IMPCamp09 Update: mind-boggling nonsense of insurance billing

We've had several IMP Mentor folks give talks about how they manage the complexity of billing the insurance industry.

Nancy Guinn MD:  "Remember that when you submit a claim for a vaccine, you have to include the CPT4 procedure code for vaccine administration, the CPT4 code that specifies the exact vaccine type - and remember that these vary by the manufacturer of the vaccine, plus the ICD9 code that justifies the need for the vaccine."

Lynn Ho MD:  "So after you've compiled all your claims for the day and checked your schedule to make sure that you have a claim for each encounter, you then submit to your electronic clearing house.  At that point you check the site to see how many of your claims were immediately rejected by the clearing house based on things like you entered the wrong date, there's a mis-match between the ICD9 and CPT4 code, you forgot to enter a modifier or entered the wrong modifier......."  OK, enough you get the point. 

The room is filled with passionate health care professionals pursuing ideal care for their patients.  These guys have to wade through this insane complexity that has been carefully erected over time to justify the existence the whole billing industry that sucks time and money away from actual patient care.

I post the anecdotes to help people understand the real-world craziness quantified in a recent Health Affairs article:  this stupid billing game and the endless back-and-forth between medical practices and insurance clerks costs medical practices an average of $68,000 per physician per year. 

To support the costs, medical practices have to crank up the number of patients seen per day and/or do more revenue-generating procedures.  This results in less time per patient encounter, increasing the risk that we miss something important and/or the knee-jerk referral to a specialist for something that would have been better addressed in the PCP office if time allowed.

We love what we do for our patients but the status quo of billing insanity degrades our profession to that of glorified billing clerks.  Right now the only recourse left for us is to keep cranking up the volume of services to pay for this stupid system or to drop any relationship with the insurance industry.

L Gordon Moore MD