Medicare is determining who receives healthcare today through MAC audits on a slippery slope towards healthcare rationing and death panels
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Medicare is determining who receives healthcare today through MAC audits on a slippery slope towards healthcare rationing and death panels
As a retired practitioner who started my practice when few had insurance,
and retired when almost everyone did, what Dr Tobin is speaking about is
not uncommon and not new. All insurance companies give doctors and patients
the choice of submitting pre-determination claims with xrays, mris, cts,
and records to get pre-approval before a doctor goes ahead and performs
treatment. more…
Pre-determinations, in the bygone age of faxes and snail mail, were
returned in less than a week, and in the age of email, are returned in 24
to 48 hours. In cases of urgency, one could, and can, get pre-approval over
the phone. If the procedure is necessary, and the documentation complete,
it is rare for any insurance company, and medicare is an ”insurance
company”, to deny services. more
If it is not an emergency, and a doctor and patient go ahead and do a
procedure, and only afterwards submit the documentation, they run the risk
of rejection. This is no different then dealing with one’s auto insurance
or home owners insurance. . If one’s car is in an accident or one’s house
is flooded or damaged, one does emergency work to mitigate further damage.
more
But one does not complete repairs until an adjuster comes out and looks at
the car or home and works in conjunction with the auto mechanic or builder.
What Dr Tobin is describing is sad for his patient, and sad for him, but if
the pre-authorization procedure was followed, this situation would not have
occurred. more
Further, now that it has occurred, all insurance companies, via Federal
law, have avenues to have denied claims reviewed and paid. If Dr Tobin can
prove that the procedure was needed, he will get paid. However, if this was
an elective procedure, a non-needed procedure, and wasn’t first
pre-authorized, the patient and the doctor may have lost their rights to
payment.more,
This issue is not a function of Federal Medicare Insurance. Its is a
function of working with any insurance company, and is one of the first
things taught to doctors attending practice management classes. end
md is just pissed hr didnt get any bucks! next time precert dr diddlydumps