But wanting to stop the flow if illegal immigrants is not racism, because you don't care what color they are - just that people should immigrate legally, so that they can come in at a rate that they can mesh well with existing society.
That is merely realizing that a national identity has value, and is worth protecting...
Mind you, I disagree with how they are trying to protect against immigration - what if some of the people they have blocked are supporters of their cause? Perhaps instead they should demand public statements on websites of the companies denouncing illegal immigration.
he's not against illegal immigration, he's just against immigration.
You should. If there is anything you can count on, it is that this will lead to more revenue and profit for them. Just as the Health Insurance Industry Bailout Act of 2010 (more commonly called "The Affordable Care Act" or "Obamacare") was the greatest corporate handout in the history of government, you can count on the insurance industry making plenty of money off of this as well. The longer an insurance company can deny payment for services, the greater the chances are that they won't have to pay it at all.
Oh, Medicare Part D was WAAAY bigger handout to corporations than ACA.
I disagree. Medicare Part D only allows Medicare users to purchase prescription coverage, but does not force it. Some people opted not to buy it for any number of reasons. The ACA, however, makes every living American an obligate consumer of the health insurance system and most of us have no option but to buy it from a for-profit company. Couple that to the fact that it gives them even more power over the consumer than they already had (which was not easy to do, but congress found a way!) and it is hard to see how anything could ever be a bigger handout.
But Medicare D specifically prohibits the government from bargaining with drug manufacturers over drug prices; while medicare haggles with doctors, hospitals, even the pharmacists themselves over their fees. The result is hedge fund managers buying up rights to a drug and jacking the price up to $750. The result is that US residents pay more for their drugs than any other country. The result is Americans sneaking into Canada or Mexico to buy drugs they can't afford; or getting suckered in by ads for "Canadian pharmacies" on the internet. According to the 2013 Medicare trustees report (“General Revenue”, Page 111), through 2012, Medicare Part D added $318 billion to the national debt; and Medicare Part D will add $852 billion to the debt over the next 10 years.
Will costs increase because doctors now have to hire more people to encode patient's charts? They already have at least one, very expensive, employee dedicated to that now. This is a typical government response to a fake problem...more rules, more crap, more costs.
The thing is that any given doctor does 90% of his/her work within maybe a dozen codes. Your garden variety family practitioner will have little use for accidents due to weightlessness or burns from flaming waterskis, and will go on coding office visit new patient, office visit returning patient, immunization, annual checkup, etc. The biggest addition will be for things like fractured toe where the body has multiple choices, they will now have to code which toe, etc. but since the code is pretty standardized about what suffixes serve for these across all the different limbs, it won't be that bad.
ICD-10 does not describe medical procedures, it only describes (as the name implies) medical ailments.
In the UK we have a separate coding system (OPCS) for describing medical procedures.
The one-code-system-to-rule-them-all is SNOMED CT, which almost no-one implements thoroughly because it's such a monster.
In the US we have a couple of procedure coding systems. There are CPT codes, used to describe procedures on outpatients, and ICD9 (soon to be 10) procedure codes, for inpatient procedures. It wasn't until getting inspired by this/. topic to investigate this stuff further that I learned that these ICD procedures are not actually part of the basic WHO ICD9 or 10.
as are not the ICD10CM, the "clinical modifications" which are the 70,000 codes being mourned herein; the central basic WHO ICD10 itself has only 15,000 codes.
You should. If there is anything you can count on, it is that this will lead to more revenue and profit for them. Just as the Health Insurance Industry Bailout Act of 2010 (more commonly called "The Affordable Care Act" or "Obamacare") was the greatest corporate handout in the history of government, you can count on the insurance industry making plenty of money off of this as well. The longer an insurance company can deny payment for services, the greater the chances are that they won't have to pay it at all.
Oh, Medicare Part D was WAAAY bigger handout to corporations than ACA. And I suspect both of them together wouldn't make a dent in your average military contract handout,
I think that capturing the data is a good thing but how they are doing is going to have a lot of errors entered. One big list of every possibility is terrible for usability. Instead of a long list I would have created a hierarchy. The major problems would be up top such as fractures, poisoning, surgical and then the valid options would be given to the user as they drill down. For example fracture -> {bone name} -> {side of body} or surgical -> suturing -> {artery name}.
like this https://en.wikipedia.org/wiki/... ? it's the same way the ICD9s have been organized for decades, just finer grained. i.e. different codes for left arm vs right arm, instead of the ICD9s which only had a code for broken arm. etc.
