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0 pointsShinkei11y ago0 comments

I don't believe you.

I am a physician too and you are repeating a lot of the falsehoods that are perpetuated among those that don't understand the billing process or aren't actually physicians.

AMA is an insurance and loan agency? I... I... don't know what to say to this. How about start by reading this (poorly written, but summary nonetheless):

http://en.wikipedia.org/wiki/American_Medical_Association

and one of their most influential functions:

http://en.wikipedia.org/wiki/Specialty_Society_Relative_Valu...

It's true that insurers set up arbitrary requirements (for sentinel effect, mostly) to try and refuse reimbursement, but often a simple change and resubmission will result in payment. These are issues that are dealt with in your contract with the insurer--have you read this contract? If not, then you can't complain! Even the CMS has a contract with its physicians.. and contrary to popular belief, they pay pretty well for most anything. It's Medicaid that is atrocious... especially since it covers children/poor and will often limit their access to healthcare.

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mudil11y ago

Sure it's true. If I do two cases, and my billing times overlap even by one minute, I am not going to get paid for either one of them by Medicare. If I place an epidural in Medicaid pt, I get paid something like $36 for the placement, and I don't get a penny for watching this pt for next 18 hours.

The question is why medicine is becoming the most miserable profession (with polling data to back it up) while the gov't interference in it is at all time's high and going higher and higher all the time.

FireBeyond11y ago

"If I place an epidural in Medicaid pt, I get paid something like $36 for the placement, and I don't get a penny for watching this pt for next 18 hours."

Wuh? I'm not a physician. But I do work for an ambulance service. And my day job has involved working with insurance reimbursement algorithms for Hospital and Insurance Administrators.

But "$36 for epidural and not a penny for the next 18 hours?"

You might want to look into that. Medicaid allows a Maximum Fee of $1.16/minute for an anesthesiologist's time.

"Essentially, hospitals will be reimbursed at $669.90 for the epidural procedure performed in the hospital setting; whereas, in office setting, after removing the portion designated for the physician professional fee, office practice expense will be reimbursed at $30.28 to $34.36 a whopping 2,315% to 2,668% with SGR cut and 1931% to 2312% without SGR cut more in the hospital setting."

Yes, epidurals are cut - but under what circumstances are you monitoring a patient bedside for 18 hours in a non-hospital setting?

And for every one of these examples, there's a flip-side:

Wisdom teeth under general anesthesia.

"Hi, I'm Mr X and I'll be your anesthesiologist today. How you doing? Now, to confirm, no allergies, right? And it says you weigh 180lb? Great, see you in theater!"

Bill:

"Pre-operative anesthesiologist consultation: $662"

For about 90 seconds. Now, I know the principles of anesthesia, though I'd never claim my knowledge was within orders of magnitude of that of a specialist, but I routinely perform RSI for ET intubation, and I know all about "the charge isn't for the time, it's the knowledge", but nonetheless.

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