Sicko Billing

Healthcare reform - mowt recent from President Obama

2009-06-16T07:47:00.000-04:00

CHICAGO, June 15 (UPI) -- President Obama tackled the thorny issues of capping medical malpractice awards and public healthcare opinion Monday before the American Medical Association.

"I'm not advocating caps on malpractice awards, which I believe can be unfair to people who've been wrongfully harmed. I do think we need to explore a range of ideas about how to put patient safety first, let doctors focus on practicing medicine and encourage broader use of evidence-based guidelines," Obama told the physicians group. "I want to work with the AMA so we can scale back excessive defensive medicine reinforcing our current system of more treatment rather than better care."

Just as important as containing the costs of healthcare, "we must also ensure that every American can get coverage that they can afford," Obama said. "We are not a nation that accepts nearly 46 million uninsured men women and children."

Obama said he said healthcare reform is simple: "Fix what's broken and build on what works"

He repeated his pledge that if people like their healthcare program, they can keep it. But people who don't like their coverage or don't have insurance can participate in a program called the Health Insurance Exchange, "a one-stop shop for (selecting a) healthcare plan."

Among the choices would be "a public option that will give people a broader range of choices and inject competition into the healthcare market (that forces) waste out of the system and keeps the insurance companies honest," Obama said.

"As I stated earlier, the reforms we propose are to reward best practices, focus on patient care, not the current piece-work reimbursement," he said. "What we seek is more stability and a healthcare system on a sound financial footing."

Obama drew warm applause when he spoke of moving medical records from a paper to an electronic-based system, and prevention and wellness programs that must be included in any healthcare reform package. He also was applauded enthusiastically when he discussed re-examining the cost medical education as well as providing as much information as possible available to physicians so they can provide the best care possible for their patients.

"Replicating best practices, incentivizing excellence, closing cost disparities -- any legislation sent to my desk that does not achieve these goals does not earn the title of reform," Obama said.

The healthcare crisis news - medical billing news!

2009-06-03T07:54:00.000-04:00

Thirteen years ago Bill Clinton became president partly because he promised to do something about rising health care costs. Although Clinton's chances of reforming the US health care system looked quite good at first, the effort soon ran aground. Since then a combination of factors—the unwillingness of other politicians to confront the insurance and other lobbies that so successfully frustrated the Clinton effort, a temporary remission in the growth of health care spending as HMOs briefly managed to limit cost increases, and the general distraction of a nation focused first on the gloriousness of getting rich, then on terrorism—have kept health care off the top of the agenda.

But medical costs are once again rising rapidly, forcing health care back into political prominence. Indeed, the problem of medical costs is so pervasive that it underlies three quite different policy crises. First is the increasingly rapid unraveling of employer- based health insurance. Second is the plight of Medicaid, an increasingly crucial program that is under both fiscal and political attack. Third is the long-term problem of the federal government's solvency, which is, as we'll explain, largely a problem of health care costs.

Healthcare Reform - some questions. Medical Billing News!

2009-05-19T15:05:00.000-04:00

Funding health care reform
Remaking America’s health care system and covering the uninsured will require a substantial financial investment. Any solution must not only be viable today, but sustainable for years to come. Where will we find the dollars? Can health care savings pay some of the cost? Should we continue the unlimited tax-exempt status for health insurance premiums on employer plans?

Determining our personal responsibility
In the simplest terms, health insurance works because the healthy help offset the cost of caring for the sick. How can we encourage more healthy individuals to purchase health insurance? Should every American be required to purchase coverage?

Removing barriers to coverage
Those who need it most – people with pre-existing conditions – are often unable to obtain health insurance. They’re either not eligible, or coverage is unaffordable. Should we require health insurers to accept anyone, regardless of their health? Should your health determine how much you pay for health insurance?

Deciding the role of government
Some believe government should run health insurance. Others believe a competitive, private-market system provides greater value. Some propose creating a government health plan to compete with private health insurers. Opponents see that as a step toward government-run health care.

Promoting the most effective medical treatments
Who decides which medical treatments, tests, and technologies are effective and should be covered? Should cost matter, or should we only ask how well the treatment works?

Encouraging wellness
A tide of chronic, preventable disease – representing 70 percent of health care costs – threatens to overwhelm our health care system. Smoking, lack of activity, and increased weight lead the list of controllable factors contributing to the problem. How can we help people live healthier lives?

Harnessing health information technology
Connecting the health care system with electronic medical records and other technologies could help reduce paperwork and unnecessary cost. Such connections could help prevent medical errors and bring the latest treatment information to the exam room. Technology can also be used to provide information on the prices and performance of health care providers, which could help patients make better-educated decisions.

SICKO healthcare - OBAMA style - medical billing news!

2009-05-13T11:40:00.000-04:00

By media & government suppressing truths and marginalizing dissent against business as usual, Medicare-for-All advocates are shut out and ridiculed for suggesting what other western nations know works best, costs less, and delivers the highest quality health care to everyone.On February 26, The New York Times headlined: "Obama Offers Broad Plan to Revamp Health Care....a (down payment $634 billion "reserve fund" for the next decade) toward his goal of covering the uninsured, and he would pay for it in part by cutting federal payments to hospitals, insurance companies and drug companies." More on that below.
Details so far are sketchy, but here's what The Times and others reported:

$634 billion as a "down payment....additional funding will be needed;"
increased prescription drug premiums for higher income Medicare recipients;
$6 billion for cancer research to the National Institutes of Health (NIH), up from last year's $5.6 billion;
faster FDA generic biotech drug approvals;
increased access to family planning services for low-income women on Medicaid;
no information on how the uninsured will be covered with details to be worked out later with Congress; one idea is make it mandatory, but tell that to people who can't afford it or enough of it;
drug makers to be required to give Medicaid at least a 22.1% discount, up from the current 15.1%;
payment cuts to insurers, hospitals, drug makers, home health agencies, and perhaps doctors;
"rebalancing the tax code so that the wealthiest pay more," but not enough;
the goal is reduce costs and achieve "universal coverage;" saying it is one thing, achieving it another;
eliminating subsidies paid to insurers selling Medicare Advantage plans and opening the process to competitive bidding; and
in introducing Kansas governor Kathleen Sebelius as HHS secretary and Nancy-Ann DeParle as White House Health Reform director, Obama proposed "affordable health care for every American" while acknowledging no "silver bullet" exists to provide it, but he'll be "flexible" to achieve it, or at least say he is while intending to do nothing to offend a powerful industry.

The Clinton Promise concerning health care reform - medical billing news!

2009-05-09T09:24:00.000-04:00

Breakdown -- America's Health Insurance Crisis - medical billing news!

2009-05-04T07:42:00.000-04:00

This article speaks about a Peter Jennings documentary...

Peter Jennings' last documentary, "Peter Jennings Reporting: Breakdown -- America's Health Insurance Crisis," premieres tonight on ABC. Throughout his storied career at ABC, Jennings reported over 60 documentaries on subjects ranging from the India-Pakistan conflict to the obesity epidemic -- all stories he believed were deserving of a full hour of prime-time investigation.