Posting as AC so as to not lose moderation above. I had this happen one time when my child went in for an annual checkup that is definitely covered. They denied the claim and said the wrong code was used.
I asked the doctor's office and they said "we think we used the correct code".
So I called the insurance company back and said "they think they used the correct code, you said they didn't, so you tell me what the correct code is." Front-liner said "we can't do that". I said "fine, you probably want me to speak to a supervisor".
Supervisor gets on and repeats that crap. I say "That's fine. Here's how we're going to proceed. You're in breach of contract. I'm going to pay the doctor and then sue your company in the local small claims court for the cost of the visit, which is around $150. I know that the contract has an arbitration clause but I will argue in court that because you've blatantly breached one part of the contract the rest of it is null and void. Even if I lose - which I won't, by the way, since I have home-court advantage and small-guy advantage - it will cost your company many times the amount of the doctor's bill just to send a couple of lawyers to court to defend your company and then lose. And you'll still end up paying the doctor's bill. Your call."
Supervisor says "The code they need to use is _______".
I see people saying "I'm going to sue!" and getting nowhere. I explain carefully that I'm dead serious about suing and I know the process, and I get results.
i got caught in a similar hotbox between MRI and insurer regarding the doctor not having preauthorized the MRI, the insurer not paying anything not preauthorized, and the MRI place saying I need to pay them, and if it was the doctor's fault, I should go after the doctor. luckily, i'm familiar enough with the biz to point out to all three that my member agreement says very specifically that if I go to a participating provider (which the doctor was) I'm not liable for any additional costs for anything he orders, so go work it out amongst yourselves, boys.
the funny part is that the doctor and the MRI were both part of the same Big Med School here, and are like ten feet apart in the same hallway, despite their apparent inability to find each other.
I have the sneaking suspicion that this is going to backfire massively. They'll have bad data hither and yon as overworked medicos end up entering the wrong codes (hey, it's a broken femur, who cares which side?) as often as the right ones. They won't get the supposed benefits of more granular data because the data will be so screwed up that they won't be able to draw any conclusions at all.
Nothing like an industry standard to screw things up on a grand scale.
It won't backfire, it'll work perfectly.
The insurance companies sit between the doctor and the patient, view medical care as an expense, and seek to avoid paying by any means.
Having an enormously complicated system of classification gives them many more ways to deny claims, leaving the patient on the hook for the bill.
I've had personal experience with this: for a procedure which was 100% covered, the anesthesiologist put the wrong diagnosis code in his notes and the insurance company wouldn't reimburse him for that reason (but everyone else - doctors, nurses, hospital - was OK).
It took 2 1/2 years and about half a vertical inch of paperwork to straighten it out, and was a nightmare. Some tidbits:
1) The insurance company could tell the doctor that he used the wrong code, but wouldn't say what the right code was.
2) The med techs swore up and down that it was the right code (in fact, the *only* code), the insurance company stated with equal strength that it was not.
3) Since it is a mistake with either the doctor or insurance company, nothing the patient can do will help - they are completely helpless.
4) A doctor can't "just change" their notes, even when they've made a clear and unarguable mistake.
5) If you resubmit a claim, the company will deny it based on the previous denial, even if the mistake has been corrected.
#3 above is the most frustrating. The patient has to convince someone else to spend time and effort to fix something which is not their problem.
This new system is just a bureaucratic boondoggle that lets insurance companies avoid payments.
It's saying, in effect, that they care more for paperwork than they do about providing health care.
Again; the insurers are now required to pay 80% of their premium out again as direct medical expenses, or refund the overage. So it does them no good to routinely deny claims, since they can hit this target honestly.
Perhaps they would have had more success trying to override Bush's decision to go with the WHO's decision in 1994 to adopt it. "What? Who is this Bush you speak of? I was so happy under Reagan, then I woke up the next day and there was the black guy president and the country was in a big mess"
Not only do doctors and nurses not need to know ICD9/10 codes, the vast majority do not know them. It was not taught to me ever in 4 years of med school and 3 years of residency. If a doctor ever uses a code, it's from the CPT set.
yeah, there's an office full of "medical coders" in the basement of every hospital, or there's a person in the office staff of a practice who is expert on the arcane art.
