… um, no, doctors are being ripped off by the Private Equity operators who have the CMS bureaucrats on their payroll.
{{ Over the past five years, CMS adopted that company’s positions on fees. Shteynshlyuger discovered that, when it comes to the issue he cares about, the most powerful decision-maker wasn’t a CMS official. It was the chief lobbyist for a middleman company called Zelis. And that man just happened to be a former CMS staffer who had authored a key federal rule on electronic payments. }}
CMS (Centers for Medicare & Medicaid Services), some standards organization that defines the encoding of every possible medical task that can be charged in the online billing systems linking doctors and insurance companies.
During my career, we had a very good billing agent that had worked for “both sides of the aisle” as far as billing in concerned. He knew all the ins and outs and collected what was due us about 99% of the time. Even then, it was ridiculous how often proper charges were denied. It often seemed to be some random number generator that kicked out X number per month, just hoping you’d give up on the collecting.
@JLC As a doctor the last thing you want to do is jam your head full of all the codes and explain them to patients. Total waste of unbillable time.
The idea that it made no sense to you is true in two ways, sometimes it made no sense other times it was not really in your wheelhouse. If a clerical error was made you personally were not going to follow up or hear about it very often. I hope.
That said Dad knew a lot about this as an admissions head and as the head of a clinic system in retirement.
What’s happening here is that lobbyists connected with Private Equity funded firm Zelis were successful in changing a rule that required insurance companies to pay doctors via ACH/ETF, which incurs no transaction fees to the doctor. Insurance companies that use Zelis as a payment processor can skim-off a 2.9% transaction fee from any payments owed a doctor or hospital. This all being done in accordance with conservative business principles inspired by Ronald Regan and pioneered by Mitt Romney during his career as a Private Equity innovator. It’s just that doctors are being harmed in this instance, rather than poor and middle-class folks.
It’s still a frigging crime. Letting Private Equity suck an extra 2.9% out of the health care budget with no improvement in anyone’s health is what’s wrong with the system.
That is easy to fix. Require the percentage to be reduced to 2% for two years, then 1.5% for two years, then to 1% for two years, then to 0.5% for two years, and then set at 45-cents per transaction thereafter. It is putting the savings in the hands of the patients. Sure, doctors/clinics/etc may not pass on the savings, but that is a Catch-22: When they whine about “high costs”, point at the $$$ they received by NOT passing on the cash savings they realized when those fees were mostly eliminated.