In this last documentary, filmed in the months before he was diagnosed with lung cancer, Peter Jennings reports on this country's broken health insurance system, which is threatening American families -- and American businesses.
Jennings reports that the growing number of uninsured affects the health care all Americans receive. He begins by reporting from emergency rooms in Houston, Texas, a city where almost one-third of the population lacks insurance. As more and more of these uninsured turn to emergency rooms for medical care, emergency care for the insured and uninsured alike suffers.

Jennings reports that one of the factors leading to the increasing number of uninsured is the difficulty involved in buying insurance. Even people who can afford the ever-increasing prices can't always get it. In most states, health insurance companies can turn down applicants who suffer from even the most common medical problems, like allergies and acne.

In the past, employer-based health insurance was a reliable place to turn for coverage, but today even that is in jeopardy. Jennings reveals how escalating health insurance costs are putting nearly all American businesses at risk. From small family-owned car repair shops to the once-mighty General Motors, the uniquely American system of employer-based health insurance is becoming unaffordable for small businesses, and unsustainable for large corporations operating in a global economy.

47 Milling Citizens without healthcare - medical billing news!

2009-04-20T09:14:00.002-04:00

Some 47 million U.S. citizens do not have health insurance, and the numbers keep growing. Because employers increasingly are moving in the direction of providing Wal-Mart-style health coverage by shifting health care costs to employees, America’s workers struggle to pay higher premiums, deductibles and co-payments—if they can afford such coverage at all.
Working families are experiencing double-digit increases in the costs of health insurance, more out-of-pocket costs for doctor visits and skyrocketing prices for prescriptions, forcing many to delay getting needed medical care or worse—to decline coverage for themselves or their families because of cost. Health care costs are rising at five times the rate of inflation. According to the Center for Studying Health System Change, health care spending rose 10 percent in 2002 and that followed a slightly more than 10 percent increase in 2001—the largest jump in more than a decade. In the first six months of 2003, health spending rose another 8.5 percent. Premiums for employer-sponsored coverage increased nearly 13 percent in 2002. As employers refuse to pay their fair share, this trend may result in millions of workers losing their employer-based coverage.
For more on this article, visit http://www.aflcio.org/issues/healthcare/whatswrong/

Lacking health insurance connects us all! medical billing news!

2009-04-16T14:31:00.000-04:00

The health-care story is everyone's story; the health and financial ruin of one eventually shakes the web that connects us all. And health-care disasters are not limited to the elderly, ethnic minorities or families living in poverty. Young people can find themselves without insurance for a variety of reasons, from lifelong disease to hubris to pure bad luck. When they do, they're at the mercy of a system that all but builds walls to keep them from adequate care.

Why aren't these people revolting in the streets?

SICKO - over 48 MILLION without health insurance! - medical billing news.

2009-04-10T15:32:00.002-04:00

There are over 48 MILLION Americans with NO health insurance.
There are approx. 32 million others who are underinsured. In the past four years the number of uninsured rose by 6 million people and more American's are forced each year to file for bankrupcy due to medical bills.

There are a handful of self-serving, powerful special interest groups who are unraveling our economy and holding us hostage. They are the American Medical Association (AMA) America's Health Insurance Plans (AHIP). the American Hospital Association (AHA) and the pharmaceutical industry. These groups are the gatekeepers of our health and spend HUNDREDS OF MILLIONS of dollars in advertising, lobbying and political contributions to keep their beds feathered and to keep the status quo.

Historically, the AMA has been the worst and most self-serving group who has, since 1912 opposed health care reform and national health insurance at least six times when reform has been seriously discussed in America. The AMA has opposed national health insurance even before there was a health insurance industry, scaring Americans into thinking national health insurance was communism and a big government takeover.

Almost 100 years has passed since the first discussion of national health insurance and we, as a nation, are more held hostage by the whims and desires of the health care/health insurance giants than ever before.

WHEN ARE WE GOING TO STOP PANDERING TO THE HEALTH CARE INDUSTRY LOBBY and make them work on our behalf, for our best interest, and make them stop holding America hostage? 18,000 people per year die because they don't have health insurance and the health industry enjoys being able to charge whatever they please and decide which services they will provide us, if, indeed, they will provide services at all.

Health Care Reform - medical billing news

2009-04-07T13:41:00.003-04:00

On health care reform, the American people are too often offered two extremes -- government-run health care with higher taxes or letting the insurance companies operate without rules. President Obama and Vice President Biden believe both of these extremes are wrong, and that’s why they’ve proposed a plan that strengthens employer coverage, makes insurance companies accountable and ensures patient choice of doctor and care without government interference.

The Obama-Biden plan provides affordable, accessible health care for all Americans, builds on the existing health care system, and uses existing providers, doctors, and plans. Under the Obama-Biden plan, patients will be able to make health care decisions with their doctors, instead of being blocked by insurance company bureaucrats.

Under the plan, if you like your current health insurance, nothing changes, except your costs will go down by as much as $2,500 per year. If you don’t have health insurance, you will have a choice of new, affordable health insurance options.

Make Health Insurance Work for People and Businesses -- Not Just Insurance and Drug Companies.
Require insurance companies to cover pre-existing conditions so all Americans regardless of their health status or history can get comprehensive benefits at fair and stable premiums.
Create a new Small Business Health Tax Credit to help small businesses provide affordable health insurance to their employees.
Lower costs for businesses by covering a portion of the catastrophic health costs they pay in return for lower premiums for employees.
Prevent insurers from overcharging doctors for their malpractice insurance and invest in proven strategies to reduce preventable medical errors.
Make employer contributions more fair by requiring large employers that do not offer coverage or make a meaningful contribution to the cost of quality health coverage for their employees to contribute a percentage of payroll toward the costs of their employees' health care.
Establish a National Health Insurance Exchange with a range of private insurance options as well as a new public plan based on benefits available to members of Congress that will allow individuals and small businesses to buy affordable health coverage.
Ensure everyone who needs it will receive a tax credit for their premiums.
Reduce Costs and Save a Typical American Family up to $2,500 as reforms phase in:
Lower drug costs by allowing the importation of safe medicines from other developed countries, increasing the use of generic drugs in public programs, and taking on drug companies that block cheaper generic medicines from the market.
Require hospitals to collect and report health care cost and quality data.
Reduce the costs of catastrophic illnesses for employers and their employees.
Reform the insurance market to increase competition by taking on anticompetitive activity that drives up prices without improving quality of care.
The Obama-Biden plan will promote public health. It will require coverage of preventive services, including cancer screenings, and increase state and local preparedness for terrorist attacks and natural disasters.

A Commitment to Fiscal Responsibility: Barack Obama will pay for his $50 - $65 billion health care reform effort by rolling back the Bush tax cuts for Americans earning more than $250,000 per year and retaining the estate tax at its 2009 level.

SICKO BILLING - no budget??

2009-04-05T11:39:00.001-04:00

Whenever I walk into a new client situation the first thing I look for is a business scorecard. Sometimes if I am lucky I find that the client has an accountant who has put together a Profit and Loss statement. Of course, in most small businesses P&L statements are usually done by an outside accounting firm and usually do not get to the client until a month or so after the fact. Rarely do I find that a business has put together a budget (a financial plan). To me this is incredible and a little bit insane.