A doctor inflating costs to recover more wasn't unusual. The codes make it easier to sniff out fraud.
I wonder if they did a cost/benefit analysis of the cost of insurance fraud versus the cost of detailed encoding.
Also, I wonder if there's not a way to phase it in gradually, one limb at a time or something, or only patent's with ID numbers that end in 3 and 7, or the like. One-Big-On-Switch launches are disasters in the waiting.
It was originally supposed to go live like 4 years ago (maybe even earlier) but has been delayed at the providers' and insurers' requests multiple times.
More like, this Byzantine complexity makes it easier to delay payment and deny coverage.
The ACA was the insurance industry's wet dream. Obama, the dems in congress, and far too many of the republicans, handed it to them on a sliver platter.
-jcr
the insurers are required to pay within 45 days, icd10 or no icd10. and they're doing a lot better at that now than they were doing a couple of decades ago.
there isn't as much pressure to deny claims to save money these days, either, since their overhead (including profit) is capped; big insurers have to spend 80% of their premium income directly on medical payments and the other 20% is the max they can keep for overhead, whereas in the past they could squeeze that down to 75/25 or even better sometimes. if they're spending less than 80% on medical expenses, they have to refund the excess income to their customers until they meed the requirement.
Mostly the result of insurance companies and doctor's fraud. A doctor inflating costs to recover more wasn't unusual. The codes make it easier to sniff out fraud.
Yes, the government does it by moving the cost of compliance to the user (the codes are on the doctor's side, the government just verifies), rather than the other way, where the government would be spending much more on fraud investigations and compliance.
I can see how having 70k codes can track issues, but I have to wonder a) what is this going to cost; and b) how in hell do they think people making 20k/year are going to do a good job at entering codes?
It's not going to cost the government much. Just like the IRS. All the complaints about the IRS being inefficient are about the cost to comply, not the cost of the IRS. The IRS is an order of magnitude (or more) cheaper than the same services from a private service. But partly because they push the cost to the person complying.
What I find funny is all the conservatives who hate ACA want the government to pay more (moving more compliance cost back to the government), rather than the smaller, more efficient government proposed.
there are two kinds of diagnosis codes; there's the ones featured here; "collision with space station" etc. which describe the event, and the ones that say things like "fracture of distal left phalange", that describe what is actually wrong with the patient. Obviously, the second variety are a good indicator to what should be being done to the patient, whereas the first variety don't tell you anything whatsoever about what procedures need to be done.
a hillbilly making minimum wage can look up a car part out of tens of millions in about 3 seconds, with 3-4 questions, using a green screen terminal connected via dialup
your nurse sister has a binder
I don't think the number of codes is the problem
well, that's what all those links provided in all those posts upthread are; search for a keyword, get the related ICD10s.
I used to think she was exaggerating how people specialized in not medical training, but in translating doctor's diagnosis into something the government could grok. One day about 5 years ago she brought over a binder that converted ailments to codes, I couldn't believe it. It was about 300 pages of stuff on something minor, like stitches and shots. She works for Kaiser and said they had as many coders as they had nurses, coders being people who converted diagnostics into codes for the government.
I can see how having 70k codes can track issues, but I have to wonder a) what is this going to cost; and b) how in hell do they think people making 20k/year are going to do a good job at entering codes?
You have to wonder why the insurance industry's lobbyists wrote the ACA this way, don't you?
the ICD10s were coming down the pike since before anybody ever heard of Barack Obama, and the ICD9s were here for decades before that.
I used to think she was exaggerating how people specialized in not medical training, but in translating doctor's diagnosis into something the government could grok. One day about 5 years ago she brought over a binder that converted ailments to codes, I couldn't believe it. It was about 300 pages of stuff on something minor, like stitches and shots. She works for Kaiser and said they had as many coders as they had nurses, coders being people who converted diagnostics into codes for the government.
I can see how having 70k codes can track issues, but I have to wonder a) what is this going to cost; and b) how in hell do they think people making 20k/year are going to do a good job at entering codes?
not to mention the large market for software that takes the list of diagnoses and procedures pertaining to a particular patient, and assembles the bill for insurers that will return the largest $$$.
original sin is basically what causes entropy to exist.
