MikePA
Super Moderator
George,
You're right. When multiple procedures are performed during the same visit it can complicate things. Why?
Procedures 1, 2 and 3 when performed separately might cost $150. When performed at the same time they could be grouped into a DRG (Diagnosis-Related Group) and only pay $120.
Doctors who know how to play the system (not saying you or anyone in your practice does this.) will try and get more money by billing the procedures separately. This can result in a review. DRGs have been around since the early 80s and have been used to reduce health care costs. The patient receives the same care, but the company paying the premiums sees lowers costs and the doctor sees lower reimbursement.
Before anyone replies, "What's the big deal about $30?" Multiply by 10s of 1000s of doctors. Yes, this started with Medicare. Yes, doctors and hospitals look for ways to maximize reimbursement and insurers look for ways to minimize it.
I agree the system has problems, but socializing it does not work, it makes things worse. Plenty of countries around the world testify to this.
You're right. When multiple procedures are performed during the same visit it can complicate things. Why?
Procedures 1, 2 and 3 when performed separately might cost $150. When performed at the same time they could be grouped into a DRG (Diagnosis-Related Group) and only pay $120.
Doctors who know how to play the system (not saying you or anyone in your practice does this.) will try and get more money by billing the procedures separately. This can result in a review. DRGs have been around since the early 80s and have been used to reduce health care costs. The patient receives the same care, but the company paying the premiums sees lowers costs and the doctor sees lower reimbursement.
Before anyone replies, "What's the big deal about $30?" Multiply by 10s of 1000s of doctors. Yes, this started with Medicare. Yes, doctors and hospitals look for ways to maximize reimbursement and insurers look for ways to minimize it.
I agree the system has problems, but socializing it does not work, it makes things worse. Plenty of countries around the world testify to this.