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To: neolib who wrote (199822)	5/3/2009 11:20:28 AM
From: i-node	Read Replies (3) \| Respond to of 306849

No he does not. The doc scrawls by hand on a sheet of paper, and another individual peers at his scrawl, tries to decode it accurately, and enters it into a computer. Actually, most clinics (approaching 100%) use a "superbill" where the doctor "checks off" the procedures that were done. It is possible for an error to occur, but with good billing people it usually is not a problem. You also failed to account for the cost of claims adjustments. I happen to have a cousin, with only a HS education who has worked for many years for BCBS as a medical claims adjuster and makes over $70K/year. These are all factors in why medical billing is inefficient. So, are you suggesting that insurance companies (or a single government payer) should just pay all claims without any review process, whatsoever? Safeway would object to just the paper, envelope and stamps involved in medical billing. As pointed out previously, very few claims involve paper, stamps or envelopes. Well beyond 95% of the claims our clients generate are able to be filed electronically. Many of the other 5% or so are consolidated at a clearinghouse and shipped in a single package to the payer. I think it is pretty well documented that the insurance payment overhead in the USA is somewhere in the 10-20% range. You seem to be claiming it is much less. What number would you place on it? Actually, I'm not sure any really knows what it is. But I can tell you that private insurance companies are motivated to weigh the cost of claims adjudication against the benefits derived. They could pay every claim that comes in with minimal cost; just let the computer receive the claims electronically and cut a check. Probably a couple cents per transaction. If you want to check the ICD9 code against the procedure code for reasonableness, it is a little more expensive. If you want to have a human look at the coding and confirm it to be acceptable, it is more expensive yet. If you want to do precertification, it costs money. United Health, a few years ago, dropped its precert requirements because they determined the time and money spent doing it wasn't worth it. So, the more intensive the adjudication you do, the more your claims operation costs, but the less likely it is an insurance will overpay a claim. With private insurers involved, that motivation is there. Not so much with government insurers. I think Medicare Part D is a great example. Bush made the highly sensible decision to set Part D up so there was no single government payer, rather, it was farmed out many private insurers. The result? 85% of Part D patients are pleased with their service, Part D is 1/3 under budget and is improving yearly. Medicare Part D may be an excellent model.