Since I have never heard of this link between entropy and sin, I doubt if many fundamentalists are going to be aware of it either, if they even know what entropy is.
How can that not have enormous implications for another civilization that did not evolve from humanity or vice-versa?
1. Maybe each planet has their own original sinners.
2. Maybe Eve's original sin extended guilt throughout the Universe (possibly faster than the speed of light).
3. Maybe God created extraterrestrial life to test the faith of believers.
4. Maybe fundamentalists just don't ponder deeply about hypothetical inconsistencies in their belief system.
Evolution is a theory, of course, created to explain a great many observations. It does extremely well. The key word there is "macroevolution", which is a term I've never seen used by people who have any understanding of the science.
The idea that science and Christianity are compatible is a comfortable lie(for some). You would never accept a new vaccine because someone had a vision in a dream and then woke up and wrote down the formula. You would use the scientific method to determine if a vaccine works or not. Religion demands that you take the word of some unknown person having a revelation thousands of years ago as the truth for some pretty important questions. You are forced to not investigate and not question. This is the antithesis of science.
yeah; but the pretty important questions are things like "what should I do with my life?" which science is not good at answering any better than the Bible is at answering how many planets might circle Alpha Centauri.
For the sake of all that is Holy, don't take those Answers in Genesis wackos as speaking for all Christians. Science and Christianity are compatible. In the earlier times of "Western Civilisation", it was mostly Christians who were the great scientists, looking to understand God by working to understand what He has created.
Macroevolution is a theory and one that explains quite a bit of what we see, but it is not considered a Law yet. (Though even scientific "Laws" can be demoted or disproven, though the process by which it became a Law would generally indicate that it is highly unlikely that it will happen.) As a physician, my belief in macroevolution does not in any way impact my ability to treat my patients. The framework of macroevolution is a convenient framework upon which to understand embryology and developmental neurology, for example. Our current understanding of embryology and developmental neurology mesh nicely with macroevolution and macroevolution helps explain aspects of those two fields.
Acupuncture (especially the Five-elements / Worsley schools) has a clear and consistent framework that explains pretty much everything and is internally consistent. Acupuncture has been shown by studies conducted in conjunction with the WHO to be a viable treatment for many conditions. Applying acupuncture techniques in accordance with those principles is fairly repeatable. The main problem is that some of the diagnostic methods are subjective - what exactly constitutes a "thready" pulse, for example - there is the problem of inter-examiner reliability, much like taking a blood-pressure using a BP-cuff and a stethoscope. Taking a BP that way is still considered an acceptable practice, and in the case of unexpected readings one usually asks for a second examiner if one is available. (This is why doctors will often check the BP after the nurse has done it if the reading is unexpected.)
As a Christian, I would actually be surprised if there was NOT life on other planets, especially intelligent life. While this may seem to be heresy to some, I think of it in that the Bible clearly states that Man(kind) were created in the Image of God. Mankind are finite, God is infinite, therefore I suspect that the one form - homo sapiens, is not adequate to contain much of the Image of God. I know this is sheer speculation as we have not yet found evidence of intelligent life on other worlds, but it makes sense to me that an infinite God would not limit Himself to creating intelligent life in just one form or on only one world. Why must intelligent life be mammalian, for example? I cannot understand how intelligent plant-based life would work, but I can at least imagine intelligent animal life that is not mammalian. Even with mammals there is significant variety. Why not marsupials? Why no tail? Why only four limbs?
I would not arrogate to limit God. I simply seek to understand what I can using the gifts and resources available to me. I would personally find it fascinating to attempt to make sense of an alien language.
Please do not think that Ken Hamm and the Answers in Genesis folks speak for all Christians. They do not.
This is too funny - captcha is "godhead"
People who were both smarter and more learned than the current crop of fundamentalists, from St. Augustine to Maimonides, took the position that the written scriptures are not to be taken as some sort of literal description to compete with the discoveries of science, or even common sense.
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Nationalism, yes.
But wanting to stop the flow if illegal immigrants is not racism, because you don't care what color they are - just that people should immigrate legally, so that they can come in at a rate that they can mesh well with existing society.
That is merely realizing that a national identity has value, and is worth protecting...
