Medicare Allowable Causes Increased Costs

From my resources, it looks like a commercial 99211 in California pays approximately $25-30

So that's about 15-40% more than Medicare allows. Thanks for proving my point.

If this is true for most codes (and yes, this is an assumption but probably correct), how does this not affect the cost of insurance?

Rick
 
So that's about 15-40% more than Medicare allows. Thanks for proving my point. If this is true for most codes (and yes, this is an assumption but probably correct), how does this not affect the cost of insurance? Rick

I'm assuming that's a rhetorical question?
 
So that's about 15-40% more than Medicare allows. Thanks for proving my point.

If this is true for most codes (and yes, this is an assumption but probably correct), how does this not affect the cost of insurance?

Rick

I agree that there is a big discrepancy between what commercial pays and what Medicare pays. I wasn't trying to say you were wrong about the difference. Still, $21 for a visit that the doctor doesn't even have to physically be present for doesn't seem too bad. I have to do a lot more for $28 for a PDP.
 
I agree that there is a big discrepancy between what commercial pays and what Medicare pays. I wasn't trying to say you were wrong about the difference. Still, $21 for a visit that the doctor doesn't even have to physically be present for doesn't seem too bad. I have to do a lot more for $28 for a PDP.

Yeah, but you don't have a huge overhead and a $500K student loan to pay off. And although it is a PITA to have to certify, I'm guessing a doctor needs a bit more training than we do.

Rick
 
Yeah, but you don't have a huge overhead and a $500K student loan to pay off. And although it is a PITA to have to certify, I'm guessing a doctor needs a bit more training than we do.

Rick

If you read the link from Unic, a 99211 code is not for a physician visit. It is for when another provider sees the patient, such as a nurse.

If the doctor's office is coding physician visits as 99211, they need to better train their coder or get a new one.
 
If you read the link from Unic, a 99211 code is not for a physician visit. It is for when another provider sees the patient, such as a nurse.

If the doctor's office is coding physician visits as 99211, they need to better train their coder or get a new one.

To be fair though, the doctor does have to pay the technician/nurse, the medical coder and use some of that money for overhead...if his office does 6 blood pressure checks/day, he may only make $20k/year off of them
 
To be fair though, the doctor does have to pay the technician/nurse, the medical coder and use some of that money for overhead...if his office does 6 blood pressure checks/day, he may only make $20k/year off of them

Yes he does, and that is the point of the 99211 code. It allows the office to get paid for things they may not have gotten paid for before. Instead of the nurse doing it at no charge as there was no physician visit, now they can submit a for a visit under 99211 and get some revenue.
 

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