‘You made that up,’ Dean tells Rove in debate (re: Medicare facts)

[Roland99]

http://rawstory.com/2009/10/dean-debates-rove-political-identity/?dsq=21272829#comment-21272829

There was little agreement, but a good bit of name calling, during the event which ranged in tone from heated to humorous.

“That’s a made up statistic, Karl Rove. ...For the first time tonight, I’m calling you on it,” said Dean, a medical physician and the former chairman of the Democratic National Committee. “You made that up."

Rove had said that Medicare rejects claims twice as often as the overall health insurance industry, and he promised to put the proof in his Wall Street Journal column next week. “And I would appreciate it if you didn’t question my integrity. ..Mr. Dean, you just called me a liar and I don’t appreciate it,” replied Rove, former deputy chief of staff and senior adviser to George W. Bush and a Fox News contributor. Later, Rove called Dean “adolescent” after the former Democratic National Committee chairman interrupted one of his answers.

Medicare does have a higher rejection rate vs. the average of private insurers (6.85% vs. 3.89%...not quite twice as much but noticeably more.)

HOWEVER, nearly HALF of the Medicare denied payments are due to one of the following three reasons:

1) Claim/service lacks information which is needed for adjudication. At least one Remark Code must be provided (may be comprised of either the Remittance Advice Remark Code or NCPDP Reject Reason Code).

2) Claim not covered by this payer/contractor. You must send the claim to the correct payer/contractor.

3) Claim denied as patient cannot be identified as our insured.

The data is here:
http://www.ama-assn.org/ama1/pub/upload/mm/368/reportcard.pdf


So, due to errors in billing (or possibly fraud in the case of #3), Medicare's actual denial of payment rate is LESS than the average of the private insurers!

Be informed and be prepared for when the right-wingnuts start going apeshit over this.

[BrklynLiberal]

1. LOL..Rove may not appreciate it..but that does not mean it is false..

"Mr. Dean, you just called me a liar and I don’t appreciate it,"

[Greyskye]

2. K&R for visibility

[Traveling_Home]

3. But if you look at the data....

You have to do the comparison after some codes are taken out of the other insurance denials too. For example 18% of denials by United Healthcare were because the claims weren't timely filed. If you take billing errors out of Medicare you have to take billing errors out of the other insurance companies too.

Additionally if Medicare did have a large denial rate because of billing errors compared to far fewer billing errors in private insurance claims then you are talking about a huge Administrative overhead being borne by the Medical community when dealing with Medicare. That also does ot speak well for Medicare's model.

[robinlynne]

5. Then we need single payer. No billing codes at all!

[Barack_America]

6. Um, that's not true. Single payer is still health insurance...

...where private hospitals and clinics are reimbursed by the government for service they provide. Billing codes are still required as different procedures receive different compensation.

I believe you are thinking of socialized medicine where hospitals are run directly by the government, sort of like our VA system. Although, I'm not certain that billing isn't involved in these systems either as a means to distribute funding from a centralized source and track spending.

[robinlynne]

10. There is no billing of any kind in England or France. no paperwork to fill out by.

the citizens. You just show up.

[Roland99]

11. But the provider has to submit bills (with billing codes) to the gov't to be reimbursed

Unless doctors and hospitals are magically working for free over there, which I kinda doubt. ;-)

[robinlynne]

15. which has nothing to do with the patients/conswumers, so is not an issue at all.

Your health care can not be denied because of billing issues.

[Roland99]

17. You're going completely off-topic. This is about providers and the insurance cos. (and Medicare)

not between patient and provider.

[robinlynne]

18. This is about " treatment denied because of wrong billing code".

[Roland99]

19. No....billing/payment denied. At least that's what the AMA study was about.

Treatment was given, hence the need to bill for it, right?