It is incredible because if you go into any business without a financial plan (budget) you do not have a clue about how much it is going to cost you to operate the business. Without a budget you do not have any control over your cost and expenses which may leave you without a profit. Without a budget you do not have a standard to compare your Profit and Loss statement to see if you are on a track for success, failure, or just survival. Without a budget to compare to you do not have a clue where in your Profit and Loss statement you should be making adjustments to ensure a profit and your business future.

Operating a business without a budget is pretty much like flying in the dark. Ask yourself where would a pilot end up without a flight plan? This picture pretty much lends itself to a business owner operating a business without a budget. Pretty crazy, don't you think? Absolutely insane! Yet I see it everyday as I visit small business owners who are in trouble. And what is more incredible to me is that most accountants and CPA's who prepare these Profit and Loss statements for the business owner

Insurance through employers - and medical billing

2009-04-02T16:54:00.001-04:00

Most Americans have health insurance through their employers. But, employment is no longer a guarantee of health insurance coverage.

As America continues to move from a manufacturing-based economy to a service economy, and employee working patterns continue to evolve, health insurance coverage has become less stable. The service sector offers less access to health insurance than its manufacturing counterparts. Further, an increasing reliance on part-time and contract workers who are not eligible for coverage means fewer workers have access to employer-sponsored health insurance.

Due to rising health insurance premiums, many small employers cannot afford to offer health benefits. Companies that do offer health insurance, often require employees to contribute a larger share toward their coverage. As a result, an increasing number of Americans have opted not to take advantage of job-based health insurance because they cannot afford it.

Who are Who are the uninsured?

Nearly 46 million Americans, or 18 percent of the population under the age of 65, were without health insurance in 2007, the latest government data available.1
The number of uninsured rose 2.2 million between 2005 and 2006 and has increased by almost 8 million people since 2000.1
The large majority of the uninsured (80 percent) are native or naturalized citizens.2
The increase in the number of uninsured in 2006 was focused among working age adults. The percentage of working adults (18 to 64) who had no health coverage climbed from 19.7 percent in 2005 to 20.2 percent in 2006.1 Nearly 1.3 million full-time workers lost their health insurance in 2006.
Nearly 90 million people – about one-third of the population below the age of 65 spent a portion of either 2006 or 2007 without health coverage.3
Over 8 in 10 uninsured people come from working families – almost 70 percent from families with one or more full-time workers and 11 percent from families with part-time workers.2
The percentage of people (workers and dependents) with employment-based health insurance has dropped from 70 percent in 1987 to 62 percent in 2007. This is the lowest level of employment-based insurance coverage in more than a decade.4, 5
In 2005, nearly 15 percent of employees had no employer-sponsored health coverage available to them, either through their own job or through a family member.6
In 2007, 37 million workers were uninsured because not all businesses offer health benefits, not all workers qualify for coverage and many employees cannot afford their share of the health insurance premium even when coverage is at their fingertips.1
The number of uninsured children in 2007 was 8.1 million – or 10.7 percent of all children in the U.S.1
Young adults (18-to-24 years old) remained the least likely of any age group to have health insurance in 2007 – 28.1 percent of this group did not have health insurance.1
The percentage and the number of uninsured Hispanics increased to 32.1 percent and 15 million in 2007.1
Nearly 40 percent of the uninsured population reside in households that earn $50,000 or more.1 A growing number of middle-income families cannot afford health insurance payments even when coverage is offered by their employers.

SICKO - It's downright American!!

2007-10-29T07:07:00.000-04:00

The radically fierce and funny fireball he aims at our health-care system is a flat-out invitation to steal. First, Moore shows us how France, England, Canada and – yikes! – Cuba actually help sick people instead of letting them wither and die for lack of health insurance. Then he instructs us to loot those places for ideas. Anti-American? Hell, no. Moore argues that if another country builds a better car, we buy it. If it crafts a better wine, we drink it. Why not free universal health care?

Found this piece at www.rollingstone.com

SICKO - 50 Million Americans without Health Insurance!

2007-10-09T07:40:00.000-04:00

I found this portion of a review of the SICKO movie at www.rottentomatoes.com.
It's a nice overview of the film's basics. What I'd like to know, for those of us/you who work in the Medical Billing industry, how does our current health care situation effect our industry? How would drastic changes effect OUR security in Medical Billing?

Sicko is not a movie about the 50 million Americans walking around without health insurance. Sicko is a movie about the other 250 million of us who have insurance, but are just as well and truly screwed. It’s also about freedom, real freedom, not the empty kind that gets thrown around as a buzzword; the freedom to live your life with the certainty that forces beyond your control won’t take away everything you have and everything you are. We don’t have that kind of freedom here in America, and Moore’s film makes that point by simply talking to real people. They’re your neighbors, your friends, your parents, some of them are even 9/11 heroes. Moore uses his camera to let them tell their stories of insurance company mistreatment and in the process paints a complete picture of a corrupt and fatally flawed system which isn’t just killing people but taking away their dignity and their liberty.

The U.S. spends more on health care than any other!

2007-09-26T20:18:00.000-04:00

This rings home when seeking articles concerning our current health care system in the U.S. I took excerpts from an article written by Dr. Schroeder, published in the New England Journal of Medicine. What do you think???

The United States spends more on health care than any other nation in the world, yet it ranks poorly on nearly every measure of health status. How can this be? What explains this apparent paradox?
The two-part answer is deceptively simple — first, the pathways to better health do not generally depend on better health care, and second, even in those instances in which health care is important, too many Americans do not receive it, receive it too late, or receive poor-quality care.
Among the 30 developed nations that make up the Organization for Economic Cooperation and Development (OECD), the United States ranks near the bottom on most standard measures of health status (One measure on which the United States does better is life expectancy from the age of 65 years, possibly reflecting the comprehensive health insurance provided for this segment of the population.) Among the 192 nations for which 2004 data are available, the United States ranks 46th in average life expectancy from birth and 42nd in infant mortality. It is remarkable how complacent the public and the medical profession are in their acceptance of these unfavorable comparisons, especially in light of how carefully we track health-systems measures, such as the size of the budget for the National Institutes of Health, trends in national spending on health, and the number of Americans who lack health insurance. One reason for the complacency may be the rationalization that the United States is more ethnically heterogeneous than the nations at the top of the rankings, such as Japan, Switzerland, and Iceland. It is true that within the United States there are large disparities in health status — by geographic area, race and ethnic group, and class. But even when comparisons are limited to white Americans, our performance is dismal. And even if the health status of white Americans matched that in the leading nations, it would still be incumbent on us to improve the health of the entire nation.
Although inadequate health care accounts for only 10% of premature deaths, health care receives by far the greatest share of resources and attention. In the case of heart disease, it is estimated that health care has accounted for half of the 40% decline in mortality over the past two decades.
Improving population health would be more than a statistical accomplishment. It could enhance the productivity of the workforce and boost the national economy, reduce health care expenditures, and most important, improve people's lives. But in the absence of a strong political voice from the less fortunate themselves, it is incumbent on health care professionals, especially physicians, to become champions for population health.
Americans take great pride in asserting that we are number one in terms of wealth, number of Nobel Prizes, and military strength. Why don't we try to become number one in health? -Steven A.Schroeder, MD

SICKO Healthcare System

2007-09-24T18:48:00.000-04:00

I found this blurb at http://www.bestamericanhospital.blogspot.com

It is certainly true that Sicko is not a careful accounting of the pros and cons of the U.S. insurance system. But the basic truth of Moore's indictment is undeniable. A recent survey by Consumer Reports found that nearly half of adults younger than 65 — most of them insured — say they are "somewhat" or "completely" unprepared to cope with a costly medical emergency in the coming year. A substantial share of the more than 1 million personal bankruptcies in the United States each year — perhaps as many as half — are due in part to medical costs and crises. In no other rich country are people even remotely as likely to report having trouble with paying medical bills or going without care because of the cost. These problems are long-standing — yes, "dating back to the 1980s" — and worsening. And they are largely due to our reliance on employment-based, voluntary private health insurance.
The question is why we let these problems fester and what we can do to address them.

