Healthcare going forward

[offthewall14420]

Doctors hate insurance companies. All the paperwork and bullshit they require for reimbursement is ridiculous.

So the insurers pay doctors an inflated rate to cover the overhead. This is all part of the rigged market.

 

[ballcaphair]

Very complicated, but it does not support your claim. It includes the following;
"In November 2015, UnitedHealth made an adjustment on its balance sheet, setting aside an initial “premium deficiency reserve” of $200 million for expected losses in those marketplaces.

Those losses have cumulatively swelled to more than $1 billion, Ms. Skolnick said, but because they have been segregated in the company’s accounting, and because the company has been leaving those markets, investors have been able to easily assess the company’s value “entirely separately from the problems it’s had with the exchanges,” she said. Other managed care companies have made similar provisions.

I believe that the same principle applied to AIDS and also to Too Big To Fails. There's a big dynamic in play. I know where you're coming from, but it is more complicated than even that.

 

[ballcaphair]

Doctors hate insurance companies. All the paperwork and bullshit they require for reimbursement is ridiculous.

So the insurers pay doctors an inflated rate to cover the overhead. This is all part of the rigged market.

As a caregiver, I spend 15% of my time charting what I've done and another 5% justifying my labors. When I do physical therapy, 30% for charting is very realistic. Pretty top heavy, as you point out.

 

[Benvolio]

As a caregiver, I spend 15% of my time charting what I've done and another 5% justifying my labors. When I do physical therapy, 30% for charting is very realistic. Pretty top heavy, as you point out.

How much of that is required by the government? Much of what the insurance companies require is required ultimately by the government.

 

[KaraBulut]

As a caregiver, I spend 15% of my time charting what I've done and another 5% justifying my labors. When I do physical therapy, 30% for charting is very realistic. Pretty top heavy, as you point out.

Most of us are told- for reimbursement and for legal reasons- if you didn't chart it, you never did it. Because there's a faction of every industry who discover ways to get paid for services that they never did, we all have to prove that we're not committing billing fraud.

 

[ballcaphair]

How much of that is required by the government? Much of what the insurance companies require is required ultimately by the government.

There is truth in this, but it is most always the the insurance companies that take us to task. A verbal survey at work confims that this is without question.

 

[ballcaphair]

Most of us are told- for reimbursement and for legal reasons- if you didn't chart it, you never did it. Because there's a faction of every industry who discover ways to get paid for services that they never did, we all have to prove that we're not committing billing fraud.

True. Part of our oath promises to expose fraudulent actions and documentation.

 

[thewiz]

One of the things that ACA was designed to do was standardize and computerize billing functions. As the past president of a small, rural hospital, our accounts receivable would age for months as we collected from numerous insurance companies, Medicaid, Medicare, and private payments. I remember well when my step-son was hit by a car and the specialist that operated on his knee apologized for "not being a participating doctor in BC-BS. You'll understand why soon." After filling out the magenta colored form which was replaced by the seafoam green form that didn't have the information contained in the new canary yellow sheet that required a detailed analysis from the specialist on surgery (that was provided on the original magenta form and stapled as an attachment to the others -- I was about to scream. It was only while having coffee with my car insurance agent that i learned I had coverage for medical costs that also covered my stepson. I ended up sending the bills to them, they paid me (even though my car was not involved) and they collected from BC-BS.

As a city manager and now consultant for EMS services, the paperwork is equally tedious and mind-blowing. Most cities utilize a third party agent that takes a portion of collections as payment. The reason is because of the multitude of forms, insurers, and no consistency.

For ACA to work, it should use standardize forms, billing, codes, and be electronic. When the bill is submitted, it should be paid within 10 days (or at most 30) by insurers electronically. What many of those insurers now do is use cities, doctors, health providers, and hospitals as financing agents. They reject billing attempts and delay payments for 6 months. Basically everyone is their bank.

Also, Ben, our system is not socialism. Check the definition of socialism: "a political and economic theory of social organization that advocates that the means of production, distribution, and exchange should be owned or regulated by the community as a whole." If we had single payer health care that might meet the test. What ACA did (because no one in Congress has the balls to do otherwise) is continue to reward private insurance companies with subsidies to insure those who could otherwise not afford care. That care would be provided anyway in emergency room settings (the most expensive method) and the costs spread to the insurance companies. Under ACA they get the best of all worlds: they get paid to cover the uninsured for conditions that would otherwise be paid by them anyway and with no risk because excess costs are paid by ACA tax credits. Insurance companies can continue to raise their costs even though their liabilities are capped. In addition, pharmaceutical companies can continue to charge whatever the market will bear (or PR teams can sell) even though most R & D is paid for through government contributions and grants. Unlike other countries with universal care, the government and programs are forbidden from group purchasing or limiting what they will pay to these companies.

