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Source is my own lived work experience. In the healthcare companies I've worked in, the size of teams to investigate benefit coverage, to bill, and then to nag
by burnte 2y ago
Source is my own lived work experience. In the healthcare companies I've worked in, the size of teams to investigate benefit coverage, to bill, and then to nag insurers to actually pay us works out to roughly 15% of the total staff. This is where _providers_ are about 25% of staff. Add to those salaries the costs of the tools we have to employ to manage it all, track it, and management of all of those folks, and it bloats the cost by 20%.
We're actually working with an AI company to build a tool that uses AI and lots of data to predict with better accuracy benefit coverage. All because insurers want barriers to treatment to lower their costs.
If we went single payer, we would virtually eliminate benefits investigation teams because Medicare is honestly super easy to determine benefits of a patient unless they're on the private Medicare Advantage plans. We could eliminate the need to work with clearing houses as we'd have one payor, not hundreds of payors each with dozens of plans and single-case agreements. RCM departments would shrink because with one payor, providers wouldn't have to constantly nag payors to actually send the money.
The admin overhead is sickening.
- apple4ever 2y agoThe problem is the overhead of government is even worse.
- psadauskas 2y ago[citation needed]
- burnte 2y agoNo, Medicare and CMS are run exceptionally well with some of the least fraud and waste in the entire government. CMS is NOT an agency you want to screw with because they come down like a ton of bricks when they find fraud. People go to prison. It's not like being a DoD contractor where they milk billions from the gov't.
- mulmen 2y agoHow much worse? How do you know? Reagan’s Nine Scariest Words quip sounds nice but it works just as well when you replace “government” with “corporate” or “church” or “next door”.