I’ve worked in healthcare for over 20 years behind the scenes from Medicare chart review to transcription. It’s not because they can. Actually, it’s so they can get what they need from the insurance company.
It’s a negotiation game of appeals. You charge $90 because you know the insurance company is going to try to get away with paying $50, when your overhead is say, $65. You go back and forth and prove your point until you get the money to cover the cost.
I agree, there is no need for fancy stuff like Muzak, etc. I learned this lesson from watching, as well as had it explained to me with one of my personal doctors with whom I had a 20-year rapport.
Granted, they obviously make a hefty salary, but there is also overhead involved with running a business (I have to get paid a living wage) that we tend to forget.
I’ve also worked in the medical records department at 2 different hospitals in 2 different states. It’s the same game. Coding is who does the billing, and that falls under my department. Many times, it’s all about the documentation…Is it right?
We could discuss ethics all day. Both systems need an overhaul. Because insurance companies try to deny honest health care, the providers feel they need to manipulate the system in order to get the bills paid.