How do you Medical Billers feel about this?

SICKO - A Review

2007-08-23T18:13:00.000-04:00

I found this review at http://www.stylusmagazine.com/articles/movie_review/sicko.htm by Yannick LeJacq.
The review is quite long, so visit the above site to read more...

When I went to see Sicko, I sat next to a group of middle-aged, mild-mannered women who were talking softly before the movie started. Then a large picture of George W. Bush appeared on screen, and the women next to me, along with most of the theater, began jeering and laughing so loudly I couldn't hear what the President was actually saying. This continued throughout the movie. The audience enunciated each punch line not with a laugh, but with a resounding “ohhhhh!” as if this were an episode of “Yo Momma.”

You could say this is all circumstantial. But, really, I think this is what Sicko is supposed to be. Almost all the overviews and reviews I've heard of the movie begin with a phrase like, “Michael Moore: first, he took on GM. Then, he took on the NRA. Next up was the Bush administration. Now, he's setting his sights on health care.” The movie poster shows Moore putting on a doctor’s glove with a mischievous and aggressive look on his face under the tagline, “This might hurt a little.” Moore is picking a fight with someone.

Many critics have noted that Sicko is Moore's most mature work, and they praise the new observational, tragic tone he carries alongside his trademark cynicism. I agree that the opening interviews of the movie are some of the best work Moore has ever done. The first half of Sicko consists largely of individual stories of people affected by America's health care system. Moore shows people cheated out of proper financial assistance for obscure reasons, and pairs them with startling confessions by people who used to work for HMOs, describing how they received praise for denying as much financial assistance as possible. But he's only interviewing people that fundamentally corroborate his view on health care. Looking back through his films, you can see that Moore reserves the most eloquent outrage for those with whom he sympathizes.

I think this is because Michael Moore, as the ideologue that he enjoys being, has no real appreciation for journalistic research. He prefers to take a polemic than analytical approach to an issue. It's easy to see why he does this. It gives him his gruff, un-intellectual charm that's made him compelling from the beginning of his career. People didn't go to see Fahrenheit 9/11, just as I'm sure they didn't go to see Sicko, to learn anything new (you can find out very easily that socialized health care means you get treated at the hospital for free); they went because, by supporting Michael Moore, they're inherently becoming part of his rant. Through him, they're shouting at the powerful, incompetent elite they're also sick of.

SICKO Billing - Words Directly From Michael Moore

2007-08-14T13:42:00.000-04:00

How about some words DIRECTLY from Michael Moore!
I found this excerpt from an article in LA times.
For more on this, visit http://www.latimes.com/entertainment/news/la-et-moore21may21

"When people say there is no confrontation in this movie, to me there is a big confrontation in this movie," Moore said in an interview here. "Because I am confronting the American audience with a question: 'Who are we, and what has happened to our soul?' To me, that's maybe more confrontation than going after the CEO of Aetna or the CEO of Pfizer." The reason Moore feels compelled to ask this "Sicko" question is because, he feels, the country unthinkingly settles for substandard and ruinously expensive medical treatment, especially when compared with countries with universal healthcare.

"I don't have to convince the American public that there is something wrong with our health care system. I think most American people already feel that way," said Moore, who enjoys great coverage himself through the Directors Guild of America. "That's why I don't spend a lot of time in the film on the healthcare horror stories. I wanted to propose that there's a different way we can go with this. I'm hoping that the American people, when they see this film, will say, 'You know, there is a better way, and maybe we should look at what they are doing in some of these other countries..."

Medical Billers need to stay up with all news in health care, whether sparked from their own individual client's level OR from a documentary which brings our health care crisis to light.

Medical Billing - "Transparent" Charges; Is This Possible?

2007-08-09T09:46:00.000-04:00

As I have mentioned, previously, a DRASTIC change to our health care system, LIKE Socialized Medicine, makes me nervous as a Medical Biller. I feel that this type of change would put my job in jeopardy.
I did, however, see a news segment recently that spoke about "Transparency" in insurance billing and payouts, according to specialty and whether the services received by the patient were done so at a hospital, clinic or private practice.
This seems like an interesting idea and I'll explain why.
The current system varies to extremes.
I have TWO Physical Therapy clients. Each submits an identical code. One of my clients receives a reimbursement of $69.27, while the other - for the exact same code - receives $16.38! What is with these numbers?? There is no rhyme or reason and getting a valid explanation from a payer is next to near impossible.
It's almost as if the representatives employed at these carriers are unable to explain such vast differences in payouts also.

In a revised "Transparent" health care system, all providers within a specialty would be reimbursed at the exact same rate, regardless of history or longevity, or which size the moon was at the time while credentialing with the carrier.
There would be SOME variation depending upon the location of the services; hospital, clinic or private practice. But, Medicare would need to impose such a regulation in order for all carriers to follow suit.
Asking Medicare for a change to this magnitude is like asking the sun to quiet its rays for a while; impossible!

However, the only organization that could force Medicare to oblige would be the government, somewhat, unfortunately...
SICKO and Michael Moore are, of course, considered fiercely liberal.
What this movie has done though, is forced a dialogue to occur regardless of one's position in the political spectrum. A republican from Iowa - Charles Grassley -is the individual that coined "Transparency".
Many advocates for change in our health care system see this point of view as the closest to the best outcome for all to date.
What do you think??

SICKO Billing - Single Payor System Would NOT Impact Quality of Care?

2007-08-07T09:11:00.000-04:00

As a Professional Mdical Biller, I continuously seek information on the possible impact of a change in our health care system.
The reason that I do this, is because I survive on the process as it exists today.
Private practice owners generally do not have the resources or the money to support the overhead in keeping medical billing in-house. They seek an outsourced solution, like ME to process electronic medical claims on their behalf.
I am convinced that a single payor system would NOT improve anything BUT the paperwork currently required. That is it. It would not impact the quality of care at all.
So, with that said, perhaps health care system in the US shouldn't change all that much?
What I would like to see change are the numbers of people that lack health coverage go away entirely.
Every person deserves health insurance and all should have it for proper medical care.

I found this quote at http://whynow.dumka.us/2007/07/02/more-on-the-sicko-issue/

"Paperwork is a major cost of the American health care system that would be radically cut by a single payer system, and would have no impact at all on the quality of care. This is something that the insurance companies could have done decades ago, but chose not to, and just made it worse. Confusing billing procedures delays payouts, and that is one of the reasons they do it, no matter what they tell you."

