Oxbow6 Posted March 7, 2014 Share Posted March 7, 2014 Here is one I really enjoy...the under 65 year old patient complains he/she was over billed for their visit/encounter because he/she just got the EOB in the mail. Let's say charge was $200 and their insurance paid $120 and their remaining balance was ZERO.. not collectible and written off...very common for those on federal and/or state medical assistance. So you know that currently he/she pays zero or close to zero for their insurance..the system writes off the balance cause under their assistance agreement the system generally can't bill the balance and collect it yet they were "overcharged"...but when asked "what did you pay out of pocket for the visit?" and their answer is "nothing but..." that's where the conversation ends. Now the conservative estimate is that the ACA will add 30M...some studies as high as 50M...people under 65 into the state's Medicaid programs nationwide..and those of you in MN thought your state had financial issues now! If my memory serves me correctly it cost roughly $7k to provide care per Medicaid enrollee. So $7K times 30M is what?? And that is yearly...just for these new enrollees. Who funds this "subsidy" for 30-50M people who will basically get (close to) free healthcare? Quote Link to comment Share on other sites More sharing options...
yzerman19 Posted March 7, 2014 Share Posted March 7, 2014 As far as I know, only one doc is going to get reimbursed for the specific billing code that applies to reading the diagnostic test. That is typically the radiologist. If I'm in the hospital seeing a patient and order for example, a chest x-ray, I might be able to look at it right after it is done, whereas there may not be a radiologist reading until after the point that the information is crucially important. My own reading of the chest x-ray gets wrapped into the billing I submit for the day (to put it simply, low, medium, or high complexity of service for that day). My own interpretation of the chest x-ray is just one of the potential components that might bump my level of care from medium or high complexity for that day. I don't bill directly for the chest x-ray, but I looked at it, I took action based upon it, and my actions (hopefully) benefited the patient. I think that's most of the rationale for why I can add that to my level of complexity, but there's also the fact that the ordering of and interpretation of a radiology study is another thing that increases the risk of harm to the patient and increases my risk of exposure to malpractice claims. Consultants like surgeons may be asked to also see the patient and they will also want to look at the radiology studies that have been done, but just like me, they aren't billing directly for viewing those studies. Yes, you want the oversight of the radiologist reading the test. But you also want the docs that have all of the clinical data about you and are seeing you in person to be seeing those x-rays for themselves. A common thing I deal with is radiologist reading of "pneumonia". Now I look at the x-ray, take into account the pattern on the x-ray along with the patient's history related to their illness, their exam, and perhaps some labs, and I figure whether it's most likely to be viral, bacterial, or fungal pneumonia. Are you a hospitalist then? If you'd prefer full anonymity, I will not be offended if you defect the question. You are clearly speaking from a position of knowledge, which is very helpful in this thread. Quote Link to comment Share on other sites More sharing options...
UNDfaninMICH Posted March 9, 2014 Share Posted March 9, 2014 Are you a hospitalist then? If you'd prefer full anonymity, I will not be offended if you defect the question. You are clearly speaking from a position of knowledge, which is very helpful in this thread. Yeah, I'm a hospitalist. And I was giving more thought to the question about the x-rays. When I was in training, the x-rays were on film, and if I wanted to see them personally I needed to go down to radiology, have someone pull the file, and put the film up on the box. All of this took time and the location was usually far-flung from where the patients were. So we waited for the radiologist to read the film and tell us what he saw. Now, the x-rays are digital and I can look at them from virtually any computer. Perhaps we should shift towards using our own interpretation when we see fit, and asking the radiologists to perform a "consult" and read the film if things are not going as we think they should go. I'm talking about basic films (whatever is considered "basic" to that given specialty). Would patients go for that? In a setting where patients more directly saw their bills, they might. I could say, "I think this x-ray and everything else about you is consistent with viral pneumonia, and we'll treat it as such. If you want a radiologist to look at your x-ray it will cost you $x more." I can tell you that the radiologist would NOT go for this, but I can also tell you that the radiologist read of certain films often adds nothing to the care of the patient. Their readings might pick up unusual things that wouldn't have otherwise been seen, but that happens fairly uncommonly, again when we're speaking of films that the doc in question deals with on a frequent basis. Arm x-rays for orthopedist, abdominal x-ray for surgeons, chest x-rays for hospitalist, etc. This is another one of those things, where if the consumer was not so far removed from the things that made up their hospital bill, there might be more movement to change. I have no idea what the historical things were that lead to all films being read by radiologists in all hospitals, but I suspect that the "healthcare as a business" mentality had something to do with it, both from the standpoint of radiologists wanting to earn their income, and from non-radiologist being worried about lawsuits over things that they didn't see on x-rays, but someone else with more training may have. Quote Link to comment Share on other sites More sharing options...
