For the past 17 years, my mom has worked as a medical biller. She started with an eye doctor, but now works for a family doctor. She is a living, breathing, day-to-day witness to the insanity of our health care system.
She’s always telling me absurdities about insurance billing practices and the archaic systems that surround them, and it just cracks me up sometimes. Only a few years ago, Medicare went to electronic billing. Before that, everything was submitted as a paper claim and a paper check.
One little known fact about our health care system is related to how Medicare pays doctors. Each year, the Medicare payment tables are approved by Congress. These payment tables determine the amount that Medicare will pay for each service a doctor might perform on a patient. All of the insurers look to Medicare as a standard on how much a medical service might be worth. Some insurers will pay more for a service than Medicare, so the Doctor’s job (the Medical biller’s job) is to charge as much as they can reasonably expect to collect from the BEST insurer for any particular service. This is what contributes the most to the explosion of the bottom line of medical bills.
But I digress. One little publicized fact is that Congress has delayed approving and publishing the Medicare payment tables for 2010 when they came due in March. They called a moratorium during the health care debate, and approved doctors to continue to use the 2009 tables through June. In June, when congress still hadn’t acted, they stopped making payments.
What was Congress waiting for?
Turns out, for the last several years, Congress had been kicking a can down the road. Medicare was supposed to be decreasing the payout for each service by a certain percentage every year, to help drive down health care costs. However, Congress just kept approving the Medicare payment tables each year without decreasing the payment amounts. Now there is a HUGE discrepancy (15 – 20%) of where payment rates are vs where they should be.
Congress failed to act in time, so the department of health and human services released new tables which now pay dramatically less for each service. Meanwhile, doctors have not lowered their fees due to the “good” insurances still paying higher amounts.
Bottom line? Doctors will colllect much less this year from Medicare than they did last year, while still billing record amounts.
Why is this not covered in the media? I dont’ know.
Meanwhile, I stumbled across this hilarious Podcast on NPR Planet Money which describes my mom’s job to a T.
Enjoy!
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