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ACA Running Thread

I suspect these are huge tax write-offs for the providers. The $5300 gets written off for taxes. Not sure though. Can someone confirm?

Here is some what Medicare paid for MRI's six years ago:
https://apsmedbill.com/whitepapers/reduced-mri-payments-are-impacting-private-practices



So Medicare for All does break the provider price gouging, but brings government (Trump at government's worst) into healthcare.
A law setting a ceiling of twice Medicare would still make this MRI $430 if your insurance didn't negotiate any discount at all.
This would make health insurance about as affordable as car insurance. Most people have car insurance and maintain that outside their employment.

Now, for those without insurance, providers will not negotiate for any relief. They are happy to sell that $11k MRI for $.10 on the dollar - they'd still get more than Medicare. That's how out of whack their pricing is.
I mean it's not considered Revenue you only consider Revenue what you actually charge.
 
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It's pretty simple, Cousin Eddie, we simultaneously want a better system AND better leadership for that system. We are not trying to put more shit in an already full RV shitter, we want indoor plumbing and a descent plumber.
 
That’s like saying there’s some conflict between saying “Wake Forest should have a good basketball program” and “Wake Forest doesn’t have a good basketball program.”

Can you imagine being dumb enough to see that meme, laugh, and then share it? I guess you’d have to be dumb enough to believe government is ineffective while voting for the people who keep it ineffective.
 
It's pretty simple, Cousin Eddie, we simultaneously want a better system AND better leadership for that system. We are not trying to put more shit in an already full RV shitter, we want indoor plumbing and a descent plumber.

Maybe the reason the government response was inept was because of the bungling and incompetent leadership at the top, and the real lesson is that professional government-run healthcare would be better at responding to the crisis than unqualified narcissistic pols dumping their responsibility onto the states, who in some (red state governors) cases then dumped their responsibilities onto overwhelmed local officials. Nah, posting a stupid meme is just a better explanation.
 
That’s like saying there’s some conflict between saying “Wake Forest should have a good basketball program” and “Wake Forest doesn’t have a good basketball program.”

Can you imagine being dumb enough to see that meme, laugh, and then share it? I guess you’d have to be dumb enough to believe government is ineffective while voting for the people who keep it ineffective.


Yep.

Even cousin Eddie would say "Bingo".
 
Pretty sure government, private industry, or any other entity ain't ever gonna get everthang jus' right.


So...I think the answer is to destroy everything in utter despair.


Or maybe we can try and do better and not expect to ever get it perfect.
 
I can't remember who it was, but someone once said that Republicans love to claim that government is incompetent and doesn't work, and then they get elected and go out and prove themselves right.
 
I know I’ve said that many times over the years. Others have too.
 
I wonder how payers (health insurance companies) will do with this. There are severe cases and hospitalizations adding to cost. However, there is a much higher volume of (lower cost) visits deferred/cancelled and visits done for free via patient portals and telephone.
 
I wonder how payers (health insurance companies) will do with this. There are severe cases and hospitalizations adding to cost. However, there is a much higher volume of (lower cost) visits deferred/cancelled and visits done for free via patient portals and telephone.

A lot of phone and other virtual visits are being billed and reimbursed like in-person visits. But overall, you’re correct that there are fewer total visits.

The biggest financial change is the drastic decrease in elective, high-reimbursing surgical procedures.
 
Yep

Most (I suspect) provider systems are losing money hand over fist.

Already hearing about staff reductions, pay cuts, etc.

Gonna get worse, probably.
 
A lot of phone and other virtual visits are being billed and reimbursed like in-person visits. But overall, you’re correct that there are fewer total visits.

The biggest financial change is the drastic decrease in elective, high-reimbursing surgical procedures.

Nope. Pretty much all phone visits up to this point have been free. There is now approval of billing codes for phone visits. We will see how that gets reimbursed when the payers actually start paying. Video visits are still inefficient. There can be significant time investment to help patients access video visits. This isn’t Skype, or some other unsecured means of communication that just requires 2 people seeing/hearing each other. Billing is also not the same. I’m billing pretty much all of my video visits down a level because physical exam is limited. Some (especially older) patients decline the video visits. The get a free call from me. So, no, it’s not like in-person visits.
 
Nope. Pretty much all phone visits up to this point have been free. There is now approval of billing codes for phone visits. We will see how that gets reimbursed when the payers actually start paying. Video visits are still inefficient. There can be significant time investment to help patients access video visits. This isn’t Skype, or some other unsecured means of communication that just requires 2 people seeing/hearing each other. Billing is also not the same. I’m billing pretty much all of my video visits down a level because physical exam is limited. Some (especially older) patients decline the video visits. The get a free call from me. So, no, it’s not like in-person visits.

Nope. Phone and video reimburse the same as of the second CMS change last week, and phone billing started March 6. Billing is based on time. I’d be happy to dm if you have questions.
 
Nope. Pretty much all phone visits up to this point have been free. There is now approval of billing codes for phone visits. We will see how that gets reimbursed when the payers actually start paying. Video visits are still inefficient. There can be significant time investment to help patients access video visits. This isn’t Skype, or some other unsecured means of communication that just requires 2 people seeing/hearing each other. Billing is also not the same. I’m billing pretty much all of my video visits down a level because physical exam is limited. Some (especially older) patients decline the video visits. The get a free call from me. So, no, it’s not like in-person visits.

We are paying providers a lot of virtual visits and have been for some time, either through established practices or telehealth specific providers (e.g., Teladoc). There is certainly some billing nuance here. Not sure I follow the free part.

The payers are still very much in analysis mode. There are a lot of moving parts (extending no cost share coverage for COVID, recession impacts, delinquency impacts, higher/lower utilization, etc). I think you'll see varying results on the markets served (ie ACA v commercial v Medicare).
 
Yep

Most (I suspect) provider systems are losing money hand over fist.

Already hearing about staff reductions, pay cuts, etc.

Gonna get worse, probably.

Yup. We've been in contact with a lot of providers and systems who make their $ off elective services. They are worried (who isn't) and some are asking for help. We are trying to work with them as best we can.
 
Nope. Phone and video reimburse the same as of the second CMS change last week, and phone billing started March 6. Billing is based on time. I’d be happy to dm if you have questions.

Rafi, I don’t have questions. Sincerely, thank you. I’m living it. Just saying things are now covered does not lead to the system automatically working. I’m aware of what you are saying exists on paper. Again, that doesn’t mean it just works. There is much provided, staff and patient education/training that has to happen. Prior video visits were for issues that lended themselves to video and by patients that specifically sought that (tech savvy). Now, we are forcing visits into that format. Also, most of us rarely bill based on time. Rather, on elements documented. Time-based is a back up.
I am telling you that billing is dramatically down for many outpatient providers. There are many reasons going into that. It is not just as simple as bill telephone or video. Please understand that we are scrambling to meet the needs of our patients with new limitations. I am not going about this with a primary goal of figuring out how I can bill for all of those services. I am trying to help my patients get through this and setting up all encounters to be billable would get in the way of that.
 
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