds good to those of the lefty political persuasian.

Agreed, Medicare takes a dump on you for EITHER over or undercoding. If something is justifiable then you do it. Unless you want to get fined, or sued.

 

Quote:To be fair Biff let me expand on a few thing on the website:

 

This is from the Billing page, the part that most people are likely to see since it applies to your regular doctor visits.

 

http://truecostofhealthcare.net/outpatient_charges/

 

"Do you know how much your doctor gets paid to see you? You probably don’t but, what if I told you most doctors don’t know how much they’re paid to see a patient either?"

 

As the agent of a physician, yes, I do. Why? Because I read the contract. Our friend is basically saying, "I entered into a contractual agreement with a corporation without fulling reading or understanding it." Furthermore, many of the physicians I work with also understand their contracts and act within those confines. It's not rocket science, it's understanding the business you're in.



 

As a patient serviced by an insurance contract I, frankly, have no right to that information because my financial responsibility is spelled out in my contract with the payer not my physician. The reimbursement for a service is between the physician and the insurance company, the patient's financial responsibility is between the patient and the insurance company. As he says, most EOBs give the information, but you have no more use for that information that you would knowing how much Wal-Mart pays General Mills for the cereal you bought yesterday. Contractually the insurance is obligated to the provider to pay a contracted amount for a service, the patient is contractually obligated to pay a fixed out of pocket amount for a service (whether a percentage, a co-payment, or other amount). This is even more pertinent if you are on employer-based coverage because the three parties involved there (doctor, insurance, premium payer) don't really include the patient at all.



 

"1. Different insurance companies will pay doctors a different amount for the same billing code." This is correct, but no different than any other large scale or bulk purchase done on contract. 


 

2. The same insurance company will also pay a doctor a different amount for the same billing code depending on the type of policy a patient has. In many cases this is true, that's because the physician chose to participate with different contracts the insurance company sells. You as a physician can choose not be participate in the HMO or the PPO or the EPO or the Capitated plan or the Medicare replacement.


 

<p style="color:rgb(39,39,39);font-family:'Open Sans', sans-serif;font-size:15px;">3. There is almost no way to find out how much an insurance company might pay for an office visit in advance. Bull [BAD WORD REMOVED].There's this neat little section in the contract called a "fee schedule" that quite clearly lays out the methodology and allowed amounts for any listed service and a methodology for paying unlisted services like new services that emerge after the contract is signed. If you've gone to the dentist recently you as the patient know exactly how much you have to pay out of pocket and how much the dentist will be paid before you agree to sit in the chair. Medical practices are learning to do the same thing.


<p style="color:rgb(39,39,39);font-family:'Open Sans', sans-serif;font-size:15px;"> 

<p style="color:rgb(39,39,39);font-family:'Open Sans', sans-serif;font-size:15px;">4. It’s not always easy to figure out how much insurance companies have paid us in the past for office visits. Yes it is, the movement to electronic payments through EFT and ERA have made it relatively simple to trend payer behaviors over time. You can use something a simple as Excel or Access to something complex like Crystal, SSRS or any number of commercial products now available to retrieve, analyze, trend and most importantly, dispute the payment activity.


<p style="color:rgb(39,39,39);font-family:'Open Sans', sans-serif;font-size:15px;"> 


5. Different insurance companies will approve and disapprove of different services, so it’s difficult to know in advance what we’ll be paid for. G
ood practice managers provide payer guides for specific contracted services
(ie can we do xray here or do you have to go to an approved facility?, can we draw labs here or do you send the patient to Labcorp because United Health requires it?), and every payer has an appeals process if the service is denied for medical necessity. Again, this is all spelled out in his insurance contract, something with which he, a purported "expert", seems to have almost no familiarity.


 

<p style="color:rgb(39,39,39);font-family:'Open Sans', sans-serif;font-size:15px;">6. The same insurance company might have several different methods of payment depending on the patient’s type of policy. Yes, because, again, they sell different kinds of contracts.


 

Much of the rest of that page contains the same types of misunderstandings. He puts the worst possible spin on every line he writes, and much of it just isn't correct.

Thats the real trick. Finding good staff. Man it seems like half the office staffs out there don't have a clue, when I had a PPO it was a nightmare calling insurance trying to figure out if so and so is in network and what I was actually going to pay. And even after they told me, it was still wrong. Someday, when I have an office staff at my command (which may be never), I will ride them hard about how they interact with patients and insurance. They better pick up the phone, and have a clue. Nothing makes me more annoyed than calling a 'gatekeeper' who wastes my time AND knows nothing.

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