And, I agree.

Michael Moore - "I've been saved"

2007-07-31T06:41:00.000-04:00

This article can be found at http://www.comcast.net in their news section.

Moore: I've Been Served
Sun Jul 29, 8:05 PM

Maybe Michael Moore isn't paranoid, because it sure seems like the government really is out to get him.

The firebrand filmmaker says he has been served with a subpoena by the federal government for a trip to Cuba for his hit health-care documentary, Sicko. The Treasury Department confirmed two months ago that it was probing Moore's visit to Cuba, during which he was accompanied by some ailing 9/11 rescue workers.

Appearing Thursday on NBC's Tonight Show with Jay Leno, the Oscar winner said he had just learned backstage that he had been served with an order compelling him to testify about his sojourn to the communist nation.

"I haven't even told my own family this yet," Moore said. "I was just informed when I was back there with Jay that the Bush administration has now issued a subpoena for me, going after me for helping these 9/11 rescue workers."

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"No, no, for going to Cuba, not for helping them," chimed in Leno.

In March, the Fahrenheit 9/11 helmer and a trio of first responders who had fallen ill after working around ground zero traveled to the U.S. Naval Base at Guantanamo Bay to demand the same quality health care that administration officials publicly promised was being given to suspected Al Qaeda terrorists held there.

After getting no response from U.S. authorities, Moore and his traveling companions subsequently received free medical treatment from Cuban doctors, which the 53-year-old helmer depicted in Sicko, ostensibly to point out the failings of America's health-care system.

"I didn't go there like Cameron Diaz, to get a tan," quipped Moore. "I was there to help them, and now I'm going to face this further harassment from the Bush people. Aren't they busy with something else?"

In May, the Treasury's Office of Foreign Assets Control, or OFAC, sent a letter to Moore requesting information about the trip, which it claimed was not approved. (Under the U.S. government's comprehensive trade embargo, American citizens are forbidden to work in Cuba unless granted an exception.)

Moore shot back with an open letter to U.S. Treasury Secretary Henry Paulson, calling for an end to the investigation and accusing the White House of playing politics by using a government agency to try to silence him.

He also stated he informed the OFAC in October about the Cuba trip, asserting that as a journalist, he qualified for an exemption to the travel ban, a point he reiterated with Leno last week.

"A journalist can go, and this is a work of journalism," said Moore. "And frankly, the larger point is being missed here. The point is that first of all, can we all agree we should take care of our 9/11 rescue workers?"

The statement elicited cheers from the studio audience.

Moore's attorney, David Boies, could not be reached for comment.

According to Reuters, Boies was contacted by a representative of the U.S. Department of Commerce, who requested the name of a person to accept the subpoena on Moore's behalf.

Aside from his burgeoning offscreen problems, Moore dropped another bombshell to Leno, saying that Harvey Weinstein—whose Weinstein company is distributing Sicko and who's also one of Hilary Clinton's biggest Hollywood supporters—asked Moore to cut scenes criticizing the Democratic presidential candidate.

The reason? Because Moore called out Clinton for purportedly accepting the most campaign donations of any senator from lobbyists representing the same private insurers and drug companies she's railed against in the past.

Moore refused, and Weinstein eventually backed down. The director also announced on The Tonight Show that the Weinstein Company has agreed to donate 11 percent of Sicko's box office to help ailing 9/11 workers who have been ignored by the Bush administration

Michael Moore slams CNN, Wolf Blitzer on live TV

2007-07-24T12:54:00.000-04:00

As a Professional Medical Biller, I am fascinated by this film SICKO along with the positive OR negative chats it is creating. I commend Michael Moore and his ability to succeed in his goal in creating the film; to spark conversation about our current health care system in the US.

This article that I found can be printed by visiting www.rawstory.com site and searching under Michael Moore or SICKO.

Read this and share what YOU think!

Michael Moore slams CNN, Wolf Blitzer on live TV
David Edwards and Josh Catone
Published: Monday July 9, 2007

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Before a live interview with documentary filmmaker Michael Moore, CNN aired a segment entitled "Sicko Reality Check" in which Dr. Sanjay Gupta, the network's chief medical correspondent, aimed to keep Moore "honest" and fact check his new film, Sicko.

The 4-minute piece concluded that Moore "did fudge the facts," and implied that Sicko was misleading in portraying health care systems in other countries, such as France, the UK, and Canada, as better than the one in the US.

When given a chance to speak, Moore immediately put host Wolf Blitzer on the defensive.

"That report was so biased, I can't imagine what pharmaceutical company's ads are coming up right after our break here," said Moore. "Why don't you tell the truth to the American people? I wish that CNN and the other mainstream media would just for once tell the truth about what's going on in this country."

Moore argued that CNN has such a lousy track record of reporting the truth about the war in Iraq and asking tough questions, that Americans should be skeptical of their reporting on health care.

"You're the ones who are fudging the facts," said Moore. "You've fudged the facts to the American people now for I don't know how long about this issue, about the war, and I'm just curious, when are you going to just stand there and apologize to the American people for not bringing the truth to them that isn't sponsored by some major corporation?"

Blizter grew defensive and backed up his fellow CNN employee, saying that he would stand behind correspondent Sanjay Gupta's record on medical issues. Moore, in response, vowed to post a rebuttal to his website, MichaelMoore.com, showing that Gupta's facts weren't accurate.

"I'm going to put the real facts up there on my website," said Moore, "so that people can see what he just said was absolutely wrong."

Turning to the war in Iraq, Moore accused Gupta, who spent time embedded with US troops in Iraq, and the mainstream media at large of refusing "to ask our leaders the hard questions, and demand the honest answers." Moore laid the blame for the continued US involvement in the war in Iraq at the feet of the media, arguing that they failed to do their jobs and question the Bush war policy.

Blitzer refused to argue with Moore about Iraq, and instead steered the conversation back to the topic of health care. Moore was asked which of the US presidential candidates he thought would best fix America's health care system.

Moore did not name a specific candidate, but said that the Democratic candidates as a whole need to be more specific about how they plan to achieve their goal of universal health care.

"Our own government admits that because of the 47 million who aren't insured, we now have about 18,000 people a year that die in this country, simply because they don't have health insurance. That's six 9/11s every single year," concluded Moore. We need "universal health care that's free for everyone who lives in this country, it'll cost us less than what we're spending now lining the pockets of these private health insurance companies, or these pharmaceutical companies."

After the interview, Blitzer found sympathy from fellow CNN hosts Lou Dobbs and Jack Cafferty.

"After watching that Michael Moore interview," said Cafferty, "I've decided whatever CNN's paying it ain't enough."

Americans Cheer "SiCKO," But NOT all Convinced

2007-07-13T07:36:00.000-04:00

So, continuously searching for updates as a professional medical biller. I think that this movie and the conversations that it is continuously spurring, are powerful. So, here is another article that I found of interest. For more information on this, visit www.reuters.com

By Andrea Hopkins

CINCINNATI (Reuters) - Fresh from the hospital and still hurting from a $757 prescription drug bill, moviegoer Ron Jackson emerged from a screening of Michael Moore's documentary on the U.S. health system feeling outraged and exuberant.

