Before Obamacare is very bad. After, don't ask.

[Sheffey]

My procession is medical coding and yes it will take a lot of time and effort to transition into ICD-10

Thank you for stating from your professional point of view that this will be expensive to implement (and you can be sure it will be even more expensive to maintain as it goes on forever because it is rare to get a regulation repealed). There are other big government types here who deny the expense. They overlook that this must be implemented by tens of thousands of businesses and I would not be surprised that the implementation and maintenance effort eventually spends billions of man hours as our IRS code does.

I will give you one example of how bad things are already. My doctor and I are considering installing punctal plugs in my tear ducts (for dry eyes). Last week I called my insurance company and asked if it was covered. The nice lady asked for the procedure code which I did not have. So she put me on hold and called my doctor's office.

Several minutes later she came back on the line and said the office could not give her the code. The lady she was talking to said there are "millions" of codes for installing punctal plugs and she did not know which one would be used.

IMO, that is a disgusting waste of human effort and money to have such a system. And mind you, this is under the current system which will be expanded at least tenfold by Obamacare!

[49er]

My procession is medical coding and yes it will take a lot of time and effort to transition into ICD-10

Thank you for stating from your professional point of view that this will be expensive to implement (and you can be sure it will be even more expensive to maintain as it goes on forever because it is rare to get a regulation repealed). There are other big government types here who deny the expense. They overlook that this must be implemented by tens of thousands of businesses and I would not be surprised that the implementation and maintenance effort eventually spends billions of man hours as our IRS code does.

I will give you one example of how bad things are already. My doctor and I are considering installing punctal plugs in my tear ducts (for dry eyes). Last week I called my insurance company and asked if it was covered. The nice lady asked for the procedure code which I did not have. So she put me on hold and called my doctor's office.

Several minutes later she came back on the line and said the office could not give her the code. The lady she was talking to said there are "millions" of codes for installing punctal plugs and she did not know which one would be used.

IMO, that is a disgusting waste of human effort and money to have such a system. And mind you, this is under the current system which will be expanded at least tenfold by Obamacare!

That is why we need single payer. Imagine how doctors' and their staffs could actually practice real medicine if they didn't have a "million" insurance companies to deal with.

But that is too socialistic and sadly, with insurance companies completely entrenched in the US society with their needs to make million dollar profits, it has about as much chance occurring as my becoming an artist or being able to parallel park.

All sarcasm aside Shelby, would you be this concerned if this was happening under Bush or didn't you have health insurance? If you don't want to to answer, that is fine but in my opinion, many who are opposing Obamacare are a bunch of hypocrites. Easy for you (speaking generally) to demonize a health insurance plan until god forbid, you are under either underinsured or don't have it through no fault of your own.

By the way, even though I interjected politics, the issue of health insurance in other countries isn't a political issue. Additionally, there was recently a column by a Republican physician saying it was time for single payer.

It is just a bleeping disgrace when so many people's health is at stake from not having health insurance or having horrible coverage, that this has become a big time political football. And for you doubters who claim this isn't true, then tell me my how that woman who posted about 6 months regarding losing her medicaid coverage and apap machine, would have been able to live on a daily basis until Squid wonderfully bailed her out.

How would you exist without your machine if you lost insurance coverage and the ability to pay? Think there are burgeoning programs out there that will give you a free machine? Get real.

Rant over.

49er

[jtmarten]

All sarcasm aside Shelby, would you be this concerned if this was happening under Bush or didn't you have health insurance? If you don't want to to answer, that is fine but in my opinion, many who are opposing Obamacare are a bunch of hypocrites. Easy for you (speaking generally) to demonize a health insurance plan until god forbid, you are under either underinsured or don't have it through no fault of your own.

It is just a bleeping disgrace when so many people's health is at stake from not having health insurance or having horrible coverage, that this has become a big time political football. And for you doubters who claim this isn't true, then tell me my how that woman who posted about 6 months regarding losing her medicaid coverage and apap machine, would have been able to live on a daily basis until Squid wonderfully bailed her out.

How would you exist without your machine if you lost insurance coverage and the ability to pay? Think there are burgeoning programs out there that will give you a free machine? Get real.

Rant over.

49er

Those without insurance still get medical care. One of the great lies of the left on this issue is squawking about how many people don't have access to medical care. Factor out all the illegal immigrants who should get NO benefits of any kind here that are afforded to citizens, and those that choose no insurance.
If you feel you don't have adequate insurance coverage, opt into a better plan. If your employer doesn't offer insurance, or not sufficient insurance - get a new job that offers a better plan.
I think most xPAP users would be better off without the insurance coverage and dealing with DME's. The equipment just isn't that expensive if you shop around, especially used.
When you see those that drafted Nobamacare scrambling to remove themselves and those that work for them from it ..... makes you wonder. But, go ahead and keep your head in the sand. I'm sure there won't be any downside for Nobama supporters when all is said and done.

[idamtnboy]

The lady she was talking to said there are "millions" of codes for installing punctal plugs and she did not know which one would be used.

A person in the medical practice who takes care of billing quite probably would not know the code. The question is more properly directed at the doctor, and they seldom will come to the phone. The doctor most likely would provide the code, or at least the procedure name from which the billing person code determine the code, but later when he has time to review your file and determine what it would be. I think you encountered the bureaucracy that rules in all medical offices these days.

IMO, that is a disgusting waste of human effort and money to have such a system.

Think about this. For every ~$50,000 per year of fraud, waste, and abuse that is saved in the American government and capital system, someone, somewhere, loses a job.

[PST]

IMO, that is a disgusting waste of human effort and money to have such a system. And mind you, this is under the current system which will be expanded at least tenfold by Obamacare!

No, Sheffey, Obamacare doesn't have anything to do with the adoption of the more detailed list of diagnostic codes. I cited an AMA factsheet in an earlier post in this thread showing the timeline for adoption of the rule. You can also find the official publication of the rule in the Federal Register four days before President Obama was inaugurated. Repeating a statement shown to be in error doesn't make it true. If you have evidence to the contrary, please cite it. You're the one who decided that this forum needed a thread about how Obamacare is making diagnostic coding more complicated. I'm curious what television show it was you referred to in the first post that claimed that Obamacare was the source of the new rule. Bet it was on Fox.

[Lugus]

Sheffey, did you notice flutterby11 did not mention money or expense in the post you quoted. She did mention time and effort which does not always translate into large amounts of money. Did you also not read 'ICD-10 but it is meant to be so much more specific than what we have now, especially things pertaining to surgeries and procedures.' I did not see flutterby11 saying it was a problem.

Change can be scary but is often for the better and can only be judged fairly sometime after the event.

flutterby11, correct me if I am wrong in my understanding of your post. My sole aim in any of my comments is always to present facts and correct obvious bias.

[khauser]

IMO, that is a disgusting waste of human effort and money to have such a system. And mind you, this is under the current system which will be expanded at least tenfold by Obamacare!

No, Sheffey, Obamacare doesn't have anything to do with the adoption of the more detailed list of diagnostic codes. I cited an AMA factsheet in an earlier post in this thread showing the timeline for adoption of the rule. You can also find the official publication of the rule in the Federal Register four days before President Obama was inaugurated. Repeating a statement shown to be in error doesn't make it true. If you have evidence to the contrary, please cite it. You're the one who decided that this forum needed a thread about how Obamacare is making diagnostic coding more complicated. I'm curious what television show it was you referred to in the first post that claimed that Obamacare was the source of the new rule. Bet it was on Fox.

The drive towards more insurance codes comes from the WHO. Not the US government. However, HHS did introduce a corresponding set of procedure codes which it requires for Medicare, etc., which means the industry as a whole will adapt it.

So Sheffey, your issues appear to be largely with the WHO. I imagine you'll say the US shouldn't "be controlled" by the WHO, but as with all global issues, we are either in, and benefit to some degree as well as incur costs by being in, or we are out, resulting in different benefits and costs. It just isn't as black and white as it would otherwise seem.

In terms of having more codes, one issue near and dear makes me wonder about it: Think of the way CPAP codes work. One code covers brick to BiPap. WTF? Of course the DME's are going to make the insurance company pay the limit on the code ... they're not going to say "Hey, I make a reasonable profit on this brick at just $400, so that's all you need to pay". And of course they are thus motivated to sell lesser machines when possible. Some are better than others about this, but remember, they get what they get REGARDLESS of which machine they place.

[old one]

Congress makes laws (eg..insider trading) and then quietly exempts themselves from major parts. Ha Ha on us.

[Wulfman...]

I would suggest that those who wish to know more about the code conversion issue, to do a Google search on the following:

"rule requiring conversion from ICD-9 codes to ICD-10 codes for healthcare reimbursement transactions"

Lots of links, but one of the most informative links I found was (second or third one down):

http: // www . hrsa . gov/healthit/icd10/

Lots of internal links, downloads and lots of information there.

But, on the subject of "Obamacare"........

Senator Max Baucus of Montana (one of the architects of the ACA) said: "I just see a huge train wreck coming..."

This could be some of the reasons for the problems with our system......

