Joe Biden’s brilliant critique of Medicare for all has made me rethink my position

the cac mamba

the cac mamba

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StatUS said:
Ok, so it's just the usual back and forth with one poster being purposefully obtuse. I'll leave then.
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who keeps track of everyone and all the billing, in medicare for all? serious question, i dont remember anyone explain that

and if im being obtuse, then what are the medicare for all politicians being? :laff:
 
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the cac mamba said:
we've already established that i'm wrong :yeshrug:

the same government that brought you 22 trillion dollar debt, the unaccountable public union, and the art of the cost overrun will carry out medicare for all, including people who come here illegally, to an absolute T :wow:
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Thank god you realize that you’re wrong. Nice set of non sequiturs too :mjlol:.
 
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the cac mamba said:
can you explain what bernie meant by putting a million health insurance workers out of a job?

i wouldnt piss on those people if they were on fire, either. im just curious how he intends to replace them :ehh:
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He wants to end private insurance. That's his vision realistically that won't happen and they'll probably still exist to offer the premium /Cadillac /supplemental plans
 
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the cac mamba said:
who keeps track of everyone and all the billing, in medicare for all? serious question, i dont remember anyone explain that

and if im being obtuse, then what are the medicare for all politicians being? :laff:
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The same people who keep track of medicare for all old heads and medicaid right now.

obviously this will create a lot more government jobs because there will be a lot more people covered.

What did i tell you? Just look at what we already have. no need for examples outside of that. you have enough pros and cons to debate that alone.

But you asked the question. so here's your answer.

How Medicare Billing Works

How Medicare Billing Works
Medicare was designed in 1965 as a single payer health system that is publicly funded. The funds to pay for Medicare services are collected from employers and self-employed individuals. The Federal Insurance Contributions Act taxes employers and employees a total of 2.9% of an individual’s income. Employees pay 1.45% and employers pay a matching 1.45% tax. Self employed individuals must pay the entire 2.9% tax themselves to contribute to the Medicare program. In a single payer health system, providers receive payment for services rendered from a general pool of funds that everyone contributes to through taxes.

The Medicare program has established a long list of services they will cover and the fee that Medicare will pay to a provider for a service provided to a beneficiary. Regardless of the cost the provider will charge for the services rendered, they will only receive the amount Medicare has determined the service is worth. Generally speaking Medicare providers will submit a bill to Medicare using the program’s coding system which identifies every service that could be provided to a beneficiary. Medicare then sends payment back to the provider for the services provided.

Medicare providers fall into two categories and these determine the manner in which billing is conducted. Participating Medicare providers are paid 80% of the Medicare allowed fee while the remaining 20% of the fee is paid for by the beneficiary. Non-participating Medicare providers will receive 80% of the Medicare determined fee and are allowed to bill 15% or more of the remaining amount to the beneficiary.

Medicare billing works differently for Part A (hospital) services and Part B (medical) services. Hospitals receive a set amount of money for each visit from a Medicare beneficiary that is not dependent on the level of care rendered to the individual. The exact amount of money paid to the hospital depends on an initial diagnosis from doctors when the patient arrives and that diagnosis is then compared to Medicare’s diagnosis related groups, which determines the amount of money passed along to the hospital for payment.

Billing for medical services rendered in a physician’s office or clinic is different however. Initially in 1965, doctors were simply reimbursed the fees they charged to Medicare. Over the decades different laws have been enacted to help balance the fees against the skyrocketing costs of medical care. The U.S. Congress has several times enacted different laws to control the rates at which doctor reimbursement fees grew from year to year. Several times during the mid 2000s the government acted to hold fees at the same level year after year. There have been many complaints in recent years that reimbursements for clinic fees are not paying doctors appropriately.

Medicare billing for medications dispensed by doctors in their offices reimburses physicians for those medications using an Average Sales Price. The ASP divides the number units of a drug sold nationwide by the dollar amount of sales to come up with a reimbursement rate. Currently doctors receive roughly 84.8% of the actual drug cost when they dispense treatments such as chemotherapy to Medicare beneficiaries. The remaining amount is paid for through copayments for those who can afford it or by Medicare Supplement Insurance plans.

