Tuesday, June 30, 2009

Introduction to Medical Billing

Medical Economics
06/30/09 - M.D.O.D by ERDoc85

Read the whole thing. The quote only gives a map and a feeling about the post. Will the best, most caring people continue to choose medicine under these conditions?

[edited] You may want to know how the government determines what to pay physicians. Government involvement is already a major problem in medicine!

As you read through the following (it might be hazardous to your health), consider the vast bureaucracy of people necessary to determine, process, audit, and bill all of this stuff. You will understand why there are so many clipboard carrying, useless flesh-bags in hospitals today.

RVU is Relative Value Unit
RVUwork        = Actual Physician Work
RVUexpense     = Practice Expenses
RVUliability   = Liability Insurance
RVUtotal = RVUwork + RVUexpense + RVUliability

GPCI = Geographic Practice Cost Index
       1.0 to 1.5 according to geographic area

CF = Medicare Conversion Factor
     $36.067 (for 2009) per RVUtotal
BF = Billing factor by treatment level 1-5
     or Critical (according to medical records)
Medicare Payment = RVUtotal × GPCI × CF × BF

You thought your medical record was only for keeping your medical history, but it also serves for legal defense and billing.

It is a source of medico-legal protection for the health care staff. Your record is replete with exactly what you said, including symptoms you denied having and warnings you were given. Anything you refused or argued about will be in great detail. This isn't for your benefit. It's to protect us from the vultures.

And, it has become your billing template! In order to bill you at any of the 6 billing levels, it must be documented that you were asked certain numbers of questions and examined in a specific number of areas.

( The complicated part is omitted here to protect the sanity of vulnerable readers. You have been warned. Smile. )

Legions of people known as "Medical Coders" sit down with every chart, count these items, and bill accordingly! All of these people make a good living, and their salaries are built into your medical care costs. It is government regulations that cause these people to exist.

Will it be simple to reform the health care system? The government has simplified it so far. No doubt (smile) more government involvement will simplify it further, supposedly lowering expenses without cutting services.

Now you know why your doc has his/her face buried in a chart instead of making eye contact with you. And why your doc spends 5 minutes with you, then excuses himself to sit outside for 15 minutes with the chart.

The Department of Work and Production

The average guy hasn't seen government control close up, except for those in banking and auto manufacturing. Why can't knowledgeable, fact-based, systematic government oversight bring community and efficiency to everyone? (smile)

A possible encounter of an ordinary guy with a government agency that is going to make his profession more efficient, by saving or increasing his salary.

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