[robinlynne]

20. When a claim is rejected, the treatment is not given. I went to a dermatologist at my

health insurance company. She burned me. left scars. She as not even a doctor, but a nurse. I filed a claim. a formal complaint to have the burns treated for free. My "claim was denied". twice. I was never seen by a doctor. Even though i requested it. (How could they decide without looking at me?) A group of 3 doctors decided not to give me treatment. This is the group every insurance company has to deny claims. That is a denied claim. A denied claim means no medical care. The claim is your request for treatment. jusgt like the young woman who died because they took so long to accept her claim.

[Roland99]

21. uhh....oookkkkaaaayyy... But you're still talking about something TOTALLY different

[Barack_America]

12. That's single provider. Not single-payer.

There's a difference.

[robinlynne]

14. nope. That is single payer. multiple provider.

[Canuckistanian]

23. Billing codes? How is that a problem in single-payer?

Nobody is ever denied health care in Canada because of arcane details such as "billing codes".

I'm sure everything a doctor does has a "billing code" of some kind, but it doesn't affect us citizens in the least.

That's the beauty of single-payer. WE, the patients don't have to worry about these things. I have NEVER EVER had to fill out a single piece of paper or wait to get "approval" for any treatment.

[Roland99]

24. But that's what this is not about. Rove has distorted the meaning of that AMA report

It's not denial of treatment, it's denial of payment for treatment rendered for various reasons (no code, wrong code, out of coverage date, etc.)

[Canuckistanian]

26. All the more reason to adopt our single-payer system

Our doctors get paid quickly and efficiently. Billing code errors (if there are many), are taken care of quickly.

It's one of the reasons our doctors are so outspoken on issue of a true single-payer system. It works. For everyone.

[Roland99]

28. I couldn't agree more. And I'm pissed as hell the single-payer amendment is being tossed aside.

H.R. 676 is NOT "too radical" (as Obama called Single-Payer).

[wolfgangmo]

25. I think I can clear this up.

Yes, Canada and other single payer systems have billing codes, but they are well known and have a set repayment amount, unlike in the US where there are 1000's of companies and all of them have their own forms and procedures which makes billing in the US similar to walking across a minefield while blind.

But yes, Canadian doctors do submit for payment. It is a single page form, easily filled out in about a minute, and it promptly paid in most cases. Makes me want to move my clinic to Canada.

[Canuckistanian]

27. Of course. All those insurers add a huge complexity to the issue

Every doctor I've ever known has only had ONE nurse/receptionist/administrator. The paperwork is easy and it frees up the doctor's time to focus on medicine.

[Roland99]

8. True...you got me on that. Just haven't had time to pick it all apart properly

Interesting to note that much of the denial reasons for some of the private carriers is that the claim was before or after coverage dates. Over 1/2 of Coventry's denials and over 1/3 of Humana's and well over 1/3 of UnitedHealthcare's denials were for invalid dates, whereas only 3.1% of Medicare denials were for that reason.


Medicare's billing codes can be a sea of confusion but it wouldn't take make to optimize that, esp. if we were moving to a Single Payer system!

[Laelth]

4. Excellent, informative thread. Thanks. n/t

:dem:

-Laelth

[sabrina 1]

7. Isn't Rove wanted to appear before Congress to answer

questions that he refuses to answer? Why is he on television talking about anything? As for his 'integrity', was he trying to be funny?

[Sal Minella]

9. "Mr. Dean, you just called me a liar and I don’t appreciate it,"

Oh but I do, I do!!! Thank you, Dr. Dean!

(And notice that Karl the Little Rancid Maggot, who has no degree, manages to demote Howard Dean, M.D., to "Mister" Dean. Little puke.)

[ljm2002]

13. That's "Dr. Dean" to you, Mr. Rove...

...somehow that phrase popped into my head just now...

[and-justice-for-all]

16. Rove is a fucking liar, why is Dean debating him??! nt

[krispos42]

22. Dean: "I apologize, Karl...

...I didn't realize you had any integrity left to question"

:evilgrin: