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Tuesday, November 26, 2002And More Debate: A reader in the healthcare business sent along an account of his more favorable experiences with Medicare: I don't think you need to worry about an immediate career in sales, however, while I am not sure of the nature of your practice I certainly do not find Medicare any more cumbersome, if as cumbersome, as the number of private insurers/HMOs with which we deal. I am the executive director of a free standing non- profit Mental Health agency that provides a very comprehensive range of emergency psychiatric services--we employ 120 persons (eight physicians), operate an inpatient unit, provide 24/7 out patient services, see 6500 persons per year and admit 140 persons per month to our inpatient unit. I have a strong hunch our billing staff would prefer the simplicity of Medicaid and Medicare over the problems presented by private insurers--varying rate schedules, pre-approval/authorization requirements, (particularly a night mare in emergency services), inaccessible 1-800 numbers, retrospective denials, differing limits on service, concurrent approvals, changing panels, on going rate negotiations, etc. One of our local hospitals has recently limited (for all practical purposes) psych admissions to Medicaid (child and adolescent therefore does not receive Medicare) as the current rate structure of the two largest HMOs in town only reimburses about 30-40% on the dollar for services provided(coincidentally the two HMOs are owned by the two largest Hospital Systems which does not include this hospital). While federal/state insurance plans certainly have problems ( as I can attest since we recently had a comprehensive Medicaid audit--with findings) the sheer volume of services and the standardization of eligible services and rates makes it quite easy to do volume billing and financial planning--the debate goes on. The key difference between us is the difference between primary care and psychiatry. Health insurance companies are notoriously bad about paying for mental health services. They dicker and dicker and do everything they can to avoid paying for it. In primary care, it’s a cardinal law of coding that you never assign a psychiatric diagnosis code to an office visit, at least not if you want to get paid. You use codes for the symptoms - insomnia, fatigue, chest pain, palpitations, anything but anxiety or depression if you can avoid it. Psychiatrists and psychologists don’t have that luxury. Medicare and Medicaid, on the other hand, are better at paying for mental health. It’s true that a single-payer system would mean a less complicated system. There would only be one entity to deal with rather than a multitude, but that’s about the only advantage. That one entity would use its clout to set prices. Even worse, it will almost certainly try to micromanage patient care, too, as Medicare and Medicaid and insurance companies, too, already do. posted by Sydney on 11/26/2002 07:27:00 AM 0 comments 0 Comments: |
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