The system of reimbursement for fees in Medicare is easily open to fraudulent billing and the practice is quickly becoming the biggest problem facing Medicare. Because there is no direct oversight of Medicare’s billing system doctors, sometimes in concert with patients, bill Medicare for services that were not rendered in order to get a larger reimbursement. Other fraudulent schemes include billing Medicare for durable medical goods such as wheel chairs multiple times for just one chair, and never even delivering the wheel chair.

Medicare billing has become a hot button topic in the United States. A lack of oversight on billing combined with ever increasing costs for medical services is causing problems with Medicare. As of 2008 Medicare cost the American public $386 billion which was roughly 13% of the total federal budget. While Medicare is project to take up only 12.5% of the federal budget in 2010, costs will rise to $452 billion.
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and

Medicare, Medicaid and Medical Billing
BILLING FOR MEDICAID
Creating claims for Medicaid can be even more difficult than creating claims for Medicare. Because Medicaid varies state-by-state, so do its regulations and billing requirements. As such, the claim forms and formats the biller must use will change by state. It’s up to the biller to check with their state’s Medicaid program to learn what forms and protocols the state follows.

In general, the medical biller creates claims like they would for Part A or B of Medicare or for a private, third-party payer. The claim must contain the proper information about the place of service, the NPI, the procedures performed and the diagnoses listed. The claim must also, of course, list the price of the procedures.

Be aware when billing for Medicaid that many Medicaid programs cover a larger number of medical services than Medicare, which means that the program has fewer exceptions.

One final note: Medicaid is the last payer to be billed for a service. That is, if a payer has an insurance plan, that plan should be billed before Medicaid.

In general, it’s much too difficult to describe the full process of billing Medicaid without going into an in-depth description of specific state programs. As this is just a basic introductory course, we won’t go into much more depth than this.
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Read all of the above and understand something. The mere fact that there are now only like 3 claim forms vs all sorts of forms to bill makes things run a lot more efficient then they did back in the late 90's before everyone was forced to use the HFCA claim form for professional (not hospital stay services), and the UB92 form for Hospital Inpatient stay services. People before then could literally bill on a piece of paper. no lie. and you would have to get someone to translate their handwriting and do data entry and plug in all the info. now you know good and well they would leave all sorts of needed information out. so you would have to have that same person call the doctor's office/clinic/patient etc to have them clarify the missing info. it was ridiculous. now we're at a point where most people have electronic claims setup where a lot of companies are pushing out 70% or more of their total claim volume via electronic transfer aka EDI transfers(same thing they use for money transactions for other non healthcare businesses, its all the same.)

what obama was trying to do with making or giving incentives for all payers to go electronic with their medical records. meaning. they can send and receive electronic medical records. you need medical records to be available to prove why you are billing for the services/diagnosis codes you are billing for. You can't be willing for a wheel chair and you sprained your thumb. well...if you read that part about fraud above. you can do that and get away with it because the government needs to hire more watch dogs and tighten it up. Guess who does a ton of stealing, a lot of foreigners who come over here and get into the healthcare game. a ton of them are well known for stealing from medicare via over pricing or UP coding(putting down a certain code for services that were not rendered that are higher on the pay rate list but are in the realm of the patient's diagnosis. ) it's like coding for insulin when dealing with a type II patient with diabetes. most of those patient's are not on insulin. the ones pumping insulin are usually the type I patients that had it since birth. but they can fool around with the diagnosis and find something in a similar family so the initial audit wont catch them.

but if you go full on medicare for all. the entire government will have all of your medical records in an electronic format. this speeds up the time that a highly certified nurse/doctor can review your records and look at your services and approve or disapprove quickly. It could cut that time down by weeks.
 
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the cac mamba said:
good :ehh: unaccountable, fully pensioned employees who can't be fired. to keep track of the entire country :mjlol:

can't wait :jaymelo:
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They already keep track of the entire countries old head, super less fortunate population, and vets. now that VA ehhhh lets not talk about them. They would have to completely gut them and move the soldiers over the medicare for all. maybe give them preferential treatment. I wouldnt be mad about that. they deserve it.
 
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