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Story on billing and coding on American Public - Media - McFeist

Posted: Apr 10, 2012

I just heard a story on American Public Media's Marketplace via my local NPR radio station. There is a transcript of it online. Very interesting, especially towards the end when they talk about how the system of billing based on codes is not cost efficient anymore with the complexity of health care and that, as insurers keep paying less and less for each code, providers dig around and find more and more codes that they can bill for on each procedure or hospital stay to make up for the decrease. At the end there is a suggestion of doing away with the system and paying lump sums to providers to save money on administrative costs, etc., but most providers do not want to do this because of the obvious limitations and loss of autonomy that might ensue.

http://www.marketplace.org/topics/life/health-care/battle-over-billing-codes

What are your thoughts on this, McFeist? - Wondering

[ In Reply To ..]
Wondering if this is going to turn into another coding-is-dead thing.

Inpatient billing abuses
Prospective Payment System
DRGs

Outpatient procedure code set belongs to the AMA, not insurers
Outpatient billing abuses errors
Unbundling
Noncompliance due to hiring of noncredentialed, inexperienced, biased family members
OPPS

Hmmm, I was struck by... - McFeist

[ In Reply To ..]
... At first I thought about the coding-is-dead thing, but then I was struck by how providers actually can benefit from the system the way it is set up now by being able to offset cuts in specific procedures or hospital stays. Is that referred to as unbundling? I don't know enough about coding and billing to understand all of the ramifications of the story.

I was also thinking that maybe this doctor is either really, really cheap or he is in a rural area where there are very few credentialed coding and billing people available to fill his need, so he uses the people he trusts most - his family.

I just don't think that this system is going to change anytime soon. I am considering coding if I don't get accepted into the program I applied to, so I listened to the story with interest. I didn't know the actual coding and billing system we have in place was under scrutiny as being so wasteful in terms of health care cost. That was a little alarming to me. You can't blame an MT about being spooked a little about that.

Oh, and it made me realize how valuable coders are with the current system in place. I knew they were valuable, but it gave me a little bit more insight as to why what coders do is such a valuable asset to providers and facilities.

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