Thursday, March 02, 2006

Another healthcare rant.

Part of what I have to do is review changes to medical coding, for the purpose of legally billing insurance companies. The reading is drab and boring, but once in a while you run across some interesting nuggets. One such idiocy is the blood product disposal stuff we have to bill for.

Before I get too far into this let me explain a rule that Medicare has. It is called the inducement rule. In a nutshell, as a hospital, we can't offer incentives for a patient to seek treatment at one hospital versus the other. The intent of this rule, was to make it so patients are treated equally without given financial incentives, an example being a patient will get cut a break on his bill at once place because that hospital just wants the extra business. This causes patients to be treated differently, and to cause unfair competition in the field of healthcare. Since healthcare is viewed as something beyond a perfunctory or tertiary service (this is your BODY they are treating here man, I don't have anything against this intent...) Medicare wants to keep the playing field level.

Now, onto blood products. There are many tests where a facility will need store the blood for a period of time. You go in for a test, they draw X amount of tubes, but the actual blood needed to run the test is less than what was drawn. Your blood is stored, and in case the test has a problem your stored blood can keep you from needing to be drawn again. Facilities charge a blood storage fee, but the kicker is that when the blood is no longer usable or needed they need to dispose of the blood. Due to the inducement rule, we MUST charge patients for destroying their own blood in order to keep from "inducing" a patient to come to our facility so they can avoid the blood disposal fee charged at other hospitals/labs.

One type of interesting phone call we get is "Why did YOU charge me to DESTROY my own blood?". On average the type of person calling is an elderly chap/lady who is not likely to have the inducement rule easily explained to them. They perceive us as JERKS for charging them for such an outrageous thing. Even when some people call in that are pretty articulate well informed individuals they have the hardest time understanding why we operate with such complicity with Medicare rules and regulations. To be perfectly honest, as open to interpretation it all is, I'm surprised half of the hospitals in the nation don't get shut down for violating "federal guidelines" yet there is such limited guidance on it. Then ordinary people try to understand this, and I tell you right now that understanding the physical field of medicine is now rivalled by trying to understand the compliance and financial aspect of healthcare. The system is getting to complex.

There will be a point in time, in which the financial person's influence on the quality of the care you receive is every bit as high as the physician, nurse or direct caregiver. That day, will truly be a sad day. Be that financial person a financial counsellor for the hospital, a claims adjuster for an auto insurance, or an HMO auditor, or billing review clerk with a health insurance company.

I don't claim to have the answers on this type of stuff, but at least you can see it from the point of view of someone working at a hospital billing this stuff out.


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