Health Issues (US) Obamacare (Affordable Care Act)

[beancounter]

As far as I know, ACA does four main things - creates a fine if you don't have insurance, gives subsidies to low-income individuals for insurance, extends medicare coverage for the poor, and creates new regulations for the insurance companies in regards to who they must cover and what they must cover.

From the doctors' perspective, nothing changes - they bill the patient & insurance company/medicare, same as before.

True, but there will be new requirements for insurance companies to follow, and no doubt a bunch of new billing codes and classifications to deal with. I'm guessing a lot of that will trickle down to the doctors office in the form of additonal training for the admin staff, possibly upgrades to their existing systems, more paperwork between the insurance company and doctors office, greater number of human errors/billing issues/disputes with the insurance company, figuring out what patient is entitled to which service, and a larger number of bad debts to deal with.

 

[nigel1]

As far as I know, ACA does four main things - creates a fine if you don't have insurance, gives subsidies to low-income individuals for insurance, extends medicare coverage for the poor, and creates new regulations for the insurance companies in regards to who they must cover and what they must cover.

From the doctors' perspective, nothing changes - they bill the patient & insurance company/medicare, same as before.

In the short-term it is perceived to mean too many patients, too little doctors. I can see this as a short-term stress on the workload for doctors. It will stabilize in the long run, though.

 

[das_nut]

True, but there will be new requirements for insurance companies to follow, and no doubt a bunch of new billing codes and classifications to deal with. I'm guessing a lot of that will trickle down to the doctors office in the form of additonal training for the admin staff, possibly upgrades to their existing systems, more paperwork between the insurance company and doctors office, greater number of human errors/billing issues/disputes with the insurance company, figuring out what patient is entitled to which service, and a larger number of bad debts to deal with.

I'm still not seeing how more people enrolled in non-government insurance plans will result in an increase in paperwork.

Say before you have ten patients - Five on Blue Cross/Blue Shield or whatnot, two on medicare, three uninsured. After the ACA, you have Six on Blue Cross/Blue Shield, three on medicare, and one still uninsured. What changes for paperwork?

 

[beancounter]

I'm still not seeing how more people enrolled in non-government insurance plans will result in an increase in paperwork.

Say before you have ten patients - Five on Blue Cross/Blue Shield or whatnot, two on medicare, three uninsured. After the ACA, you have Six on Blue Cross/Blue Shield, three on medicare, and one still uninsured. What changes for paperwork?

The billing codes and reimbursement rates.

 

[ledboots]

The billing codes are changing to comply with HIPPA; I don't think it has anything to do with the ACA law directly.

From 2011
ANNA WILDE MATHEWSToday, hospitals and doctors use a system of about 18,000 codes to describe medical services in bills they send to insurers. Apparently, that doesn't allow for quite enough nuance.A new federally mandated version will expand the number to around 140,000—adding codes that describe precisely what bone was broken, or which artery is receiving a stent.

It will also have a code for recording that a patient's injury occurred in a chicken coop. (See code.)Indeed, health plans may never again wonder where a patient got hurt. There are codes for injuries in opera houses (see code), art galleries (see code), squash courts (see code) and nine locations in and around a mobile home (see codes), from the bathroom to the bedroom." ....

......"Why are there codes for injuries received while sewing, ironing, playing a brass instrument, crocheting, doing handcrafts, or knitting—but not while shopping, wonders Rhonda Buckholtz, who does ICD-10 training for the American Academy of Professional Coders, a credentialing organization.

Code V91.07XA, which involves a "burn due to water-skis on fire (see codes)," is another mystery she ponders: "Is it work-related?" she asks. "Is it a trick skier jumping through hoops of fire? How does it happen?"" http://m.us.wsj.com/articles/SB10001424053111904103404576560742746021106?mobile=y

 

[beancounter]

The billing codes are changing to comply with HIPPA; I don't think it has anything to do with the ACA law directly.

From 2011
ANNA WILDE MATHEWSToday, hospitals and doctors use a system of about 18,000 codes to describe medical services in bills they send to insurers. Apparently, that doesn't allow for quite enough nuance.A new federally mandated version will expand the number to around 140,000—adding codes that describe precisely what bone was broken, or which artery is receiving a stent.

It will also have a code for recording that a patient's injury occurred in a chicken coop. (See code.)Indeed, health plans may never again wonder where a patient got hurt. There are codes for injuries in opera houses (see code), art galleries (see code), squash courts (see code) and nine locations in and around a mobile home (see codes), from the bathroom to the bedroom." ....

......"Why are there codes for injuries received while sewing, ironing, playing a brass instrument, crocheting, doing handcrafts, or knitting—but not while shopping, wonders Rhonda Buckholtz, who does ICD-10 training for the American Academy of Professional Coders, a credentialing organization.

Code V91.07XA, which involves a "burn due to water-skis on fire (see codes)," is another mystery she ponders: "Is it work-related?" she asks. "Is it a trick skier jumping through hoops of fire? How does it happen?"" http://m.us.wsj.com/articles/SB10001424053111904103404576560742746021106?mobile=y

Glad you stopped by LB! Can you give us the specific reasons why doctors don't like the ACA? I want to hear it from someone at the source! That's you!

