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and somehow got vilified a few weeks ago when Blue Cross tried to adopt Medicare's anesthesia billing rules LOL That is absolutely fucking NOT why Blue Cros

and somehow got vilified a few weeks ago when Blue Cross tried to adopt Medicare's anesthesia billing rules LOL That is absolutely fucking NOT why Blue Cross Blue Shield got vilified. Please stop making disingenuous arguments. BCBS attempted to weaponize Medicare statistics and set a hard cap on anesthesia coverage based on the average time Medicare says a procedure takes. This is NOT how Medicare reimbursement works. Medicare pays anesthesia providers for the entire time a patient is under. Full stop.

tptacek 2y ago
No, from everything I understand about the situation, this is the opposite of the truth. Feel free to cite a source saying otherwise! I'll read it!
- inferiorhuman 2y ago
  Yeah, go read the rules set forth by CMS. Medicare pays for the entire cost of anesthesia. So here's why I'm so dismissive of your garbage argument. From Medicare's policy manual: https://www.cms.gov/files/document/chapter2cptcodes00000-01999final11.pdf https://www.cms.gov/files/document/chapter2cptcodes00000-019... A unique characteristic of anesthesia coding is the reporting of time units. Payment for anesthesia services increases with time. In addition to reporting a base unit value for an anesthesia service, the anesthesia practitioner reports anesthesia time. Anesthesia time is defined as the period during which an anesthesia practitioner is present with the patient. It starts when the anesthesia practitioner begins to prepare the patient for anesthesia services in the operating room or an equivalent area and ends when the anesthesia practitioner is no longer furnishing anesthesia services to the patient (i.e., when the patient may be placed safely under postoperative care). Compare this to BCBS's policy (which they've tried to scrub from the internet): https://www.asahq.org/about-asa/newsroom/news-releases/2024/11/anthem-blue-cross-blue-shield-will-not-pay-complete-duration-of-anesthesia-for-surgical-procedures https://www.asahq.org/about-asa/newsroom/news-releases/2024/... Anthem will arbitrarily pre-determine the time allowed for anesthesia care during a surgery or procedure. If an anesthesiologist submits a bill where the actual time of care is longer than Anthem's limit, Anthem will deny payment for the anesthesiologist’s care. With this new policy, Anthem will not pay anesthesiologists for delivering safe and effective anesthesia care to patients who may need extra attention because their surgery is difficult, unusual or because a complication arises. There's a vast gulf between those two approaches. Medicare pays for the time a procedure takes, BCBS does not. BCBS deserves every ounce of vitriol they got over that. Your entire argument appears to be that doctors are corrupt and cannot be trusted which is entirely orthogonal to the the issue with pre-determining the amount of time a procedure will take. Meanwhile BCBS overcharged (a.k.a. fraudulently charged) the federal government for over $100 million. Doctors are not the problem with health care in the United States. https://www.reuters.com/legal/anthem-must-face-us-government-lawsuit-alleging-medicare-advantage-fraud-2022-10-03/ https://www.reuters.com/legal/anthem-must-face-us-government... UHC? $7.5 billion (with a b) in fraudulent Medicare charges. https://www.startribune.com/report-unitedhealth-group-tops-list-of-medicare-advantage-insurers-receiving-billions-in-questionable-payments/601169613 https://www.startribune.com/report-unitedhealth-group-tops-l... Cigna? They