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soup
Senior Member
2740 Posts |
 Posted - 03/07/2012 : 11:54:58 AM
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For those that don't know medical charges are dependent upon the reimbursement "codes" for Medicare issued by HHS. This applies for patients on Medicare, Medicaid, covered by insurance, or uncovered.
Essentially each history and physical,test,disgnoses,treatment,etc. are called procedures and receive a "code" for which a given amount is reimbursed.
Now, HHS wants to increase the number of "codes" from an unwieldy 18,000 to an ungodly, unfathomable 148,000. If they figure out how to implement such mandates it will drive quality of care down and costs up dramatically.
For instance, HHS wishes to apply 36 different "codes" for treating a snake bite, depending upon the type of snake, its geographical region, and whether the incident was accidental, intentional self-harm, assault, or undetermined. The treatments for snake bites are basically the same wherever they occur.
Do you really want your medical care provider spending his/her time trying to figure whether someone tried to kill you by putting an asp in your bed or whether you stepped on the **** thing? Homicidal snake bites get greater reimbursements.
Think of the tremendous increase in "coding" staff and computer costs.
The Obama administration thinks that decisions about health care are simply too complex for the average American and the provider. After all only the experts in Washington can understand the difference between walking into a wall and walking into a lamppost. Someone has to figure out how to get rid of this monstrosity. |
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cataddict
Senior Member
274 Posts |
Posted - 03/07/2012 : 12:14:17 PM
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| Source? because that data doesn't correspond with the switch from icd-9 to icd-10. |
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soup
Senior Member
2740 Posts |
Posted - 03/07/2012 : 12:17:35 PM
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| HHS, Medical Care providers. HHS delayed implementation because no one knows how to implement it. |
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Reelly Old
Senior Member
1348 Posts |
Posted - 03/07/2012 : 12:17:43 PM
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from an unwieldy 18,000 to an ungodly, unfathomable 148,000.
That would be in keeping with most progressive advancements. If the system works, screw with it until it no longer does ...
If The Gas Price Commission Couldn't Figure Out &@&$t Last Year, Are They Smarter This Year?
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cataddict
Senior Member
274 Posts |
Posted - 03/07/2012 : 12:27:21 PM
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| sources? icd-10 is 68,000 codes. |
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soup
Senior Member
2740 Posts |
Posted - 03/07/2012 : 12:53:52 PM
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I'm sorry Cataddict but I simply cannot disclose the HHS sources.
So, I'll accept the ICD-10 number of 68,000. Do you consider 68,000 to be an outrageous number and that the direction the system is progressing is detrimental to the medical care system? |
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cataddict
Senior Member
274 Posts |
Posted - 03/07/2012 : 12:58:18 PM
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| as someone that works at a hospital the new system is better, the old icd-9 is from the 70's. the only problem we have is that it is being delayed, everything was already setup for the change over. |
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soup
Senior Member
2740 Posts |
Posted - 03/07/2012 : 1:22:50 PM
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| In your opinion, will strict adherence to a coding system which contains an exorbitant number of "codes" increase or decrease the number of "procedures" performed/patient? Will a continuing increase in "codes" increase medical costs? For the purposes of treating a snake bite is it efficacious for a provider to determine whether it was accidental or a result of intentional self-harm? If that information is coded, will there be a charge for it? |
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cataddict
Senior Member
274 Posts |
Posted - 03/07/2012 : 1:43:40 PM
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| The reason self-harm needs to be determined is because then that person needs a psych evaluation and other precautions need to be taken to ensure the patients safety as well as that of the caregiver. It won't affect the number of procedures just the accuracy of the records and billing. Some of the secretary's might be frustrated with the changeover but after a few months everything will be fine. |
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skinneej
Prolific Poster
12112 Posts |
Posted - 03/07/2012 : 1:47:35 PM
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| Icd9 is for drugs. Procedure codes are CPT codes. Maybe that explains the numbers. |
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cataddict
Senior Member
274 Posts |
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skinneej
Prolific Poster
12112 Posts |
Posted - 03/07/2012 : 2:14:15 PM
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| Okay, you are right. They are diagnosis codes right? Not sure that soup specified though. If you add up all the diagnosis codes and procedure codes I wonder what you get? |
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soup
Senior Member
2740 Posts |
Posted - 03/07/2012 : 2:33:21 PM
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Here's the press release announcing the delay
http://www.hhs.gov/news/press/2012pres/02/20120216a.html
How is an increase in the number of codes really going to make the system more efficient?