Mind you, I disagree with how they are trying to protect against immigration - what if some of the people they have blocked are supporters of their cause? Perhaps instead they should demand public statements on websites of the companies denouncing illegal immigration.
he's not against illegal immigration, he's just against immigration.
http://www.qaster.com/q/561944...
You should. If there is anything you can count on, it is that this will lead to more revenue and profit for them. Just as the Health Insurance Industry Bailout Act of 2010 (more commonly called "The Affordable Care Act" or "Obamacare") was the greatest corporate handout in the history of government, you can count on the insurance industry making plenty of money off of this as well. The longer an insurance company can deny payment for services, the greater the chances are that they won't have to pay it at all.
Oh, Medicare Part D was WAAAY bigger handout to corporations than ACA.
I disagree. Medicare Part D only allows Medicare users to purchase prescription coverage, but does not force it. Some people opted not to buy it for any number of reasons. The ACA, however, makes every living American an obligate consumer of the health insurance system and most of us have no option but to buy it from a for-profit company. Couple that to the fact that it gives them even more power over the consumer than they already had (which was not easy to do, but congress found a way!) and it is hard to see how anything could ever be a bigger handout.
But Medicare D specifically prohibits the government from bargaining with drug manufacturers over drug prices; while medicare haggles with doctors, hospitals, even the pharmacists themselves over their fees. The result is hedge fund managers buying up rights to a drug and jacking the price up to $750. The result is that US residents pay more for their drugs than any other country. The result is Americans sneaking into Canada or Mexico to buy drugs they can't afford; or getting suckered in by ads for "Canadian pharmacies" on the internet. According to the 2013 Medicare trustees report (“General Revenue”, Page 111), through 2012, Medicare Part D added $318 billion to the national debt; and Medicare Part D will add $852 billion to the debt over the next 10 years.
Will costs increase because doctors now have to hire more people to encode patient's charts? They already have at least one, very expensive, employee dedicated to that now. This is a typical government response to a fake problem...more rules, more crap, more costs.
The thing is that any given doctor does 90% of his/her work within maybe a dozen codes. Your garden variety family practitioner will have little use for accidents due to weightlessness or burns from flaming waterskis, and will go on coding office visit new patient, office visit returning patient, immunization, annual checkup, etc. The biggest addition will be for things like fractured toe where the body has multiple choices, they will now have to code which toe, etc. but since the code is pretty standardized about what suffixes serve for these across all the different limbs, it won't be that bad.
It is the Democrat administration that is pushing this. Congressional Republicans are trying to stop it.
The beauty of the above two sentences is that you can reuse them for just about any political news story, ever.
Except wars.
ICD-10 does not describe medical procedures, it only describes (as the name implies) medical ailments.
In the UK we have a separate coding system (OPCS) for describing medical procedures.
The one-code-system-to-rule-them-all is SNOMED CT, which almost no-one implements thoroughly because it's such a monster.
In the US we have a couple of procedure coding systems. There are CPT codes, used to describe procedures on outpatients, and ICD9 (soon to be 10) procedure codes, for inpatient procedures. It wasn't until getting inspired by this /. topic to investigate this stuff further that I learned that these ICD procedures are not actually part of the basic WHO ICD9 or 10.
as are not the ICD10CM, the "clinical modifications" which are the 70,000 codes being mourned herein; the central basic WHO ICD10 itself has only 15,000 codes.
You should. If there is anything you can count on, it is that this will lead to more revenue and profit for them. Just as the Health Insurance Industry Bailout Act of 2010 (more commonly called "The Affordable Care Act" or "Obamacare") was the greatest corporate handout in the history of government, you can count on the insurance industry making plenty of money off of this as well. The longer an insurance company can deny payment for services, the greater the chances are that they won't have to pay it at all.
Oh, Medicare Part D was WAAAY bigger handout to corporations than ACA. And I suspect both of them together wouldn't make a dent in your average military contract handout,
I think that capturing the data is a good thing but how they are doing is going to have a lot of errors entered. One big list of every possibility is terrible for usability. Instead of a long list I would have created a hierarchy. The major problems would be up top such as fractures, poisoning, surgical and then the valid options would be given to the user as they drill down. For example fracture -> {bone name} -> {side of body} or surgical -> suturing -> {artery name}.
like this https://en.wikipedia.org/wiki/... ?
it's the same way the ICD9s have been organized for decades, just finer grained. i.e. different codes for left arm vs right arm, instead of the ICD9s which only had a code for broken arm. etc.
