Mom’s Job

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.


[audio:|titles=Planet Money_ The Pain-In-The-Butt Index]

3 thoughts on “Mom’s Job”

  1. What happens when people start getting reimbursed less for a service? They stop providing that service. If Medicare decreases payment fewer doctors will accept medicare patients. You may have insurance but you will not be able to find a doctor who accepts it. That is what is happening in Massachussets. Everyone has coverage but no one can get into a doctor. Doctors there are now becoming selective as to who they will see. Better insurance (non-Medicare) better access.

  2. No wonder we can’t understand the health care system!! Your mom has to be extraordinary to do her job. May God bless her!

  3. On the other hand, primary care physicians would go out of business if they charged only the medicare amounts. Primary care clinics currently slot only a few appointments a day for medicare patients because they lose money on them. That’s why it takes so long for such patients to get an appointment. Sure, there are efficiencies that could be implemented, but they wouldn’t make up for the difference. On top of that, PCPs currently have only 10-15 minutes per patient in order to see enough patients to cover costs, and they’re busy all day every day (my wife is a PCP). Obama-care will shovel more people into the medicare camp without providing any incentive for med students to enter primary care field. Where will these newly-insured people go? More and more PCPs are considering cash-only services. I bet they’d be cheaper than you think.

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