Oxbow6 Posted May 3, 2014 Share Posted May 3, 2014 NDBCBS loses $97M+ last year. Healthcare spendibg up 10% in 1st quarter nationwide. Sharpest rise since 1980. Obamacare vs eventual single payer system under Hillary. Death by stoning or hanging...discuss. Oh and homeownership lowest since 1995. Quote Link to comment Share on other sites More sharing options...
Bison Dan Posted May 3, 2014 Share Posted May 3, 2014 NDBCBS losses $97M+ last year. Healthcare spendibg up 10% in 1st quarter nationwide. Sharpest rise since 1980. Obamacare vs eventual single payer system under Hillary. Death by stoning or hanging...discuss. Oh and homeownership lowest since 1995. With 92 million Americans not working homeownership would be a dream - 1 out of 5 Americans on food stamps. Cost of hiring workers cost prohibitive. European style economics. Quote Link to comment Share on other sites More sharing options...
werewolfoflondon Posted May 3, 2014 Share Posted May 3, 2014 Don't 47% of people net a zero tax liability? Maybe they should just take the credits away that makes them not pay any income tax. Also take away the mortgage interest deductions. Quote Link to comment Share on other sites More sharing options...
werewolfoflondon Posted May 8, 2014 Share Posted May 8, 2014 NDBCBS loses $97M+ last year. Healthcare spendibg up 10% in 1st quarter nationwide. Sharpest rise since 1980. Obamacare vs eventual single payer system under Hillary. Death by stoning or hanging...discuss. Oh and homeownership lowest since 1995. http://www.inforum.com/event/article/id/434173/ An inconvenient truth. How much did your premiums go up between Jan. 2001 and Jan. 2009? Minimum of a 100% since the average was a 120%. And how did your policy change also? Be honest now. I know that is hard for the right to do when it comes to this. Boehner just told us how many people had not paid their premiums for their new health insurance. Though the insurance companies said he was full of it. You will still believe it along with Bison Dan and the others. Don't forget that Obama's response to Hurricane Katrina was terrible. Quote Link to comment Share on other sites More sharing options...
Bison Dan Posted May 8, 2014 Share Posted May 8, 2014 http://www.inforum.c...icle/id/434173/ An inconvenient truth. How much did your premiums go up between Jan. 2001 and Jan. 2009? Minimum of a 100% since the average was a 120%. And how did your policy change also? Be honest now. I know that is hard for the right to do when it comes to this. Boehner just told us how many people had not paid their premiums for their new health insurance. Though the insurance companies said he was full of it. You will still believe it along with Bison Dan and the others. Don't forget that Obama's response to Hurricane Katrina was terrible. ACA was suppose to cure the problem of people being uninsured, right. Out of the 40M or so what we are down to 38-39M. Wow great job. Now people have policies covering things they don't want and high deductibles and co-pays. (12,300.00) out of pocket. How many families can afford that? Plus who's paying for it? Taxpayers! It's a joke and you now it. SS going broke, MC almost broke, and now we have another entitlement that's underfunded. 1 Quote Link to comment Share on other sites More sharing options...
Oxbow6 Posted May 8, 2014 Share Posted May 8, 2014 http://www.inforum.c...icle/id/434173/ An inconvenient truth. How much did your premiums go up between Jan. 2001 and Jan. 2009? Minimum of a 100% since the average was a 120%. And how did your policy change also? Be honest now. I know that is hard for the right to do when it comes to this. Boehner just told us how many people had not paid their premiums for their new health insurance. Though the insurance companies said he was full of it. You will still believe it along with Bison Dan and the others. Don't forget that Obama's response to Hurricane Katrina was terrible. Don't worry...your goal of this country becoming the new Sweden or worse...Canada...is on the horizon. But at least we are starting to be infiltrated with Tim Horton's. The "new" American dream..."What's mine is mine and what is yours is mine...and BTW it's not my fault". Quote Link to comment Share on other sites More sharing options...
Oxbow6 Posted May 8, 2014 Share Posted May 8, 2014 And on a side note the CEO of NDBCBS was canned effective immediately last week after the report came out that BCBS of ND lost $73M+ in 2013. Was on a BCBS board a few years when von Ebers was the CEO. Is good man, a very intelligent man. With the current ACA format and as more of it is rolled out, more of his kind will find themselves with a pink slip...it's just the trickle down effect of a bad idea and plan that in realilty as it is being implemented is even worse than initally thought. Quote Link to comment Share on other sites More sharing options...
werewolfoflondon Posted May 8, 2014 Share Posted May 8, 2014 ACA was suppose to cure the problem of people being uninsured, right. Out of the 40M or so what we are down to 38-39M. Wow great job. Now people have policies covering things they don't want and high deductibles and co-pays. (12,300.00) out of pocket. How many families can afford that? Plus who's paying for it? Taxpayers! It's a joke and you now it. SS going broke, MC almost broke, and now we have another entitlement that's underfunded. I see you are a FauxNews fan. The land where facts do not matter. Quote Link to comment Share on other sites More sharing options...