"It's a great movie," said Jackson, 63. "I have insurance, and I still paid over $700 for one prescription -- just 30 days' worth. They've let Wall Street control the whole thing, it's as plain as the nose on my face."

Weeks into the staggered release of Moore's "SiCKO" across the United States, moviegoing Americans have revived the debate over national health care -- a staple in most of the developed world, but long resisted in the United States.

Health-care reform is a hot topic in the 2008 presidential campaign, and a slew of candidates have promised changes to bring better care to both insured Americans and the nation's 45 million uninsured.

Atia Huff, 64, said she was heartened by the applause that broke out at the end of the movie but worried only those who already agreed with Moore's outlook would bother to attend.

"I think it's preaching to the choir," Huff said.

Moore won an Academy Award for 2002's anti-gun documentary "Bowling for Columbine." He made more enemies -- and drew the label "enemy of America" from the right -- with a critical look at President George W. Bush's war on terrorism in his 2004 documentary "Fahrenheit 9/11."

"SiCKO" tells the stories of Americans who say they were denied life-saving treatment by insurers. The film has received mixed reviews, with some criticizing it for a lack of substantive comparison of the U.S. health-care system with that of countries that offer universal health care.

"It should be compulsory viewing for everybody, but some people don't want to hear," said Huff, a retired interpreter. She said she's already seen the movie twice -- the first time with a school teacher who said she'd worked too hard for her health-care benefits to pay for those who hadn't.

"I'm very pessimistic it will ever change," Huff said.

Many Americans remain firmly opposed to universal care.

"We are not a socialist country .... If our system is so poor, how is it we have one of the highest standards of living in the world?" asked Cincinnati electrician and businessman Mike Cavanaugh, who offers health insurance to his workers.

"Anyone, and I mean almost anyone, who is willing to go to work 40 or 50 hours a week and pretty much just do the minimum can have a decent life here," he said. "Tell Michael Moore to find a new home if he cannot appreciate the blessings this great country has bestowed upon him."

But in downtown Washington, Tom and Sue Stevens left a "SiCKO" screening more convinced than ever that the United States should adopt universal health care.

"We are ready, but the politicians and the businessmen are not. The health-care industry certainly is going to oppose this for all they're worth," said Tom, a college professor.

Sue, a retired medical technician, said she'd seen hospital administrators fight to contain costs for needed care.

"Everything now is based on cost -- how much money they can save. And a lot of people that work in hospitals themselves can't afford the insurance that hospitals offer because their pay is so low," she said.

In New York City, 75-year-old Philip Peppis said he was ready to vote for change in November 2008.

"How did this country get so completely selfish?" he asked after leaving a "SiCKO" matinee. "It's really embarrassing, the way this country treats people."

But in Columbus, Ohio, small business owner Sherry Pymer said she had no intention of seeing the movie and would never support universal health care.

"I'd be very, very afraid of that. You hear the stories about how bad health care is in Canada," said Pymer, 55. "Michael Moore is nothing to me. He's just somebody looking to get a big rise out of somebody."

SICKO - Michael Moore Takes on Capital Blue Cross

2007-07-09T10:46:00.001-04:00

I found this article which made the hairs on the back of my neck stand tall!
More on this article and Michael Moore at www.MichaelMoore.com

Moore takes on Capital BlueCross
By David Wenner / Patriot-News

Central Pennsylvania's Capital BlueCross walked right into the crosshairs of Michael Moore.

The controversial director of the documentary "Sicko" obtained a memo written by Barclay Fitzpatrick, Capital's vice president for corporate communications.

Moore gave the memo top billing on his Web site yesterday. His taunts at Capital soon spread across the Internet.

Of Fitzpatrick, Moore writes: "His job, it seems, was to go and watch 'Sicko,' observe the audience reaction, and then suggest a plan of action to deal with the movie."

Fitzpatrick wrote in the memo, "You would have to be dead to be unaffected by Moore's movie."

In previous films, Moore has gone after the auto industry and the federal government's reaction to the Sept. 11, 2001 terrorist attacks. In "Sicko," now playing nationwide, he takes on the health care industry.

"Sicko" recounts stories of people who were denied medical care by insurers. Moore shows former health insurance employees who say their goal was finding ways to deny claims. He ends with a call for a government-run health system.

But Fitzpatrick says Moore focused on exceptions rather than the norm, and called the movie one-sided and misleading. Often, the medical treatment being denied was experimental, he noted.

Moore challenged Capital yesterday on his Web site, calling for a debate involving "just me and your CEO openly debating the merits of a system that kills thousands of innocent Americans every year."

In an e-mailed statement, Capital spokesman Joe Butera said, "Like most health-care companies, we already were being asked about Michael Moore's movie before it came out. So our communications person decided to see it. He wrote a memo summarizing his personal opinions and impressions of the film."

Butera added, "What his memo doesn't say is the company's position on [Moore's] movie. So here it is: We think anything that addresses the complex subject of health care is overall a good thing because it is such an important issue for our nation."

Butera said neither CEO Anita Smith nor Fitzpatrick would comment further.

In his memo, Fitzpatrick chided the film for ignoring the main culprits of America's health care crisis, which he said have much to do with lifestyle factors including poor nutrition, obesity and lack of exercise.

Still, he concluded that the vast majority of moviegoers who see the film will "have their perceptions substantially affected" in a way that would harm the reputation of Capital and other health insurers. Capital should prepare employees to respond to questions from customers, friends, family and neighbors, he wrote.

Fitzpatrick suggested "the most successful strategy will not be in attacking the movie for its weaknesses or misperceptions, but in distancing ourselves and our brand from the groups and motivations he attacks, demonstrating the good that we do and achieve ... and in articulating our disappointment that he did not address the truly relevant issue of improving our health and wellness."

Butera said Capital isn't interested in a debate.

"We remain focused on our mission -- not on debating others. We will continue to work hard every day to fulfill our mission by delivering quality health care at an affordable cost," he wrote.

Fitzpatrick's memo pointed out Moore makes no distinction between for-profit insurers, which include many of the nation's best-known insurers, and non-profit plans such as Capital.

The for-profit plans, which in the Harrisburg area include Health America and Aetna, generate profits for stockholders. The non-profit Blues accumulate "reserves," which must benefit their customers, or serve a charitable purpose.

In 2005, Pennsylvania's four Blues plans agreed to contribute $1 billion toward the state's insurance program for the poor. The Blues have pointed out that most of their reserves are amassed through investments, and they aim to collect premiums that are roughly equal to what they pay toward medical expenses and overhead.

In an online chat, Moore noted that Capital has $795 million in reserves and that Smith's salary is "over $800,000 a year."

"If that is non-profit, I am sure a lot of people would be interested in working for that kind of pay. Where is all that money coming from?" Moore wrote.

Smith actually earned $1.2 million in 2006, according to the Pennsylvania Insurance Department. Ken Melani of Highmark Inc. was the highest paid Blues CEO in the state, earning $3.2 million.

SICKO - Does it Pave a Way for Socialized Medicine?

2007-07-04T08:56:00.002-04:00

I am an owner of a medical billing firm and medical claims processing trends are my passion and expertise. I have NOT seen SICKO (Michael Moore's newest documentary), but I have read MANY reviews and commentaries about the film. There has been one pressing question on MY mind...
WILL THIS SEND OUR COUNTRY CLOSER TO SOCIALIZED MEDICINE?