Posting as AC so as to not lose moderation above. I had this happen one time when my child went in for an annual checkup that is definitely covered. They denied the claim and said the wrong code was used.
I asked the doctor's office and they said "we think we used the correct code".
So I called the insurance company back and said "they think they used the correct code, you said they didn't, so you tell me what the correct code is." Front-liner said "we can't do that". I said "fine, you probably want me to speak to a supervisor".
Supervisor gets on and repeats that crap. I say "That's fine. Here's how we're going to proceed. You're in breach of contract. I'm going to pay the doctor and then sue your company in the local small claims court for the cost of the visit, which is around $150. I know that the contract has an arbitration clause but I will argue in court that because you've blatantly breached one part of the contract the rest of it is null and void. Even if I lose - which I won't, by the way, since I have home-court advantage and small-guy advantage - it will cost your company many times the amount of the doctor's bill just to send a couple of lawyers to court to defend your company and then lose. And you'll still end up paying the doctor's bill. Your call."
Supervisor says "The code they need to use is _______".
I see people saying "I'm going to sue!" and getting nowhere. I explain carefully that I'm dead serious about suing and I know the process, and I get results.
i got caught in a similar hotbox between MRI and insurer regarding the doctor not having preauthorized the MRI, the insurer not paying anything not preauthorized, and the MRI place saying I need to pay them, and if it was the doctor's fault, I should go after the doctor.
luckily, i'm familiar enough with the biz to point out to all three that my member agreement says very specifically that if I go to a participating provider (which the doctor was) I'm not liable for any additional costs for anything he orders, so go work it out amongst yourselves, boys.
the funny part is that the doctor and the MRI were both part of the same Big Med School here, and are like ten feet apart in the same hallway, despite their apparent inability to find each other.
I have the sneaking suspicion that this is going to backfire massively. They'll have bad data hither and yon as overworked medicos end up entering the wrong codes (hey, it's a broken femur, who cares which side?) as often as the right ones. They won't get the supposed benefits of more granular data because the data will be so screwed up that they won't be able to draw any conclusions at all.
Nothing like an industry standard to screw things up on a grand scale.
It won't backfire, it'll work perfectly.
The insurance companies sit between the doctor and the patient, view medical care as an expense, and seek to avoid paying by any means.
Having an enormously complicated system of classification gives them many more ways to deny claims, leaving the patient on the hook for the bill.
I've had personal experience with this: for a procedure which was 100% covered, the anesthesiologist put the wrong diagnosis code in his notes and the insurance company wouldn't reimburse him for that reason (but everyone else - doctors, nurses, hospital - was OK).
It took 2 1/2 years and about half a vertical inch of paperwork to straighten it out, and was a nightmare. Some tidbits:
1) The insurance company could tell the doctor that he used the wrong code, but wouldn't say what the right code was. 2) The med techs swore up and down that it was the right code (in fact, the *only* code), the insurance company stated with equal strength that it was not. 3) Since it is a mistake with either the doctor or insurance company, nothing the patient can do will help - they are completely helpless. 4) A doctor can't "just change" their notes, even when they've made a clear and unarguable mistake. 5) If you resubmit a claim, the company will deny it based on the previous denial, even if the mistake has been corrected.
#3 above is the most frustrating. The patient has to convince someone else to spend time and effort to fix something which is not their problem.
This new system is just a bureaucratic boondoggle that lets insurance companies avoid payments.
It's saying, in effect, that they care more for paperwork than they do about providing health care.
Again; the insurers are now required to pay 80% of their premium out again as direct medical expenses, or refund the overage. So it does them no good to routinely deny claims, since they can hit this target honestly.
Perhaps they would have had more success trying to override Bush's decision to go with the WHO's decision in 1994 to adopt it.
"What? Who is this Bush you speak of? I was so happy under Reagan, then I woke up the next day and there was the black guy president and the country was in a big mess"
Not only do doctors and nurses not need to know ICD9/10 codes, the vast majority do not know them. It was not taught to me ever in 4 years of med school and 3 years of residency. If a doctor ever uses a code, it's from the CPT set.
yeah, there's an office full of "medical coders" in the basement of every hospital, or there's a person in the office staff of a practice who is expert on the arcane art.
