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Is Obamacare Good for Billing business?

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RichardP:
I'm confused by some of the statements above.  Am I missing something here?

1.  DMK said  "People thought they were going to get free health care for all."  The Affordable Care Act requires everyone to purchase health insurance or else pay a fine.  How does that reality lead people to believe that there is going to be "free health care for all"?  The reality is that someone (you and me?) is already paying big bucks for all the poor folks who use hospital ERs and then never pay anything towards their care.  Theoretically, requiring everyone to have insurance will reduce this expense - which should be reflected in lower health insurance premiums.  Probably won't be, tho.

2.  DMK said "The legal system indeed will hold all this up because you can't MANDATE a purchase of a private product."  Actually, the United States Supreme Court ruled a few months ago on this issue.  The Affordable Care Act was ruled legal, and the Federal Government can fine each individual that does not purchase health insurance.  There is nothing more the legal system can do to hold this up.  Given that the U.S. Supreme Court decided the issue, who is any lawyer going to appeal to?

The Federal Government is not going to "force" anybody to purchase a private product.  That is not, and has never been, the issue here.  The reality is that the U.S. Supreme Court said it was legal for the Federal Government to "tax" you if you fail to purchase health insurance.  At some point, it will be cheaper to purchase health insurance than to pay the fine.

3.  States can be granted waivers.  If the Republicans had won the White House, granting waivers to each state requesting them would have been the quickest end-run around the Affordable Care Act.  They didn't win the White House, so this approach will have limited, if any, use.

4.  Regardless of whether a State has requested and been granted waivers, or they simply refuse to comply - there is a deadline by which a State must fashion its response to the Affordable Care Act.  Under provisions of the ACA, which was upheld by the U.S. Supreme Court, if the State does not comply by the deadline, the Federal Government can (and probably will) step in and implement its own healthcare exchange (a "market" where anyone can buy reasonably-priced health insurance).  Given that the U.S. Supreme Court has already ruled on this issue, to whom are the lawyers going to appeal to stop the Federal Government from doing what the U.S. Supreme Court said it could do?

5.  Bureaucracies move at glacial speed.  There will probably be delays in implementing the healthcare exchanges and other parts of the ACA just because of the slowness with which bureaucracies move.  It is hard to see how legal wrangling will delay anything, given that the U.S. Supreme Court has spoken on the issue.

6.  tallmanusa said:  "In a democracy, the majority, even by 1%, decides the issue ...".  First, we are a Republic, not a democracy ("I pledge allegience to the flag, and to the Republic for which it stands").  Second, because we are a Republic, not a democracy, the court system serves in part to protect us from the "tyranny of the majority"  There are many instances in which the majority has spoken, yet the court has given the victory to the minority.  Never could understand why the "tyranny of the minority" is any more desireable than the "tyranny of the majority", but ...  In the case of the ACA, and regardless of what the majority may wish, the U.S. Supreme Court has ruled in favor of the Federal Government's position.

7.  If a biller is doing a proper job, they are going to catch coding mistakes on the part of the doctor.  Either he did not code for work that was actually done (a good biller can catch that, if doctor did "A", that means he also had to do "B", but he hasn't coded for that), or he coded the work incorrectly.  With a paper fee slip or superbill, you can send that piece of paper back to the doctor and have him make the changes on it.  Then, what the biller bills for matches exactly what the doctor has written on a piece of paper.  There will never be any question of the biller billing for things the doctor didn't order.  Consider an EMR.  How do the required changes outlined in this point get made?  Biller talks to doctor, maybe by phone.  Doctor says, "Oh, thanks for the heads up.  Go ahead and make the necessary changes before you send your file off to the clearinghouse" - and then forgets to make (or is locked out of making) changes to the EMR to reflect the new charges the biller submits.  Now, in an audit, the biller has billed for things that are not present in the patient's electronic chart.  That is a big no no for billers, and penalties can be stiff.  Not having a paper trail that matches exactly between what the doctor did and what the biller billed is laying the groundwork for some potential problems that not many people seem to be discussing.

