Affordable Care Act - Early Observations

[UtahSkier]

I don't have any direct experience with the new regulations... But a few experiences are being reported.

I had no idea the new rules were so intrusive...

According to the new regulations, the doctor can’t get paid for your visit if you have a test the same day. And the insurance will not reimburse for two tests given on the same day

Examining the "time suck" behind the Affordable Care Act

Examining the "time suck" behind the Affordable Care Act - Phoenix Business Journal

 

[M Paquette]

I'm not entirely sure the reason the doctor is splitting testing and exams is being stated accurately.

If you are in this situation, I'd suggest carefully examining the Medicare billing statements to see if perhaps a doctor visit is being coded with each test, as well as on days when you are being examined.

I can't find anything in the regulations that require testing and exams be on different days. I don't think a doctor cannot code for multiple outpatient visits on a single day the way the rules are written. Splitting out the testing and exams on different days may enable him to code doctor visits on each day, recovering some additional reimbursement.

 

[MichaelB]

UHC forced this upon us a year ago after asking the two previous years. They are separating doctor visits and tests in order to deal with each under separate categories of coverage and deductible. I don't know that this is the case here, but it sounds very similar.

 

[rbmrtn]

Sounds like more of coding issue and the office in question just charging for more visits than needed. Also confusion on wellness visits vs medically necessary visits.

This is some info on coding this

Medical Billing and Coding Essentials: Annual Wellness Visits

This document mentioned says service can be performed during the same visit, if coded correctly.

http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/clm104c12.pdf

 

[Animorph]

Sounds like my insurance. They disallow whole charges, saying they are covered as part of the office visit or whatever. Part of the doctor/insurance contract.

 

[MichaelB]

We had a long discussion with our agent on this. He said that in many insurance plans, Doctor visits were covered at higher rates than lab tests, and some Doctors had taken advantage of that by covering the tests as part of the visit. By separating them the cost of the lab tests was treated more equitably across plans and patients.

I think this just shows how difficult it is to control health care costs. Efforts to limit costs are met with both patients and service providers looking for ways to get around them

 

[samclem]

I think this just shows how difficult it is to control health care costs. Efforts to limit costs are met with both patients and service providers looking for ways to get around them

That's for sure. The more detailed the rules, the more effort goes into finding a way to maximize returns through "effective" use of them. That's a lot of overhead (on both sides of the fence) being paid for something that has nothing directly to do with medical care.
Cost controls and bureaucracy seem to be big issue for any "fee for service" arrangement where the entity receiving the service isn't the entity paying the provider.

 

[Malcolm2]

Cost is a direct result of regulation. For example, why are the same drugs dramatically more expensive in the U.S. than other countries? I have personally seem this. Sadly, Obamacare will only add regulation not address this issue or the related abuse of the civil courts that is occurring on a massive scale.

 

[gerrym51]

Cost is a direct result of regulation. For example, why are the same drugs dramatically more expensive in the U.S. than other countries? I have personally seem this. Sadly, Obamacare will only add regulation not address this issue or the related abuse of the civil courts that is occurring on a massive scale.

Malcolm-i am a pharmacist-drugs are more expensive here if their patents have not run out.

Our FDA usually approves drugs a few years after the European common market-which includes canada.

ergo the patents run out sooner in the european common market and are available sooner generically than the USA.

 

[Malcolm2]

Malcolm-i am a pharmacist-drugs are more expensive here if their patents have not run out.

Our FDA usually approves drugs a few years after the European common market-which includes canada.

ergo the patents run out sooner in the european common market and are available sooner generically than the USA.

Interesting, thanks for the insight. I wish we could fix this! Seems wrong that the USA develops a great number of great drugs but effectively subsidizes other countries.

 

[jollystomper]

I have noticed with the practice I go to that lab tests are only done on the same day when it is part of my annual physical, perhaps because our insurance covers that in full. However, when coming it for tests only we do not see a doctor so the only charge is for the test and not a doctor visit.

 

[grasshopper]

My doc already fixed this, we get our lab orders 1 month before our physicals. My Urologist gives me an order 6 months before my next visit.