No it wasn’t insurance fraud. You should understand the talking point before talking about the talking point.
Covid update from a doc on the front lines
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That's absolutely true. Now who knows to what extent, if any fraud occurred, but by statute hospitals were paid higher Medicare rates for Covid 19 patients and treatment. There was a financial incentive to declare symptoms as Covid
Here. They didn't even need test confirmation.
Fact check: Hospitals get paid more if patients listed as COVID-19, on ventilators
Hospitals are paid more for Medicare patients with COVID-19, but a senator who first said that says he doesn't think the system is being gamed.
www.usatoday.com
Coding manipulation to maximize reimbursement has been going on since we adopted the Harvard coding system. The hastily drafted Covid reimbursement rules exacerbated the problem and providers quickly caught on That’s not to say there wasn’t fraud but I think a lot of the overspending was taking advantage of poor regulations and incompetent people who administer them.Here. They didn't even need test confirmation.
Fact check: Hospitals get paid more if patients listed as COVID-19, on ventilators
Hospitals are paid more for Medicare patients with COVID-19, but a senator who first said that says he doesn't think the system is being gamed.www.usatoday.com
"emotion"? "passion"??
SMH at people who consider themselves to be educated yet so easily duped by some politician requires neither of these.
Wow. Listen to the guy who sees tin foil cowboy hats and tonic water in the hydroxy and ivermectin discussion.
I don't know what she says because I don't watch her, but I do usually see a couple of Carlson's segments each week.
My point was that I'll listen carefully to what a front lines health care worker has to say while dismissing the conclusions of some guy down the street, a TV personality, or a guy on a message board who thinks he has some special insight or even expertise on Covid and vaccines based on unreliable hearsay or limited anecdotal evidence.
The issue with Carlson is that he has a huge megaphone as host of the most-watched cable news show. He uses that megaphone and influence as a purveyor of misinformation about Covid and vaccines, featuring conspiracy theorist anti-vaxxers like Alex Berenson and RFK, Jr.
Hell, we all are “some guy” on a message board who read stuff, talk to people who know stuff, have experienced stuff, think about stuff, and post about stuff. Dismissing such stuff under the “some guy on a message board theory” is not a sign that you also read or think.
Just because I go to the doctor does not mean they should give me treatment they believe will help. Googling, there is a belief over use of zpacks has damaged the entire class of drugs fighting pneumonia. Here is one such story from New Zealand.
Azithromycin: use it wisely - BPJ 60 April 2014
The Best Practice Advocacy Centre delivers educational and continuing professional development programmes to medical practitioners and other health professional groups throughout New Zealand.
I would not want to get a test to get a zpack, but if the alternative is fewer drugs to attack pneumonia I think it would be worth it.
You know this stuff better than I, is that wrong?
Thank you. Your timing is impeccable. You and another guy (I won't name names, but he self-identifies as a CPA) are exactly who I was talking about. If you're citing a credible source (which isn't often), that's one thing. But you both frequently rely on little stories and anecdotes as somehow suggestive of expertise. That's nonsense.
How is it not insurance fraud to code someone with COVID when they do not have COVID to simply get more reimbursement? I am not a lawyer, to a layman that sounds fraud.
Too dichotomous Marv. Patient presents complaining of all kinds of shit, looks like Covid, symptoms in keeping, admin can code Covid predicated on that without testing confirmation
Sure if they lie, that is fraud. But code manipulation generally isn’t lying. It’s just exploiting loopholes and ambiguities. Providers hire or consult with experts in code manipulation to maximize rev.enue. That’s the down side of our fee for service system.
Huh? First what is wrong with anecdotal stories in discussions here? Second, how is that suggestive of expertise?
See what I did here? (Probably not).
You spoke of anecdotal statements as if they were bad and also said if I cite an anecdote, that’s an unreliable indication of expertise. I asked you to support both comments by asking simple questions in a Socratic fashion.
You failed miserably. I hope you don’t consider yourself to be a critical thinker.
Buh bye.
Early, when there were no tests, I can see that. After tests were ubiquitous there was no legal duty to actually test?
I don't know. I don't know if at some point it ceased being okay to go with "presumed" as opposed to lab-tested
I will suggest the standard should be verification if 1) there is increased reimbursement 2) verification exists. How do we make that the law?
Honestly Marv I don't know a lot about how Medicare provider agreements work. I can tell you that when I was living my horrible prior life I reviewed thousands of medical records and Medicare reimbursement was by far the lowest with providers. So maybe the hospital lobbying groups went to their legislators and said we are already getting f*ucked under Medicare and now you want us to treat Covid shit too. You have to take care of us a bit on this one.
That's not really responsive to your post but maybe tangentially salient on why there wasn't/isn't a big push for lab verification vs presumptions
Forgive me, but that sounds completely made up.
Medical staff is frustrated with these idiots, but I don't believe that a nurse would say that.
Be careful about listening to someone on the "front lines" - sometimes they more than a little cray-cray.
Prescribing a zpak is not prescribing a placebo.Just because I go to the doctor does not mean they should give me treatment they believe will help. Googling, there is a belief over use of zpacks has damaged the entire class of drugs fighting pneumonia. Here is one such story from New Zealand.
