Thursday, January 9, 2014

The Bill Arrives

Until the final bill arrives for any number of things, car repair, home remodeling and other services you end up often with case of "sticker shock". That is the disorder that happens when the costs that you have anticipated but not budgeted may be shocking; however, they are not often without some notice or forewarning. In some cases it falls to the notion that expect the worst and hope for the best. But with medical care there is never a best case scenario. The reality is that the lack of transparency, the kind or no kind of insurance situation, the hospital, the actual Doctor and even where you live or other extraneous factors can lead to more than shock, it can lead to a full on rupture.

The one field out of many perhaps the only one other than real estate or stock market that can destroy a families entire life savings if not their lives in many other ways. And interesting that of the options we haveit fits into a category of those that nearly bankrupted the country as well.

The whole notion of the Affordable Care Act was to increase the insurance rolls and in turn reduce costs by not have a tiered billing system.  Well on paper that was a good idea. On 1000 of pages of paper.  Ironic that it mirrors hospital billing as it too comes on thousands of paper. And every picture tells a story, well in medical billing it is every code and no it is not one size fits all even when the injury or procedure is just that one size and one type.

Been to a Doctor lately? Many enter with Ipods or PC's in which to enter codes and diagnosis to prompt of course upselling and cross referencing for billing codes dependant upon the insurance you possess.

The requirement to convert all medical records has done nothing to help patients, but what it has done other than make software providers rich is offerred new ways to inflate bills and increase the fraud they already perpetuate. If I didn't know better I would think Attorney's wrote the software as they know all about excessive billing.

The irony that the Affordable Care Act has nothing to do with affordability or care.

Report Finds More Flaws in Digitizing Patient Files
By REED ABELSON JULIE CRESWELL
Published: JAN. 8, 2014


Although the federal government is spending more than $22 billion to encourage hospitals and doctors to adopt electronic health records, it has failed to put safeguards in place to prevent the technology from being used for inflating costs and overbilling, according to a new report by a federal oversight agency.

The report, released on Wednesday by the Office of the Inspector General for the Health and Human Services Department, is the second in two months to warn about flaws in the oversight of the ambitious federal program aimed at converting patient records from paper to electronic. It comes as the Obama administration continues to face broad criticism over the troubled rollout of its health care law — especially the HealthCare.gov site.

Despite spending “considerable resources to promote widespread adoption of E.H.R.’s,” or electronic health records, the government has “directed less attention to addressing potential fraud and abuse,” according to the report. Medicare has not changed the way it tries to detect fraud and has provided its contractors “with limited guidance,” the report said.

The report was especially critical of the lack of guidelines around the widely used copy-and-paste function, also known as cloning, available in many of the largest electronic health record systems. The technique, which allows information to be quickly copied from one document to another, can reduce the time a doctor spends inputting patient data. But it can also be used to indicate more extensive — and expensive — patient exams or treatment than actually occurred. The result, some critics say, is that hospitals and doctors are overcharging Medicare for the care they are providing. While the report did not estimate the amount of fraud that may be occurring, earlier government estimates have said it could run in the hundreds of millions of dollars.

Although the amount is a fraction of the trillions of dollars spent annually on health care, the lack of safeguards at a time when the new technology is becoming pervasive could allow the fraud to balloon.

“As E.H.R. adoption has increased, so has its involvement in our cases,” said Michael Cohen, an inspector at the oversight agency’s investigations office, which is charged with investigating health care fraud in government programs.

In a separate analysis released last month, the inspector general’s office found that three-quarters of the hospitals it surveyed had no formal policy surrounding the use of copy-and-paste for electronic health records. Its latest report faults Medicare for failing to provide guidance to the contractors who actually handle the payments on how to ferret out fraud stemming from the digital transformation. The office plans to make the scrutiny of cloning a priority for the coming year.

In a statement, Medicare officials called preventing fraud “a top priority” and said, “We are working to create strong standards for validating electronic health records to ensure that we allow beneficiaries to receive the care they need and at the same time protect taxpayers from fraud waste and abuse.”

They also said they were developing better instructions for their contractors, but argued that the agency’s specific recommendation about how contractors should detect fraud — by closely reviewing changes to specific patient documents — would not be appropriate for every situation. Hospitals say they are already carefully monitoring the use of electronic records.

“Hospitals already have strong safeguards,” said Linda E. Fishman, a senior executive for public policy at the American Hospital Association. But, she said, they are also being pushed to adopt the new systems as quickly as possible. Federal officials “don’t want providers to take their foot off their gas pedal,” she said. a

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