I wonder if they did a cost/benefit analysis of the cost of insurance fraud versus the cost of detailed encoding.
Also, I wonder if there's not a way to phase it in gradually, one limb at a time or something, or only patent's with ID numbers that end in 3 and 7, or the like. One-Big-On-Switch launches are disasters in the waiting.
It was originally supposed to go live like 4 years ago (maybe even earlier) but has been delayed at the providers' and insurers' requests multiple times.
The codes make it easier to sniff out fraud.
More like, this Byzantine complexity makes it easier to delay payment and deny coverage.
The ACA was the insurance industry's wet dream. Obama, the dems in congress, and far too many of the republicans, handed it to them on a sliver platter.
-jcr
the insurers are required to pay within 45 days, icd10 or no icd10. and they're doing a lot better at that now than they were doing a couple of decades ago.
there isn't as much pressure to deny claims to save money these days, either, since their overhead (including profit) is capped; big insurers have to spend 80% of their premium income directly on medical payments and the other 20% is the max they can keep for overhead, whereas in the past they could squeeze that down to 75/25 or even better sometimes. if they're spending less than 80% on medical expenses, they have to refund the excess income to their customers until they meed the requirement.
Mostly the result of insurance companies and doctor's fraud. A doctor inflating costs to recover more wasn't unusual. The codes make it easier to sniff out fraud. Yes, the government does it by moving the cost of compliance to the user (the codes are on the doctor's side, the government just verifies), rather than the other way, where the government would be spending much more on fraud investigations and compliance.
I can see how having 70k codes can track issues, but I have to wonder a) what is this going to cost; and b) how in hell do they think people making 20k/year are going to do a good job at entering codes?
It's not going to cost the government much. Just like the IRS. All the complaints about the IRS being inefficient are about the cost to comply, not the cost of the IRS. The IRS is an order of magnitude (or more) cheaper than the same services from a private service. But partly because they push the cost to the person complying. What I find funny is all the conservatives who hate ACA want the government to pay more (moving more compliance cost back to the government), rather than the smaller, more efficient government proposed.
there are two kinds of diagnosis codes; there's the ones featured here; "collision with space station" etc. which describe the event, and the ones that say things like "fracture of distal left phalange", that describe what is actually wrong with the patient. Obviously, the second variety are a good indicator to what should be being done to the patient, whereas the first variety don't tell you anything whatsoever about what procedures need to be done.
a hillbilly making minimum wage can look up a car part out of tens of millions in about 3 seconds, with 3-4 questions, using a green screen terminal connected via dialup
your nurse sister has a binder
I don't think the number of codes is the problem
well, that's what all those links provided in all those posts upthread are; search for a keyword, get the related ICD10s.
You have to wonder why the insurance industry's lobbyists wrote the ACA this way, don't you?
the ICD10s were coming down the pike since before anybody ever heard of Barack Obama, and the ICD9s were here for decades before that.
I used to think she was exaggerating how people specialized in not medical training, but in translating doctor's diagnosis into something the government could grok. One day about 5 years ago she brought over a binder that converted ailments to codes, I couldn't believe it. It was about 300 pages of stuff on something minor, like stitches and shots. She works for Kaiser and said they had as many coders as they had nurses, coders being people who converted diagnostics into codes for the government. I can see how having 70k codes can track issues, but I have to wonder a) what is this going to cost; and b) how in hell do they think people making 20k/year are going to do a good job at entering codes?
not to mention the large market for software that takes the list of diagnoses and procedures pertaining to a particular patient, and assembles the bill for insurers that will return the largest $$$.
If this is in fact what is occurring then this isn't evidence against climate change, it was one of the more extreme predictions OF climate change.
I think the creationist - errrrrm - denialists's answer is "That Michael Mann is such a fucking Jerk! So much for global warming!"
Sorry, I keep getting denialists and creationists mixed up - probably the identical tactics.
don't forget the ultimate rebuttal of AGW: "Al Gore is fat!"
Meanwhile the Arctic Ocean on this planet is getting colder, further showing that global warming is a lie: http://www.washingtonpost.com/...