8.  tallmanusa said:  "Doctors have to adopt EMR by 2015".  A bit more complicated than that.  A doctor who doesn't meet Medicare requirements by 2015 will have Medicare payments reduced by 1%.  That increases to 2% in 2016, 3% in 2017, 4% in 2018, and maybe up to 95% depending on future adjustments.  This is a big non-issue for doctors who are not Medicare providers.  If these penalties are actually imposed, I think we will see a significant exodus of doctors from the Medicare program.  Maybe to be replaced by PAs taking over the care of Medicare and Medicaid patients.

9.  tallmanusa said "offer EHR to every provider, as Obamacare mandates it".  First, the ACA does not mandate the use of EMRs.  It simply reduces payment to Medicare providers as discussed in the previous point.  Second, EMRs add about 1 1/2 hours to the work-day of those doctors that I know are using them.  EMRs have never been about increasing efficiency (they don't).  They are about collecting patient outcomes so that the Federal Government can aggregate them, data mine them, and come up with best practices for any given health issue.  Each doctor who chooses to use an EMR gives up about 1 1/2 hours of income every day just so the government will be able to collect this data (I've talked with data aggregator companies that are doing this right now).  Be careful about possible backlash if you don't make sure your potential client knows this before he takes on an EMR for the first time.  If you oversell the benefits to the doctor of an EMR (the benefits accrue to the government, not the doctor), you may lose him as a client.

10.  rdmoore2003 said "the computers will do it all".  For those who think that technology is what gets doctors paid for their work, I invite you to read through the points I make on this page: http://www.medicalbillinglive.com/members/index.php?topic=6930.30 .  One who knows how to bill properly is who gets the doctor paid.  Wetware, not software.

rdmoore2003:

--- Quote from: RichardP on November 29, 2012, 05:01:38 AM ---I'm confused by some of the statements above.  Am I missing something here?

10.  rdmoore2003 said "the computers will do it all".  For those who think that technology is what gets doctors paid for their work, I invite you to read through the points I make on this page: http://www.medicalbillinglive.com/members/index.php?topic=6930.30 .  One who knows how to bill properly is who gets the doctor paid.  Wetware, not software.

--- End quote ---

yes it is very obvious you are missing a heck of alot

rdmoore2003:
IMO, the last month or so I have noticed alot of new members voicing their political views.   This is a billing forum, not a debate.   Everyone has their own opinions on how things will go.  I posted a "sarcastic" reply and then political views are then put to the test,( so to speak).   PAY ATTENTION....ENOUGH WITH POLITICAL ISSUES...LETS RETURN TO OUR BILLING FORUM....THANK YOU

DMK:

--- Quote from: RichardP on November 29, 2012, 05:01:38 AM ---I'm confused by some of the statements above.  Am I missing something here?

1.  DMK said  "People thought they were going to get free health care for all."  The Affordable Care Act requires everyone to purchase health insurance or else pay a fine.  How does that reality lead people to believe that there is going to be "free health care for all"?  The reality is that someone (you and me?) is already paying big bucks for all the poor folks who use hospital ERs and then never pay anything towards their care.  Theoretically, requiring everyone to have insurance will reduce this expense - which should be reflected in lower health insurance premiums.  Probably won't be, tho.

2.  DMK said "The legal system indeed will hold all this up because you can't MANDATE a purchase of a private product."  Actually, the United States Supreme Court ruled a few months ago on this issue.  The Affordable Care Act was ruled legal, and the Federal Government can fine each individual that does not purchase health insurance.  There is nothing more the legal system can do to hold this up.  Given that the U.S. Supreme Court decided the issue, who is any lawyer going to appeal to?

The Federal Government is not going to "force" anybody to purchase a private product.  That is not, and has never been, the issue here.  The reality is that the U.S. Supreme Court said it was legal for the Federal Government to "tax" you if you fail to purchase health insurance.  At some point, it will be cheaper to purchase health insurance than to pay the fine.



