Today NPR had an interesting story on Medical Billing. You can listen to the full story online. My mother worked in a doctors office for many years, and she has often said that one of the best things the government could do to cut costs is to standardize the codes and forms used for medical billing. There’s a whole profession that you may not know about called ‘medical coding’. I was talking to someone once, and asked her what she did, “Medical coding, you probably don’t know what that is”, she replied. Actually, I do. I worked at a startup company, deNovis Inc., for a few months in 2003 that was supposed to be writing a system to revolutionize medical plans management and billing, but unfortunately it failed without realizing its goals. Medical coding is the process of checking the doctor’s notes about what they’re doing with a patient and turning that into the ‘codes’, that is, the numbers that identify a particular problem or treatment that the insurer recognizes and hopefully covers. Even with that knowledge, what I didn’t realize is that people specialize in coding for different areas. The woman I was talking to at the time specialized in coding for urology. Don’t ask her to try to code for say pediatrics, she wouldn’t know the right codes.
The irony of the story on NPR is that the people in the story didn’t start out in medical billing. They got into healthcare as a co-owner of a birthing center. But once they had the birthing center business, they discovered that the big problem was getting paid. The other irony is that the guy is actually a cousin of George W. Bush. (Don’t you think he might have said a few things at a family barbeque?)
Anyhow, one of the best parts of the article is the ‘pain in the butt‘ index. This is the company’s rating of how hard it is to get paid by different insurers. On the website, this is much more politely called the ‘Payer View’.
Of course, this is just looking at it from the payee point of view and not how easy it is to deal with the compnay from the insured point of view. I’ve been insured by 4 of the companies that rate in the top 15 overall payers according to their ratings. Three of them I would generally agree with the rating. The other one was a complete ‘pain in the butt’ to use their terminology, as I had to call and argue about coverage about this or that procedure every month on my first pregnancy. When you’re seven months pregnant, arguing about why or why not a particular test is covered at this or that percentage shouldn’t have to be high on your priorities. But from my experience, they tried to deny everything they possibly could and it was up to me to argue it.