What I have always "learned" is that socialized medicine is a disaster. I am wondering if this was simply a message generated by the US government and for-profit insurance carriers to, in turn, guarantee a steady flow of high premiums for our coverage. What do you think?

In Massachusetts, there is a new law that no person can even "choose" to be WITHOUT health insurance. If, at tax time, a person is "caught" not maintaining coverage, tax penalties will apply. This simply does not make any sense to me. Most of the people that do not have medical insurance are FORCED into that predicament - they cannot afford the high premiums. Family plans are hundreds of dollars per month (more times, over $1,000 per month). So, not only does the uninsured person struggle to simply AFFORD the insurance, they'll NOW have tax penalties for NOT being able to afford it.
I watched an interview on the news early Sunday morning about this very situation and mandated change effective this July, 2007. I watched in disbelief! In the same breath, it was explained that if an individual shows up at the ER for care, they will not be refused treatment regardless of their insurance status. It is such a double-edged sword!

I am looking forward to seeing Michael Moore's movie SICKO. I am curious to see if it will change my "learned" opinion about socialized medicine.

For more dialogue and information about this and other topics, visit www.MedicalBillingFoundation.com.

SICKO - Does it Pave a Way for Socialized Medicine?

2007-07-04T08:56:00.001-04:00

Medical Billing - SICKO. Uninsured and Counting...

2007-07-03T09:03:00.001-04:00

I found an interesting article yesterday at www.billadvocates.com. It gave more information about our current health care status, the costs, and what groups like MBAA are doing to help stay part of the solution of this national crisis. They are continuously fighting to keep healthcare costs down, for CONSUMERS, small businesses and healthcare providers alike.

In November of 2005, LexisNexis announced that it would launch advanced information and data access technology in association with the National Health Care Anti-Fraud Association (NHCAA), law enforcement and regulatory agencies.

Conceived as a public service for the healthcare industry, it was created in response to what the company calls a:

"$51 billion issue" and a "crime phenomenon."

The issue they're talking about is healthcare fraud, and it accounts for an estimated 3% of America's $1.7 trillion annual healthcare cost.

Guess who's paying for it?

That's right. You are.

"Health care spending in the U.S. is five times that of defense and three times that of eduction," the article says. "Health care insurers, Medicare and Medicaid, and consumers bear the cost of fraud, which represents an ever-growing burden in the form of increased premiums, taxes, co-pays and deductibles."

Of this $51 billion issue, upwards of $10 billion of it is likely coming from overcharges on medical bills like yours.

Today's complex medical billing system allows fraud and abuse to go undetected. Studies have shown that as many as 9 out of 10 medical bills from hospitals and providers contain errors. Their errors are compounded by the fact that insurance companies are not reimbursing correctly--they just pay the incorrect bills unquestioningly, but deny legitimate charges.

And people wonder why healthcare costs are skyrocketing?

With 61 medical billing advocates across the country, MBAA is fighting to keep healthcare costs down, for consumers, businesses and healthcare providers alike.

MBAA has also developed a self-help workbook, The Medical Bill Workbook, to help individuals counter out-of-control medical costs.

MBAA also provides CONSUMER cost awareness seminars to educate the public about insurance reimbursement and billing practices rampant in the medical profession today that are creating the massive rise in healthcare costs we've all seen first hand.

To learn what you can do as a MEDICAL BILLER, keep watch on a growing group called The Medical Billing Foundation. The members of this foundation are professional medical billers and THEY offer webinas, conference calls, and regional seminars to keep those working as medical billers remain on top of the latest industry changes and upcoming mandates in the industry. Visit www.MedicalBillingFoundation.com regularly as this is an ever-changing site filled with valuable resources. Be patient however, as this is a foundation LONG in the making.

Medical Billing - SICKO Movie Review by Victoria Alexander, FilmsInReview.com

2007-07-02T10:16:00.000-04:00

As a Medical Biller, I am continuously seeking education (in all forms) about the status of our country's health care system. And, that education can include newspaper articles, web announcement and resources and FILMS! I found an interesting review of Michael Moore's SICKO that I decided to post here for YOUR review.

If you get sick, move to Canada, France, or Cuba.

If Michael Moore’s “Sicko” is seen by enough Americans it can actually make a positive impact for change. But only if people start protesting and rioting in large numbers for a change in policy.

I’m terrified now that I might get sick. I’ll have to move to Europe or hope that the Brazilian healer John of God can work a miracle for me.

Why is Moore so impressed with the national health care of countries like Canada, France and England? Why does he go to Cuba? Could it be that instead of building a war industry and invading countries, they are spending tax money on their citizen’s health care? All three countries have free health care for any medical crisis.

A new report from the Congressional Research Service says the U.S. is now spending close to $10 billion dollars a month on the occupations of Iraq and Afghanistan – an increase of nearly $8 billion dollars from one year ago.

$10 billion dollars each month could subsidize a lot of prescriptions.

“Sicko,” as you all know, is Moore’s documentary on the health care system in the U.S. Moore has a clear message: there are billions of dollars in profits at stake that the industry wants to keep for itself. They do not want to pay any medical bills and thereby provide so many technical loopholes that it is impossible to outsmart them.

The private health care industry wants you to have an insurance policy in place but they are not willing to pay for your health care once you get sick. The industry policy is to deny claims. They get away with outrageous practices by doling out enormous contributions to politicians and employing an army of lobbyists with ready cash.

Moore introduces a group of average Americans who have had to face dire medical emergencies and whose claims were denied by their insurance carriers. It is sickening. Kaiser Permanente is at the top of Moore’s Evil Triumvirate.

A friend of mine’s teenage son was diagnosed last year with leukemia. To date, and his treatment is ongoing, his medical bills have exceeded $700,000. Even with a good health insurance plan, my friends have huge, supplemental medical bills. (In London, Moore cannot find a billing department. There is no place to pay for a hospital stay and they give you cab fare when you leave the hospital.)

When Moore hears about how terrorists are being cared for at Guantanamo Bay, Cuba, he decides to take a group of volunteer Ground Zero rescue works and sick people to Cuba. While they are not allowed on the base, they go to a Cuban hospital where they are welcomed and treated. One woman starts crying when she is told she can have her bottle of medicine for five cents. In the U.S. the same bottle costs her $120 a month.

Moore blames President Nixon for starting the whole HMO debacle now plaguing average Americans. Hillary Clinton was tasked to bring universal health care to every American but the health industry spent more than $100 million to defeat her plan. Hillary learned her lesson and has now recognized her error in judgment. She has embraced the “for profit only” scheme of the health industry.

Apparently, sick people do not vote. Why not have voter registration forms at hospitals and pharmacies?

“Sicko” is important and well done. Moore takes a backseat and allows his subjects to express themselves and show us how a medical crisis has changed their lives.

While we are led to believe we are the most powerful, rich and caring country in the world, we are only allowing the well-heeled to have appropriate medical care. When Americans do not have to cross the Canadian and Mexican borders to fill their prescriptions and the health care industry plays fair, then we can turn our attention to Darfur and spreading “democracy” in the Middle East.