My first comment about people thinking they were going to get free health care is from listening to patients who come through our office.  The general public does actually think they will get whatever they want, whenever they want, and not have to pay anything.  When we start to to discuss what the ACA actually is, most people are shocked.  That's not what they "heard" on the news or the story they "read" on the internet.  Don't get me wrong, I think everyone should get to go to the doctor when they need to, and people shouldn't have to die because they can't afford the care they need.  It's a well intentioned attempt to fix a problem, it just wasn't thought all the way through.  The poor who use the ER are usually immediately enrolled into Medicaid (which we all pay for in one form or another) so their bill gets paid in some form for pennies on the dollar. That can't last forever as we all know.  The middle class / working poor are going to suffer far more than the truly poor, who have had a "system" of sorts in place for a long time.

"Requiring" people to buy health insurance or be "taxed" IS a mandate.  And they are already running up against religious groups who view insurance as "gambling" who refuse to buy insurance and will not pay the fine.  I don't know the answer this problem, the concept is that if we ALL pay in and participate that costs will go down.  But that's not logical, and doesn't take everything into account.  My personal health insurance (I'm a business owner, not in a group, and have paid for my own high-deductible plan for many years) has doubled in price in the last 2 years, I'd consider dropping my health insurance but now I'd be taxed.  My insurance company cites the upcoming expansion of health care and how they have to absorb all the people with pre-existing conditions as well as "increased physician fees".

My big problem with the mandate or fine is that if people couldn't afford insurance before, how can they afford it now?  And if there's no money in the family budget for insurance premiums, how can they pay the tax?  Again, it's well intentioned, but not thought through. 

Your posts are great, and your points are very well stated and thought provoking.  I keep coming at these issues from 4 different perspectives, as a provider of services, a patient, a biller, and as a business owner / tax payer.  I'm surrounded with health care discussions every day, and the public perspective is truly fascinating.


--- End quote ---

PMRNC:
While I do think there's a time and place for political talk, there are MANY political discussions which do impact our businesses and industry a great deal. The Affordable Care Act is one of them. I don't know about the rest of you, but it's part of my job to educate my clients, I can't do that w/out talking about this healthcare bill because our industry is about to change DRAMATICALLY. This is NOT just about people getting "affordable coverage" as much as our politicians would like us to believe, it's much more and if you don't get that, you will find yourself chasing your tail in the next few years and never catching it.    With that said, I'm going to weigh in on the many statements/questions given:


--- Quote ---1.  DMK said  "People thought they were going to get free health care for all."  The Affordable Care Act requires everyone to purchase health insurance or else pay a fine.  How does that reality lead people to believe that there is going to be "free health care for all"?  The reality is that someone (you and me?) is already paying big bucks for all the poor folks who use hospital ERs and then never pay anything towards their care.  Theoretically, requiring everyone to have insurance will reduce this expense - which should be reflected in lower health insurance premiums.  Probably won't be, tho.
--- End quote ---

I'm sure the Affordable Care act was supposed to be logically "affordable" .. WHO it's affordable to is "key" to understand that you have to know to whom the discounts are available to and how it impacts those it does not make affordable to (PROVIDERS)   

Let's take a look at the patient / family affordability.   We don't know yet what premium's will come but I can tell you this..2014 - ,the annual penalty for taxpayers NOT obtaining health insurance will be $95 per adult and $47.50 per child, up to a family maximum of $285 or 1 percent of family income, whichever is greater. Now what do you think a premium on say a family of 4 will be? NOW you tell me.. pay penalty or premium??  I CAN also tell you this as a FACT.. Premium coverage WILL be as much as 25-60% HIGHER than the penalty.     It should also be noted that if you OPT to pay the penalty there are still many ways to adjust your tax return/status (withholding) to OFFSET that cost and ultimately pay NOTHING <g> (See IRS isn't so bad)  .. PLUS...  because the Supreme court says this isn't a TAX the IRS will have NO means to FORCE this penalty aside from deducting it from your refund if one is due, but again, you can adjust withholding to offset it.  The ACA also makes note that the IRS is NOT allowed to assess penalties, interest OR apply liens, or seizures to collect this penalty.  So now let's look at this from a COMMON sense point of view and again from a consumer / patient prospective.   Pay $5000 a year premium (probably will be a high deductible OOP plan or managed care plan) or pay the penalty?   Which do you think the majority of consumers who are already uninsured are going to pick? 