CEO's for insurance companies and pharmaceutical companies continue to be rewarded with outrageous compensation packages that are only limited by ACA (which they would love removed). Competition is largely discouraged.

 

[Sausy]

As socialist things go, in the medical field it would be a vast improvement. The ACA has done some real good in getting millions insured who otherwise would not have been, and would put off seeing their physician until that emergency room scenario would occur. But with the Republicans vowing to oppose anything smacking of a system of health care with public undertones, and no great appetite by enough Democrats to even go for Medicare for All type of arrangement... ACA was the best we could get. The LAST thing it does is provide a socialistic dispensation of medical care... and in all the modern industrial nations under some kind of public delivery of health care, precisely none have majorities of people wanting to reverse course.

 

[Benvolio]

As socialist things go, in the medical field it would be a vast improvement. The ACA has done some real good in getting millions insured who otherwise would not have been, and would put off seeing their physician until that emergency room scenario would occur. But with the Republicans vowing to oppose anything smacking of a system of health care with public undertones, and no great appetite by enough Democrats to even go for Medicare for All type of arrangement... ACA was the best we could get. The LAST thing it does is provide a socialistic dispensation of medical care... and in all the modern industrial nations under some kind of public delivery of health care, precisely none have majorities of people wanting to reverse course.

Wrong. The law taxes some to subsidize others so part have pay double--pay for their own and pay taxes to give others a free ride--and then see their own care degraded as they have to wait in line. To that extent certainly it is socialism.

 

[KaraBulut]

Wrong. The law taxes some to subsidize others so part have pay double--pay for their own and pay taxes to give others a free ride--and then see their own care degraded as they have to wait in line. To that extent certainly it is socialism.

If we want to go down that path, then let's look at actual wealth distribution.

• The richest 1% pay an effective federal income tax rate of 24.7% in 2014; by contrast, a taxpayer making around $75,000 is paying a 19.7% rate. Source
• The richest 1% of Americans own 35% of the nation’s wealth. The bottom 80% own just 11% of the nation’s wealth. Source
• The average federal income tax rate of the richest 400 Americans was just 20 percent in 2009. Source
• Because investment income and capital gains is taxed at a lower rate than payroll taxes, those who work for a living carry a disproportionate amount of taxes. In 2009, the year before the ACA surplus tax paid by people who make more than $250,000 per year, the IRS reported that 1,470 households reported income of more than $1 million in 2009 but paid zero federal income taxes. Source

People who work are increasingly subsidizing the lifestyle of wealthy people who don't get paid a salary but instead live off investments and have substantial tax shelters to reduce their effective rate.

To that extent certainly it is socialism.

 

[KaraBulut]

One of the things that ACA was designed to do was standardize and computerize billing functions...

Minor correction: standardization of billing transactions was in the HIPAA act (1996, Part C "Administrative Simplification" which amended Title XI of the Social Security Act.). The EDI standards weren't put into full force until about a decade later (circa 2006-2008) but the majority of healthcare billing and payment in the US is processed electronically under the ASC X12 5010 standard.

Before the EDI standards went into effect, it was not uncommon for Medicare days in AR to be in the 30-60 day range. Today, most Medicare claims are paid by electronic transfer on the average between 10 to 14 days.

As a city manager and now consultant for EMS services, the paperwork is equally tedious and mind-blowing. Most cities utilize a third party agent that takes a portion of collections as payment. The reason is because of the multitude of forms, insurers, and no consistency.

Ambulance billing is an outlier. While most hospital and physician bills go on standard EDI transactions like the 837I or 837P, ambulance billing is still a fucking mess. Just a few minutes reading through the ambulance billing page on the CMS website will give you a migraine. The medical necessity guidelines are vague and can be quite arbitrary. A lot of non-governmental payers don't even cover ambulance services.

 

[gsdx]

People who work are increasingly subsidizing the lifestyle of wealthy people who don't get paid a salary but instead live off investments and have substantial tax shelters to reduce their effective rate.