"Baucus has been criticized for his ties to the health insurance and pharmaceutical industries, and has been one of the largest beneficiaries in the Senate of campaign contributions from these industries. From 2003 to 2008, Baucus received $3,973,485 from the health sector, including $852,813 from pharmaceutical companies, $851,141 from health professionals, $784,185 from the insurance industry and $465,750 from HMOs/health services, according to the Center for Responsive Politics. A 2006 study by Public Citizen found that between 1999 and 2005 Baucus, along with former Senate majority leader Bill Frist, took in the most special-interest money of any senator ."

Also:

"Harry Reid: $50,000 invested in a health care index,
Judd Gregg=$560,000 worth of stock holdings in major health care companies
Family of Jane Harman: 3.2 million dollars in more than 20 health care companies
John Kerry: at least 5.2 million dollars in companies such as merck and eli lilly
Chris Dodd: Wife serves on the boards of 4 health care companies"


Den

.

[NachtWürger]

I saw this on TV and could just not believe that our government is this damn stupid so I looked it up myself.

Totally disgusting what regulators do!

They also have nine codes for encounters with turkeys:

Do what you want. I thought I was through for the night but now I need another drink.

Please don't tell me government will make medical practice cheaper and more accessible. It never has! It never will!

You are right to be disgusted and some fear of what is to happen to the industry is also justified. There are some small fixes that could be done that would make a great improvement in the most advanced medical care on the planet. But none of these fixes involve creating 140,000 diagnostic codes.

I did work first job out of college with a major company that the technocrats took hold of. They create great detailed and complicated systems that tracked everything. I fought it tooth and nail with only being able to achieve small delays. Their systems of doing things got bigger and bigger and codes began to drive the company. They overlooked that customers, competitors and suppliers were advancing further and faster without such complication.

I hung on to the bloody end and they were fortunate to find a new CEO who saw the problem and the only solution. The company could not be saved but he was highly skilled in cutting it up into pieces and selling it off to competitors. That great and old company no longer exists → killed by the technocrats.

I have no experience in government but my experience with that company leads me to see a parallel. Your and my country has been taken over by technocrats. They come in the form of a myriad of agencies (FDA, EPA ... Wikipedia has the full list which is very long.) which are allowed to write regulations and promulgate rules.

So when you are a technocrat working in any of these agencies and your job descriptions says "... write regulations ... promulgate rules ...", that is what you do, apparently with great gusto. Most of these technocrats are highly "educated" and want to put that education to use. So they don't want to write simple rules that focus on achieving good outcomes effectively and efficiently. They want to write elegant rules that are works of art unto themselves.

This needs to be busted up. The number of agencies needs to be reduced and the size needs to be greatly reduced. Authority to promulgate rules needs to be strictly limited and much of the responsibility needs to return to Congress. The Constitution only allows Congress to make regulations. Congress should be prohibited from sending this responsibility off to the agencies.

I think this can all be achieved but it will likely take one of Dreamstalker's doomsday events to get it done.

BTW, don't let the partisan hacks get you down. They are wedded since youth to one party or the other and act on tribal instincts. They know "the answers" come from their tribal leaders and any analysis they pretend to do is always with the conclusion firmly in mind from the onset.

If you are interested in reducing the complexity and size of government, you should get involved in your state's Libertarian Party.

Ciao.

[idamtnboy]

So they don't want to write simple rules that focus on achieving good outcomes effectively and efficiently. They want to write elegant rules that are works of art unto themselves.

This needs to be busted up. The number of agencies needs to be reduced and the size needs to be greatly reduced. Authority to promulgate rules needs to be strictly limited and much of the responsibility needs to return to Congress. The Constitution only allows Congress to make regulations. Congress should be prohibited from sending this responsibility off to the agencies.

Unquestionably, a laudable goal. Sadly, it doesn't work. Simple regulations are what led to western US mountains being ripped apart for gold in the 1800's, with toxic chemicals still flowing in some streams and piles of gravel rubble where once were pristine fishing holes. Simple regulations are what permitted child labor to exist in the 1800's, and Love Canal contamination to destroy a town, and factories to have machines that chopped off worker's fingers and hands, and made it so the Cuyahoga River could support fires on its surface, and allowed Enron executives to destroy the retirement of thousands of employees and investors, and created market conditions that brought about the housing market collapse of 2008.

American business loves simple regulation because it gives lots of loopholes to skirt the intent of legislation. If so many business leaders weren't a sorry combination of incompetence, ineptness, and dishonesty driven by unbridled greed for money, there would be no need for extensive regulations. The minority of businesses that are plain crooked ruin the business climate for all the honest ones.

[Sheffey]

I saw this on TV and could just not believe that our government is this damn stupid so I looked it up myself.

Totally disgusting what regulators do!