Now let's broaden this to include those that are employed and have coverage through their company/group sponsored health plan (contrib or non contrib)
Employers with 50 or more lives, will ONLY pay a penalty of $2,000 for every employee in the company if even one employee opts to obtain insurance through an exchange. However, the first 30 employees are not counted in calculation of the penalty. Example: an employer with 75 employees would pay the penalty for 45 workers, or $90,000 (45 x $2.000).
So the next question I would ask if you were the owner of business, would you rather pay $2000 penalty OR $5-10K premium?? Now you see why Obama said over and over.. "YOU can keep your existing health care plan" he just failed to mention that companies were given that INCENTIVE to force you into the exchanges !   

So that covers premiums even assuming they don't increase (which we know is a crock of ..&*^^




--- Quote ---2.  DMK said "The legal system indeed will hold all this up because you can't MANDATE a purchase of a private product."  Actually, the United States Supreme Court ruled a few months ago on this issue.  The Affordable Care Act was ruled legal, and the Federal Government can fine each individual that does not purchase health insurance.  There is nothing more the legal system can do to hold this up.  Given that the U.S. Supreme Court decided the issue, who is any lawyer going to appeal to?
--- End quote ---
       

Well this is going to make lots of lawyers more money.. and there are states who've started nullification processes.. how this plays out is anyone's guess. States that don't create exchanges will have them created for them by the federal govt <shiver>  And then some states will find legal loopholes that may even HOLD up the process.. we all know how court's and the legal process runs, add to that govt regulations and the many times they are pushed off.. This isn't going to be smooth sailing by any stretch of the imagination.


--- Quote ---The Federal Government is not going to "force" anybody to purchase a private product.  That is not, and has never been, the issue here.  The reality is that the U.S. Supreme Court said it was legal for the Federal Government to "tax" you if you fail to purchase health insurance.  At some point, it will be cheaper to purchase health insurance than to pay the fine.
--- End quote ---

No the Supreme court said they could not uphold tax provisions so "poof"..wave the magic executive order want and that's not a "penalty" read above on how that penalty will go.


--- Quote ---3.  States can be granted waivers.  If the Republicans had won the White House, granting waivers to each state requesting them would have been the quickest end-run around the Affordable Care Act.  They didn't win the White House, so this approach will have limited, if any, use.

4.  Regardless of whether a State has requested and been granted waivers, or they simply refuse to comply - there is a deadline by which a State must fashion its response to the Affordable Care Act.  Under provisions of the ACA, which was upheld by the U.S. Supreme Court, if the State does not comply by the deadline, the Federal Government can (and probably will) step in and implement its own healthcare exchange (a "market" where anyone can buy reasonably-priced health insurance).  Given that the U.S. Supreme Court has already ruled on this issue, to whom are the lawyers going to appeal to stop the Federal Government from doing what the U.S. Supreme Court said it could do?
--- End quote ---

I honestly don't know.. I just know that the "wheels of justice grind slowly" We are at the mercy of our Senators and Governors..


--- Quote ---5.  Bureaucracies move at glacial speed.  There will probably be delays in implementing the healthcare exchanges and other parts of the ACA just because of the slowness with which bureaucracies move.  It is hard to see how legal wrangling will delay anything, given that the U.S. Supreme Court has spoken on the issue
--- End quote ---
.

You'd be surprised at what a party resistance can accomplish.. but I won't speculate.


--- Quote ---6.  tallmanusa said:  "In a democracy, the majority, even by 1%, decides the issue ...".  First, we are a Republic, not a democracy ("I pledge allegience to the flag, and to the Republic for which it stands").  Second, because we are a Republic, not a democracy, the court system serves in part to protect us from the "tyranny of the majority"  There are many instances in which the majority has spoken, yet the court has given the victory to the minority.  Never could understand why the "tyranny of the minority" is any more desireable than the "tyranny of the majority", but ...  In the case of the ACA, and regardless of what the majority may wish, the U.S. Supreme Court has ruled in favor of the Federal Government's position.
--- End quote ---

Yes indeed, they rammed it down our throats, and down the throats of medical providers. Whenever that happens look for other ways for those "wronged" to get ahead, get even or find a way not to deal with it all.. which is what is going to lead us to a collapse.. My prediction.. by 2017 we will be in full blown crisis mode in the healthcare industry.