 

[das_nut]

The billing codes and reimbursement rates.

Did the ACA change either the billing codes or the medicare reimbursement rates?

Obviously, the ACA did not change private insurance reimbursement rates, which are negotiated between the hospital and the private insurance companies.

 

[beancounter]

Did the ACA change either the billing codes or the medicare reimbursement rates?

Obviously, the ACA did not change private insurance reimbursement rates, which are negotiated between the hospital and the private insurance companies.

The ACA changed the pre existing condition exclusion and allowed young people to stay on their parent's insurance through age 26. Why are you so certain that they are strictly acting as a 3rd party broker and didn't change/add any other conditions and requirements to any part of the medical care process?

 

[das_nut]

The ACA changed the pre existing condition exclusion and allowed young people to stay on their parent's insurance through age 26.

Neither of which should change the billing codes used - people still develop conditions when they have insurance.

Why are you so certain that they are strictly acting as a 3rd party broker and didn't change/add any other conditions and requirements to any part of the medical care process?

The analysis I've read of the ACA.

 

[Clueless Git]

Questions:

1. You have to buy insurance or pay a fine?

2. The insurance companies cannot refuse anyone insurance?

3. What stops the insurance companies putting the cost of compulsory insurance up to insanely high levels?

4. What stops people from choosing to pay a fine if the fine is more affordable than the insurance?

 

[beancounter]

Neither of which should change the billing codes used - people still develop conditions when they have insurance.


The analysis I've read of the ACA.

OK, then. That's what I asked for earlier. "if you have some info, please share". Can you post a link?

 

[RascalsMom]

4. What stops people from choosing to pay a fine if the fine is more affordable than the insurance?

Nothing... But the fine goes up every year for a few years, so it will eventually be pretty high.

 

[Clueless Git]

Nothing... But the fine goes up every year for a few years, so it will eventually be pretty high.

So, if the insurance companies simply set the premium for people they don't want to risk insuring higher than the maximum fine ...

What I'm thinking is that no one has mentioned any safeguard against simply pricing high risk people right out of the game, as it were.

 

[beancounter]

What I'm thinking is that no one has mentioned any safeguard against simply pricing high risk people right out of the game, as it were.

That's done in the form of high deductables... It looks great on the surface because the premiums are low, but then looking at the fine print, you can see just how anemic the plan is.

 

[ledboots]

Did the ACA change either the billing codes or the medicare reimbursement rates?

Obviously, the ACA did not change private insurance reimbursement rates, which are negotiated between the hospital and the private insurance companies.

Medicare reimbursement rates are lower to hospitals and physicians r/t the ACA. Many small hospitals cannot survive and are/will be snapped up by the huge hospital corporations. The urology group we share an office with has stopped accepting medicare patients altogether, and there really isn't too much choice left for these old guys with prostate, urinary, or sexual difficulties anymore.

The ER docs are happy, hoping that the gomers (get out of my emergency room) and frequent flyers will get preventive healthcare. The ERs will likely get smaller, concentrating on traumas.

The physicians i know mostly hate the ACA. The new rules of what insurance companies must cover are a nightmare logistically.

Free electric breast pumps for everyone, I say yay! (But there is of course a huge undersupply of breast pumps, companies have "preferred" suppliers who never have the pumps in stock, etc.) Insurance must cover maternity? Yay! (Except now most plans have huge deductibles, leaving the new parents owing thousands.)

The physicians mostly hate the electronic medical record vs paper charting, too. They are used to talking face to face with a patient, not having a computer come between them.

 

[ledboots]

Questions:

1. You have to buy insurance or pay a fine?
Yes. Some still get insurance as an employee benefit (still pay premiums) and the deductibles on these plans are often much higher than they were pre ACA.
2. The insurance companies cannot refuse anyone insurance?
Nope.

3. What stops the insurance companies putting the cost of compulsory insurance up to insanely high levels?
Nothing. They have choices often, choosing between high premiums or a high deductible.

4. What stops people from choosing to pay a fine if the fine is more affordable than the insurance?

Nothing. If I were young, healthy, and a risk-taker, I would just wait till I got hurt or sick to buy insurance. If I didn't, i would pay the fine. The government plan that most will get only pays 70 percent of covered expenses anyway.

 

[das_nut]

Nothing. If I were young, healthy, and a risk-taker, I would just wait till I got hurt or sick to buy insurance. If I didn't, i would pay the fine. The government plan that most will get only pays 70 percent of covered expenses anyway.

Yep. That's one of the flaws.

I'll live with the ACA, because it's better than what we had before, but I really wish we'd get a single-payer system.

 

[JaneBryan]

Obamacare is facing an unexpected new fee. It's to help cover people with pre-existing conditions under President Obama's health care overhaul.
The $63-per-head fee -- buried in a recent regulation -- will hit health plans serving an estimated 190 million Americans, mostly workers and their families. It's payable starting in 2014.

 

[das_nut]

At this point, why don't we socialize the system like any sane nation?

 

[beancounter]

At this point, why don't we socialize the system like any sane nation?

The short answer is that the insurance industry would be very unhappy.