werewolfoflondon Posted May 8, 2014 Share Posted May 8, 2014 Don't worry...your goal of this country becoming the new Sweden or worse...Canada...is on the horizon. But at least we are starting to be infiltrated with Tim Horton's. The "new" American dream..."What's mine is mine and what is yours is mine...and BTW it's not my fault". I see you chose to ignore my facts. The ACA had nothing to do with their loses and you know it. Quote Link to comment Share on other sites More sharing options...
werewolfoflondon Posted May 8, 2014 Share Posted May 8, 2014 ACA was suppose to cure the problem of people being uninsured, right. Out of the 40M or so what we are down to 38-39M. Wow great job. Now people have policies covering things they don't want and high deductibles and co-pays. (12,300.00) out of pocket. How many families can afford that? Plus who's paying for it? Taxpayers! It's a joke and you now it. SS going broke, MC almost broke, and now we have another entitlement that's underfunded. It is OK for the taxpayers to subsidize your insurance but not others? Quote Link to comment Share on other sites More sharing options...
Oxbow6 Posted May 8, 2014 Share Posted May 8, 2014 I see you chose to ignore my facts. The ACA had nothing to do with their loses and you know it. Nothing to do with it is incorrect...just like you assuming the "facts" you cited in the article make all of NDBCBS and Noridian business dealings corrupt. No offense but your "knowledge" on this whole topic is limited at best along with your understanding of the ACA. Quote Link to comment Share on other sites More sharing options...
MafiaMan Posted May 8, 2014 Share Posted May 8, 2014 I see you are a FauxNews fan. The land where facts do not matter. Hey, I tuned into MSNBC to see what the news of the day was on Monday and THIS was what I got... http://www.youtube.com/watch?v=xsBpYZgj45g Lean forward. Quote Link to comment Share on other sites More sharing options...
Redneksioux Posted May 8, 2014 Author Share Posted May 8, 2014 I see you chose to ignore my facts. The ACA had nothing to do with their loses and you know it. The average joe in the US does not understand the aca and obviously you don't work in health care. Ask anyone that works in health care how the aca is and will affect them moving forward. Ask patients that require numerous health care services how the aca is affecting them. And moving forward the aca will have negative effects on these patients more and more. Many rural health care facilities cannot afford to employ physicians and have been working with nurse practitioners and physicians assistants. Now the aca wants to take rx rights away from these providers and require physicians orders. This is not good for health care in North Dakota and many other rural areas. With that said didn't most of noridian's loss come from their electronic deal/fail in Maryland? Imagine how bad their losses would be if they didn't have the revenue their cms funded audit team brings in. 1 Quote Link to comment Share on other sites More sharing options...
Oxbow6 Posted May 8, 2014 Share Posted May 8, 2014 The average joe in the US does not understand the aca and obviously you don't work in health care. Ask anyone that works in health care how the aca is and will affect them moving forward. Ask patients that require numerous health care services how the aca is affecting them. And moving forward the aca will have negative effects on these patients more and more. Many rural health care facilities cannot afford to employ physicians and have been working with nurse practitioners and physicians assistants. Now the aca wants to take rx rights away from these providers and require physicians orders. This is not good for health care in North Dakota and many other rural areas. With that said didn't most of noridian's loss come from their electronic deal/fail in Maryland? Imagine how bad their losses would be if they didn't have the revenue their cms funded audit team brings in. Can you please try not to bring any reason or "facts" to this discussion...it really clouds the issue for some here! Quote Link to comment Share on other sites More sharing options...
gfhockey Posted May 8, 2014 Share Posted May 8, 2014 Ladiesadies ladies. Let's have beers 2 Quote Link to comment Share on other sites More sharing options...
Oxbow6 Posted May 8, 2014 Share Posted May 8, 2014 Hey, I tuned into MSNBC to see what the news of the day was on Monday and THIS was what I got... News that matters.................... Quote Link to comment Share on other sites More sharing options...
Oxbow6 Posted May 8, 2014 Share Posted May 8, 2014 Ladiesadies ladies. Let's have beers Only if you are buying! Quote Link to comment Share on other sites More sharing options...
gfhockey Posted May 8, 2014 Share Posted May 8, 2014 I slept at an Americas best value inn last nite Quote Link to comment Share on other sites More sharing options...
iluvdebbies Posted May 8, 2014 Share Posted May 8, 2014 I slept at an Americas best value inn last nite Did you find some chicken? 1 Quote Link to comment Share on other sites More sharing options...
gfhockey Posted May 8, 2014 Share Posted May 8, 2014 Naw found me some Tatonka Quote Link to comment Share on other sites More sharing options...
gfhockey Posted May 8, 2014 Share Posted May 8, 2014 Naw found me some Tatonka Quote Link to comment Share on other sites More sharing options...
iluvdebbies Posted May 8, 2014 Share Posted May 8, 2014 Naw found me some Tatonka Like shooting fish in a barrel in western ND! Quote Link to comment Share on other sites More sharing options...
Recommended Posts
Join the conversation
You can post now and register later. If you have an account, sign in now to post with your account.