settled their fraud cases for $200+ million. https://www.justice.gov/opa/pr/cigna-group-pay-172-million-resolve-false-claims-act-allegations https://www.justice.gov/opa/pr/cigna-group-pay-172-million-r... https://www.justice.gov/usao-sdny/pr/united-states-reaches-37-million-settlement-fraud-lawsuit-against-cigna-submitting https://www.justice.gov/usao-sdny/pr/united-states-reaches-3... Independent Health Association? $100 million. https://kffhealthnews.org/news/article/medicare-advantage-fraud-lawsuit-settlement-new-york/ https://kffhealthnews.org/news/article/medicare-advantage-fr... Private insurance is one of the biggest drivers of the obscene cost of health care in this country.
  - tptacek 2y ago
    No, they do not. This was a whole controversy last year. https://www.asahq.org/about-asa/newsroom/news-releases/2023/11/final-2024-medicare-physician-payment-rule https://www.asahq.org/about-asa/newsroom/news-releases/2023/... Lots of stuff to go find at this search: [medicare anesthesia upcoding] Reiterating: this is exactly why Blue Cross was vilified, and people angry about it were getting played by a lobbying group of some of the best-compensated professionals in America. Anesthesiologists getting paid more is not a consumer protection policy; it is the opposite of that, and it's wild that people think it might be otherwise.
    - inferiorhuman 2y ago
      Did you read what you posted? Because all you've cited is a bunch of complaints about the conversion factor and not the time factor. Medicare pays for the entire duration of the procedure. BCBS does not want to do that. Again. Go through the CMS regs and show me where Medicare puts a hard cap on payment like BCBS was trying to do. I know that's a tall ask because, simply put, they do not.
      - tptacek 2y ago
        Here's r/actuary on it: https://www.reddit.com/r/actuary/comments/1h70wic/does_anyone_have_context_or_details_regarding/ https://www.reddit.com/r/actuary/comments/1h70wic/does_anyon... I don't believe you're coming to this with a detailed understanding of the policy CMS has today or that Anthem was proposing. Sorry, at this point, unless you can cite a comparably specific source, I simply don't believe you, and we're probably at an impasse.
        inferiorhuman 2y ago
        And you're coming at this from a profit doesn't drive up the cost of medical care which is in and of itself a pretty gross misunderstanding of what profit is. Again, did you read what you cited? That redditor is justifying the cap that BCBS wants to implement, not disproving that Medicare does not implement a time cap. I'm not here to do your research for you. CMS regs and guidelines are a matter of public record. If you don't want to actually cite the comparable regs you claim exist that's not my problem. fleeing to abstraction. You're citing an insurance actuary who posted to reddit claiming no, it's not the for-profit insurance companies that are the problem, it's the corrupt doctors. That's absolutely fucking asinine. What next? A fox claiming it's the chickens that are the problem? Unlike private insurance companies, the rules and regs that Medicare puts forth are a matter of public record and you're still unable to cite anything supporting your claim that Medicare puts a hard time limit on anesthesia reimbursement. So go ahead, stop waving your hands and start citing something. You do understand what time units are, right? www.cms.gov What's that? You're going to continue tilting at windmills and railing against the evils of overpaid doctors instead of showing anything that supports your specious claims about Medicare? Okay then.

