“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.
I am supposed to apply for medicare in a matter of days. I am wondering if I should just keep my private insurance?