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I work in healthcare as a CIO. I interact with all of our billing systems, processes, and departments. Frankly, I think the estimate of a 14% savings due to red
by burnte 7y ago
I work in healthcare as a CIO. I interact with all of our billing systems, processes, and departments. Frankly, I think the estimate of a 14% savings due to reduced administration to be low. Single payer would eliminate 30% of non-medical jobs in my company.
Teams eliminated or dramatically reduced:
* VOB, verification of benefits, they fight with the insurance company just to determine what coverage the patient has, and it is purposefully not automated. If it were automated, it would be easier for us to know what they'll pay. By making it a manual process (or at least only partially automated) we have a greater chance of making a mistake they can reject a claim over. We also have a greater chance of simply getting someone on a bad day and refusing to cover things preemptively, required it to be elevated to our Appeals department.
* Coding, people whose jobs it is to make sure the notes left in the record by medical staff (doctors, nurses, techs, etc) is properly translated to ICD10 codes.
* Billers, people whose job it is to bundle up claims and records, make sure they're properly sorted for each insurance company, and submit the claims.
* UR, utilization review, the group that reviews how accurately we're tracking the treatment guidelines of the INSURER so they don't deny the claim for missing a comma. Our UR group missed a small technicality on some claims and we had to submit paper copies of every claim for 6 months to the insurer, in addition to the electronic requests as a "remediation and verification step", aka, punishment. We would literally print out the electronic claim, and mail it, so it's going to be identical to the electronic claim, but we had to do it for 6 months for one facility to one insurer.
* Collections, the people who call up the insurance company to demand payment for claims they approved but haven't paid on. This is a much larger group than you'd think, as most insurers will happily make you wait for payment until you complain.
* Appeals. They address complains made by insurers over rejected claims, either fixing the issue with the charge, or going to the insurers appeals department to tell them why it's correct. They also talk to insurers over patients that are rejected at the VOB stage.
* Out Of Network, these folks do nothing but deal with insurers we're not in-network with, collecting payments, negotiating Single Case Agreements, etc.
VOB and OON would be gone completely. Coders, UR, Bilelrs would have a lot less to do because there would be one insurer to deal with, so we could have fewer people. Medicare pays promptly and without hassle on approved claims, so does Tricare, so we'd need a lot fewer people in collections. We'd need fewer appeals people too due to one set of rules for everyone.
Healthcare in the USA is REALLY messed up, it's the worst sausage I've ever seen being made.
- chasd00 7y agoi said this in another thread but you're assuming the single paying entity gets it even close to right.
- codegeek 7y agoMay be it doesn't. So should we just accept the Status quo ? I personally cannot and this issue is very important to me.
- redler 7y agoOne architectural difference is that the single-paying entity's job would be primarily to pay. The job of the many current entities is to not pay -- and to develop labyrinthine, nondeterministic, unknowable structures of great complexity to that specific end. Payments for care under our for-profit system are actually called "medical loss".
- burnte 7y agoConsidering how many other industrialized nations have it, we'd have to try incredibly hard to get it wrong. Plus, it's not like we can't make changes later. Plus we already have Medicare, and do that pretty well.