tptacek 2y ago

No, from everything I understand about the situation, this is the opposite of the truth. Feel free to cite a source saying otherwise! I'll read it!

inferiorhuman 2y ago
Yeah, go read the rules set forth by CMS. Medicare pays for the entire cost of anesthesia. So here's why I'm so dismissive of your garbage argument. From Medicare's policy manual: https://www.cms.gov/files/document/chapter2cptcodes00000-01999final11.pdf https://www.cms.gov/files/document/chapter2cptcodes00000-019... A unique characteristic of anesthesia coding is the reporting of time units. Payment for anesthesia services increases with time. In addition to reporting a base unit value for an anesthesia service, the anesthesia practitioner reports anesthesia time. Anesthesia time is defined as the period during which an anesthesia practitioner is present with the patient. It starts when the anesthesia practitioner begins to prepare the patient for anesthesia services in the operating room or an equivalent area and ends when the anesthesia practitioner is no longer furnishing anesthesia services to the patient (i.e., when the patient may be placed safely under postoperative care). Compare this to BCBS's policy (which they've tried to scrub from the internet): https://www.asahq.org/about-asa/newsroom/news-releases/2024/11/anthem-blue-cross-blue-shield-will-not-pay-complete-duration-of-anesthesia-for-surgical-procedures https://www.asahq.org/about-asa/newsroom/news-releases/2024/... Anthem will arbitrarily pre-determine the time allowed for anesthesia care during a surgery or procedure. If an anesthesiologist submits a bill where the actual time of care is longer than Anthem's limit, Anthem will deny payment for the anesthesiologist’s care. With this new policy, Anthem will not pay anesthesiologists for delivering safe and effective anesthesia care to patients who may need extra attention because their surgery is difficult, unusual or because a complication arises. There's a vast gulf between those two approaches. Medicare pays for the time a procedure takes, BCBS does not. BCBS deserves every ounce of vitriol they got over that. Your entire argument appears to be that doctors are corrupt and cannot be trusted which is entirely orthogonal to the the issue with pre-determining the amount of time a procedure will take. Meanwhile BCBS overcharged (a.k.a. fraudulently charged) the federal government for over $100 million. Doctors are not the problem with health care in the United States. https://www.reuters.com/legal/anthem-must-face-us-government-lawsuit-alleging-medicare-advantage-fraud-2022-10-03/ https://www.reuters.com/legal/anthem-must-face-us-government... UHC? $7.5 billion (with a b) in fraudulent Medicare charges. https://www.startribune.com/report-unitedhealth-group-tops-list-of-medicare-advantage-insurers-receiving-billions-in-questionable-payments/601169613 https://www.startribune.com/report-unitedhealth-group-tops-l... Cigna? They settled their fraud cases for $200+ million. https://www.justice.gov/opa/pr/cigna-group-pay-172-million-resolve-false-claims-act-allegations https://www.justice.gov/opa/pr/cigna-group-pay-172-million-r... https://www.justice.gov/usao-sdny/pr/united-states-reaches-37-million-settlement-fraud-lawsuit-against-cigna-submitting https://www.justice.gov/usao-sdny/pr/united-states-reaches-3... Independent Health Association? $100 million. https://kffhealthnews.org/news/article/medicare-advantage-fraud-lawsuit-settlement-new-york/ https://kffhealthnews.org/news/article/medicare-advantage-fr... Private insurance is one of the biggest drivers of the obscene cost of health care in this country.
- tptacek 2y ago
  No, they do not. This was a whole controversy last year. https://www.asahq.org/about-asa/newsroom/news-releases/2023/11/final-2024-medicare-physician-payment-rule https://www.asahq.org/about-asa/newsroom/news-releases/2023/... Lots of stuff to go find at this search: [medicare anesthesia upcoding] Reiterating: this is exactly why Blue Cross was vilified, and people angry about it were getting played by a lobbying group of some of the best-compensated professionals in America. Anesthesiologists getting paid more is not a consumer protection policy; it is the opposite of that, and it's wild that people think it might be otherwise.
  - inferiorhuman 2y ago
    Did you read what you posted? Because all you've cited is a bunch of complaints about the conversion factor and not the time factor. Medicare pays for the entire duration of the procedure. BCBS does not want to do that. Again. Go through the CMS regs and show me where Medicare puts a hard cap on payment like BCBS was trying to do. I know that's a tall ask because, simply put, they do not.
    - tptacek 2y ago
      Here's r/actuary on it: https://www.reddit.com/r/actuary/comments/1h70wic/does_anyone_have_context_or_details_regarding/ https://www.reddit.com/r/actuary/comments/1h70wic/does_anyon... I don't believe you're coming to this with a detailed understanding of the policy CMS has today or that Anthem was proposing. Sorry, at this point, unless you can cite a comparably specific source, I simply don't believe you, and we're probably at an impasse.
      - inferiorhuman 2y ago
        And you're coming at this from a profit doesn't drive up the cost of medical care which is in and of itself a pretty gross misunderstanding of what profit is. Again, did you read what you cited? That redditor is justifying the cap that BCBS wants to implement, not disproving that Medicare does not implement a time cap. I'm not here to do your research for you. CMS regs and guidelines are a matter of public record. If you don't want to actually cite the comparable regs you claim exist that's not my problem. fleeing to abstraction. You're citing an insurance actuary who posted to reddit claiming no, it's not the for-profit insurance companies that are the problem, it's the corrupt doctors. That's absolutely fucking asinine. What next? A fox claiming it's the chickens that are the problem? Unlike private insurance companies, the rules and regs that Medicare puts forth are a matter of public record and you're still unable to cite anything supporting your claim that Medicare puts a hard time limit on anesthesia reimbursement. So go ahead, stop waving your hands and start citing something. You do understand what time units are, right? www.cms.gov What's that? You're going to continue tilting at windmills and railing against the evils of overpaid doctors instead of showing anything that supports your specious claims about Medicare? Okay then.