Posted on 01/26/2014 5:07:06 AM PST by Red in Blue PA
Every day the scorecards went up, where they could be seen by all of the hospital’s emergency room doctors.
Physicians hitting the target to admit at least half of the patients over 65 years old who entered the emergency department were color-coded green. The names of doctors who were close were yellow. Failing physicians were red.
The scorecards, according to one whistle-blower lawsuit, were just one of the many ways that Health Management Associates, a for-profit hospital chain based in Naples, Fla., kept tabs on an internal strategy that regulators and others say was intended to increase admissions, regardless of whether a patient needed hospital care, and pressure the doctors who worked at the hospital.
This month, the Justice Department said it had joined eight separate whistle-blower lawsuits against H.M.A. in six states. The lawsuits describe a wide-ranging strategy that is said to have relied on a mix of sophisticated software systems, financial incentives and threats in an attempt to inflate the company’s payments from Medicare and Medicaid by admitting patients like an infant whose temperature was a normal 98.7 degrees for a “fever.”
(Excerpt) Read more at finance.yahoo.com ...
The trend toward complexity in medical coding is all too real. The response that you suggest has been adopted by some providers but, by definition, cannot be embraced by more than a few or the health care system starts to implode. So far, the trend under Obamacare is of rising doctor compensation, probably because doctors are grabbing as much gold while they still can.
[ Twenty some odd years ago my Mother worked at the non-profit county hospital here in my small Texas hometown. It was sold to Hospital Corporation of America (HCA) and at midnight when the transfer of ownership took hold, the price of a bottle of sterilized water went from $2.30 to $23.75. ]
Heck Bendy i think that Hospitals should be able to treat illegals and then to bill their country of origin at 5X-10X their going rate and keep the prices low for us citizens!!!
But the government scheming to keep these same people out of the hospital is perfectly justifiable.
Our government is so F’d up.
In California they made big changes to the billing codes about 7-10 years ago. It was impossible to tell what the correct codes should be in some instances. Billing agents had to call the state to find out the right codes. And when they called the state, the state was vague and nonresponsive.
It’s all a big game out there. The government doesn’t like spending money on health care, and when it has a lock on it, the stuff is really going to hit the fan.
The game is all about entrapment of providers. What I’m doing now is recording all conversations that my billing staff has with insurance companies, and screen saving the websites that we are directed to by the insurance representatives. My billing staff always asks whether the individual on the line is a qualified representative of the company. BTW, we have one party consent for recording in WI. If we get into a dispute, the recordings are transcribed by a certified transcriber.
Good for you. I think that’s prudent.
Same thing happened with college tuition, they assumed student loans and taxpayers were paying for it.
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