Tuesday, February 27th, 2007

Every practitioner in the United States knows that the current US Department of Health & Human Services (DHHS) billing code system doesn't work.  A whole industry has sprung up around the simple fact that it doesn't work, trying desperately to keep practitioners out of trouble when they attempt to wend their way through the billing miasma.

And, a miasma it is.

Worse, is that the system, cumbersome and confusing, has been contracted out, region by region, to insurance companies - and not necessarily "health" insurance companies, for management.  In Los Angeles, for instance, several years ago, when a billing person in a practitioner's office called "Medicare" on the telephone to get assistance, the phone was answered by an employee of a Title Insurance Company.

US Medicare has NO FEDERAL EMPLOYEES. None.  It is all contracted out.

Yes, I said Title Insurance . Title insurance is protection against loss arising from problems connected to the title to your real estate property (like your home).  

Scary?  Yes, that is.  And even scarier is that those Medicare contractors' employees and even the practitioner's billing staff are offered cash incentives to rat on their employers when they can identify  "fraudulent claims."  Practitioners walk a difficult line, trying to bill Medicare, Medicaid, or health insurance using the DHHS system developed by and for physicians.  Accusations of fraud are flung easily - since the government rewards whistle-blowers and collects a whooping $10,000 per claim in penalties against those who bill incorrectly - including the Medicare and Medicaid contractors.  No wonder insurance companies are reluctant to cover alternative medicine practitioners. There's good money, for anyone to snitch on a practitioner who uses the wrong codes or on an insurance company who processes an incorrectly coded claim.

I'm not surprised when I hear that health practitioners drop out of the system in waves.  They just don't need the hassle.  Take a system that is "sketchy" at best, designed by bureaucratic dolts in an agency that has little, or no, concept of its role - DHHS - and severely penalize those who have to use it - and you have a formula for disaster.