I disagree with you about the snake bite example. Whether the person needs a psych consult has nothing to do with treating the snake bite. I'll try to get you a list of codes and you can count them. |
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soup
Senior Member
2740 Posts |
Posted - 03/07/2012 : 2:48:00 PM
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How about a hypothetical? Take a hospital system which operates numerous hospitals with EDs in a number of states in smaller communities. The system used to pay ED providers an hourly wage. It tried to keep ED costs down as a service to the community. For instance, an ED provider would contact the patient's regular provider upon presentation in the ED as a courtesy and for consult. For that the hospital system did not charge.
Then the hospital system contracted out the ED services to an ED specialized business which pays the providers on a fee-for-service basis. The computer system in the ED prompts the provider to answer whether or not they have contacted the patient's regular provider. That is a billable code. That change plus others which cause the ED provider to order more procedures has resulted in a 30% increase in ED charges over about a 2yr period.
Now, will building a bigger computer system able to handle a dramatic increase in codes increase or decrease medical costs in the those EDs? |
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PalmerScott
Senior Member
785 Posts |
Posted - 03/07/2012 : 5:56:30 PM
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Theoretically, electronic medical records 'should' make things better/faster. Banks pass our money around on the wires as zeroes and ones all the time. EMRs will eventually get there. But, I don't think it will be for another decade, at least, until it starts to mature to the point of making things better instead of worse.
But, I don't thing the technology used for handling our records is the troublesome part, be it manilla folders or EMRs. The real scary issue is that next year, the IRS steps in as the agency responsible for making sure we're all complying with ObamaCare. They are the enforcement agency. In order to calculate your taxes, they'll be checking your records to make sure you're participating in an 'approved' plan purchased through the new exchange. We thought audits were scary before...
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17' Henry O Hornet
26' Palmer Scott
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cataddict
Senior Member
274 Posts |
Posted - 03/07/2012 : 6:33:28 PM
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| soup, it makes for less typing. instead of a long written explanation it is all encoded. same info, different way of transmitting and viewing it. Think of it this way, Yamaha Four stroke 150hp counter rotating 25" shaft= LF150TXR. the coding works the same way. t63.x64=snake venom, self induced. It's a subsect not a new code. We'll see what happens when it rolls out in 2013 but it should be a good thing. |
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soup
Senior Member
2740 Posts |
Posted - 03/07/2012 : 7:41:36 PM
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| I've hesitated to ask this directly, but. What do you expect more codes to do to medical costs? Less typing by a coder has no affect on what goes on between provider and patient. I presented a perfectly feasible hypothethical in which strict adherance to medical codes significantly increased medical costs. Now, why would you expect more codes to decrease that cost? |
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soup
Senior Member
2740 Posts |
Posted - 03/07/2012 : 7:45:08 PM
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| BTW--according to Sebelius, it is not rolling out in 2013. Additionally, providers don't type, they press keys after prompts to direct them to the more expensive codes. |
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cataddict
Senior Member
274 Posts |
Posted - 03/07/2012 : 9:03:02 PM
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| soup post your source, I'm not going to explain things to you when you are getting things from un-named possibly biased sources. You have no first hand knowledge of how the system works and you have made incorrect statements as if they are fact; "providers don't type, they press keys after prompts to direct them to the more expensive codes." |
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Reelly Old
Senior Member
1348 Posts |
Posted - 03/07/2012 : 11:49:35 PM
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Theoretically, electronic medical records 'should' make things better/faster.
Yeah, it's a theory thing. I've had four major procedures in the last four years, and plenty of dealings with insurance. Trust me when I tell you almost every problem was due to mis-coding either by the provider or during insurance processing. My wife was even turned down for long term care insurance once because of incorrect coding of her medical records. Electronic medical records will always be subject to 'garbage in, garbage out', only more people will have access to bad information, more people will be needed to keep all the new crap straight, and it will be almost impossible to correct ...
We're From The Government. Wait, Don't Run Away, We're Here To Help.
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soup
Senior Member
2740 Posts |
Posted - 03/08/2012 : 05:43:45 AM
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Cataddict
I asked you to consider whether the system of medical coding, electronic recording of patient/provider interactions, increased bureaucracy, etc. increase or decrease medical costs and efficiency and whether they influence medical care directly or indirectly. So far you have refused. So I quit.
To answer your insult. I've had 1st hand experience for over 40yrs.
To list all my sources would be impractical and a breach of confidentiality.
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Obamacare;Medical Care;Medical Costs
