The crazy bookkeeping of medical relations between the provider and the patient... [View All]

If you are on Medicare you may have noticed the outrageous difference between the cost charged to the patient and the amount Medicare will pay.

You may have a procedure that wholesales for say $250. The Hospital or medical billing center, keeps it on record as $250. Medicare says it will pay $36.50 for that particular procedure.

Now the hospital or medical billing center must know what Medicare will pay up front. They should know what to do in order to make a profit and still continue to service the needs of the community.

I do know this, before I became eligible for Medicare, my deductible was what the Insurance didn't pay.

My conclusion is, as an accountant, that the hospital, or doctor or wellness clinic all charge a larger fee than they have to in order to make up, in some cases, the minuscule amount of money Medicare pays for a procedure or treatment. For instance, I had a pain blocking procedure that was listed on my bill as over $3,500. Medicare was willing to pay about $275.

The only thing I can say is the whole costing throughout the entire medical system is out of whack due to such wide variations in payments expected and charges levied. You have what Medicare pays, the insurance companies pay, the amount patients are expected to pay and then the amounts the hospitals write off for treating emergency room visits by indigent or insuranceless patients.

I know I am rambling here but this stuff has been running around my brain for about six years or so now ever since I started to descend into the world of being covered by insurance and Medicare.

One more thing; because of this out of whack payment/reimbursement system, I wouldn't trust any financial information tossed out by the Health Care industry saying they are losing money. Unless they throw open their books, there is no way to determine how much of those losses, say from low Medicare payments, are in their to mask the profits in other areas of the hospital.

Here in Cleveland, the "world famous" Cleveland Clinic has started to have only one billing area for all procedures and medical personal. I get one bill from Cleveland Clinic Affiliated hospitals. That bill includes the doctors, the therapists, the tests and the room fees. All of it is charged and billed by one center. The doctors work for the Clinic, the specialists work for the clinic, the medical technicians work for the clinic. This to me is how the whole system should be operated.

When I was in the hospital for over 30 days back in 2004, I received bills from several doctors, from radiologists, from technician contractors, food service, room fees, television rental, supplies. The hospital, at the time, was only one of about twenty or so billing centers. The last time I was in back in 2008, I was charged one bill for my entire stay, one from my primary care doctor and one from the home medical staff I needed because I was discharged and did my own IV's. It was the same hospital from 2004,, but they had fully integrated into the cleveland clinic system in 2008.

The system will continue to be out of whack until more medical billing centers are consolidated. This really cuts down the paper work involved and makes it a whole lot easier for Medicare, insurance companies, patients, hospitals and other wellness or care facilities and, of course, doctors and specialists.

BTW, my fever is fast approaching 101 so if I sound slightly or even heavily incoherent, you will understand. I could be facing another stay in the hospital within the nexst few days. Wish me luck. I do know I won't have to care about the billing because I will, if I go in, be at a Cleveland Clinic Hopsital.