--- Quote ---7.  If a biller is doing a proper job, they are going to catch coding mistakes on the part of the doctor.  Either he did not code for work that was actually done (a good biller can catch that, if doctor did "A", that means he also had to do "B", but he hasn't coded for that), or he coded the work incorrectly.  With a paper fee slip or superbill, you can send that piece of paper back to the doctor and have him make the changes on it.  Then, what the biller bills for matches exactly what the doctor has written on a piece of paper.  There will never be any question of the biller billing for things the doctor didn't order.  Consider an EMR.  How do the required changes outlined in this point get made?  Biller talks to doctor, maybe by phone.  Doctor says, "Oh, thanks for the heads up.  Go ahead and make the necessary changes before you send your file off to the clearinghouse" - and then forgets to make (or is locked out of making) changes to the EMR to reflect the new charges the biller submits.  Now, in an audit, the biller has billed for things that are not present in the patient's electronic chart.  That is a big no no for billers, and penalties can be stiff.  Not having a paper trail that matches exactly between what the doctor did and what the biller billed is laying the groundwork for some potential problems that not many people seem to be discussing.
--- End quote ---

Agree.. nothing there I don' t agree with. My clients will be advised to maintain the proper documentation trail, people also forget that CMS will issue penalties for not complying with EMR, however I won't have to worry about this, I won't have a single provider left in the Medicare/Medicaid program.


--- Quote ---8.  tallmanusa said:  "Doctors have to adopt EMR by 2015".  A bit more complicated than that.  A doctor who doesn't meet Medicare requirements by 2015 will have Medicare payments reduced by 1%.  That increases to 2% in 2016, 3% in 2017, 4% in 2018, and maybe up to 95% depending on future adjustments.  This is a big non-issue for doctors who are not Medicare providers.  If these penalties are actually imposed, I think we will see a significant exodus of doctors from the Medicare program.  Maybe to be replaced by PAs taking over the care of Medicare and Medicaid patients.
--- End quote ---


--- Quote ---Exactly..  I've already seen this. I have ONE client left in my billing company to transition OUT of Medicare. My consulting clients are mostly those transitioned or will be transitioned out of Medicare and Medicaid.
--- End quote ---



--- Quote ---9.  tallmanusa said "offer EHR to every provider, as Obamacare mandates it".  First, the ACA does not mandate the use of EMRs.  It simply reduces payment to Medicare providers as discussed in the previous point.  Second, EMRs add about 1 1/2 hours to the work-day of those doctors that I know are using them.  EMRs have never been about increasing efficiency (they don't).  They are about collecting patient outcomes so that the Federal Government can aggregate them, data mine them, and come up with best practices for any given health issue.  Each doctor who chooses to use an EMR gives up about 1 1/2 hours of income every day just so the government will be able to collect this data (I've talked with data aggregator companies that are doing this right now).  Be careful about possible backlash if you don't make sure your potential client knows this before he takes on an EMR for the first time.  If you oversell the benefits to the doctor of an EMR (the benefits accrue to the government, not the doctor), you may lose him as a client.
--- End quote ---

I happen to agree with this as well. I'll also add that I have no problem admitting to my clients (both billing and consulting) that I'm more comfortable referring them out to an EMR provider, I don't plan to have anything to do with implementation of EMR. I won't lose because of this.. I'll actually gain from this :)

One more note:   If you are a healthcare administrator, practice manager, physician, provider, biller or consultant, YOU will be behind the 8 ball if you don't LEARN and understand the ACA.   It cost about $200 (shop around) to have the full bill printed, It's in your best interest to have it in front of you so you can educate the providers you will be working with.

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