4 ms·

> There are tens of thousands of procedure and drug codes (things that are done or given) and tens of thousands of diagnostic codes www.mcmaster.com has half a

by kortex 4y ago

> There are tens of thousands of procedure and drug codes (things that are done or given) and tens of thousands of diagnostic codes www.mcmaster.com has half a million products. Amazon has who the hell knows. Even factoring in combinations, sheer number alone should not make the problem any more complex than any inventory/product system.

medizin123 4y ago
Conveniently, I have worked both in a publishing firm with a catalogue of several million books and in a health firm and am neck-deep in translating algorithmic coverage systems into someone else’s algorithmic coverage system. Please allow me to bloviate: It is logically complicated far and beyond ordering a book. Understanding what is even needed for billing up-front isn’t possible in all cases. What happens when you have extra bleeding during a procedure and now need additional units of blood and associated equipment and care? How do you bill this in advance? Then, we have “medically necessary” issues. Your insurance may cover an issue if it is medically necessary, but it often isn’t clear if it is or isn’t until game-day. Then what? Or, of course, the hospital and insurer may have different professionals engaged in a spirited debate over whether or not a given piece of academic literature supports or denies the necessity of a procedure. So there we have an issue that isn’t algorithmic at all (a human debate!) Then we have all kinds of other fun issues, like the coding being a living document. The AMA regularly “refactors” coding as the medical world evolves. What was billed yesterday as one code may become two or three different items each with their own conditions applied. Except the old code is still supported as well so now someone has to go back and sus out the discrepancy between the ordering provider and the insurance payer. So, for very rote procedures it actually is easy to give flat rates and solid estimates. I have a local Doc-in-a-Box facility that offers a flat-rate $90 service for a standard visit which even includes things like x-rays and steroid shots. When I went in with a stomach bug and needed some add-ons it was a simple piece-sheet line item as you wish. BUT! The world isn’t this simple, medicine is a very complex practice, and so we can’t simply estimate a price out-of-the-gate. As an exercise, think to yourself - my friend walked up and asked me to make his awesome Facebook-for-Cats app. Well, please provide me an exact billing of what you will need in terms of time and cost. If you’re now thinking “well shoot, what features does he need?” You’ve now founded yourself in a bounded-but-open question. These also happen in medicine and are why “just give me the number” isn’t easy.

by kortex 4y ago

medizin123 4y ago

Conveniently, I have worked both in a publishing firm with a catalogue of several million books and in a health firm and am neck-deep in translating algorithmic coverage systems into someone else’s algorithmic coverage system. Please allow me to bloviate: It is logically complicated far and beyond ordering a book. Understanding what is even needed for billing up-front isn’t possible in all cases. What happens when you have extra bleeding during a procedure and now need additional units of blood and associated equipment and care? How do you bill this in advance? Then, we have “medically necessary” issues. Your insurance may cover an issue if it is medically necessary, but it often isn’t clear if it is or isn’t until game-day. Then what? Or, of course, the hospital and insurer may have different professionals engaged in a spirited debate over whether or not a given piece of academic literature supports or denies the necessity of a procedure. So there we have an issue that isn’t algorithmic at all (a human debate!) Then we have all kinds of other fun issues, like the coding being a living document. The AMA regularly “refactors” coding as the medical world evolves. What was billed yesterday as one code may become two or three different items each with their own conditions applied. Except the old code is still supported as well so now someone has to go back and sus out the discrepancy between the ordering provider and the insurance payer. So, for very rote procedures it actually is easy to give flat rates and solid estimates. I have a local Doc-in-a-Box facility that offers a flat-rate $90 service for a standard visit which even includes things like x-rays and steroid shots. When I went in with a stomach bug and needed some add-ons it was a simple piece-sheet line item as you wish. BUT! The world isn’t this simple, medicine is a very complex practice, and so we can’t simply estimate a price out-of-the-gate. As an exercise, think to yourself - my friend walked up and asked me to make his awesome Facebook-for-Cats app. Well, please provide me an exact billing of what you will need in terms of time and cost. If you’re now thinking “well shoot, what features does he need?” You’ve now founded yourself in a bounded-but-open question. These also happen in medicine and are why “just give me the number” isn’t easy.