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Thursday, September 20, 2012

The Hidden Agenda: Demonize Doctors as Unethically Working the System of Payment

This is the comment Barbara left on the Marketplace where they have the article:  I will tell you that I couldn't listen to the whole interview with the physician they chose to portray doctors in this piece.  Mr. Warner clearly worked to pick a doctor that would completely prejudice the listener from minute one, and support this piece's agenda.  The title of the conference "Coding Con" (listen to the audio to understand that is name of the conference he attended) is titled that way because it is the insurance industries con of the doctors that she is addressing, not a lesson or conference for doctors on how to code in order to con (swindle) the insurance companies. If you listen to the audio link, keep that in mind.....  

I am the Barbara Cobuzzi that is heard in this piece. I spent a large amount of time with Gregory Warner, being interviewed and recording, explaining how coding and billing worked. I told him how doctors canNOT unbundle and cannot bill for every little thing and that compliance dictates what is billable and codeable. I explained how complex the coding system is and that just because a payer reduces reimbursement the provider can't just bill for another thing to offset the losses, they end up taking it on the chin. I showed him how the third party payers continue to increase premiums and reduce payments to providers at the same time and providers, particularly when they participate with the payers cannot increase their fees. Even though a provider may have their own "fee schedule", it means little when they participate since the provider is subject to whatever the payer says they are willing to allow for the service. So, as costs increase due to HIPAA, EHRs, ICD-10 implementation, additional staff for compliance, etc, the doctor still sees reduced income while the third party payer increases their premiums to the insured.
I cannot understand why people think that the doctors are rich and the 1 presenters abusing the system? Doctors don't even get to start earning real money until they are in their 30's. They leave medical school deeply in debt, to the tune of $300-400,000. They work insane hours, starting at 5am and finishing at 7pm if they are lucky. They have intense stress, because although people sometimes make a mistake in their jobs, a doctor dare not make a mistake ever, never ever, because their patient's life, function, limb, etc hang in the balance. We as patients expect our doctors to be super beings, computers, but add in a dash of compassion, bedside manner, and at the same time we think they do not deserve to be paid well. Well for one, I want the doctor treating me to not worry about money, not worry about how he or she will pay the rent on his or her office, meet payroll, and pay his or her mortgage, because ladies and gentlemen, that is what they are worrying about. I want my doctor to be totally focused on me, the patient.
And the doctor worries about his or her documentation and coding, because a governmental authority can accuse them of fraud or abuse when in reality they were just bad documenters, focusing on the patient. They walk this thin line being put under the microscope where the payers and the government is looking for the criminals and there are criminals out there, but they are usually not your corner doctor, they are the mob, one who buys Medicare numbers to bill for services never provided, etc. Not the guy who just did not write everything down.
Most doctors do not upcode, unbundle and think about how to game the system. They go to coding conferences like the one where I spoke at to learn how to code correctly, how to make sure they are not leaving any fairly earned compliant dollars on the table and most importantly that they are meeting all the strict and complex rules set about for coding, which are not only set by the AMA, but then re-set by Medicare and just about every payer, every one has their own interpretation as to how to use the codes.
So, instead of going to classes to stay up on the latest and greatest in clinical issues, the doctors and their staff have to stay up with the latest and greatest in coding and compliance regulations. Running and working in a medical office is not clerical and is not child's play.
I spent a lot of time with Greg (yes, that is what I call him after all the time we spent together including dinners and lunches) and I educated him. We also emailed back and forth after the conference, where I answered any question he had. But I think that Greg had an agenda when he came to CodingCon and it did not matter what he was told during his introduction and education into the Coding and Reimbursement in the Medical field by myself and my colleagues. I think he wanted the piece to fit his agenda in the end. I am disappointed because I did not think that Greg would do this based on what he had learned.
Barbara J. Cobuzzi, MBA, CPC, CPC-H, CPC-P, CPC-I, CENTC, CHCC

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