They also have nine codes for encounters with turkeys:

Do what you want. I thought I was through for the night but now I need another drink.

Please don't tell me government will make medical practice cheaper and more accessible. It never has! It never will!

You are right to be disgusted and some fear of what is to happen to the industry is also justified. There are some small fixes that could be done that would make a great improvement in the most advanced medical care on the planet. But none of these fixes involve creating 140,000 diagnostic codes.

I did work first job out of college with a major company that the technocrats took hold of. They create great detailed and complicated systems that tracked everything. I fought it tooth and nail with only being able to achieve small delays. Their systems of doing things got bigger and bigger and codes began to drive the company. They overlooked that customers, competitors and suppliers were advancing further and faster without such complication.

I hung on to the bloody end and they were fortunate to find a new CEO who saw the problem and the only solution. The company could not be saved but he was highly skilled in cutting it up into pieces and selling it off to competitors. That great and old company no longer exists → killed by the technocrats.

I have no experience in government but my experience with that company leads me to see a parallel. Your and my country has been taken over by technocrats. They come in the form of a myriad of agencies (FDA, EPA ... Wikipedia has the full list which is very long.) which are allowed to write regulations and promulgate rules.

So when you are a technocrat working in any of these agencies and your job descriptions says "... write regulations ... promulgate rules ...", that is what you do, apparently with great gusto. Most of these technocrats are highly "educated" and want to put that education to use. So they don't want to write simple rules that focus on achieving good outcomes effectively and efficiently. They want to write elegant rules that are works of art unto themselves.

This needs to be busted up. The number of agencies needs to be reduced and the size needs to be greatly reduced. Authority to promulgate rules needs to be strictly limited and much of the responsibility needs to return to Congress. The Constitution only allows Congress to make regulations. Congress should be prohibited from sending this responsibility off to the agencies.

I think this can all be achieved but it will likely take one of Dreamstalker's doomsday events to get it done.

BTW, don't let the partisan hacks get you down. They are wedded since youth to one party or the other and act on tribal instincts. They know "the answers" come from their tribal leaders and any analysis they pretend to do is always with the conclusion firmly in mind from the onset.

If you are interested in reducing the complexity and size of government, you should get involved in your state's Libertarian Party.

Ciao.

Thanks for taking the time to post that. I am too old to worry about myself and I don't want to think about what my grandkids face.

But I am optimistic about much in our country. The majority of Americans support rights for gays and soon our government will follow in line. There is a coming revolution in education and the federal government monopoly will be finally broken. With the coming bankrupting of three states many others will act dramatically to insure their solvency and fiscal strength. The younger generation is discovering personal freedom that the baby boomers abandoned. Obamacare will cause a crisis that will lead to the states kicking the federal government out of medical care. Our unsustainably high imprisonment rates will lead to an end to the war on drugs. Technology will continue to give individuals their personal freedom back. And more.

I left the Republican party to support Bill Clinton and now I have voted for the Libertarian ticket in the last three Presidential elections. I have no hope that the Republican or Democrats parties will ever do anything good for our country. Fortunately many young people have figured this out and are taking a great interest in the libertarian philosophy. I believe the Tea Pot will crack soon and many of the baggers will change their ways and take up party with us. So the future could look bright but it may take a generation or like you said a major catastrophe.

I believe I will stay out of politics on this forum because there are too many big-government types here who seem to have a lot of time on their hands.

I am also disappointed with the alarmist advice I received on my dry eyes issue and the advice on that blue painters tape.

But on the other hand Pugsy gave me some great advice about managing my pressure settings!

I will use the forum more judiciously in the future.

Thanks again.

[billbolton]

Thank you for stating from your professional point of view that this will be expensive to implement

You are missing the point that is even more expensive NOT to implement ICD-10

[TheUglyTruth]

You are missing the point that is even more expensive NOT to implement ICD-10

Please tell me you are joking.

Struck by turkey, initial encounter
Struck by turkey, subsequent encounter
Struck by turkey, sequela
Pecked by turkey, initial encounter
Pecked by turkey, subsequent encounter
Pecked by turkey, sequela
Other contact with turkey, initial encounter
Other contact with turkey, subsequent encounter
Other contact with turkey, sequela

[billbolton]

Please tell me you are joking.

I'm not joking.

ICD-9 in the US is quite simply a mess. It has codes in the wrong places (because the right places have run out of space), many other issues related to capturing adequate clinical detail, and being able to cope with newly arising types of injuries/diseases/conditions/presentations - all of which are are only sustainable by very expensive workarounds

ICD-10 has been around since 1992 and has been widely adopted by many national public health systems. The real question is why its taken the US healthcare system 20+ years to get to the point of implementing ICD-10