Dr. Dorin was adamant that the AMA probably represents closer to 10% than 17 % and that their monopoly on billing needs to go and be opened to a free market.
Exactly how does all the billing monopoly work?
Who gets paid for what and how close are the billings to actual costs? If all doctors are forced to use this billing code to bill Medicare for their services rendered to medicare patients is this the reason why some doctors refuse to even take medicare patients?
We are seeing more of that in South Florida.
Who gets paid for what and how close are the billings to actual costs? ...is this the reason why some doctors refuse to even take medicare patients?
The term: "Cost Shifting".
It should be illegal, it is how the providers "make ends meet" due to the government's giving away "free healthcare" to Medicaid and Medicare patients.
The ratios are different in every state, but hypothetically, if the commercial rate paid by insurance companies for a doctor's visit were $50, for the same doctor's visit:
Medicaid pays $27.
Medicare pays $38.
Insurance pays $50.
Cash patient pays $75.
Further, the Medicaid patient don't usually have primary care physicians and use the expensive emergency room as their doc. Also, since this is free and there is no copay, they go there at the drop of a hat for a case of the sniffles or a hangnail. (overutilization) Both cost shifting and overutilization should be made illegal.
Additionally, many states not only reimburse providers at a rate of pennies on the dollar, they also are hundreds of millions behind on their payments...more cost shifting.
If the government wants to give away "free healthcare" it should at least pay the providers a decent rate and in full. They also need to police the gimmee girls on their hospital habits.
In a nutshell you pay for medical welfare twice; once in taxes, and again in elevated premiums due to inflated claims from cost shifting.
“Who gets paid for what and how close are the billings to actual costs? If all doctors are forced to use this billing code to bill Medicare for their services rendered to medicare patients is this the reason why some doctors refuse to even take medicare patients?”
I don’t pretend to know all about this, but here’s what I do know and remember from when I did medical billing (for all different providers - mental health, general practitioners, durable medical suppliers, chiropractors, etc.) for all types of insurance carriers including medicare/medicaid -
EVERYTHING, what gets reimbursed or does NOT, depends on coding - both diagnoses and procedures. I had to purchase two books (which got updated/changed yearly, not for free!!), CPT (for procedure codes) and ICD-9 (diagnostic codes). These first two basic softcover books cost around $150 if I recall, and that was 18 years ago! I also seem to recall I had to purchase them through the AMA, or arm of it.
More and more docs are turning down medicare patients due to financial reasons. Not only does medicare deny more and more claims (thanks to obama/congress funding cuts), but it reimburses a fraction of what the private carriers do, to the docs.
Any health care providers out there (non-AMA, preferrably) please fill in the blanks for us, and whether the situation has changed much.