re: What in the hell is wrong with medical billing?

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Unpopular opinion: single payer will get rid of a lot of this confusion by streamlining the process. All you guys with private insurance are already paying for the freeloaders anyway.

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Single payer in the USA means traditional Medicare 4 all. Right now traditional Medicare only pays 80% of outpatient costs. The patient is responsible for the other 20%. However, that 20% is determined by how much Medicare reimburses. If a Medicare patient comes to my clinic for altered mental status and foul smelling urine. If I put the diagnosis as altered mental status and a uti I won’t get reimbursed for the visit because Medicare has decided that altered mental status due to UTI and UTI not a billable diagnosis anymore. If I call it acute encephalopathy of unknown origin and acute cystitis (urinary tract infection located in the bladder) then Medicare reimburses. If I call it acute metabolic encephalopathy secondary to acute cystitis without hematuria (aka urinary bladder infection without blood in the urine) Medicare reimburses even more because Medicare believes my medical decision making is higher. It’s not. The patient has a UTI and altered mental status and the most common cause of altered mental status in the elderly is UTIs and the treatment is the exact same. Basically Medicare is rewarding me for using big words instead of simple words. As I said before, Medicare requires the patient to pay 20% of outpatient costs. If Medicare reimburses a higher amount it means my office has to bill the patient more than their copay in order to maintain the 80/20 Medicare split. This all sounds sketchy but it’s completely legal (it is all in the fine print in the welcome to Medicare information). In fact Medicare encourages doctors to be specific as possible and use medical terminology when it comes to how we diagnose things because they believe it provides better care and helps reduce errors. The other insurance companies follow Medicare’s leave since they have to follow Medicare’s rules if they wish to participate in Medicare part C or Obamacare. Insurance companies usually lose money with Obamacare but they make a lot of money from Medicare part C so they play by Medicare’s rules.

The US medical system is broken and it is mainly broken because of Medicare. Medicare is the biggest insurance company in the country and the biggest part of the problem because it makes the rules and the other insurance companies copy them. How is Medicare for All going to fix this? Single payer is just another example of doubling down on a failed system because it sounds like a good idea if you don’t think about the causes of the problem.