Posted on 04/17/2021 7:22:12 AM PDT by Lordjazz
I am aware of what all the ins and outs of medical billing. All of you are getting only part of this story. I will explain this once and once only to set the records straight.
1. The idiot who thinks he know everything stated that a CoVID diagnosis pays the physician $13,000 and $39,000 if they die. He will not retract it. He deserves to be ridiculed until he admits he is wrong
2. The DRG for CoVID is U07.1. / U07.2. These set the PAYMENT for COVID
3. The PAYMENT for CoVID is the BASE FACTOR x the CONVERSION FACTOR, which varies regionally in the Medicare System
4. The DRG is what pays the hospital
5. WHAT IS PAYING more is the fact that EVEN IF A PATIENT IS UNINSURED, The HOSPITAL will receive Medicare rates for the DRG. In other words this DISEASE has been socialized in terms of payment. Thus, there is likely the potential for FRAUD based on fraudulent TESTING. U07.1 (CoVID confirmed) Pays, currently U07.2 to the best of my knowledge does NOT PAY
6. CODING is not the hospitals pursue. ALL CODING is from the ATTENDING PHYSICIAN documentation. I fill out QUERIES sent to me by the hospital coders on a regular basis to clarify what my note is (specific language to fit coding) in order for them to determine the PROPER code. Thus, if the hospital were to “push” me to code something CoVID and I do not support it in a note, they CANNOT code for it.
As is usual with everyone who thinks the are a freaking expert on everything, they only know the LITTLE BIT that they can cut and paste and use as talking points to SHOVE AN ANGENDA through.
This is how it works at the hospital level, and I am still waiting for IDIOT BOY to apologize for his blatant falsehoods that have been GROSSLY DISPROVEN even though HIS OWN WORDS HANG HIS ARGUMENT.
My daughter works in medical coding and I can fully agree with your comment.
MOM MD is here to help educate the FLAT EARTHERS who are often wrong and are capable of cut and paste only with no understanding of what they are saying. She has a great deal of credibility because she is absolutely correct in what she says. Typical LIBTARD argument to try and SHUT DOWN conversation with a talking point “crowd control”. You hardly speak for those who know the truth. But you could be elected Prime Minister of the FLAT EARTH continent.
HERE is the GREATEST Freemail I have ever received. When HILLARYS CANKLES CANNOT win an argument in OPEN FORUM, He / she / it SNEAKS INTO FREEPMAIL and STALKS me privately. I want all to see the VERBATIM private response I have received with such intellectual bravado as to be considered virtually Shakespearian.
Shame Shame HC you not being brave enough to say it in public.
I will give you *that*.
If said physician is an employee of a hospital, there’s a tremendous amount of pressure to find the evil SARS-Covid.
In fact, there’s more pressure to find that than there is to find & treat a true evil disease within the patient that causes him/her to suffer.
I fail to see how asking a child of 9, who nearly ripped off his thumb in an accident will benefit by being asked if he has fever, chills, shortness of breath, difficulty in breathing, etc. but that’s where we are.
Fix the doggone thumb, will you please?!
Still, as an employee, doc will still make the same $$. The hospital, on the other hand will increase their $$. They get paid based on DRG, diagnosis-related groups, where certain patients with certain conditions (SARS-Covid) thus requiring more resources to treat. An example is when an 80 year old with 7 comorbid conditions falls and breaks a wrist, they require more resources to treat than a 24 year old who falls and breaks their wrist and has no comorbid conditions. The idea is that more resources requires more $$. Makes sense in a weird sort of way.
The problem is, physicians aren’t contracted for that, nor do they use HCC, another method of coding, (Hierarchical Condition Coding) which is based on the presumption that the more work a doc has to do, the more money he should be paid, kind of like the DRG except DRG is facility-based & the HCC is used for professional fees (doctors’ work) where ever they provide their services. Providers are told if they code via HCC they get extra money if they follow the HCC way of reporting, but in reality, their contracts state what each procedure is going to pay, regardless of diagnosis attached. They get NO extra money, even if Jim Bob Walton has 5 comorbid conditions that rank in higher HCC and Dr. Warner has to treat all 5 conditions in a single encounter.
The managed care company reports the HCCs that they physicians don’t & gets that extra money from Medicare as “reimbursement” for the extra work the doctor performs but there’s no trickle-down effect; the doc gets .
nothing but extra work & administrative worries and added expense for his/her employees.