Azithromycin: use it wisely - BPJ 60 April 2014
The Best Practice Advocacy Centre delivers educational and continuing professional development programmes to medical practitioners and other health professional groups throughout New Zealand.bpac.org.nz
I would not want to get a test to get a zpack, but if the alternative is fewer drugs to attack pneumonia I think it would be worth it.
You know this stuff better than I, is that wrong?
Do you want them to give you treatment they don’t believe will help?
Bacterial resistance to antibiotics is a real thing. Is it the natural response by bacteria or is it over prescribing?
Probably a little of both.
You seem to advocating for antibiotic use only when we know it will help.
How do we know that without getting a culture and waiting on results?
All I know is there are procedures, rules as to when it should be prescribed and it is said they are not followed. Same for opioids. How long does it take to know if viral? Do we need better tests?
You would know if it was bacterial. Grow on culture medium, use different antibiotic discs to see what it is sensitive to and prescribe accordingly.
Similar to what they commonly due with UTI but they always start you on what they think will work. If culture comes back differently change antibiotic.
There aren’t really procedures or rules but rather treatment suggestions.
Spartan I have a question for you. I’ve gotten to know our local pharmacy pharmacists. Really great folks. They are getting killed on social media because people can’t leave their dr appointments and pick up their scripts instantly. The pharmacy is overwhelmed and understaffed. I feel for them. One pharmacist told me that the on demand filling of scripts is the problem and is not sustainable. What is your opinion on the topic?
I’ve worked for independent and chain pharmacies. I’m assuming the pharmacists you are interacting with work for chains.
The model is broke. It happened when they went to computer scheduling and models.
They offer all of these services that take the responsibility away from the customer.
Automatic refill, contacting the prescriber when the customer is out of refills, on and on.
With most best practices, the model is designed by someone that doesn’t work in the pharmacy.
The customer now thinks we are their slaves and my profession bears some responsibility for that because we have created the monster.
On demand is still possible but the customer has to assume more responsibility for their maintenance medication.
So tying it back in, how would you describe scripts for hydroxy or ivermectin? Isn't that hoping for placebo effect given what we think we know about both?
I don’t see how we get placebo effect with CoViD. Unless you’re talking about treatment of asymptomatic.
Neither are anti-virals. Could they help with symptoms? It doesn’t make sense to me but medicine is constantly evolving so who knows.
The DRGs came from Yale. Hospitals are subject to retrospective audits based on algorithmic analysis to detect coding outliers, and violators are subject to criminal prosecution. I assure you Medicare's program integrity people are good at what they do.
I thought the CPT system was based on work at Harvard. Regardless, I’m not talking about illegal conduct or maybe not even outliers. Billing with CPT codes is inherently flawed and I think is a gravy train for the providers. It gets worse as medical services expand into new processes . The medical providers quickly learned how to game the system with Covid patients. Remembering the health care reform discussions, it was noteworthy that the AMA fully came on board when it became clear that reform would not touch the CPT fee for service model. Because of that system, we see outrageous charges for things like pushing an IV.
I don’t hold myself out as an expert on Covid. The experiences I repeat on here are true occurrences in my circle of family, friends, clients and acquaintances. They happened. Take them however you wish.
I’ve seen enough to absolutely believe ivermectin has helped people with Covid.
I’ve watched in person three golf buddies have nasty heart reactions after taking the Booster. Even the left wing Biden/Harris/Fauci loving attorney had to admit the vaccine caused a problem.
What are the odds on three guys between 63-72 over the course of the month all having heart issues after the Booster? Not one of these was reported to anyone that they got included in CDC statistics. You go ahead and say I am lying if you like.
There are multiple things I see happening. A doctor might think it helps, that is fine. Doctors have a right to do what they think is best.
The second is the patient demands those drugs, and they know patients doctor shop. So they prescribe. We know this happened with opioids.
Others see patients who are afraid. They prescribe to calm fears not thinking it will attack COVID.
I do not know what to call the second, the third sounds close to "placebo".
I respect that.
I just don’t think of it as prescribing a placebo.
You're correct (the CPT-relative value scale was developed at Harvard), but CPT coding is for doctors. What you're referring to is the higher DRG payment to hospitals (I'm not sure there is any different payments to physicians for treating COVID or pneumonia.)
There are undoubtedly flaws in the payment systems (providers knew how to maximize payment before COVID), but they actually work well overall to encourage efficiency. The coding and payment systems aren't the reason for outrageous charges. They've actually replaced payment systems that rely on charges, which are now mostly a residual of those old systems.
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anon_6hv78pr714xta
Guest
Anecdoctal hearsay:
I have a friend who does med mal defense for some hospitals and played poker with an administrator at one. The administrator said during spring and summer of 2020, if someone tested positive for covid but might have died from something else, no matter how severe (think Stage IV cancer), covid was always listed as a contributing cause of death and that was enough to qualify for higher payments.
Lots of gray area here.
Contributing being the operative word. And regardless of that, if a cancer patient or heart patient came into the hospital Covid positive, wouldn't there have been additional costs involved in treating them simply because he had Covid? And wouldn't it be reasonable for those additional costs to be reimbursed?