Indeed. Rich people can afford to hire the poorer people who know the ways to keep the rich people from paying taxes. Just ask Trump. He hasn't paid taxes for ages.

 

[gsdx]

ambulance billing is still a fucking mess.

I've had 2 trips to hospital and both cost me $45 each. (It's not covered by my OHIP.) What does an ambulance ride cost in the States?

 

[thewiz]

I've had 2 trips to hospital and both cost me $45 each. (It's not covered by my OHIP.) What does an ambulance ride cost in the States?

When my husband died a year ago, the ambulance cost was $798; my insurance paid $400 and I had to pay the other $398.

 

[ballcaphair]

Claims are that the feds cannot manage healthcare cost effectively. Insurance companies make the whole care issue so cheap and inclusive, don't they?

 

[Sausy]

Indeed. Rich people can afford to hire the poorer people who know the ways to keep the rich people from paying taxes. Just ask Trump. He hasn't paid taxes for ages.

He does play it both ways... gets incensed when scrutiny of his tax records and calls for their release are made. However says there's nothing to it even when he has claimed to be under constant auditing by the IRS.

 

[gsdx]

he has claimed to be under constant auditing by the IRS.

Is all the money he's making off his weekend golf vacations taxable? Is all the rent he's being paid by the government taxable? Is all the money he's making from his website selling $40 hats taxable? Is all the money he's making from being paid to feed himself and his family in his own restaurant in his own hotel taxable?

Oh, stupid me. No conflict of interest here, you know.

Americans should be incensed at having to pay him. I bet they've fired painters and housekeepers and boys who mow their lawns for far less.

 

[Benvolio]

If we want to go down that path, then let's look at actual wealth distribution.

• The richest 1% pay an effective federal income tax rate of 24.7% in 2014; by contrast, a taxpayer making around $75,000 is paying a 19.7% rate. Source
• The richest 1% of Americans own 35% of the nation’s wealth. The bottom 80% own just 11% of the nation’s wealth. Source
• The average federal income tax rate of the richest 400 Americans was just 20 percent in 2009. Source
• Because investment income and capital gains is taxed at a lower rate than payroll taxes, those who work for a living carry a disproportionate amount of taxes. In 2009, the year before the ACA surplus tax paid by people who make more than $250,000 per year, the IRS reported that 1,470 households reported income of more than $1 million in 2009 but paid zero federal income taxes. Source

People who work are increasingly subsidizing the lifestyle of wealthy people who don't get paid a salary but instead live off investments and have substantial tax shelters to reduce their effective rate.

To that extent certainly it is socialism.

That is very misleading. The Social Security tax goes into a separate fund to be disbursed when people are able to begin collecting . Most people pay in less than the eventual receive. People who pay only that and not income tax are paying nothing to support the country. The top 20% of tax payers pay 84% of the federal income tax.https://www.google.com/url?sa=t&rct...674384&usg=AFQjCNFMnsSVoGLjoHgbrV_2soNNM_bAQQ

But taxes on the successful can never be high enough for the marxist/liberals. They gather votes by preaching hatred of the rich and claiming that the rich do not pay taxes.

 

[Benvolio]

If we want to go down that path, then let's look at actual wealth distribution.

• The richest 1% pay an effective federal income tax rate of 24.7% in 2014; by contrast, a taxpayer making around $75,000 is paying a 19.7% rate. Source
• The richest 1% of Americans own 35% of the nation’s wealth. The bottom 80% own just 11% of the nation’s wealth. Source
• The average federal income tax rate of the richest 400 Americans was just 20 percent in 2009. Source
• Because investment income and capital gains is taxed at a lower rate than payroll taxes, those who work for a living carry a disproportionate amount of taxes. In 2009, the year before the ACA surplus tax paid by people who make more than $250,000 per year, the IRS reported that 1,470 households reported income of more than $1 million in 2009 but paid zero federal income taxes. Source

People who work are increasingly subsidizing the lifestyle of wealthy people who don't get paid a salary but instead live off investments and have substantial tax shelters to reduce their effective rate.

To that extent certainly it is socialism.

The top 40% pay 106% of income taxes. https://www.google.com/url?sa=t&rct...s.html&usg=AFQjCNGRLe0VvTz_q7dPhjCN5K7sbvUYoQ