Medical Billing and SICKO's Impact

2007-06-29T07:59:00.000-04:00

As a professional Medical Biller, I feel that it is my responsibility to stay current with our country's health care system and that does include the viewing of Michael Moore's movie SICKO - scheduled for release today, June 29, 2007. Regardless of one's political views, I encourage billers to place their (political) opinions on the back burner while viewing this film. Even if you have not been a fan of Michael Moore and his previous documentaries, the importance of seeing THIS Michael Moore's movie should be of great importance as an active member of the medical billing industry. Many of us can agree that our health care system is (politely) chaotic, regardless of where we fall in the political spectrum. Remaining a TOP medical biller requires staying current with ALL heath care news from ALL sources and sides. I happen to be a fan of Michael Moore and of his previous documentaries. I am sure that, like his last, Moore will offer his usual mix of cynical humor contrasted with piercingly sobering personal narratives, which brings both a chuckle and an "oh my" type of reaction. I understand that Moore traces the START of our health care crisis all the way back to the early 1970's to the presidency of Richard Nixon - pressured to launch the Health Maintenance Organization (HMO) system. That HMO system is the largest, internationally, of for-profit medicine. That HMO system is also the direct cause of phenomena like NO-insurance, UNDER-insurance and toppling health care standards. The direct result has been a continuous downhill tumble, crashing under the health care standards of similarly wealthy countries around the world - most of which have government sponsored and paid universal heath care structures. As many billers, I too hope to remain part of a solution toward improving the processing of healthcare claims and insurance follow up - ultimately getting practices paid. I love what I do. I especially love the glee evident on my client's faces while they witness the immediate, positive impact made to their practice by choosing to work with my medical billing firm and me. I, too, encourage billers to use this film as a conversation point with prospective clients - to point out where the system falls down in places where billers can pick things UP.

Medical Billing - OUTSOURCED; a Not-so SICKO option

2007-06-28T10:52:00.000-04:00

I am very excited about the release of Michael Moore's documentary, SICKO, this Friday June 29! I am not only a member of the American general public who subscribes to an HMO Plan, I am also the owner of a Medical Billing Firm. Eligibility, Authorizations, Referrals, Diagnosis Codes, CPT Codes, Electronic Claim Submissions, EOB's, Payment Postings, Aging Tracking, Patient Statements, Claim Payments and Claim Denials, along with the ever-changing Insurance Carrier Rules are ALL part of my day-to-day world. Keeping up with Medicare, Medicaid, and all Other insurance carriers and their regulations is at a MINIMUM, a daunting task! I understand that the point behind Michael Moore's movie SICKO is to spark passions and cause debates nationally about the current state of our healthcare system (or there lack of) and to generate NEW, perhaps radical plans for our nation's future when it comes to healthcare. The primary reason that we, medical billers, are directly, often negatively effected by our weak healthcare system is due to to (a) the incapability of following the goings on and changes per specific insurance carrier nationally and (b) the difficulty in getting compensated for claims processed. Both the advantage to our medical billng clients and the CURSE of our own business strategy is that we DO NOT earn a dime until the practice is paid for services rendored for their patients. And, when (not if) claims are denied, we billers are faced with the frustrating task of follow up to learn the rejection reasons in order to REsubmit the original claim. See, what many don't realize is that on the busy CMS 1500 forms, each box requires DIFFERENT information according to each individual carrier. If ONE single piece is either missing or out of place, the claim is rejected. The EOB's don't offer a total explanation either in a lot of cases. This forces the tying up of phone lines ringing into these carriers from the 4 corners of the country every day of the week. The frustrated doctor and/or medical practice owner has more than likely undertaken this process for him or herself at one point or another. From those agravations of TRYING to get paid, they do one of 2 things; they either hault excepting health insurance entirely OR they seek an outsourced solution - a medical billing firm. Although I don't support or recommend that any practice owner stops taking insurance, especially in this economy, I certainly do appreciate the decision to do so. "Pocket money" even for health care or maintenance is simply NOT as readily available to the general population. People PAY for their insurance coverage and they will more than likely select a healthcare professional based on whether that practitioner accepts their health insurance or not. In fact, many practice owners who once had the luxury of NOT taking health insurance are returning to it being accepted due to their patient's financial circumstances - EVEN their own! This, of course, does WONDERS for my medical billing business. If it makes sense - and MOSTLY it does - practice owners should seek outsourced medical billers to fill the necessary filing process. It is SO much more cost-effective for that practice. Eliminating staff is neither recommended or an absolute necessity. There will always be a need for a front desk person AND a back office manager. Those folks have a lot of responsibilities BEYOND medical billing that should keep their jobs safe. Who would otherwise check patients in, verify elegibility and authorizations for visits, deal with the copier machine repair person, make sure all information is gathered for filing, help GROW the practice? The practice owners? Not likely! Their job remains as it should - to effectively practice good medicine. Medical billers ensure that happens and in fact, HELPS the general public receive the best possible care that they require and deserve by taking over this pain on behalf of practice owners. So, Michael Moore's movie SICKO points out the "issues" of our healthcare system, which is LONG overdue. Where do we go from here? I, for one, am determined to remain a part of the SOLUTION toward IMPROVING the state of our current system by accurately and effectively filing medical claims on my client's behalf. I look forward to learning other medical biller's feedback and reviews of the movie, considering OUR necessary positions in the healthcare industry. Share your comments here OR visit www.MedicalBillingFoundation.com. Many more opinions, suggestions and strategies will be offered there. All of us medical billing business owners should use the release of this film to our advantage by discussing it and pointing out how WE ARE part of the working solution!

SiCKO Shows Reality of Medical Biller's World

2007-06-26T07:52:00.000-04:00

With the release this Friday (June 29) of Michael Moore's "SiCKO", audiences will get to see firsthand the vagaries of the U.S. health insurance system. Those of us in the medical billing field, who do our level best to process and advocate for appropriate payment to the doctors we represent, see the games the insurance carriers play every day.

Depending upon the day of the week, it seems, the rules change. What was supposed to be represented in each field of the CMS1500 one day, is unacceptable the next, requiring resubmission after resubmission. The payers know all too well that a significant portion of these rejected claims will fall by the wayside eventually. Hence the point of Moore's documentary.

And of course, the payers will rely on "government regulations" as the reason for modifications, clarifications (obfuscations, in fact). The reality, as SiCKO reflects, is that the massive lobbying community has a chokehold on the leadership of this country. Those new regulations that are fomented in a dizzying fashion out of Washington are, of course, absurdly beneficial to the insurance companies, but lawyered in such a way as to appear either (a) legitimate, or (b) completely hidden from view altogether until a rejected claim comes our way, illustrating the new rule.

The "When did THAT happen?" feeling we often get tends to make one unsure of one's professional abilities from time to time. Not to mention the doctor's frustration that payments for services rendered are increasingly questioned.

For medical billing professionals, this is not a do or die mission, but hopefully with the light shed by SiCKO, perhaps some of the lobbyists will not be quite as bold in the future, and more importantly, health insurance plans will be more accountable to the patient and to the medical practices in this country.

Donald Roche
The Medical Billing Foundation
http://www.MedicalBillingFoundation.com