As for hospitals, in NY the Gov. made it next to impossible for physicians to be sued for malpractice and thus they could pretty much do what they wanted. Granted, many are ethical and wouldn’t presume to “pad the books”, as it were, but give some enticement here & there mixed with old fashioned peer pressure...no doubt about it. So yeah, a patient who “catches” Covid fetches a good price. Multiply that by a group of non-productive “slackers” in the nursing homes & wow...what else can we do? That’s why you had legislators pulling their parents from the nursing homes - dumb or misinformed, they were NOT.
says the guy (HC) who doesn’t even have his own info but hides behind his GF.
i dont know who you are but you are full of crap. The people you are maligning are those working every day at risk to themselves to care for others. How many times have you stood at bedside and taken that risk? I know of no one that pads the books - but if you want to call me a liar lazy or any of the other names in your screed i care not. your insults are as insignificant and mistaken as your posting. Piss off
There is no reference to your employment in #131
Yeah, the same one who decided to PRIVATE EMAIL me and simply called me a paid troll and moron. He has to hide behind his Girlfriend and PRIVATE MESSAGE because he is so weak that he cannot speak with any erudite conversation in a public forum.
I wonder if his GF is really his wet nurse being the sniveling child he is...
Fair enough, I didn’t develop it. Many physicians are either employed by hospital or salaried. It is a dangerous assumption. That being said, even in the employment model, there is strict adherence to independent medical judgment. Please excuse my short cut argument.
The reason you ask a child who nearly ripped of his thumb if fever chills etc is because you are assessing for SEPSIS and possible SHOCK. Not everything is COVID. Please understand that while I respect your coding, there is a lot that goes into clinical medicine that is NOT in the coders manual.
F/C/N/V/Short of breath are also referred to as constitutional symptoms which point toward systemic issues.
Perhaps we could leave the medicine to the actual physicians....
Your post proves my point.
I’m neither a flat earther, anti or pro vaxer, but you are right there with the insults right out of the gate.
It’s people like you that have people like me distrusting everything that we are being told by anyone.
You have no credibility with me, so as we used to say when we were kids,”Tell it to the Marines!”
You’re just another gas bag.
I think you threw the baby out with the bath water.
Medicine is a scary and a wonderful scientific art.
I do not insult, in fact, I was defending physicians. You guys are in the middle of some very bad things, damned if you do, damned if you don’t.
Please don’t take that nonsense to heart (I know it’s hard). You spent your lifetime to help others.
Point well taken, however, I think you misunderstand what I’m saying or maybe I didn’t say it right. What I’m seeing are brand new inserts to the templates, with a standard question set asked prior to examining the patient. It’s the “Covid screening” to see if said patient requires a covid test - whether their fingers are falling off or being followed up for a resolving issue. Another standard set is the new mental health screening.
I understand very well, the clinical nature of checking for sepsis & shock, but this rule does not apply to every single patient, new or established, for every single patient in every single circumstance. I get it, I see it in many different specialties, regardless of the nature of injury or illness.
Never would I presume to even think I’m in the same league with any of you. 28 years doesn’t give me that right and I’m well aware. You guys, esp FP, IM, Peds get the short end of the stick yet you work the hardest & deserve the most respect, IMHO.
Yeah, there are some pretenders out there, some who lack judgement and are so out for money. I’ve seen them too. I’ve walked off on jobs with them as well. Still, docs aren’t getting penny one extra from diagnosing anyone with covid, as I’m sure you’re more than well aware.
It’s not fair to lump all physicians with those who do receive incentive (can we say KICK-BACKS?) for it. I don’t understand a lot of things & that’s one of them. I see the DRG, the HCC and I see how the doctors will save or make money & have yet to see it, although it confuses me how a doc in one part of a state can receive $150 for the same exam & code that another doc does & he gets $340, for pretty much the same kind of case(s). Doesn’t take too much to confuse me these days, I guess.
It wasn’t that long ago that physicians were public enemy #1. Looks like someone is trying hard to restore that “honor”.
My apologies if you felt offended. That was not my intent.
No apologies needed, thanks for clarifying. I understand what you are saying. It just seems we are questioned relentlessly in my profession when all we want to do is take care of the patient.
Hospitals are sprouting in Florida not because of money making, but because 18 months ago Florida transitioned from a Certificate of Need state to a Non certificate of need state. Why dont you go educate yourself on what that means. Hint, it means that the government no longer restricts competition to boost profits and allows for free market competition
Absolutely. Definitely not enough places to get a $1000 chest x-ray. How much is a CT scan these days? $3k? These new mini hospitals are money printing operations and you know it. Although, maybe up on your high horse you can’t see that.
Well if you knew anything about how the government requires things to be done then you could possibly have a modicum of understanding of how medical economics works.
Obviously you have not the first clue. And frankly it would take weeks to educate you. So sit there snd cluck away but the straight our ignorance of your statement is at once breathtaking and beyond hope for you to understand.
NEVER, EVER apologize to an IDIOT BOY.
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