Who’s To Blame For Doctors’ Cash Flow Crisis?
Doctors never cease from complaining about insurers’ bureaucracy. It’s one reason why they cannot stand the repeated Medicare “doc fixes” that have occurred at least once a year for over a decade: When Congress does not increase the physician fee schedule before the previous fix runs out, they fear that Medicare contractors will slow roll their claims, creating a big cash flow problem.
(That’s one reason why the lobbyists supporting today’s fiscally irresponsible “doc fix” waited until March 19 to let us know it was coming to the House of Representatives. Last year’s fix expired on March 31. Delaying until the last minute means the lobbyists can more easily drive politicians into a panicked herd and head them off a fiscal cliff.)
The cash flows can be observed by patients, who receive physicians’ invoices and insurers’ Explanation of Benefits (EOBs). One reader went to the doctor on July 31, 2014. As shown in the graphic below, the health plan processed the claim on August 25 and mailed it to the beneficiary on August 29.
There it sat, in a manila file folder at the beneficiary’s home, until a few days go. As the graphic below shows, the doctor’s office finalized the claim with the insurer on March 31, and printed a statement on April 2.
It is a pretty simple claim: One procedure costing $144.41. Yet it took eight months to send an invoice to the patient! Is this any way to run a business? Whose fault is it? The insurer’s or the physician’s?
One thing is for sure: No functioning retail market, where customers paid provider directly, would function like this.
Just wait until ICD-10 kicks in…
It all seems much more complicated than it should be. That is one of the reasons I think very high deductibles for the non-poor would be good.
Back when I was a child and few people had insurance my father would pay he doctor in cash at the end of the appointment. It was over and done at that point. Insurance is an awkward way to pay for things, and Government is almost as bad. When the numbers get big the insurer cannot resist trying to pay late so that they can improve cash flow similarly it seems Doctors cannot resist waiting for a bump in compensation.
If they were dealing direct with customers Doctors would have to keep things simple.