Cruz/Palin 2016 - Restoring America from the Liberal War against common sense
https://en.wikipedia.org/wiki/...
Alright we got some liquid water, time to for a trip to Mars.
run a pipeline to california
original sin is basically what causes entropy to exist.
Since I have never heard of this link between entropy and sin, I doubt if many fundamentalists are going to be aware of it either, if they even know what entropy is.
How can that not have enormous implications for another civilization that did not evolve from humanity or vice-versa?
1. Maybe each planet has their own original sinners. 2. Maybe Eve's original sin extended guilt throughout the Universe (possibly faster than the speed of light). 3. Maybe God created extraterrestrial life to test the faith of believers. 4. Maybe fundamentalists just don't ponder deeply about hypothetical inconsistencies in their belief system.
well then... https://en.wikipedia.org/wiki/...
Evolution is a theory, of course, created to explain a great many observations. It does extremely well. The key word there is "macroevolution", which is a term I've never seen used by people who have any understanding of the science.
what's all this I hear about "mackerel evolution"? https://books.google.com/books...
The idea that science and Christianity are compatible is a comfortable lie(for some). You would never accept a new vaccine because someone had a vision in a dream and then woke up and wrote down the formula. You would use the scientific method to determine if a vaccine works or not. Religion demands that you take the word of some unknown person having a revelation thousands of years ago as the truth for some pretty important questions. You are forced to not investigate and not question. This is the antithesis of science.
yeah; but the pretty important questions are things like "what should I do with my life?" which science is not good at answering any better than the Bible is at answering how many planets might circle Alpha Centauri.
For the sake of all that is Holy, don't take those Answers in Genesis wackos as speaking for all Christians. Science and Christianity are compatible. In the earlier times of "Western Civilisation", it was mostly Christians who were the great scientists, looking to understand God by working to understand what He has created.
Macroevolution is a theory and one that explains quite a bit of what we see, but it is not considered a Law yet. (Though even scientific "Laws" can be demoted or disproven, though the process by which it became a Law would generally indicate that it is highly unlikely that it will happen.) As a physician, my belief in macroevolution does not in any way impact my ability to treat my patients. The framework of macroevolution is a convenient framework upon which to understand embryology and developmental neurology, for example. Our current understanding of embryology and developmental neurology mesh nicely with macroevolution and macroevolution helps explain aspects of those two fields.
Acupuncture (especially the Five-elements / Worsley schools) has a clear and consistent framework that explains pretty much everything and is internally consistent. Acupuncture has been shown by studies conducted in conjunction with the WHO to be a viable treatment for many conditions. Applying acupuncture techniques in accordance with those principles is fairly repeatable. The main problem is that some of the diagnostic methods are subjective - what exactly constitutes a "thready" pulse, for example - there is the problem of inter-examiner reliability, much like taking a blood-pressure using a BP-cuff and a stethoscope. Taking a BP that way is still considered an acceptable practice, and in the case of unexpected readings one usually asks for a second examiner if one is available. (This is why doctors will often check the BP after the nurse has done it if the reading is unexpected.)
As a Christian, I would actually be surprised if there was NOT life on other planets, especially intelligent life. While this may seem to be heresy to some, I think of it in that the Bible clearly states that Man(kind) were created in the Image of God. Mankind are finite, God is infinite, therefore I suspect that the one form - homo sapiens, is not adequate to contain much of the Image of God. I know this is sheer speculation as we have not yet found evidence of intelligent life on other worlds, but it makes sense to me that an infinite God would not limit Himself to creating intelligent life in just one form or on only one world. Why must intelligent life be mammalian, for example? I cannot understand how intelligent plant-based life would work, but I can at least imagine intelligent animal life that is not mammalian. Even with mammals there is significant variety. Why not marsupials? Why no tail? Why only four limbs?
I would not arrogate to limit God. I simply seek to understand what I can using the gifts and resources available to me. I would personally find it fascinating to attempt to make sense of an alien language.
Please do not think that Ken Hamm and the Answers in Genesis folks speak for all Christians. They do not.
This is too funny - captcha is "godhead"
People who were both smarter and more learned than the current crop of fundamentalists, from St. Augustine to Maimonides, took the position that the written scriptures are not to be taken as some sort of literal description to compete with the discoveries of science, or even common sense.